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 private foundations)
MediumBullet Do not enter Social Security numbers on this form as it may be made public. By law, the IRS
generally cannot redact the information on the form.
MediumBullet Information about Form 990 and its instructions is at www.IRS.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
A For the 2013 calendar year, or tax year beginning 10-01-2013 , 2013, and ending 09-30-2014
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 province, country, and ZIP or foreign postal code
Meriden, CT06451
D Employer identification number

06-0646715
E Telephone number

G Gross receipts $ 230,245,746
F Name and address of principal officer:
Lucille Janatka
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
subordinates?
H(b)
Are all subordinates
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 13
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 10
5 Total number of individuals employed in calendar year 2013 (Part V, line 2a) ...... 5 1,417
6 Total number of volunteers (estimate if necessary) ............. 6 298
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a -249,891
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b -358,932
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 423,136 618,553
9 Program service revenue (Part VIII, line 2g) ......... 223,930,472 223,796,456
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 4,787,978 3,158,071
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 2,726,510 2,672,666
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 231,868,096 230,245,746
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 5,000 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) 98,793,282 88,984,007
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet304,876    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 115,114,886 119,789,513
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 213,913,168 208,773,520
19 Revenue less expenses. Subtract line 18 from line 12....... 17,954,928 21,472,226
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 273,104,731 276,677,123
21 Total liabilities (Part X, line 26)............. 159,518,705 169,235,531
22 Net assets or fund balances. Subtract line 21 from line 20..... 113,586,026 107,441,592
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
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Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ............
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2013)
Form 990 (2013)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line 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 closely 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 organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations 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 $ 30,304,607 including grants of $   ) (Revenue $ 29,594,271 )
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 for services. Fiscal year 2014 was a year of improvement for the Emergency Department. Our focus aimed to improve the patient experience by decreasing our "door to provider time" which is the patient arrival time to the time when a patient is seen by the ED Provider. As a result, 83% of all patient were seen within 30 minutes of arrival during FY14. Our "Physician First" process continues to focus on delivering patient-centered care directly to our patients in a timely and efficient manner. We also were selected by the Emergency Nurse's Association to present a Poster on this innovative model at their annual meeting. Overall, the total number of ED visits for FY 2014 was 58,613; this is a 2% decrease from FY13. Remaining constant compared to FY 13, 11% of our patients were admitted to MidState Medical Center as inpatients. The percentage of patients who left without being seen was 1%, which is below the national benchmark of 2%. Approximately 25% of all Emergency Department patients arrived by ambulance. Emergency Medicine Physicians (EMP) - The Organization continued its relationship with EMP to provide Physician and Physician Assistant staffing to care for the ED patients. EMP focuses on patient satisfaction, medical staff satisfaction and providing exceptional emergency care. Partnerships - The MidState ED does not work alone in providing excellent care to those it serves. In FY 2014, the ED provided ongoing education to local EMS providers from the Wallingford Fire Department and Hunter's Ambulance. The ED Department also developed a special paramedic continuing education program with the Simulation Center at MMC. The ED continued to build its relationship with the Meriden Police Department to work more collaboratively in situations when emergency care intersects with law enforcement matters by participating in a joint educational training session. The MidState ED also partners with Hartford Hospital's LifeStar helicopter program to deliver lifesaving care to critically ill patients that need a higher level of care than what MidState can provide. Together, we are focusing on decreasing transfer time in cardiology patients with a diagnosis of ST Elevation Myocardial Infarction (STEMI). The LifeStar program has placed one of their stretchers at MMC to improve the transfer process. Senior Emergency Care Services - The Organization identified a need to improve the transition of care for the senior population that is over 65. Our goal is to provide seniors with the services needed to maintain independence and overall health and well-being. During FY 14 , the Department continued the process of screening all patients 65 and older to identify patients at risk, and match resources to their needs. Our RN staff has requested 337 Pharmacy consults that have resulted in identification 367 Pharmacological Interactions. This innovative program was presented in a poster format at the 2014 Patient Experience Collaborative at Hartford HealthCare. This program was also presented at a statewide conference on care of the geriatric population. Community Outreach - The staff of the ED are committed to community service and enriching the lives of others. In FY 2014, the ED participated in the collection of food for area food banks. Additionally, the ED participated in community health fairs.We have continued our pilot program that involves a multidisciplinary team to assist ED patients by ensuring we have matched their needs with the community resources to improve medical care and compliance. Patient Satisfaction - Overall patient satisfaction scores for FY 2014 were in the 34th percentile. This is an area the ED Department will be focusing on improving for FY 15. Our initiative to improve throughput of the admitted patients by the hospitalist (currently at 7.5 hours), as well as development of standard hand-off process to inpatient nursing are being piloted this year. The department continues to make reduced wait times a priority. For Fiscal Year 2014, patients waited an average of only 7 minutes to see a provider as compared to 12 minutes in 2011 when the Organization began its focus on the patient experience. Education - In FY 2014, the MidState ED continued to play a critical role in staff education integrating best practices treatment and protocols for the care of our patients. The Organization has encouraged our RN staff to become certified "emergency nurses". To date three RN's have successfully passed the CEN exam.
4b (Code:   ) (Expenses $ 22,939,278 including grants of $   ) (Revenue $ 28,105,472 )
The Digestive Health Center at MidState is a comprehensive resource for the prevention, diagnosis and treatment of a full range of gastrointestinal disorders that affect the esophagus, stomach, small intestine and colon. The staff provides first class care to all of our patients and works well together to provide a seamless transition from pre to post procedure and home care. Our staff ensures that each patient has a visit that is as pleasant and comfortable as possible. The Department cares for inpatients as well as an outpatient population. Along with providing upper endoscopies and colonoscopies, the department provides radiofrequency ablation for patients with high grade Barrett's Esophagus, Manometry and pH testing for patients with chronic motility and reflux problems and ERCP (endoscopic retrograde cholangiopancreatogram). Overall the department saw a total of 10,665 cases for fiscal year 2014 an increase of 320 cases from the previous year. This year only 32 of our patients were admitted post procedure. Digestive Health Center (DHC) - The Department continues to maintain and improve our relationships with both the Connecticut GI and Gastroenterology Specialists physicians. We welcomed a new physician Dr. Madhavi Bhoomagoud late in 2014 and she continues to grow her practice, becoming a valued member of the team. Another one of our physicians spoke to over 150 GI nurses and associates at the 2014 Fall Conference for the Connecticut GI Nurses and Associates addressing current challenges in Crohn's and Colitis care. The Organization works in collaboration with the Anesthesia department to provide the same level of care to our patients 24 hours a day, seven days a week whether in the actual Digestive Health area or traveling to the ER, ICU or OR areas.Electronic Health Records - The department has been using electronic health records for over 12 years. The Physicians and Multicare (nursing) records are interfaced to provide seamless charting from pre to intra and post care. In response to "The Joint" recommendations, the electronic medication reconciliations have also been implemented. Patient Satisfaction - The Endoscopy unit has continued to maintain consistently high Press Ganey Scores. We monitor monthly "likelihood of recommending center" and for FY2014 averaged 94.4%. Our "Overall care received" average for the year was 95.3 and our "wait time prior to procedure" was 90.6%. Community Outreach - March is Colorectal Cancer Awareness month and in the spirit of sharing knowledge, the Digestive Health Center staff presented to our "MidState family" information on colon cancer screening. In May 2014, staff from DHC spoke at the Wallingford Senior Center Health Fair on GI Diseases. Additionally, RNs spoke at the Meriden Senior center and at local congregations. The DHC sponsored a GI conference in September 2014 where Dr. Kevin Jo spoke on the topic of Fecal Incontinence. Two of our nurses taught at the "Hands On" ERCP course in October 2014. Over 35 GI health professionals took advantage of this regionally recognized course.
4c (Code:   ) (Expenses $ 30,665,416 including grants of $   ) (Revenue $ 24,779,174 )
Oncology Services at MidState Medical Center is a multi-discipline service line consisting of radiation oncology, medical oncology, support services and surgical services. Each patient seeking care for an oncological based health need is treated in a state of the art facility with physicians, nurses and support staff from Midstate Medical Center collaborating with our 4 other Hartford HealthCare partners. This collaboration operates in the form of cancer conferences and disease management teams through which a single standard of care is delivered at the highest quality. The oncology program at Midstate Medical Center strives to provide compassionate, high-quality care to all of its patients, regardless of their financial ability to pay for these services. The department provides a medical social worker who helps patients with financial assistance, stress management that often accompanies a cancer diagnosis as well as an onsite genetics counselor for a high risk program. In September 2014, Hartford Healthcare Cancer Institute was certified as the charter member of the Memorial Sloan Kettering cancer alliance. Overall, the total number of newly diagnosed cancers at Midstate Medical Center in calendar year 2014 was 593; a 5% increase over last year. These visits result in the multiple chemotherapy treatments, radiation therapy fractions and surgical procedures, though not every patient receives treatment for their cancer. Cancer Conferences - The organization's multidisciplinary approach to cancer care is highlighted through the cancer conferences in which patient's diagnosis and disease are discussed confidentially across the various disciplines. Imaging, pathology, medical and radiation oncology as well as surgery provide expertise to guide treatment options and plan the care needed to meet the standards of care outlined by the National Comprehensive Cancer Network (NCCN) guidelines. Accreditation - Our cancer program continues to strive towards re-accreditation and operates under the direction of the cancer committee which meets quarterly. In 2014, we formed a leadership committee overseeing the process of reviewing the new standards published by the American College of Cancer Commission on Cancer in an effort to receive re-accreditation in 2016. The Breast Program leadership was restructured to align with Hartford HealthCare Cancer Institute's model and will seek re-accreditation late in Calendar year 2015. Community Outreach - Midstate Medical Center's cancer program has a robust community outreach program providing several opportunities for patients, caregivers and the community to participate at no cost. A few of these programs include: outreach to the Hispanic community, survivorship programs, integrative therapies and support groups. Through a grant, we were able to add an additional part-time outreach coordinator that will help facilitate programs, education and various other opportunities to establish support groups.
(Code:   ) (Expenses $ 100,349,039 including grants of $   ) (Revenue $ 141,242,129 )
In towns across central Connecticut, MidState Medical Center (MMC) is committed and focused on efforts to promote health and wellness in the communities the hospital serves. Each year, MidState makes a concerted effort to go above and beyond its call to the community. Our physicians, nurses, and staff reach out to thousands of individuals every year through health-related programs and special events. Additionally, MMC 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. Financial Assistance - MidState Medical Center is the leading safety net provider of acute medical care for the communities it serves. MidState routinely provides services to uninsured patients and to people covered under government programs for which it does not receive full payment. Eligibility for the financial assistance programs is dependent on income and other personal circumstances.
4d Other program services (Describe in Schedule O.)
(Expenses $ 100,349,039 including grants of $   ) (Revenue $ 141,242,129 )
4e Total program service expensesMediumBullet184,258,340
Form 990 (2013)
Form 990 (2013)
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 (see instructions)? 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, or have a section 501(h) election in effect during the tax year? 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 IIIClick to see attachment............................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which 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 for escrow or custodial account liability; 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 temporarily restricted endowments, permanent endowments, 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, line 10?
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 VIIClick 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 VIIIClick 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 IXClick 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 XClick 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 XClick 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 and XII 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 and XII 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
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
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 (see instructions)....
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
 
No
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
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H.... Click to see attachment
20a
Yes
 
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return?
20b
Yes
 
Form 990 (2013)
Form 990 (2013)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or government 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 or 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, line 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 lines 24b through 24d and complete Schedule K. If “No,” go to line 25a................
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
Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? If so, 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 employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? 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
 
No
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 direct or indirect 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 M..
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.............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N,
Part I...........................
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, Part II, III, or IV, and Part V, line 1........................ Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, 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
35b
Yes
 
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 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2013)
Form 990 (2013)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V ..............
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
179
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
1,417
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” to line 3b, 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, securities account, or other financial 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 as charitable contributions?...
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
 
No
b
If "Yes," did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
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. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the 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 amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
Form 990 (2013)
Form 990 (2013)
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 or note to any line 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
13
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
10
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
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
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
Did the organization have local chapters, branches, or affiliates? ............
10a
Yes
 
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
Yes
 
11a
Has the organization provided a complete 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 this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done.......................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
 
No
14
Did the organization have a written document retention and destruction policy? .........
14
 
No
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 15a or 15b, 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," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take 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
CT
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 made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization:
MediumBulletCarolyn Freiheit389 John Downey DriveNew BritainCT06051 (860) 224-5272
Form 990 (2013)
Form 990 (2013)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line 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. 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 organization compensated any current officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(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; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) Christopher W Beale........................................................................
Director
 2.00
.......................   		X           0 0 0
(2) Irfan S Chughtai MD........................................................................
Director
 2.00
.......................   		X           0 0 0
(3) Lewis LevinMD........................................................................
Director (Thru Oct. 2103)
 2.00
.......................   		X           1,600 0 0
(4) Lucille A Janatka........................................................................
President/CEO
 20.00
.......................40.00 		X   X       670,426 0 125,486
(5) Bruce C Eldridge........................................................................
Director
 2.00
.......................   		X           0 0 0
(6) Joseph E Mirra........................................................................
Director
 2.00
.......................   		X           0 0 0
(7) James N Smith........................................................................
Secretary
 2.00
.......................   		X           0 0 0
(8) Richard A Smith MD........................................................................
Dir, Pres. Medical Staff
 20.00
.......................   		X           60,000 0 0
(9) Marcia B Proto........................................................................
Vice Chair
 3.00
.......................   		X   X       0 0 0
(10) James LPellegrino........................................................................
Director (Thru Nov. 2013)
 2.00
.......................   		X           0 0 0
(11) Giovanna T Weller........................................................................
Director
 2.00
.......................   		X           0 0 0
(12) Frederick Ulbrich III........................................................................
Director
 2.00
.......................   		X           0 0 0
(13) Carl D Grant........................................................................
Chair
 3.00
.......................   		X   X       0 0 0
(14) John W Redmond MD........................................................................
Director
 2.00
.......................   		X           0 0 0
(15) Lawrence S Lazaroff........................................................................
Director
 2.00
.......................   		X           0 0 0
(16) Carolyn Freiheit........................................................................
VP, Finance
 20.00
.......................40.00 		    X       0 212,012 56,015
(17) Ralph W Becker........................................................................
VP & CFO (Thru Jan. 2014)
 60.00
.......................   		    X       0 333,839 95,382
Form 990 (2013)
Form 990 (2013)
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 (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(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; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) Catherine Stevens........................................................................
VP, Patient Care
 60.00
.......................   		    X       216,738 0 42,957
(19) Steven Hanks MD........................................................................
VP, Medical Affairs
 5.00
.......................55.00 		    X       0 629,647 161,712
(20) Mary Morgan........................................................................
VP,Human Resources
 5.00
.......................55.00 		    X       0 181,420 65,766
(21) Cindy L Russo........................................................................
SVP, Operations
 60.00
.......................   		      X     282,749 0 13,851
(22) Robert van Heiningen........................................................................
VP, HR (Thru Oct.2013)
 60.00
.......................   		      X     224,714 0 20,859
(23) Joseph Vaccarelli........................................................................
Director, Lab
 5.00
.......................55.00 		      X     0 208,221 9,669
(24) Elizabeth C DeSanto........................................................................
In House General Counsel
 60.00
.......................   		      X     155,813 0 38,381
(25) Thomas Vaccarelli........................................................................
VP,Facilities & Support
 5.00
.......................55.00 		      X     0 196,017 68,051
(26) Robert Flade........................................................................
Director,Emergency Nursing
 5.00
.......................55.00 		      X     0 148,514 33,034
(27) Donna Sassi MD........................................................................
Director, Surgery
 60.00
.......................   		      X     150,748 0 32,823
(28) Walter J Kupson III........................................................................
Medical Director Mediquick
 60.00
.......................   		        X   320,293 0 45,805
(29) Timothy M Pratt........................................................................
Hospitalist
 60.00
.......................   		        X   273,691 0 21,218
(30) Mark Schaner........................................................................
Hospitalist
 60.00
.......................   		        X   273,191 0 45,071
(31) Joyce Akhtar........................................................................
Hospitalist
 60.00
.......................   		        X   262,401 0 21,054
(32) Adwoa P Nyanin MD........................................................................
Hospitalist
 60.00
.......................   		        X   274,974 0 29,828
(33) Harold Kaplan........................................................................
Former VP, Medical Affairs
 5.00
.......................55.00 		          X 333,690 0 26,836
(34) John F Greene Jr........................................................................
Former VP, Medical Affairs
 10.00
.......................50.00 		          X 315,720 137,537 30,356
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 3,816,748 2,047,207 984,154
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet139
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. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
Clinical Lab Partners LLC129 Patricia M Genova DrNewingtonCT06111 Laboratory Services 1,683,816
Emergency Medical Physicians1084 Hartford TpkVernonCT06066 Medical Services 1,164,933
Signal Medical Services IncPO Box 977FarmingtonCT06034 Medical Services 1,104,761
Fuda Construction6 Bar Will DrMeridenCT06450 Construction 836,341
Origin IncorporatedPO Box 70870Saint PaulMN55170 Staffing Services 497,929
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet20
Form 990 (2013)
Form 990 (2013)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII .............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512-514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 46,200
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		572,353
g Noncash contributions included in lines
1a-1f:$ 		 
h Total. Add lines 1a-1f.......MediumBullet 618,553
Program Service RevenueAmt Business Code
2a Outpatient Care 621400 129,972,977 129,972,977    
b Inpatient Care 624100 92,001,756 92,001,756    
c Lab Services 621500 508,593 435,510 73,083  
d Supply Vendor Rebate 900099 371,594 371,594    
e Other Health Programs 621300 55,700 55,700    
f All other program service revenue . 885,836 883,509 2,327  
g Total. Add lines 2a–2f........MediumBullet 223,796,456
OtherAmt RevenueAmt 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 1,306,665   367 1,306,298
4 Income from investment of tax-exempt bond proceeds..MediumBullet        
5 Royalties...........MediumBullet        
(i) Real (ii) Personal
6a Gross rents 2,449,272  
b Less: rental expenses 0  
c Rental income or (loss) 2,449,272  
d Net rental income or (loss).......MediumBullet 2,449,272     2,449,272
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 1,851,406  
b Less: cost or other basis and sales expenses 0  
c Gain or (loss) 1,851,406  
d Net gain or (loss)..........MediumBullet 1,851,406     1,851,406
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ..
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet      
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 722210 549,062     549,062
b Income-Pass Thru Entity 900003 -325,668   -325,668  
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet 223,394
12 Total revenue. See Instructions......MediumBullet 230,245,746 223,721,046 -249,891 6,156,038
Form 990 (2013)
Form 990 (2013)
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).Check if Schedule O contains a response or note to any line in this Part IX ...............
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 United States. See Part IV, line 21    
2 Grants and other assistance to individuals in the United States. See Part IV, line 22    
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16    
4 Benefits paid to or for members    
5 Compensation of current officers, directors, trustees, and key employees .... 5,849,173 474,975 5,374,198  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 424,648 424,648    
7 Other salaries and wages 63,057,370 60,758,242 2,099,964 199,164
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 4,651,261 4,497,019 140,881 13,361
9 Other employee benefits ....... 10,265,381 9,924,965 310,927 29,489
10 Payroll taxes ........... 4,736,174 4,579,116 143,453 13,605
11 Fees for services (non-employees):        
a Management ......        
b Legal ......... 73,299   73,299  
c Accounting ........... 277,664   277,664  
d Lobbying ........... 40,432   40,432  
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ...... 151,925   151,925  
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 16,681,034 14,211,668 2,469,366  
12 Advertising and promotion .... 422,810   422,810  
13 Office expenses ....... 7,394,757 6,321,085 1,059,213 14,459
14 Information technology ...... 161,934 161,934    
15 Royalties ..        
16 Occupancy ........... 6,676,310 6,676,310    
17 Travel ............ 78,607 9,935 68,672  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ......        
19 Conferences, conventions, and meetings .... 49,817 2,808 46,875 134
20 Interest ........... 4,582,099 4,582,099    
21 Payments to affiliates ....... 4,378,866 3,125,777 1,253,089  
22 Depreciation, depletion, and amortization ..... 12,906,996 12,516,058 390,938  
23 Insurance .............. 3,029,485 2,753,277 276,208  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a Medical Supplies 29,231,222 29,221,512 9,710  
b Purchased Services 28,405,119 19,297,503 9,081,946 25,670
c Repairs & Maintenance 4,453,468 4,362,094 82,658 8,716
d Dues & Subscriptions 517,498 115,211 402,009 278
e All other expenses 276,171 242,104 34,067  
25 Total functional expenses. Add lines 1 through 24e 208,773,520 184,258,340 24,210,304 304,876
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2013)
Form 990 (2013)
Page 11
Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash–non-interest-bearing ............. 395,005 1 398,880
2 Savings and temporary cash investments ......... 26,628,698 2 44,581,226
3 Pledges and grants receivable, net ........... 64,859 3 41,986
4 Accounts receivable, net ............. 38,544,433 4 28,352,212
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
  5  
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
  6  
7 Notes and loans receivable, net ............. 50,000 7 0
8 Inventories for sale or use .............. 2,719,853 8 3,431,508
9 Prepaid expenses and deferred charges .......... 2,116,575 9 2,245,299
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 261,200,832
b Less: accumulated depreciation ..... 10b 145,547,862 122,016,038 10c 115,652,970
11 Investments—publicly traded securities ..........   11  
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 ........... 80,569,270 15 81,973,042
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 273,104,731 16 276,677,123
Liabilities 17 Accounts payable and accrued expenses ......... 11,895,780 17 9,175,414
18 Grants payable .................   18  
19 Deferred revenue ................   19  
20 Tax-exempt bond liabilities .............   20  
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Loans and other 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 (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.................... 147,622,925 25 160,060,117
26 Total liabilities. Add lines 17 through 25......... 159,518,705 26 169,235,531
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. 96,806,371 27 89,763,992
28 Temporarily restricted net assets ........... 2,047,687 28 2,099,252
29 Permanently restricted net assets ........... 14,731,968 29 15,578,348
Organizations that do not follow SFAS 117 (ASC 958), 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 ........... 113,586,026 33 107,441,592
34 Total liabilities and net assets/fund balances ........ 273,104,731 34 276,677,123
Form 990 (2013)
Form 990 (2013)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI ..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
230,245,746
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
208,773,520
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
21,472,226
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
113,586,026
5
Net unrealized gains (losses) on investments ...............
5
3,264,768
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
-30,881,428
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
107,441,592
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line 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
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 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?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
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
Yes
 
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
Yes
 
Form 990 (2013)
Form 990, Special Condition Description:
Special Condition Description
Additional Data


Software ID:  
Software Version:  
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.
right arrow Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
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 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
Provide the following information about the supported organization(s).
(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 monetary support
Yes No Yes No Yes No
Total  

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 2
Part II
Support Schedule for Organizations Described in Sections 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) right arrow (a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (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) right arrow (a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (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. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..            
11 Total support (Add lines 7 through 10).  
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization, check this box and stop here.................................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 3
Part III
Support Schedule for Organizations Described in Section 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) right arrow (a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (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) right arrow (a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (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) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and 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) 2013

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.
Arrow Bullet Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Name of the 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 on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, 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) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
Page 2
Name of organization
Midstate Medical Center
  		Employer identification number

06-0646715
Part I
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

   
RESTRICTED
RESTRICTED
RESTRICTED, RESTRICTEDRESTRICTED

$RESTRICTED


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
Page 3
Name of organization
Midstate Medical Center
  		Employer identification number

06-0646715
Part II
Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(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) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
Page 4
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
that total 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 $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(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) (2013)

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.SchCMd Bullet Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
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 35c (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 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 function 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 Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2013

Schedule C (Form 990 or 990-EZ) 2013
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 SchCMd Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
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) 2010 (b) 2011 (c) 2012 (d) 2013 (e) Total
2a Lobbying nontaxable amount          
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		 
c Total lobbying expenditures          
d Grassroots nontaxable amount          
e Grassroots ceiling amount
(150% of line 2d, column (e))		  
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2013


Schedule C (Form 990 or 990-EZ) 2013
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)).
For each "Yes" response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
No
Yes
(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? ........
Yes
 
40,432
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? ..........................
 
No
 
j
Total. Add lines 1c through 1i ...............................
40,432
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 carry over 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) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible 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
Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, line 2; and Part ll-B, line 1. Also, complete this part for any additional information.
Return Reference Explanation
Part II-B, Line 1: 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 FY14 was $40,432.
Schedule C (Form 990 or 990EZ) 2013

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, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions. SchDMd Bullet Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
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 can 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 through 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, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax 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 section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, 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 (ASC 958), 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 XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), 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 (ASC 958) 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 Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2013

Schedule D (Form 990) 2013
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, 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 XIII.
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 XIII 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 XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance .... 15,855,675 14,919,840 12,501,553 12,946,811 11,876,168
b Contributions ........     240,834 258,750 229,064
c Net investment earnings, gains, and losses 785,129 1,155,553 2,534,968 -330,623 1,188,658
d Grants or scholarships .....          
e Other expenditures for facilities
and programs ........ 		54,476 219,718 272,520 287,232 270,479
f Administrative expenses ....     84,995 86,153 76,599
g End of year balance ...... 16,586,328 15,855,675 14,919,840 12,501,553 12,946,811
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet90.000 %
b
Permanent endowment SchDMd Bullet5.000 %
c
Temporarily restricted endowment SchDMd Bullet5.000 %
The percentages in lines 2a, 2b, and 2c should equal 100%.
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)
Yes
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
Yes
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11a. See Form 990, Part X, line 10.
Description of property (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 ................   114,490,931 41,233,498 73,257,433
c Leasehold improvements ............   8,283,536 5,606,770 2,676,766
d Equipment ................   136,591,933 98,707,594 37,884,339
e Other .................   584,432   584,432
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 115,652,970
Schedule D (Form 990) 2013

Schedule D (Form 990) 2013
Page 3
Part VII
Investments—Other Securities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11b. 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) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11c. See Form 990, Part X, line 13.
(a) Description of investment (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) Funds Held In Trust 14,799,538
(2) Other Assets 270,421
(3) Security Deposits 9,000
(4) Other Investments - Partnerships 2,134,257
(5) Amortizable Bond Issue Costs 1,586,561
(6) Investment in Endowment LLC 42,123,273
(7) Funds Designated for Debt Service 6,307,694
(8) Insurance Receivable 14,742,298

Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 81,973,042
Part X
Other Liabilities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes  
Accrued Pension Liability 34,688,717
Accrued Pension Plan - Other 3,686,074
IBNR Malpractice Reserve 2,855,735
Bond Rebate Fund 4,211,094
Other Liabilities 8,961,414
Long Term Debt - Intercompany 87,519,905
Professional Liab. Claims - Long Term 14,742,298
Due to Affiliates 3,394,880

Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 160,060,117
2. Liability for uncertain tax positions In Part XIII, 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 (ASC 740). Check here if the text of the footnote has been provided in Part XIII ..................................................
Schedule D (Form 990) 2013

Schedule D (Form 990) 2013
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
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 XIII.) ............ 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 XIII.) ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
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 XIII.) ............ 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 XIII.) ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
Part XIII
Supplemental Information
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, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Return Reference Explanation
Part V, Line 4: Midstate Medical Center (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 include those assets of donor-restricted funds as well as board designated funds that the Medical Center must hold in perpetuity or for donor-specific period(s). 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. The income generated by the funds are used mainly for capital purchases.
Schedule D (Form 990) 2013

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.
MediumBullet Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
Midstate Medical Center
 
Employer identification number

06-0646715
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: .........
3b
Yes
 
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

5a

Yes

 
b
If "Yes," did the organization's financial assistance 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 discountedcare to a patient who was eligibile for free or discounted care? ..............
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? ..........
6a
Yes
 
b
If "Yes," did 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
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance 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 Financial Assistance at cost
(from Worksheet 1) .. 		    2,851,066 0 2,851,066 1.370 %
b Medicaid (from Worksheet 3,
column a) .... 		    49,369,960 36,595,448 12,774,512 6.120 %
c Costs of other means-tested
government programs (from
Worksheet 3, column b) . 		           
d Total Financial Assistance
and Means-Tested
Government Programs . 		    52,221,026 36,595,448 15,625,578 7.490 %
Other Benefits
     542,836 6,065 536,771 0.260 %
e Community health
improvement services and
community benefit operations
(from Worksheet 4) ..
f Health professions education
(from Worksheet 5) .. 		    244,079 0 244,079 0.120 %
g Subsidized health services
(from Worksheet 6) .. 		    526,384 287,324 239,060 0.110 %
h Research (from Worksheet 7)            
i Cash and in-kind
contributions for community
benefit (from Worksheet 8) 		    12,245 0 12,245 0.010 %
j Total. Other Benefits ..     1,325,544 293,389 1,032,155 0.500 %
k Total. Add lines 7d and 7j .     53,546,570 36,888,837 16,657,733 7.990 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(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     344   344 0 %
3 Community support     571   571 0 %
4 Environmental improvements            
5 Leadership development and training for community members     190   190 0 %
6 Coalition building     3,604   3,604 0 %
7 Community health improvement advocacy            
8 Workforce development     5,662   5,662 0 %
9 Other            
10 Total     10,371   10,371  
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did 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. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
6,385,283
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
0
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
61,250,580
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
65,522,733
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-4,272,153
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
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(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) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)
How many hospital facilities did the organization operate during the tax year?1
Name, address, primary website address, and state license number 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 Midstate Medical Center
435 Lewis Avenue
Meriden,CT06451 		X                  
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
MidState Medical Center
Name of hospital facility or facility reporting group  
If reporting on Part V, Section B for a single hospital facility only: line number of
hospital facility (from Schedule H, Part V, Section A) 		1
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9.................... 1 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20 12
3 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? 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 Yes  
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Part VI................................ 4   No
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply as of the end of the tax year):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If "No," explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........ 7   No
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 8a   No
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 250.000000000000%
If "No," explain in Part VI the criteria the hospital facility used.
11 Used FPG to determine eligibility for providing discounted care?................. 11 Yes  
If "Yes," indicate the FPG family income limit for eligibility for discounted care: 400.000000000000%
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If "Yes," indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
i
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?....... 14 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 15 Yes  
16 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
17 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?.......... 17   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 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?.......... 19 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individual 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? ............................ 21   No
If "Yes," explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ......................... 22   No
If "Yes," explain in Part VI.
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B.Provide descriptions required for Part V, Section B, lines 1j, 3, 4, 5d, 6i, 7, 10, 11, 12i, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22. If applicable, provide separate descriptions for each facility in a facility reporting group, designated by "Facility A," "Facility B," etc.
Form and Line Reference Explanation
MidState Medical Center Part V, Section B, Line 3: Seven focus groups were conducted in Meriden and Wallingford between December 2011 and January 2012. A combination of social service agency workers, chamber of commerce members, and residents were recruited to ensure full representation from the Meriden and Wallingford communities. The following five groups were identified as having members that could best speak to the basic and healthcare needs in the communities:* Meriden Human Service Providers* Wallingford Community Forum members * United Way Agency Directors* Meriden Chamber of Commerce members* Quinnipiac Chamber of Commerce membersA MidState representative worked with the leader of each of these groups to schedule a focus group date and distribute recruitment letters to the group members. The MidState representative also worked with key individuals in the Meriden and Wallingford communities to recruit 6-10 residents for two additional focus groups. In Meriden, the Health & Human Services Department social worker talked with her colleagues to identify individuals who could speak to their basic health care needs, or needs they were seeing among their family or friends. In Wallingford, the Executive Director of the YMCA and the Spanish Community of Wallingford were critical in helping to recruit residents. The Meriden resident focus group was held at the Meriden Health Department. The Wallingford resident focus group was held at the Spanish Community of Wallingford. There were a total of 53 focus group participants with a diverse distribution of ages, races and education levels. The focus groups addressed the following topics with agency workers, chamber members and residents:* Basic needs, such as housing, food, and transportation* Healthcare related needs* How these needs have changed in the last three years* Social services currently being utilized in the community* Community strengths* Opportunities for improvement in the community
MidState Medical Center Part V, Section B, Line 7: To be the most effective, it is understood that not all needs can be addressed by MidState Medical Center. The key areas being addressed are within the capacity and resources of the hospital: Diabetes, Overweight and Obesity, Prostate and other Cancers awareness for screenings, Cardiac and Stroke. Where possible, the hospital partners with and/or supports the efforts of other agencies better positioned to address needs not within the hospital's scope. These include: Smoking Cessation which the Meriden/Wallingford Substance Abuse Council addresses and Physical Activity which is being addressed by the YMCA with its Activate Wallingford program.
MidState Medical Center Part V, Section B, Line 20d: The Hospital is in process of adopting the final 501R regulations.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?2
Name and address Type of Facility (describe)
1 Mediquick-Midstate Medical Center
61 Pomeroy Avenue
Meriden,CT06450 		Urgent Care Center
2 Mediquick-Midstate Medical Center
680 South Main Street
Cheshire,CT06410 		Urgent Care Center
3
4
5
6
7
8
9
10
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs 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.
Form and Line Reference Explanation
MidState Medical Center Part V, Section B, Line 3: Seven focus groups were conducted in Meriden and Wallingford between December 2011 and January 2012. A combination of social service agency workers, chamber of commerce members, and residents were recruited to ensure full representation from the Meriden and Wallingford communities. The following five groups were identified as having members that could best speak to the basic and healthcare needs in the communities:* Meriden Human Service Providers* Wallingford Community Forum members * United Way Agency Directors* Meriden Chamber of Commerce members* Quinnipiac Chamber of Commerce membersA MidState representative worked with the leader of each of these groups to schedule a focus group date and distribute recruitment letters to the group members. The MidState representative also worked with key individuals in the Meriden and Wallingford communities to recruit 6-10 residents for two additional focus groups. In Meriden, the Health & Human Services Department social worker talked with her colleagues to identify individuals who could speak to their basic health care needs, or needs they were seeing among their family or friends. In Wallingford, the Executive Director of the YMCA and the Spanish Community of Wallingford were critical in helping to recruit residents. The Meriden resident focus group was held at the Meriden Health Department. The Wallingford resident focus group was held at the Spanish Community of Wallingford. There were a total of 53 focus group participants with a diverse distribution of ages, races and education levels. The focus groups addressed the following topics with agency workers, chamber members and residents:* Basic needs, such as housing, food, and transportation* Healthcare related needs* How these needs have changed in the last three years* Social services currently being utilized in the community* Community strengths* Opportunities for improvement in the community
MidState Medical Center Part V, Section B, Line 7: To be the most effective, it is understood that not all needs can be addressed by MidState Medical Center. The key areas being addressed are within the capacity and resources of the hospital: Diabetes, Overweight and Obesity, Prostate and other Cancers awareness for screenings, Cardiac and Stroke. Where possible, the hospital partners with and/or supports the efforts of other agencies better positioned to address needs not within the hospital's scope. These include: Smoking Cessation which the Meriden/Wallingford Substance Abuse Council addresses and Physical Activity which is being addressed by the YMCA with its Activate Wallingford program.
MidState Medical Center Part V, Section B, Line 20d: The Hospital is in process of adopting the final 501R regulations.
Schedule H (Form 990) 2013
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, line 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
SchJMediumBullet Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
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 or provision of all of 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
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..
2
 
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
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
Yes
 
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
Yes
 
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 Regulations 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 Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2013

Schedule J (Form 990) 2013
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is 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) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (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 as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1)Lucille A JanatkaPresident/CEO (i)
(ii)		 536,357
0 		103,773
0 		30,296
0 		99,695
0 		25,791
0 		795,912
0 		0
0
(2)Carolyn FreiheitVP, Finance (i)
(ii)		 0
194,962 		0
13,750 		0
3,300 		0
47,365 		0
8,650 		0
268,027 		0
0
(3)Ralph W BeckerVP & CFO (Thru Jan. 2014) (i)
(ii)		 0
259,817 		0
63,725 		0
10,297 		0
61,837 		0
33,545 		0
429,221 		0
0
(4)Catherine StevensVP, Patient Care (i)
(ii)		 199,355
0 		17,383
0 		0
0 		8,873
0 		34,084
0 		259,695
0 		0
0
(5)Steven Hanks MDVP, Medical Affairs (i)
(ii)		 0
498,515 		0
37,935 		0
93,197 		0
137,676 		0
24,036 		0
791,359 		0
0
(6)Mary MorganVP,Human Resources (i)
(ii)		 0
168,920 		0
12,500 		0
0 		0
42,198 		0
23,568 		0
247,186 		0
0
(7)Cindy L RussoSVP, Operations (i)
(ii)		 256,809
0 		25,940
0 		0
0 		10,200
0 		3,651
0 		296,600
0 		0
0
(8)Robert van HeiningenVP, HR (Thru Oct.2013) (i)
(ii)		 161,714
0 		63,000
0 		0
0 		7,356
0 		13,503
0 		245,573
0 		0
0
(9)Joseph VaccarelliDirector, Lab (i)
(ii)		 0
185,501 		0
8,386 		0
14,334 		0
8,028 		0
1,641 		0
217,890 		0
0
(10)Elizabeth C DeSantoIn House General Counsel (i)
(ii)		 148,125
0 		7,688
0 		0
0 		6,487
0 		31,894
0 		194,194
0 		0
0
(11)Thomas VaccarelliVP,Facilities & Support (i)
(ii)		 0
180,897 		0
11,563 		0
3,557 		0
45,928 		0
22,123 		0
264,068 		0
0
(12)Robert FladeDirector,Emergency Nursing (i)
(ii)		 0
135,508 		0
6,408 		0
6,598 		0
24,384 		0
8,650 		0
181,548 		0
0
(13)Donna Sassi MDDirector, Surgery (i)
(ii)		 142,068
0 		7,532
0 		1,148
0 		6,290
0 		26,533
0 		183,571
0 		0
0
(14)Walter J Kupson IIIMedical Director Mediquick (i)
(ii)		 311,178
0 		9,115
0 		0
0 		10,200
0 		35,605
0 		366,098
0 		0
0
(15)Timothy M PrattHospitalist (i)
(ii)		 254,543
0 		19,148
0 		0
0 		10,200
0 		11,018
0 		294,909
0 		0
0
(16)Mark SchanerHospitalist (i)
(ii)		 250,788
0 		22,403
0 		0
0 		10,200
0 		34,871
0 		318,262
0 		0
0
(17)Joyce AkhtarHospitalist (i)
(ii)		 254,538
0 		3,731
0 		4,132
0 		10,200
0 		10,854
0 		283,455
0 		0
0
(18)Adwoa P Nyanin MDHospitalist (i)
(ii)		 253,292
0 		21,256
0 		426
0 		10,200
0 		19,628
0 		304,802
0 		0
0
(19)Harold KaplanFormer VP, Medical Affairs (i)
(ii)		 85,267
0 		0
0 		248,423
0 		0
0 		26,836
0 		360,526
0 		0
0
(20)John F Greene JrFormer VP, Medical Affairs (i)
(ii)		 300,720
104,075 		15,000
6,311 		0
27,151 		0
15,285 		0
15,071 		315,720
167,893 		0
0
Schedule J (Form 990) 2013

Schedule J (Form 990) 2013
Page 3
Part III
Supplemental Information
Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Return Reference Explanation
Part I, Line 3 Hartford HealthCare Executive Compensation Committee approves CEO and other Executive compensation. See detailed explanation on Sch O as references to Form 990, Part VI, Section B, Line 15.
Part I, Lines 4a-b Hartford Healthcare Corporation, a related organization, maintains a 457(f) plan. Participants include certain officers and key employees at the President, Executive Vice President, Senior Vice President and Vice President levels that are reported by Midstate medical Center on Form 990, Part VII. Contributions are made by Hartford Healthcare Corporation to the plan based on a percentage of the participant's compensation. Participants vest in the plan at the earlier of reaching age 55 and having 5 years of service, death, disability, involuntary separation without reasonable cause or upon reaching age 65. Each participant ceases to be eligible for further contributions by Hartford Healthcare Corporation on the date of the participant's separation from service. Participants receive a one-time lump sum payment of the accumulated amount during the 30-day period following the participant's separation from service. 2013 SERP accrual made on behalf of the following individual: Ms. Lucille Janatka $89,495 Mr. Harold Kaplan (Former Vice President) severance payment began in February of 2013. Total severance payment in 2013 was $248,423.46.
Part I, Line 7 The hospital has an At Risk Plan that encourages and rewards achievements of significant functional goals for management that contribute to organization(s) strategic and financial direction. The Plan utilizes market practice alignment to ensure competitive recruitment and retention. Awards are based on CEO and/or Hartford HealthCare Corporation's Compensation Committee discretionary assessment of overall organization performance and individual contribution to results.
Schedule J (Form 990) 2013

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, line 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBullet See separate instructions.
MediumBulletInformation about Schedule L (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
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) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No





2
Enter the amount of tax incurred by 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-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22
(a) Name of interested person (b) Relationship with organization (c) Purpose of loan (d) Loan to or from the organization? (e)Original principal amount (f)Balance due (g) In default? (h) Approved by board or committee? (i)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 assistance (d) Type of assistance (e) Purpose of assistance
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2013
Schedule L (Form 990 or 990-EZ) 2013
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 251,481 See Part V   No
Part V
Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).
Return Reference Explanation
Part IV (a) Name of Interested Person: Joseph E. Mirra(b) Relationship between Interested Person and Organization: Director(c) Amount of Transactions: $251,481(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 $251,481 for physician billing and provider enrollment services during the year.(e) Sharing of Organization Revenues? = No
Schedule L (Form 990 or 990-EZ) 2013

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.
MediumBullet Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
Name of the organization
Midstate Medical Center
 
Employer identification number

06-0646715
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 HealthCare 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, acquisitions, dissolutions, etc.
Form 990, Part VI, Section B, line 11 The Form 990 was prepared by the Hartford HealthCare's Tax Department. It was then reviewed by an independent accounting firm. It was then forwarded to the organization's top management including the VP, Finance 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 VP, Finance 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 HealthCare Corporation (HHC). The HHC Conflict of Interest Policy (Policy) requires all covered individuals, including board members and officers, to provide a disclosure of relationships that create or have the appearance of creating a conflict of interest or commitment. The Policy requires updates if changes in circumstances arise during the year that either (a) create a new potential conflict of interest or commitment or (b) change or eliminate a conflict of interest or commitment previously disclosed. Conflict of Interest disclosure statements are maintained by the HHC Office of Compliance, Audit & Privacy (OCAP). All employee disclosures are reviewed by OCAP to determine if there is a potential conflict. Legal counsel reviews all cases where the individual has a significant financial interest and these cases are forwarded to the System Executive Compliance Steering Committee. The System Executive Compliance Steering Committee assesses and recommends whether 1) the conflict be eliminated, 2) the proposed activity be prohibited, or 3) a Conflict of Interest management plan be implemented. Results of the survey of board members are reported to the HHC Nominating and Governance Committee for determinations of conflicts and the management of them, where applicable. Form 990, Part VI, Section B, Lines 13 & 14 The Hospital does have a written Document Retention and Destruction policy as well as a written Whistleblower policy. Although the policies were not formally approved by the Board, they were in effect for the entire tax year.
Form 990, Part VI, Section B, line 15 The Independent Executive Compensation Committee (Committee) of the Board of Directors of Hartford HealthCare on behalf of MidState Medical Center, hires an outside consultant, Integrated Healthcare Strategies, to determine best practices in governing executive compensation. The following steps are taken: - Use of an Independent Executive Compensation Committee (Committee) of the Board of Directors of Hartford HealthCare, on behalf of MidState Medical Center, established and regularly reviews Executive Compensation Philosophy - The Committee regularly reviews scope and depth of positions taking into account complexity and the financial impact and accountability of all "disqualified persons" - Benchmark peer groups are selected for comparison based on organizational size, operating revenue, geography and other relevant factors - Analysis of current total compensation versus market is performed by an independent third party compensation consulting firm and is then reviewed by the committee - Recommendations are made based on data analysis to ensure appropriate competitive positioning within parameters of the compensation philosophy - The CEO compensation is determined by the Committee based on comparative market information and organizational performance - All changes are reviewed and approved by the Executive Compensation Committee The CEO compensation determination process is reviewed on an annual basis. All other executive compensation are regularly reviewed for scope and depth of positions taking into account complexity and the financial impact and accountability.
Form 990, Part VI, Section C, line 18 The Hospital's Form 990, 990T and form 1023 and its attachments are available upon request.
Form 990, Part VI, Section C, line 19 The Hospital's Financial Statements, Governing Documents and the Conflict of Interest Policy are available for inspection upon request at the Hospital's address.
Form 990, Part XI, line 9: Unrealized Loss on Swap Value -134,060. Change in Funding Status of Pension -20,941,673. Income From Pass Thru Entities 325,301. Return on Investments held by Endowment, LLC 93,356. Transfer to Affiliated Entity - HHC -8,455,256. Rounding -10. Unrealized Gain (Loss) on Funds Held in Trust 846,380. Endowment LLC K-1 -2,615,466.
FORM 990 PART XII LINE 3A & B Although the organization was not required to undergo A-133 Federal Audit, the results were included in a consolidated A-133 audit performed at the parent level Hartford HealthCare Corporation.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2013

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" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.
MediumBullet Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047
2013
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 (if applicable) 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 0 0 Midstate Medical Center
 










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 entity?
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

One State Street Suite 19

Hartford,CT06103
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) Hartford HealthCare At HomeInc

1290 Silas Deane Hwy Suite 4B

Wethersfield,CT06109
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) Connecticut Health System Inc

80 Seymour Street

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

200 Retreat Aveue

Hartford,CT06106
06-0646683 		Supporting Organization to Hartford Hospital CT 501(C)(3) 11(c) Hartford Hospital
 
Yes
 
(11) VNA Health Resources Inc

1290 Silas Deane Hwy Suite 4B

Wethersfield,CT06109
06-1161422 		Home Health Care CT 501(C)(3) 9 Hartford HealthCare At Home Inc
 
Yes
 
(12) MidState Medical Center Auxiliary

435 Lewis Avenue

Meriden,CT06451
06-6063082 		Fundraising CT 501(C)(3) 11(a) 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 Hartford HealthCare Corporation
 
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 Hartford HealthCare Corporation
 
Yes
 
(17) Bradley Health Services

100 Grand Street

New Britain,CT06050
06-1367014 		Healthcare Services CT 501(C)(3) 9 Hartford HealthCare Corporation
 
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) 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
 
(20) Mulberry Gardens of SouthingtonLLC

58 Mulberry Street

Plantsville,CT06479
82-0586577 		Assisted Living & Adult Day Care Facility CT 501(C)(3) 9 Central CT Senior Health Services Inc
 
Yes
 
(21) HHC PhysiciansCare Inc

80 Seymour Street

Hartford,CT06102
45-4456939 		Practice Medicine and Provide Health Care Services to the Public CT 501(C)(3) 9 Hartford HealthCare Corporation
 
Yes
 
(22) Hartford HealthCare Accountable Care Org Inc

200 Retreat Avenue FL 9

Hartford,CT06102
46-0886367 		To Manage and Coordinate Care for Medicare Beneficiaries CT 501(C)(3) 7 HHC PhysiciansCare Inc
 
Yes
 
(23) Hartford HealthCare Corp Group (VEBA)

777 Main Street

Hartford,CT06102
26-6671355 		To Provide Medical,Dental,Life,Other Benefits to Employees CT 501(C)(9) N/A Hartford HealthCare Corporation
 
Yes
 
(24) Backus Corporation

326 Washington Street

Norwich,CT06360
22-2757608 		Support CT 501(C)(3) 11(b) Hartford HealthCare Corporation
 
Yes
 
(25) The William W Backus Hospital

326 Washington Street

Norwich,CT06360
06-0250773 		Healthcare Services CT 501(C)(3) 3 Hartford HealthCare Corporation
 
Yes
 
(26) Backus HealthCare Inc

326 Washington Street

Norwich,CT06360
22-2481794 		Support CT 501(C)(3) 11(a) Hartford HealthCare Corporation
 
Yes
 
(27) Rushford Foundation Inc

883 Paddock Avenue

Meriden,CT06450
06-1432692 		Supporting Organization CT 501(C)(3) 11(a) Rushford Center Inc
 
Yes
 
(28) Caring for Colleagues Employee Crisis Fund

100 Grand Street

New Britain,CT06052
26-4469178 		Employee Fund CT 501(C)(3) 7 Hartford HealthCare Corporation
 
Yes
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
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) Omni Home Health Services E CT LLC

12 Case Street 317
Norwich,CT06360
06-1458837 		Home Health Care CT N/A
                  
(2) New Britain MRI Limited Partnership

100 Grand Street
New Britain,CT06050
06-1271349 		Magnetic Resonance Imaging CT N/A
                  
(3) Hartford HealthCare Endowment LLC

80 Seymour Street
Hartford,CT06102
45-4181103 		Endowment Management CT N/A
 Investment 2,615,467 42,123,273   No     No 5.100 %
(4) Ambulance Service of Manchester LLC

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

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

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

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

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

1703 West Main Street
Willimantic,CT06226
06-1469575 		Outpatient Care Clinic CT N/A
                  
(10) HHC Southington Surgery Center LLC

81 Meriden Avenue
Southington,CT06489
46-5500829 		Surgery Services CT N/A
 Related   300,000   No     No 25.000 %
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
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) HHMOB Corporation & Subsidiaries

80 Seymour Street
Hartford,CT06102
06-1140244 		Real Estate & Parking CT N/A
 C       Yes  
(2) Hartford HealthCare Indemnity Services LTD

40 Church Street
  Hamilton  
BD
Captive Insurance BD N/A
 C       Yes  
(3) Windham Health Services Inc

112 Mansfield Avenue
Willimantic,CT06226
06-1461101 		Home Health Care CT N/A
 C       Yes  
(4) Windham Physician Hospital Organization

112 Mansfield Avenue
Willimantic,CT06226
06-1441614 		Medical Services CT N/A
 C       Yes  
(5) Windham Family Medical Services PC

112 Mansfield Avenue
Willimantic,CT06226
06-1491649 		Medical Services CT N/A
 C       Yes  
(6) CenConn Services Inc

100 Grand Street
New Britain,CT06050
22-2836001 		Investment Management CT N/A
 C       Yes  
(7) Midstate Medical Group PC

435 Lewis Avenue
Meriden,CT06450
20-4327968 		Medical Services CT N/A
 C       Yes  
(8) Hartford Physician Services PC

80 Seymour Street
Hartford,CT06102
06-1254082 		Medical Services CT N/A
 C       Yes  
(9) Meriden Imaging Center

101 North Plains Indusrial Park
Meriden,CT06429
06-1541468 		Imaging CT MidState Medical Center
  		S -325,943 2,214,713 80.000 % Yes  
(10) Hartford Physician Hospital Organization Inc

80 Seymour Street
Hartford,CT06102
22-2785918 		Physician & Hospital Support CT N/A
 C       Yes  
(11) Aetna Ambulance Service Inc

PO Box 1150
Manchester,CT06045
06-0795431 		Ambulance Services CT N/A
 C       Yes  
(12) Metro Wheelchair Service Inc

PO Box 300
Manchester,CT06045
06-0878432 		Wheelchair Services CT N/A
 C       Yes  
(13) WWB Corporation

326 Washington Street
Norwich,CT06360
06-1094836 		Holding Company CT N/A
 C       Yes  
(14) ConnCare Inc

326 Washington Street
Norwich,CT06360
06-1387598 		Healthcare Services CT N/A
 C       Yes  
(15) Backus Medical Center Condo Assoc Inc

330 Washington Street
Norwich,CT06360
06-1542647 		Condo Association CT N/A
 C       Yes  
(16) Windham Professional Office Condominium Association Inc

112 Mansfield Avenue
Willimantic,CT06226
06-1090041 		Condo Association CT N/A
 C       Yes  
(17) Select Physicians Network

112 Mansfield Avenue
Willimantic,CT06226
06-1426901 		Managing Offices of Physicians and Surgeons CT N/A
 C       Yes  
Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 3
Part V
Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
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 or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
 
No
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
 
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 related organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) Hartford Hospital

 P 3,484,832 FMV
(2) Hartford Hospital

 M 1,551,428 FMV
(3) Hartford Hospital

 L 96,327 FMV
(4) Hartford Hospital

 O 2,259,034 FMV
(5) Hartford HealthCare Rehabilitation NetworkLLC

 Q 277,876 FMV
(6) Hartford HealthCare PhysiciansCare Inc

 P 399,502 FMV
Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
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)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(e)
Are all partners
section
501(c)(3)
organizations? 		(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 Yes No






























Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R (see instructions).
Return Reference Explanation
Schedule R (Form 990) 2013
Additional Data


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