TY 2014 Form 990

(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)
(1) Bruce Eldridge........................................................................ Director (Thru June 2015)	2.00 .......................	X
(2) Joseph Mirra........................................................................ Director (Thru June 2015)	2.00 .......................	X
(3) James Smith........................................................................ Director (Thru June 2015)	2.00 .......................	X
(4) Letterio Asciuto MD........................................................................ Director	2.00 .......................	X
(5) Marcia Proto........................................................................ Director (Thru June 2015)	2.00 .......................	X
(6) Steven Basche........................................................................ Director	2.00 .......................	X
(7) Giovanna Weller........................................................................ Director (Thru June 2015)	2.00 .......................	X
(8) Paul Czepiga........................................................................ Director	2.00 .......................	X
(9) Nadine Francis-West........................................................................ Director	2.00 .......................	X
(10) Frederick Ulbrich III........................................................................ Director (Thru June 2015)	2.00 .......................	X
(11) Carl Grant........................................................................ Director	2.00 .......................	X
(12) Joseph Harrison MD........................................................................ Director	2.00 .......................	X
(13) John Redmond MD........................................................................ Director	2.00 .......................	X
(14) Lawrence Lazaroff........................................................................ Director (Thru June 2015)	2.00 .......................	X
(15) Jason Howey........................................................................ Director	2.00 .......................	X
(16) Christopher Beale........................................................................ Director (Thru June 2015)	2.00 .......................	X
(17) Irfan Chughtai MD........................................................................ Director	2.00 .......................	X

(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)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) Bruce Koeppen MD........................................................................ Director	2.00 .......................	X					0	0	0
(19) John Rathgeber........................................................................ Director	2.00 .......................	X					0	0	0
(20) Alan Weiner MD........................................................................ Director (Thru June 2015)	2.00 .......................	X					18,679	0	0
(21) George Springer Jr Esq........................................................................ Director	2.00 .......................	X					0	0	0
(22) Joseph Voelker........................................................................ Chair	3.00 .......................	X	X				0	0	0
(23) Denise McNair........................................................................ Vice Chair	3.00 .......................	X	X				0	0	0
(24) Lucille Janatka........................................................................ President/CEO	30.00 .......................30.00	X	X				0	3,295,845	107,940
(25) Margaret Marchak........................................................................ Secretary	3.00 .......................57.00		X				0	541,910	108,761
(26) Carolyn Freiheit........................................................................ VP, Finance	30.00 .......................30.00		X				0	267,639	25,014
(27) Catherine Stevens........................................................................ VP, Patient Care	0.00 .......................60.00			X			0	262,718	47,387
(28) Steven Hanks MD........................................................................ VP, Medical Affairs	5.00 .......................55.00			X			0	1,266,987	61,233
(29) Mary Morgan........................................................................ VP,Human Resources	5.00 .......................55.00			X			0	242,040	34,658
(30) Cindy Russo........................................................................ SVP, Operations	60.00 .......................				X		310,691	0	52,392
(31) Walter Kupson III........................................................................ Medical Director Mediquick	60.00 .......................				X		297,311	0	56,216
(32) Timothy Pratt........................................................................ Hospitalist	60.00 .......................				X		285,337	0	38,399
(33) Joyce Akhtar........................................................................ Hospitalist	60.00 .......................				X		293,591	0	33,255
(34) Adwoa Nyanin MD........................................................................ Hospitalist	60.00 .......................				X		346,648	0	41,945
(35) Ralph Becker........................................................................ Former, VP & CFO	0.00 .......................					X	0	385,957	30,904
(36) John Greene MD........................................................................ Former VP, Medical Affairs	0.00 .......................					X	0	600,775	48,711

(A) Name and business address	(B) Description of services	(C) Compensation
Clinical Lab Partners LLC 129 Patricia M Genova Dr Newington,CT06111	Laboratory Services	1,311,077
Emergency Medical Physicians PO Box 637233 Cincinnati,OH45263	Medical Services	1,311,030
Insight Health Corporation PO Box 847689 Dallas,TX75284	Medical Services	1,210,733
FIP Construction Inc 308 Farmington Avenue Farmington,CT06032	Construction	893,693
Fuda Construction 74 Edgemark Acres Meriden,CT06451	Construction	836,341
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 35

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 domestic organizations and domestic governments. See Part IV, line 21 ....	2,300	2,300
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ....
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16 ............
4	Benefits paid to or for members ....
5	Compensation of current officers, directors, trustees, and key employees ....	1,752,581		1,752,581
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....
7	Other salaries and wages ....	64,960,924	61,629,585	3,252,581	78,758
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	3,736,330	3,271,000	465,330
9	Other employee benefits .......	10,400,372	9,105,090	1,295,282
10	Payroll taxes ...........	4,558,160	3,990,478	567,682
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	59,950		59,950
c	Accounting ...........	42,817		42,817
d	Lobbying ...........	29,849		29,849
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	246,166	246,166
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ....	17,728,411	17,728,411
12	Advertising and promotion ....	41,685		41,685
13	Office expenses .......	3,232,806	2,414,911	803,981	13,914
14	Information technology ......	8,317,494	7,632,399	685,095
15	Royalties ..
16	Occupancy ...........	5,686,495	3,763,817	1,922,678
17	Travel ............	58,304	8,948	49,217	139
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......
19	Conferences, conventions, and meetings ....	198,303	143,090	55,213
20	Interest ...........	3,968,133	3,933,128	35,005
21	Payments to affiliates .......	12,502,548	10,647,756	1,854,792
22	Depreciation, depletion, and amortization .....	12,305,503	5,375,802	6,929,701
23	Insurance ..............	2,726,698	2,726,698
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	34,831,402	34,831,402
b	Purchased Services	9,228,910	7,979,793	1,146,687	102,430
c	Hospital Provider/User	9,163,234	9,163,234
d	Repairs & Maintenance	4,287,548	3,275,588	1,006,411	5,549
e	All other expenses	1,111,859	1,026,663	84,398	798
25	Total functional expenses. Add lines 1 through 24e	211,178,782	188,896,259	22,080,935	201,588
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 if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
	1	Cash–non-interest-bearing .............	398,880	1	11,808,350
2	Savings and temporary cash investments .........	44,581,226	2	0
3	Pledges and grants receivable, net ...........	41,986	3	38,093
4	Accounts receivable, net .............	28,352,212	4	23,565,335
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 .............		7
8	Inventories for sale or use ..............	3,431,508	8	3,846,758
9	Prepaid expenses and deferred charges ..........	2,245,299	9	1,656,273
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	267,441,070
b	Less: accumulated depreciation .....	10b	157,707,829	115,652,970	10c	109,733,241
11	Investments—publicly traded securities ..........		11
12	Investments—other securities. See Part IV, line 11 .....		12	18,172,907
13	Investments—program-related. See Part IV, line 11 .....		13	66,102,603
14	Intangible assets ...............		14
15	Other assets. See Part IV, line 11 ...........	81,973,042	15	36,961,295
16	Total assets. Add lines 1 through 15 (must equal line 34)......	276,677,123	16	271,884,855
	17	Accounts payable and accrued expenses .........	9,175,414	17	18,273,929
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....................	160,060,117	25	164,128,704
26	Total liabilities. Add lines 17 through 25.........	169,235,531	26	182,402,633
		Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............	89,763,992	27	72,575,241
28	Temporarily restricted net assets ...........	2,099,252	28	2,488,431
29	Permanently restricted net assets ...........	15,578,348	29	14,418,550
	Organizations that do not follow SFAS 117 (ASC 958), check here 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 ...........	107,441,592	33	89,482,222
34	Total liabilities and net assets/fund balances ........	276,677,123	34	271,884,855

- TIN:

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.
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Attach to Form 990 or Form 990-EZ.
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Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

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.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

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.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 11a through 11d that describes the type of supporting organization and complete lines 11e, 11f, and 11g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations .............................

Provide the following information about the supported organization(s).

(i)Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i)Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2014

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)		(a) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(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 VI.)..
11	Total support Add lines 7 through 10.

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2014 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2013 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2014. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2013. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2014. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2013. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

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) 2014

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)		(a) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513..
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(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 VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2014 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2013 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2014 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2013 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2014. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2013. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2014

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations....

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed, (ii) the reasons for each such action, (iii) the authority under the organization's organizing document authorizing such action, and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (a) its supported organizations; (b) individuals that are part of the charitable class benefited by one or more of its supported organizations; or (c) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in IRC 4958(c)(3)(C)), a family member of a substantial contributor, or a 35-percent controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part II of Schedule L (Form 990).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9(a)) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9(a)) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of IRC 4943 because of IRC 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Schedule A (Form 990 or 990-EZ) 2014

Page 5

Part IV

Supporting Organizations (continued)

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (1) a written notice describing the type and amount of support provided during the prior tax year, (2) a copy of the Form 990 that was most recently filed as of the date of notification, and (3) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2014

Page 6

Part V – Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

1. Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970. See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6
7	Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2014

Page 7

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2014 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2014	(iii) Distributable Amount for 2014
1 Distributable amount for 2014 from Section C, line 6
2 Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions)
3 Excess distributions carryover, if any, to 2014:
a From 2009.......X
b From 2010.......X
c From 2011.......X
d From 2012.......X
e From 2013.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2014 distributable amount
i Carryover from 2009 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2014 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2014 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions)
6 Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2015. Add lines 3j and 4c.
8 Breakdown of line 7:
a From 2010.......X
b From 2011.......X
c From 2012.......X
d From 2013.......
e From 2014.......

Schedule A (Form 990 or 990-EZ) (2014)

Schedule A (Form 990 or 990-EZ) 2014

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2014

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Name of the organization

Midstate Medical Center

Employer identification number

06-0646715

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

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

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... 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) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Page 2

Name of organization Midstate Medical Center

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	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Page 3

Name of organization Midstate Medical Center

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) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Page 4

Name of organization
Midstate Medical Center

Employer identification number

06-0646715

Part III

Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10)
that total more than $1,000 for the year from any one contributor. 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

(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

(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

(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

(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) (2014)

Additional Data

Software ID:
Software Version:

- TIN:

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

Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

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) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), 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.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures .................................... SchCMd Bullet

Volunteer hours ........................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ......... SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ...... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............

Yes No

Was a correction made? .........................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ................................... SchCMd Bullet

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

Did the filing organization file Form 1120-POL for this year? ..........................

Yes No

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) 2014

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 Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(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? ......................................	Yes No

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 separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2011	(b) 2012	(c) 2013	(d) 2014	(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) 2014

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)

Yes

(b)

Amount

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:

Volunteers? .........................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....

Media advertisements? ....................................

Mailings to members, legislators, or the public? .........................

Publications, or published or broadcast statements? .......................

Grants to other organizations for lobbying purposes? .......................

Direct contact with legislators, their staffs, government officials, or a legislative body? ........

Yes

29,849

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......

Other activities? ..........................

Total. Add lines 1c through 1i ...............................

29,849

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 .................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....

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

Were substantially all (90% or more) dues received nondeductible by members? ................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ................

Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........

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."

Dues, assessments and similar amounts from members .....................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).

Current year .........................................

Carryover from last year ....................................

Total ............................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

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? ................................

Taxable amount of lobbying and political expenditures (see instructions) ..............

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, lines 1 and 2 (see instructions), 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). CHA engages 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. CHA allocates portion of its dues as lobbying expenses. The total amount of dues allocated for lobbying purpose in FY15 was $29,849.

Return Reference

Explanation

Part II-B, Line 1:

MidState Medical Center (MMC) is a member of both Connecticut Hospital Association (CHA). CHA engages 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. CHA allocates portion of its dues as lobbying expenses. The total amount of dues allocated for lobbying purpose in FY15 was $29,849.

Schedule C (Form 990 or 990EZ) 2014

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

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.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

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 value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

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? ............

Yes No

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? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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.


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

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

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)? .......................................

Yes No

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.

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.

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)

Revenue included in Form 990, Part VIII, line 1 ........................ SchDMd Bullet

(ii)

Assets included in Form 990, Part X .............................. SchDMd Bullet

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:

Revenue included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

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) 2014

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

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):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

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?........

Yes No

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.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIII and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?

Yes No

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 ....	16,586,328	15,855,675	14,919,840	12,501,553	12,946,811
b	Contributions ........				240,834	258,750
c	Net investment earnings, gains, and losses	-140,689	785,129	1,155,553	2,534,968	-330,623
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........	0	54,476	219,718	272,520	287,232
f	Administrative expenses ....				84,995	86,153
g	End of year balance ......	16,445,639	16,586,328	15,855,675	14,919,840	12,501,553

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

90.000 %

Permanent endowment SchDMd Bullet

5.000 %

Temporarily restricted endowment SchDMd Bullet

5.000 %

The percentages in lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

Yes

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

Yes

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		(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	44,883,662	69,607,269
c	Leasehold improvements ............	8,283,537	5,910,043	2,373,494
d	Equipment ................	141,911,331	106,914,124	34,997,207
e	Other .................	1,505,271		1,505,271
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				109,733,241

Schedule D (Form 990) 2014

Page 3

Part VII

InvestmentsOther 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
(3)Other (A) Other Investments	2,954,157	F
(B) Funds Held in Trust	15,218,750	F







Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	18,172,907

Part VIII

InvestmentsProgram 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
(1) Investment in Endowment LLC	66,102,603	F








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)	66,102,603

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				14,865,382
(2) Amortizable Bond Issue Costs				1,508,826
(3) Funds Designated for Debt Service				6,307,695
(4) Security Deposits				9,000
(5) Insurance Receivable				14,254,370
(6) Bond Billing				16,022



Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				36,961,295

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 Post Retirement Expenses		46,123,235
IBNR Malpractice Reserve		2,744,464
Other Liabilities		981,658
Long Term Debt - Intercompany		86,420,749
Accrued Malpractice		14,317,689
Due to Affiliates		2,563,110
Hospital Provider Tax		3,372,290
General Reserve		3,365,512
Swap Valuation		4,239,997
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		164,128,704
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) 2014

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 (losses) 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) 2014

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H (Form 990)

Department of the TreasuryInternal Revenue Service

Hospitals

Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

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

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...

Yes

If "Yes," was it a written policy? .......................

Yes

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.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

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.

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:

Yes

100% 150% 200% Other 25000.0000000000 %

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: .........

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used 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.

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"? ..............

Yes

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

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......

Yes

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? ..............

Did the organization prepare a community benefit report during the tax year? ..........

Yes

If "Yes," did the organization make it available to the public? ..............

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(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) ..	2,106,034	0	2,106,034	1.000 %
b	Medicaid (from Worksheet 3, column a) ....	48,442,436	29,028,397	19,414,039	9.190 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) .
d	Total Financial Assistance and Means-Tested Government Programs .	50,548,470	29,028,397	21,520,073	10.190 %
Other Benefits		297,013	0	297,013	0.140 %
e	Community health improvement services and community benefit operations (from Worksheet 4) ..	297,013	0	297,013	0.140 %
f	Health professions education (from Worksheet 5) ..	360,836	0	360,836	0.170 %
g	Subsidized health services (from Worksheet 6) ..	641,205	262,786	378,419	0.180 %
h	Research (from Worksheet 7)
i	Cash and in-kind contributions for community benefit (from Worksheet 8)	12,228	0	12,228	0.010 %
j	Total. Other Benefits ..	1,311,282	262,786	1,048,496	0.500 %
k	Total. Add lines 7d and 7j .	51,859,752	29,291,183	22,568,569	10.690 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2014

Schedule H (Form 990) 2014

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.

		(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support	468	468	0 %
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building	2,745	2,745	0 %
7	Community health improvement advocacy
8	Workforce development	948	948	0 %
9	Other
10	Total	4,161	4,161

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

4,423,863

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. ......

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

Enter total revenue received from Medicare (including DSH and IME).....

59,728,440

Enter Medicare allowable costs of care relating to payments on line 5.....

66,970,345

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-7,241,905

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:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

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.......................

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) 2014

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 (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	Midstate Medical Center 435 Lewis Avenue Meriden,CT06451 0070	X

Schedule H (Form 990) 2014

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 letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a State as a hospital facility in the current tax year or the immediately preceding tax year?.......................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C..........

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 12....................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 14

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 Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C................................

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Did the hospital facility make its CHNA report widely available to the public? ..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): See Part V

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. .............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 14

Is the hospital facility's most recently adopted implementation strategy posted on a website? ........

If "Yes" (list url):

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Yes

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

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)? ...........................

12a

If "Yes" to line 12a, did the organization file Form 4720 to report the section 4959 excise tax? ......

12b

If "Yes" to line 12b, 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) 2014

Page

Part VFacility Information (continued)

	MidState Medical Center
Name of hospital facility or letter of facility reporting group

Yes

Financial Assistance Policy (FAP)

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 included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 250.000000000000%
and FPG family income limit for eligibility for discounted care of 400.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application.

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application.

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process.

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications.

Other (describe in Section C)

Included measures to publicize the policy within the community served by the hospital facility?.......

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url): http://www.midstatemedical.org/pv_patient_billing_insurance.aspx

The FAP application form was widely available on a website (list url): http://www.midstatemedical.org/pv_patient_billing_insurance.aspx

A plain language summary of the FAP was widely available on a website (list url):
http://www.midstatemedical.org/pv_patient_billing_insurance.aspx

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notice of availability of the FAP was conspicuously displayed throughout the hospital facility

Notified members of the community who are most likely to require financial assistance about availability of the FAP

Other (describe in Section C)

Billing and Collections

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 all of the actions the hospital facility or other authorized party may take upon non-payment?..................................

Yes

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:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2014

Page

Part VFacility Information (continued)

	MidState Medical Center
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility or other 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?.........

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 18. (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required 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?................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

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.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Section C)

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? ................................

If "Yes," explain in Section C.

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? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2014

Page

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
MidState Medical Center	Part V, Section B, Line 3j: This assessment incorporated data from both quantitative and qualitative sources. Quantitative data input include primary research and secondary research. The survey instrument used for this study was based largely on the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System (BRFSS), as well as various other public health surveys and customized questions addressing gaps in indicator data relative to health promotion and disease prevention objectives and other recognized health issues.To ensure the best representation of the population surveyed, a telephone interview methodology - one that incorporates both landline and cell phone interviews - was employed. The sample design used for this effort consisted of a random sample of 603 individuals age 18 and older in the MidState Medical Center service area. Because the study was part of a larger effort involving multiple regions and hospital service areas, the surveys were distributed among various strata. Once the interviews were completed, these were weighted in proportion to the actual population distribution so as to appropriately represent the Hartford Region as a whole.A variety of existing (secondary) data sources was consulted to complement the research quality of the Community Health Needs Assessment.Part V, Section B, Line 7ahttps://www.midstatemedical.org/healthy_reports_assessment.aspx
MidState Medical Center	Part V, Section B, Line 5: To solicit input from key informants, individuals who have a broad interest in the health of the community, an Online Key Informant Survey was also implemented as part of this process. These individuals included physicians, public health representatives, health professionals, social service providers and a variety of other community leaders. Input was solicted from the following: Berlin Senior Center Boys and Girls Club of Meriden Bristol Community Organization Bristol-Burlington Health District Calendar House Southington Senior Center Central Connecticut Senior Health Services Community Health Center, Inc. Connecticut Association for Community Action Girls Incorporated of Meriden Greater New Britain Chamber of Commerce Meriden Senior Center Meriden-Wallingford Chrysalis, Inc. MHT Christians in Action MidState Medical Center Quinnipiac Chamber of Commerce South Central CT Substance Abuse Council Southington Library Southington Public Schools The Hospital of Central Connecticut United Way Wallingford Health Department Wallingford Senior Center Women and Families Center YMCA Participants were chosen because of their ability to identify primary concerns of the populations with whom they work, as well as of the community overall. Key informants were contacted by email, introducing the purpose of the survey and providing a link to take a survey online. Key informants were asked to rate the degrees to which various health issues were a problem in the Central Region. Follow-up questions asked them to describe why they identified areas as such, and how these might be better addressed. MidState Medical Center recognizes that it cannot measure all possible aspects of health in the community, nor can it adequately represent all possible populations of interest. In terms of content, the assessment was designed to provide a comprehensive and broad picture of the health of the overall community. The CHNA analysis and report yielded a wealth of information about the health status, behaviors and needs for our population. A distinct advantage of the primary quantitative (survey) research is the ability to segment findings by geographic, demographic and health characteristics to identify the primary and chronic disease needs and other health issues of vulnerable populations, such as uninsured persons, low-income persons, and racial/ethnic minority groups. For additional statistics about uninsured, low-income, and minority health needs please refer to the complete Community Health Needs Assessment report, which can be viewed online at: https://www.midstatemedical.org/healthy_reports_assessment.aspx After reviewing the Community Health Needs Assessment findings, the community representatives met on June 10, 2015 to determine the health needs to be prioritized for action. During a detailed presentation of the CHNA findings, we used audience response system (ARS) technologies to lead steering committee members through a process of understanding key local data findings (Areas of Opportunity) and ranking identified health issues against the following established, uniform criteria: Magnitude, Impact/Seriousness/Feasibility, Consequences of Inaction. From this exercise, the areas of opportunity were prioritized as follows by the committee: Mental Health, Nutrition, Physical Activity & Weight Status, Diabetes, Substance Abuse, Cancer, Heart Disease and Stroke.
MidState Medical Center	Part V, Section B, Line 11: As individual organizations begin to parse out the information from the 2015 Community Health Needs Assessment, it is MidState Medical Center's goal that this will foster greater desire to embark on a community-wide community health improvement planning process. MidState Medical Center has expressed this intention to partnering organizations and is committed to being a productive member in this process as it evolves. In addition, formal collaboratives have been formed, and system-wide initiatives have been launched that address nutrition education such as our partnership with a statewide super market retailer. In acknowledging the wide range of priority health issues that emerged from the CHNA process, MidState Medical Center determined that it could only effectively focus on those which it deemed most pressing, most under-addressed, and most within its ability to influence: * Nutrition, Physical Activity & Weight Status* Mental Health & Substance Abuse * Heart Disease/Stroke* Diabetes* Cancer Other identified needs were:* Substance Abuse * Infant Health & Family Planning * Injury & Violence * Potentially Disabling Conditions * Sexually Transmitted Diseases * HIV/AIDS * Chronic Kidney Disease In acknowledging the wide range of priority health issues that emerged from the CHNA process, MidState Medical Center determined that it could only effectively focus on those which it deemed most pressing, most under-addressed, and most within its ability to influence. Health Priorities Not Chosen for Action / ReasonChronic Kidney Disease:MMC believes that efforts outlined herein to improve and increase awareness of healthy lifestyles will have a positive impact on the detection of kidney disease and that we do not have the available resources to create a separate set of kidney-specific initiatives.Dementia, including Alzheimer's Disease:MMC believes that this priority area falls more within the purview of local organizations, such as the area Alzheimer's Resource Center. MMC will support communication of these services. Potentially Disabling Conductions:Those voting felt that more pressing health needs existed. Limited resources and lower priority excluded this as an area chosen for action.Respiratory Diseases:MMC participates in a statewide asthma collaborative established by the CT Department of Public Health and The CT Hospital Association. MMC will support the established initiatives from this collaborative.Sexually Transmitted Diseases:MMC believes that this priority area falls more within the purview of the community/district health departments and other community organizations. Limited resources and lower priority excluded this as an area chosen for action.HIV/AIDS:MMC believes that this priority area falls more within the purview of the community/district health departments and other community organizations. Limited resources and lower priority excluded this as an area chosen for action.Infant Health & Family Planning:MMC has limited resources, services, and expertise to address these issues. Other community organizations have infrastructure and programs in place to better address these needs. Limited resources excluded this as an area chosen for action.Injury & Violence Prevention:MMC believes that this priority area falls more within the purview of the community/district health departments and other community organizations. Limited resources and lower priority excluded this as an area chosen for action.Sch H Part V, Line 9:Although the approved implementation strategy date reflects the 2014 tax year, the implementation strategy was approved in December 2015. The organization reports its data on a fiscal year basis. As a result, the current software prevents the disclosure of the 2015 date on the current Form. The correct date (2015) will be reflected on FY16 Form.
MidState Medical Center	Part V, Section B, Line 13h: Family eligibility criteria for Financial Assistance also include family size, employment status, financial obligations, and amount and frequency of the health care expenses.
MidState Medical Center	Part V, Section B, Line 15e: In addition, patient may ask nurse, physician, chaplain, or staff member from Patient Registration, Patient Financial Services, Office of Professional Services, Case Coordination, or Social Services about initiating the Financial Assistance Application process.
MidState Medical Center	Part V, Section B, Line 16i: Patients are informed directly by staff of the availability of the Financial Assistance Policy.
MidState Medical Center	Part V, Section B, Line 22d: For FY15, the hospital did a computation to determine on average insurance companies reimbursement for the types of services rendered. The average (discount) was offered to all self-pay patients without regards to financial ability. Patients who were unable to pay their bills were able to apply for financial assistance. Based upon factors including family size & income, patients were eligible to receive write-offs ranging between 25 - 100%.The Hospital Financial Assistance Policy (effective January 1, 2016) is compliant with IRS Code Sec. 501R. Per the Hospital's policy, no individual who is determined to be eligible for financial assistance will be charged more for emergency or other medically necessary care than the amount generally billed to individuals who have insurance covering such care. The basis to which any discount is applied is equivalent to the billed charges posted to a patient account minus any prior insurance payments and adjustments from the patient's insurance (if applicable). Starting January 1, 2016, the Hospital used the IRS 501R prescribed methodology to compute self-pay discount (AGB discount). The Hospital calculates AGB based on a retrospective or look back review of amounts allowed by government (Medicare, Medicaid, etc.) and commercial insurance.
Part V, Section B, Line 16	Financial Assistance Policy Website Availability
MidState Medical Center Part V, Section B, line 16a website:	http://www.midstatemedical.org/pv_patient_billing_insurance.aspx
MidState Medical Center Part V, Section B, line 16b website:	http://www.midstatemedical.org/pv_patient_billing_insurance.aspx
MidState Medical Center Part V, Section B, line 16c website:	http://www.midstatemedical.org/pv_patient_billing_insurance.aspx

Schedule H (Form 990) 2014

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) 2014

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
Part I, Line 3c:	Midstate Medical Center used the Federal Poverty Guidelines to determine eligibility.
Part I, Line 7:	The organization utilized the Ratio of Cost to Charges (RCC) derived from the FY 2015 Medicare cost report which already incorporates or is net of non-patient care costs (i.e. bad debt, non-patient care, etc.). The ratio was further reduced to incorporate the directly identified community expenses. This cost to charge ratio was used to calculate costs for Part I lines 7a, b, & g. The costs associated with the activities reported on Part I, Line 7e were captured using actual time multiplied by an average salary rate. These costs were removed from the calculations above to avoid duplication. Costs reported in Part III, Section B6, were calculated from the Medicare cost report and reduced for Medicare costs previously reported on Part I Line 7g.
Part I, Line 7g:	No physician clinic costs were included in the subsidized Health Services cost calculations.
Part II, Community Building Activities:	MidState Medical Center has a very robust community benefits program. MidState coordinates a Community Vision group that interacts with the community to address needs and facilitate responses to identified needs. Through Community Vision, MidState has collaborated with the United Way of Meriden and Wallingford to address food collection and distribution for the needy while also conducting semi-annual food collections within the hospital for distribution to those in need. More specifically, MidState is involved in a Family Zone in Meriden that is modeled after the Harlem Children Zone in New York and provides extended services to families who reside in a targeted segment of the community. MidState representatives also serve on a housing coalition that addresses the need for housing and shelter in its primary service area. Since basic needs, such as food and housing, are tied to health status, MidState's participation in these initiatives alongside the United Way has been important and beneficial to the community the hospital serves. MidState staff is also involved in workforce development activities through a regional board that is focused on training, education, and employment opportunities. This enhances the training of the workforce and also can lead to career opportunities at MidState Medical Center. Furthermore, MidState is proud of the school business partnerships it has in the community, further addressing workforce development efforts among the area's youth and understanding that employment is another factor tied to health status.Since the mid-1990s, MidState has had a close-knit relationship with nearby John Barry Elementary School which has provided opportunities for staff to adopt classrooms and enrich the academic experience of students through read-a-loud days and other classroom activities, as well as promote tailored education to students on important health topics including the signs and symptoms of stroke. By educating students on disease risk factors at an early age, it is the hope that their knowledge base will increase, they will share information with their families and perhaps recognize a health problem in a loved one. Over 20 years ago MidState and its community partners, under the Healthy Meriden initiative, established the Multidisciplinary Geriatric Service Provider Team to bring together all the geriatric service providers in the area to address health issues that the elderly face and how the organizations around the table can better address those issues through collaboration, more coordinated service, and networking. The team still continues to meet monthly and participation is strong. MidState assists with organizing these meetings and serves as a meeting location for the group. Through this specialized team, work is being done to improve the healthcare services available to our aging population.For FY15, the Medical Center expended $4,161 on community building activities as reported on Part II of schedule H and in the narratives above.
Part III, Line 2:	The Hospital has established estimates based on information presently available of amounts due to or from Medicare, Medicaid, and third-party payers for adjustments to current and prior year payment rates, based on industry-wide and Hospital-specific data. Such amounts are included in the accompanying consolidated balance sheets.
Part III, Line 3:	In 2012, a pre-bad debt financial assistance screening was put in place to identify patients that may eligible for financial assistance. Pre-bad debt accounts that are identified as meeting the requirements are adjusted prior to being sent to bad debt. Therefore, any bad debt expense that could have been attributable to charity care at the end of FY15 is immaterial.
Part III, Line 4:	Please see the text of the footnote that describes bad debt expense on pages 19 - 22 of the Audited Financial Statement.
Part III, Line 8:	Providing for those in need, including Medicare patients and serving all patients regardless of their ability to pay is an essential part of the organization's mission. The hospital serves all patients without regard to any payment shortfall. Therefore the Medicare shortfall should be considered to be a community benefit. The organization Medicare Cost Report was used to accumulate actual costs related to Part III, Section B, Line 6.
Part III, Line 9b:	MidState Medical Center has adopted the Financial Assistance Policy of its Parent Company, Hartford HealthCare Corporation. The following is included in the Financial Assistance Policy: For those patients that qualify for financial assistance and for whom in the System's sole determination are cooperating in good faith to resolve the System's outstanding accounts, the Systems' facilities may offer extended payment plans to eligible patients, will not impose wage garnishments or liens on primary residences, will not send unpaid bills to outside collection agencies and will cease all collection efforts.
Part VI, Line 2:	MidState Medical Center conducts needs assessment every three years. The assessment includes: 1. Primary data, including focus groups, surveys both on paper and on the phone. This data addresses behaviors and perceptions.2. Secondary data, including morbidity and mortality data, crime statistics, housing and homeless information, substance abuse, alcohol, and tobacco survey results, workforce data, and demographic information.3. Other available data from various local, state, and national resources.This data is correlated and evaluated and leads to specific issues related to basic needs, health, housing, workforce, and issues related to specific age groups, including seniors and youth. A community group, incorporating MidState Medical Center, United Way, Chamber of Commerce, as well as other health and human service organizations, key opinion leaders, business leaders, clergy, and other volunteers collaborate to address these issues. This group has convened community-based task forces to address identified issues.The Center continues to use emergency room data to track increases in medical conditions such as falls, flu, drug overdoses, etc. The same approach is taken in our outpatient clinics. We periodically canvas our Social Work/Case Management staff as to what they are seeing and hearing about as they work with patients. We also track requests from other entities such as area non profits, local government agencies and public schools. These requests often reflect growing needs and issues in our community.
Part VI, Line 3:	MidState Medical Center disseminates information about its Financial Assistance Policy as follows: (i) provides signage regarding this Policy and written summary information describing the Policy along with financial assistance contact information in the Emergency Department, Labor and Delivery areas and all other Hospital patient registration areas: (ii) to directly provide each patient with a written summary information describing the Policy along with financial assistance contact information in all admission, patient registration discharge, billing and collection written communications; (iii) posts the Policy on the Hospital's website; (iv) educates all admission and registration personnel regarding the Policy so that they can serve as an informational resource to patients regarding the Policy.
Part VI, Line 4:	MidState Medical Center is located in central Connecticut. Its primary service area has a total population of 178,012 people. Of those, 22% are under the age of 18 and 15% are Seniors. The racial makeup is 77% White, 4% Black, 14% Hispanic and 3% Asian. Females make up 51% of the populations and males account for 49%. There are about 5,000 veterans in the service area. 8% of the population lives below the poverty level. Approximately 26% speak a language other than English at home. 32% have a Bachelor's degree or higher.
Part VI, Line 5:	The mission of MidState Medical Center is to improve the health and healing of the people and communities we serve. In towns across central Connecticut, MidState is committed and focused on efforts to promote health and wellness.MidState Medical Center extends medical staff privileges to all qualified physicians in its community. The Hospital/Medical Center has partnered with the Community Health Center to provide health services to the underserved in the community. In addition, MidState participates in Community Vision to improve community health and well-being.MidState has contracted to use the services of an organization to assist its patients in determining eligibility and applying for state and federal means tested programs such as Medicare and Medicaid, as well as for the MidState Medical Center Financial Assistance Program. Additionally, the MidState Emergency Department and satellite MediQuick Urgent Care facilities provide medical care regardless of patients' ability to pay for services. In towns across central Connecticut, MidState Medical Center 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, MidState has partnered with various community organizations to improve the quality of life of its residents. MidState has coordinated and participated in many different program categories, including health fairs, countless educational seminars and dozens of free health screenings. The hospital also offers a number of support groups for cancer patients, new moms, diabetes patients and bereavement support. Through the combination of these programs, MidState has served tens of thousands of people. Our MidState physicians and clinicians hold speaking engagements at various community locations to offer individuals the opportunity to ask questions and learn about specific health conditions and ways of leading a healthier lifestyle. Programming is consistently offered free of charge for local senior centers, libraries, YMCAs, women's groups, faith communities, Rotary clubs, Kiwanis, and other community groups. Together the Central Region participates in a Healthy Family FunFest held at the Aqua Turf annually and open to the public free of charge.MidState takes a collaborative approach to building a healthier community, working with a variety of organizations on a number of initiatives to enhance the health and well-being of those we serve. In the last year, MidState is privileged to have worked with the United Way of Meriden & Wallingford, the Cheshire and Wallingford YMCAS, its local health departments and the Meriden Chamber Health and Wellness Council. MidState has been particularly involved this year in the Activate Wallingford initiative with the Wallingford YMCA to address the issue of childhood obesity in the Wallingford Community. Our medical and consumer health library offers a broad range of resources and services to support the needs of patients, caregivers and area residents for accurate and current health information. The Tremaine Resource Center supports student research and offers services to patients in the hospital.
Part VI, Line 6:	Hartford Healthcare Corporation (HHC) is organized as a support organization to govern, manage and provide support services to its affiliates. HHC, through its affiliates including Midstate Medical Center, strives to improve health using the "Triple Aim" model: improving quality and experience of care; improving health of the population (population health) and reducing costs. The Strategic Planning and Community Benefit Committee of the HHC Board of Directors ensures the oversight for these services by each hospital community. HHC and its affiliates including all supporting organizations, develop and implement programs to improve the future of health care in our Southern New England region. This includes initiatives to improve the quality and accessibility of health care; create efficiency on both our internal operations and the utilization of health care; and provide patients with the most technically advanced and compassionate coordinated care. In addition, HHC continues to take important steps toward achieving its vision of being "nationally respected for excellence in patient care and most trusted for personalized, coordinated care."The affiliation with HHC creates a strong, integrated health care delivery system with a full continuum of care across a broader geographic area. This allows small communities easy and expedient access to the more extensive and specialized services the larger hospitals are able to offer. This includes continuing education of health care professionals at all the affiliated institutions through the Center of Education, Simulation and Innovation located at Hartford Hospital, the largest of the system hospitals. The affiliation further enhances the affiliates' abilities to support their missions, identity, and respective community roles. This is achieved through integrated planning and communication to meet the changing needs of the region. This includes responsible decision making and appropriate sharing of services, resources and technologies, as well as cost containment strategies. Additionally, the hospital is affiliated with several other non hospital charitable organizations. These organizations provide significant benefits to the community. These benefits are not reported in the Community Benefit data provided by the hospital.
Part VI, Line 7, Reports Filed With States	CT

Schedule H (Form 990) 2014

Additional Data

Software ID:
Software Version:

- TIN:

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

Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

Midstate Medical Center

Employer identification number

06-0646715

Part I

Questions Regarding Compensation

Yes

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.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

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....

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? ..

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.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

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:

Receive a severance payment or change-of-control payment? ................

Yes

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

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), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

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:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

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:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

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 ............

Yes

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 .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2014

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 in column(B) reported as deferred in prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1Lucille JanatkaPresident/CEO	(i) (ii)	0 ............................... 560,112	0 ............................... 128,700	0 ............................... 2,607,033	0 ............................... 20,800	0 ............................... 87,140	0 ............................... 3,403,785	0 ............................... 2,575,769
2Margaret MarchakSecretary	(i) (ii)	0 ............................... 432,566	0 ............................... 101,007	0 ............................... 8,337	0 ............................... 72,165	0 ............................... 36,596	0 ............................... 650,671	0 ............................... 0
3Carolyn FreiheitVP, Finance	(i) (ii)	0 ............................... 222,058	0 ............................... 33,605	0 ............................... 11,976	0 ............................... 8,068	0 ............................... 16,946	0 ............................... 292,653	0 ............................... 0
4Catherine StevensVP, Patient Care	(i) (ii)	0 ............................... 225,924	0 ............................... 33,429	0 ............................... 3,365	0 ............................... 20,800	0 ............................... 26,587	0 ............................... 310,105	0 ............................... 0
5Steven Hanks MDVP, Medical Affairs	(i) (ii)	0 ............................... 559,245	0 ............................... 77,262	0 ............................... 630,480	0 ............................... 20,252	0 ............................... 40,981	0 ............................... 1,328,220	0 ............................... 595,590
6Mary MorganVP,Human Resources	(i) (ii)	0 ............................... 198,366	0 ............................... 30,550	0 ............................... 13,124	0 ............................... 7,409	0 ............................... 27,249	0 ............................... 276,698	0 ............................... 0
7Cindy RussoSVP, Operations	(i) (ii)	264,887 ............................... 0	44,729 ............................... 0	1,075 ............................... 0	20,800 ............................... 0	31,592 ............................... 0	363,083 ............................... 0	0 ............................... 0
8Walter Kupson IIIMedical Director Mediquick	(i) (ii)	282,512 ............................... 0	14,441 ............................... 0	358 ............................... 0	20,800 ............................... 0	35,416 ............................... 0	353,527 ............................... 0	0 ............................... 0
9Timothy PrattHospitalist	(i) (ii)	266,524 ............................... 0	18,518 ............................... 0	295 ............................... 0	20,800 ............................... 0	17,599 ............................... 0	323,736 ............................... 0	0 ............................... 0
10Joyce AkhtarHospitalist	(i) (ii)	272,011 ............................... 0	19,941 ............................... 0	1,639 ............................... 0	20,800 ............................... 0	12,455 ............................... 0	326,846 ............................... 0	0 ............................... 0
11Adwoa Nyanin MDHospitalist	(i) (ii)	316,922 ............................... 0	24,091 ............................... 0	5,635 ............................... 0	20,800 ............................... 0	21,145 ............................... 0	388,593 ............................... 0	0 ............................... 0
12Ralph BeckerFormer, VP & CFO	(i) (ii)	0 ............................... 23,987	0 ............................... 0	0 ............................... 361,970	0 ............................... 5,200	0 ............................... 25,704	0 ............................... 416,861	0 ............................... 0
13John Greene MDFormer VP, Medical Affairs	(i) (ii)	0 ............................... 437,708	0 ............................... 101,617	0 ............................... 61,450	0 ............................... 20,800	0 ............................... 27,911	0 ............................... 649,486	0 ............................... 0

Schedule J (Form 990) 2014

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. 2014 SERP accrual made on behalf of the following individual: Ms. Margaret Marchak $53,965 2014 SERP payouts were made to the following individuals: Ms. Lucille Janatka $2,575,769 Dr. Steven Hanks $595,590 Mr. Raplh Becker (Former CFO) was paid a lumpsum severance of $305,000 in 2014.
Part I, Line 7	Hartford HealthCare Corporation, a related organization, 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) 2014

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

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

Information about Schedule L (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

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), section 501(c)(4), and 501(c)(29) 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	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

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?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e)Original principal amount	(f)Balance due	Yes	No	Yes	No	Yes	No






Total ...... $

Part III

Grants or Assistance Benefiting 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) 2014

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?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) See Part V	See Part V		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: $383,422(d) Description of Transaction: Mr. Joseph Mirra was 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 $383,422 for physician billing and provider enrollment services during the year.(e) Sharing of Organization Revenues? = No(a) Name of Interested Person: Alan Weiner, MD(b) Relationship between Interested Person and Organization: Director(c) Amount of Transactions: $18,679(d) Description of Transaction: Dr. Alan Weiner is a board member of MidState Medical Center (MMC) and provides services as the Vice President Medical Staff. MMC paid Dr. Weiner $18,679 for President of Medical Staff services during the year.(e) Sharing of Organization Revenues? = No(a) Name of Interested Person: John Redmond, MD(b) Relationship between Interested Person and Organization: Director(c) Amount of Transactions: $35,000(d) Description of Transaction: Dr. John Redmond is a Board member of Hartford HealthCare's Cental Region. The Region consists of MidState Medical Center, Hospital of Central Connecticut & Rushford Center Inc. Dr. Redmond is the President of the Medical Staff at MidState Medical Center. He was paid a stipend of $35,000 for his services.(e) Sharing of Organization Revenues? = No

Schedule L (Form 990 or 990-EZ) 2014

Additional Data

Software ID:
Software Version:

- TIN:

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 990-EZ 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

2014

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 4	The Amended and Restated Certificate of Incorporation of the Corporation includes the following substantive amendments: 1. The Corporation's purposes have been revised but are consistent with its charitable purposes. 2. The board's role was revised to focus on quality in health care. 3. Section 12 relating to the indemnification of directors, officers, and committee members of the Corporation has been revised consistent with Connecticut Law. The Organizations' governing documents are available upon request.
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 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 of Finance for review. The final Form was provided to the entire Board prior to submission to the Internal Revenue Services (IRS). Once the entire review process was completed, the Form was signed by the VP of Finance and then filed with the IRS.
Form 990, Part VI, Section B, line 12c	The hospital's board has adopted the policy of the member, Hartford HealthCare Corporation (HHC). HHC's 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). Employee disclosures are reviewed by OCAP in collaboration with the Covered Individuals' supervisor when deemed appropriate, to determine if there is a potential conflict. Oversight review of employee disclosures is provided by the HHC Conflict of Interest Committee (the Committee) which includes representation from the Medical Staff, the Legal Department, Human Resources, Supply Chain Management and Compliance. The Committee assesses and may recommend the conflicting interest either be (a) eliminated for a continued relationship with HHC, or (b) managed through a management plan. Board member disclosures 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, 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, a division of Gallagher Benefit Services, Inc., to determine best practices in governing executive compensation. The following steps were 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" - National peer groups are selected for comparative purposes based on organizational size, operating revenue, geography and other relevant factors - Analysis of current total compensation versus market is performed by 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 compensation philosophy - The CEO compensation is reviewed 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 is 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:	K-1 Income (Pass Thru Entities) 193,403. Pension Adjustment -11,535,650. Transfer to Affiliates -19,448,519. Change In Unrealized Loss on Residual Trust -1,161,043. Unrealized Loss on Investment Income -16,783. Return on Investments held by Endowment LLC 1,245. Endowment LLC - Actual Income from Inv. Sch K-1 -4,575,284. Endowment LLC - Investment Income Reported on TB -3,012,049. Rounding 2.
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) 2014

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

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?
(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	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		No
(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) Eva Stearns Faulkner Foundation 435 Lewis Avenue Meriden,CT06451 06-6065398	Supporting Organization	CT	501(C)(3)	3	MidState Medical Center	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)	MidState 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) 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
(19) 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
(20) 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
(21) Hartford HealthCare Accountable Care Org Inc 1290 Silas Deane Hwy Wethersfield,CT06109 46-0886367	To Manage and Coordinate Care for Medicare Beneficiaries	CT	501(C)(3)	7	HHC PhysiciansCare Inc	Yes
(22) 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
(23) Backus Corporation 326 Washington Street Norwich,CT06360 22-2757608	Supporting Organization	CT	501(C)(3)	11(b)	Hartford HealthCare Corporation	Yes
(24) The William W Backus Hospital 326 Washington Street Norwich,CT06360 06-0250773	Healthcare Services	CT	501(C)(3)	3	Hartford HealthCare Corporation	Yes
(25) Backus HealthCare Inc 326 Washington Street Norwich,CT06360 22-2481794	Supporting Organization	CT	501(C)(3)	11(a)	Hartford HealthCare Corporation	Yes
(26) Rushford Foundation Inc 883 Paddock Avenue Meriden,CT06450 06-1432692	Supporting Organization	CT	501(C)(3)	11(a)	Rushford Center Inc	Yes
(27) 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
(28) Central Connecticut Health Alliance 100 Grand Street new Britain,CT06052 22-2785033	Support Services	CT	501(C)(3)	11(b)	Hartford HealthCare Corporation	Yes

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2014

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
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	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	4,878,122	82,548,241		No			No	9.330 %
(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	8,832	309,824		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?
(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		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	-193,310	2,861,178	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

Schedule R (Form 990) 2014

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

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 . . . . . . . . . . . . . . . . . . . . . . .

Yes

b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .

m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .

o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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	M	714,602	FMV
(2) Hartford Hospital	O	905,540	FMV
(3) Hartford Hospital	P	762,453	FMV
(4) Hartford Hospital	R	568,863	FMV
(5) Hartford HealthCare At Home Inc	O	76,938	FMV
(6) HHC PhysiciansCare Inc	A	728,697	FMV
(7) HHC PhysiciansCare Inc	P	166,260	FMV
(8) The Hospital of Central Connecticut	P	520,953	FMV
(9) The Hospital of Central Connecticut	Q	455,759	FMV
(10) The Hospital of Central Connecticut	A	9,171	FMV
(11) Rushford Center Inc	A	1,203	FMV

Schedule R (Form 990) 2014

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)	(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?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2014

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) 2014

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: The mission of Midstate Medical Center is to improve the health and healing of the people and communities we serve.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	15
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	13
5	Total number of individuals employed in calendar year 2014 (Part V, line 2a) ......	5	1,298
6	Total number of volunteers (estimate if necessary) .............	6	236
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	-134,773
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	-220,954

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	618,553	583,828
9	Program service revenue (Part VIII, line 2g) .........	223,796,456	225,478,397
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	3,158,071	5,130,630
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	2,672,666	1,554,348
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	230,245,746	232,747,203
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	2,300
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)	88,984,007	85,408,367
16a	Professional fundraising fees (Part IX, column (A), line 11e).....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 201,588
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	119,789,513	125,768,115
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	208,773,520	211,178,782
19	Revenue less expenses. Subtract line 18 from line 12.......	21,472,226	21,568,421
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	276,677,123	271,884,855
21	Total liabilities (Part X, line 26).............	169,235,531	182,402,633
22	Net assets or fund balances. Subtract line 21 from line 20.....	107,441,592	89,482,222

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 29,534,608 including grants of $ ) (Revenue $ 32,692,673 )
	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. In fiscal year 2015, we continued to focus on our patients' 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 for FY15 67% of all patient where seen within 30 minutes of arrival, for fiscal year 2016 we will be reviewing opportunities to improve this measure as we focus on decreasing the wait time to see a provider. Our "Physician First" process continues focusing on delivering patient-centered care directly to our patients in a timely and efficient manner. Overall, the total number of ED visits for FY15 was 57,710, this is a 1.5% decrease from FY14. For FY 15, 11% of our patients were admitted to MidState Medical Center as inpatients. The percentage of patients who left without being seen was 1.5%, which is below the national benchmark of 2%. Approximately 25% of all Emergency Department patients arrived by ambulance. Emergency Medicine Physicians (EMP):We continue our relationship with Emergency Medicine Physicians (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 FY15, the ED continues to provided ongoing education to local EMS providers, including the Wallingford Fire Department, Hunter's Ambulance and the Meriden Fire Department. We also developed a special paramedic continuing education program with the Simulation Center. The ED continued to build its relationship with the Meriden Police Department and work collaboratively in situations when emergency care intersects with law enforcement matters. 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. In August of 2015, LifeStar was relocated from Hartford Hospital to MidState Medical Center campus. This has allowed us to continue to focus on decreasing transfer time in cardiology patients with a diagnosis of ST Elevation Myocardial Infarction (STEMI). Senior Emergency Care Services:We identified a need to improve the transition of care for the senior population that is over 65. This group of patients' accounts for 20% of our ED visits annually. Our goal is to provide seniors with the services needed to maintain independence and overall health and well-being. During FY 15, we 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 372 Pharmacy consults that have resulted in identification of 363 Pharmacological Interactions; we are all working together to provide safe collaborative care. In focusing on maintaining independence, our staff made 260 referrals to the Connecticut Center for Healthy Aging to assist in meeting the distinct needs of this group. Community Outreach:The staff of the ED are committed to community service and enriching the lives of others. In FY15, the ED participated in the in collecting food for area food banks. Our staff also participated in a community program "adopt a family" for the holiday season. As a group, we embraced this challenge to provide for those less fortunate. Our adopted family was overwhelmed by the outpouring of gifts and the generosity of our staff. Patient SatisfactionFor FY 15, we began our focus on a patient's Likelihood to Recommend the MidState ED. For this measure our scores were in the 30th percentile. Our initiative to improve throughput times of the admitted patients continues to improve as we have been able to develop a standard hand-off process to inpatient nursing staff.Education:In FY 2015, the MidState ED continued to play a critical role in staff education integrating best practices treatment and protocols for the care of our patients. We have encouraged our RN staff to become certified "emergency nurses", and are active member of the Emergency Nursing Association.

4b	(Code: ) (Expenses $ 19,572,423 including grants of $ ) (Revenue $ 25,202,932 )
	Digestive Health Center:For patients in Central Connecticut, 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 top notch care to all of our patients and work well together to provide a seamless transition from pre-procedure to procedure room and home. Our staff ensures that each patient has a visit that is as pleasant and comfortable as possible. We care for inpatients as well as an outpatient population. Along with providing upper endoscopies and colonoscopies, we provide radiofrequency ablation for patients with high grade Barrett's Esophagus, and ERCP (endoscopic retrograde cholangiopancreatogram). Pulmonologist's frequent our department as we continue to care for patients having Bronchoscope procedures. Overall we saw a total of 10,861 cases for fiscal year 2015, an increase of 196 cases from the previous year. This year only 32 of our patients were admitted post procedure. Digestive Health Center Physicians:We continue to maintain and improve our relationships with both the Connecticut GI and Gastroenterology Specialists physicians. One of our physicians spoke to over 150 GI nurses and associates at the 2015 Fall Conference for the Connecticut GI Nurses and Associates addressing current challenges in Crohn's and Colitis care. DHC 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 we are in the actual Digestive Health area or traveling to the ER, ICU or OR areas.Electronic Health Record:We have been using an electronic health record for over 12 years in DHC. The MD and Multicare (nursing) records interface between the MD and nursing records to provide seamless charting from pre, intra and post care. To be current with "The Joint" recommendations, we also have electronic medication reconciliations. Patient Satisfaction: Our Endoscopy unit has continued to maintain consistently high Press Ganey scores. Our overall care received for the year averaged 95.2% and our wait time prior to procedure was 90.6%.The unit goal was to maintain a >85 score on response to concerns and complaints. The staff well exceeded the goal with a score of 94. 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 2015, 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. Two of our nurses taught at the "Hands On" ERCP course in October 2015. Over 45 GI health professionals took advantage of this regionally recognized course.

4c	(Code: ) (Expenses $ 28,632,615 including grants of $ ) (Revenue $ 25,205,315 )
	Oncology Services: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 services. We provide a medical social worker who helps patients find the financial resources and assists in alleviating the stress that often accompanies a cancer diagnosis. We also provide an onsite genetics counselor and a high risk program. There is an on-site full time nurse navigator to provide support and guidance through the patient's treatment, from diagnosis to survivorship. In March 2015, the lung screening trial and study closed, it provided screening to 500 patients. We have continued to provide the lung screening program to the community and work closely with the physicians to educate on smoking prevention and cessation. Cancer Conferences:Our 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:The breast program leadership was restructured to align with Hartford HealthCare Cancer Institute's structure and achieved re-accreditation in November 2015. Our cancer program continues to meet the standards of the American College of Surgeons Commission on Cancer and operates under the direction of the cancer committee which meets quarterly. In 2016, we will form a Network Cancer committee to include the 5 sites of the Hartford HealthCare Cancer Institute and seek accreditation in 2017.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. Additionally, we provide cancer screenings that include: head and neck, skin, and breast screenings. Education is also provided during the screening sessions.

	(Code: ) (Expenses $ 111,156,613 including grants of $ 2,300 ) (Revenue $ 142,184,074 )
	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 $ 111,156,613 including grants of $ 2,300 ) (Revenue $ 142,184,074 )
4e	Total program service expenses188,896,259

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	1,552,257	6,863,871	686,815

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512-514
1a	Federated campaigns..1a		61,756
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d		39,477
e	Government grants (contributions)1e

f	All other contributions, gifts, grants, and similar amounts not included above1f		482,595

g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			583,828
			Business Code
2a	Patient Care		624100	225,220,241	225,220,241
b	Ref. Testing & Fees		621500	255,462	199,526	55,936
c
d
e
f	All other program service revenue .			2,694		2,694
g	Total. Add lines 2a–2f........			225,478,397
3	Investment income (including dividends, interest, and other similar amounts).......			1,422,051			1,422,051
4	Income from investment of tax-exempt bond proceeds..
5	Royalties...........
		(i) Real	(ii) Personal
6a	Gross rents	2,455,993
b	Less: rental expenses	1,234,700
c	Rental income or (loss)	1,221,293
d	Net rental income or (loss).......			1,221,293			1,221,293
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	3,704,579	4,000
b	Less: cost or other basis and sales expenses	0	0
c	Gain or (loss)	3,704,579	4,000
d	Net gain or (loss)..........			3,708,579			3,708,579
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..
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...
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..
Miscellaneous Revenue			Business Code
11a	Cafeteria Income		722210	526,458			526,458
b	Income-Pass Thru Entity		900003	-193,403		-193,403
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			333,055
12	Total revenue. See Instructions......			232,747,203	225,419,767	-134,773	6,878,381


				(A) Beginning of year		(B) End of year
1	Cash–non-interest-bearing .............			398,880	1	11,808,350
2	Savings and temporary cash investments .........			44,581,226	2	0
3	Pledges and grants receivable, net ...........			41,986	3	38,093
4	Accounts receivable, net .............			28,352,212	4	23,565,335
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 .............				7
8	Inventories for sale or use ..............			3,431,508	8	3,846,758
9	Prepaid expenses and deferred charges ..........			2,245,299	9	1,656,273
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	267,441,070
b	Less: accumulated depreciation .....	10b	157,707,829	115,652,970	10c	109,733,241
11	Investments—publicly traded securities ..........				11
12	Investments—other securities. See Part IV, line 11 .....				12	18,172,907
13	Investments—program-related. See Part IV, line 11 .....				13	66,102,603
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			81,973,042	15	36,961,295
16	Total assets. Add lines 1 through 15 (must equal line 34)......			276,677,123	16	271,884,855
17	Accounts payable and accrued expenses .........			9,175,414	17	18,273,929
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....................			160,060,117	25	164,128,704
26	Total liabilities. Add lines 17 through 25.........			169,235,531	26	182,402,633
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............			89,763,992	27	72,575,241
28	Temporarily restricted net assets ...........			2,099,252	28	2,488,431
29	Permanently restricted net assets ...........			15,578,348	29	14,418,550
	Organizations that do not follow SFAS 117 (ASC 958), check here 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 ...........			107,441,592	33	89,482,222
34	Total liabilities and net assets/fund balances ........			276,677,123	34	271,884,855