SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Go to www.irs.gov/Form990EZ for instructions and the latest information.
OMB No. 1545-0047
2021
Open to Public Inspection
Name of the organization
The Charlotte Hungerford Hospital
 
Employer identification number

06-0646678
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? ......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: . . . . . . . .
3b
Yes
 
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the 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.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

4

Yes

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

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
 
No
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .
5c
 
 
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
 
No
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
 
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) . . . 		    1,818,949   1,818,949 0.960 %
b Medicaid (from Worksheet 3, column a) . . . . .     47,297,393 37,723,730 9,573,663 5.070 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .            
d Total Financial Assistance and Means-Tested Government Programs . . . . .     49,116,342 37,723,730 11,392,612 6.030 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     846,733 126,721 720,012 0.380 %
f Health professions education (from Worksheet 5) . . .     10,567   10,567 0.010 %
g Subsidized health services (from Worksheet 6) . . . .     2,205,707 1,586,606 619,101 0.330 %
h Research (from Worksheet 7) .            
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .     155,860   155,860 0.080 %
j Total. Other Benefits . .     3,218,867 1,713,327 1,505,540 0.800 %
k Total. Add lines 7d and 7j .     52,335,209 39,437,057 12,898,152 6.830 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and
training for community members		            
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development     22,156   22,156 0.010 %
9 Other            
10 Total     22,156   22,156 0.010 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................
1
 
No
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
7,010,247
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
0
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
36,015,280
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
38,944,366
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-2,929,086
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership % 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
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?1Name, 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) 		Licensed Hospital General Medical and Surgical Children's Hospital Teaching Hospital Critical Access Hospital Research Facility ER-24Hours ER-Other Other (describe) Facility reporting group
1 The Charlotte Hungerford Hospital
540 Litchfield Street
Torrington,CT06790
https://www.charlottehungerford.org/
0042 		X X         X X    
Schedule H (Form 990) 2021
Page 4
Schedule H (Form 990) 2021
Page 4
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)
The Charlotte Hungerford Hospital
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): 		1
Yes No
Community Health Needs Assessment
1 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?........................ 1   No
2 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............... 2   No
3 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...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 21
5 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 ................. 5 Yes  
6 a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C.................................. 6a Yes  
b 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. ............................ 6b   No
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 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. .............. 		8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 21
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): See Part V, Page 8
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 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   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on 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) 2021
Page 5
Schedule H (Form 990) 2021
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
The Charlotte Hungerford Hospital
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 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):
a
b
c
d
e
16 Was widely publicized within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
See Part V, Page 8
b
See Part V, Page 8
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2021
Page 6
Schedule H (Form 990) 2021
Page 6
Part VFacility Information (continued)

Billing and Collections
The Charlotte Hungerford Hospital
Name of hospital facility or letter of facility reporting group  
Yes No
17 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 nonpayment?.................................. 17 Yes  
18 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
f
19 Did the hospital facility or other authorized 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?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 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?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Schedule H (Form 990) 2021
Page 7
Schedule H (Form 990) 2021
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
The Charlotte Hungerford Hospital
Name of hospital facility or letter of facility reporting group  
Yes No
22 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
23 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? ............................... 23   No
If "Yes," explain in Section C.
24 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? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2021
Page 8
Schedule H (Form 990) 2021
Page 8
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, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 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
The Charlotte Hungerford Hospital Part V, Section B, Line 5: The Community Health Needs Assessment is a systematic, data-driven approach to determining the health status, behaviors and needs of residents in Hartford HealthCare's service areas. The information garnered from the assessment may be used by Hartford HealthCare to inform decisions and guide efforts to improve community health and wellness. Hartford HealthCare operates in five Community Benefit regions Central Region (Hospital of Central Connecticut & MidState Medical Center), East Region (Backus Hospital, Natchaug Hospital & Windham Hospital), Hartford Region (Hartford Hospital), Northwest Region (Charlotte Hungerford Hospital) and Fairfield Region (St. Vincent's Medical Center). The collaborative regional approach has been decades in the making across Connecticut. The Hartford HealthCare (HHC) regional approach improves the efficiency of the CHNA process and utilizes essential components of collaborative partnerships including: *Creating a vision that is broadly understood*Working across organizational boundaries*Including those most affected by health challenges in solution-creation*Utilizing ongoing planning and joint accountability to measure changeThe regional approach includes partners within and across regions, hospital services areas, and community-based health equity champions. Recognizing the need to reduce and eliminate health disparities and to increase diversity at the leadership and governance levels of health care and other local organizations is a central and necessary first step in community health improvement. The second step to improving health equity is to collect and use data about race, ethnicity, and language preference to develop a shared understanding of the challenges in the community. Education about cultural sensitivity is also required. The HHC regional teams involved a team of health "Equity Champions" representing multiracial or other marginalized communities to help ensure the research is reflective of the community perspectives.Please note, due to overlap in fiscal years, this narrative includes a combination of information from both 2021 and 2022 CHNA, as well as both 2018-2021 and 2022-2025 CHIP. The Charlotte Hungerford Hospital worked closely with health service area collaboratives including local public health departments to complete its CHNA. At a minimum, local public health worked with Charlotte Hungerford Hospital to review hospital, state and local data and help define 2021-2022 CHNA priorities. Additionally, to increase their understanding of community members' perspectives on identified health issues and ideas for addressing them, staff solicited input from individuals representing the broad interests of the community such as staff from social service and public health organizations and community residents. Staff collected feedback through a range of methods, including focus groups and interviews. Community input came from diverse groups in terms of age, race/ethnicity, cultural group, and other demographics. A special effort was made to reach historically underserved communities including, but not limited to: Black African American, Hispanic and LGBTQA+ communities. Where possible, the hospital aligned their process with assessments being conducted by local public health and other community agencies. Input from persons representing the broad interests of the community was taken into account through key informant interviews with sixteen (16) individuals. Stakeholders included: individuals with special knowledge of or expertise in public health; local public health departments; hospital staff and providers; representatives of social service organizations; and leaders, representatives, and members of medically underserved, low-income, and minority populations.Data from multiple sources were gathered and assessed, including secondary data published by others and primary data obtained through community input. Input from the community was received through key stakeholder interviews. Interviewees represented the broad interests of the community and included individuals with special knowledge of or expertise in public health as listed below;Brooker MemorialCenter for Healthy AgingCharlotte Hungerford Hospital Emergency DepartmentCommunity Health & Wellness Center (CHWC)Connecticut Alliance for Basic Human NeedsDepartment of Social Services, Town of WinchesterFoodShare/CT Food BankMcCall Center for Behavioral HealthNew Opportunities, Inc.Northwestern Connecticut YMCAOur Culture is BeautifulPrime Time HouseSullivan Senior CenterTorrington Area Health DistrictUnited Way of Central and Northeastern ConnecticutIn addition, data were gathered to evaluate the impact of various services and programs identified in the hospital's previous CHNA process.In addition, Charlotte Hungerford Hospital participated in Community Health Alliance a collaborative convened by CHH of health and human service providers and agencies and consumers in the area to help oversee the CHNA and CHIP processes and to tackle other health-related challenges in the community. Its purposes include information-sharing, coordination of resources, messaging and co-creating and co-administering of activities. This group jointly reviews the CHNA and helps develop and ultimately endorses the CHIP action plan. Members include: Community Health and Wellness Center Winsted Senior Center Northwestern CT YMCA Torrington Youth Service Bureau New Beginnings Winsted Youth Service Bureau Brooker Memorial Town of Winchester Social Services FISH Town of Thomaston New Opportunities North Canaan Social Services Torrington Community Soup Kitchen NW Hills Council of Governments Torrington Area Health District NW CT Community Foundation The B.E.R.E.A.D.Y. Project The Gilbert School Our Culture is Beautiful Salvation Army - Winsted NW CT United Way Sullivan Senior Center Torrington Housing Authority Friendly Hands Food Bank.
The Charlotte Hungerford Hospital Part V, Section B, Line 6a: For this community health assessment, Charlotte Hungerford Hospital collaborated with the following Hartford Healthcare hospitals: Backus Hospital, Hartford Hospital, Hospital of Central Connecticut, MidState Medical Center, Natchaug Hospital, and Windham Hospital. These facilities collaborated by gathering and assessing secondary data together, scheduling and conducting interviews together, and by relying on shared methodologies, report formats, and staff to manage the CHNA process. Hospital facility's website (list url): Part V, Section B, Line 6aOther website (list url): Part V, Section B, Line 6b
The Charlotte Hungerford Hospital Part V, Section B, Line 7d: The needs assessment was published in September 2022 and is available on the hospital's website. In addition, electronic copies are available upon request.
The Charlotte Hungerford Hospital Part V, Section B, Line 11: The 2022 Community Health Needs Assessment ("CHNA") for Charlotte Hungerford Hospital, part of Hartford HealthCare's (HHC) Northwest Region, leveraged numerous sources of local, regional, state and national data along with input from community-based organizations and individuals to provide insight into the current health status, health-related behaviors and community health needs for the Hospital service area. In addition to assessing traditional health status indicators, the 2022 CHNA took a close look at social influences of health (SIOH) such as economic insufficiency, housing, transportation, education, fresh nutritious food availability, and neighborhood safety and contains an Equity Profile. These two enhancements are in response to the lessons of COVID and in recognition of an emerging national priority to identify and address health disparities and inequities. HHC and CHH are committed to addressing these disparities and inequities through its Community Health Improvement Plan (CHIP). The intent of our CHIP is to be responsive to community needs and expectations and create a plan that can be effectively executed to leverage the best of the system resources, regional hospital and network resources, and community partners. The CHIP supports HHC's mission "to improve the health and healing of the people and communities we serve and is part of HHC's vision to be "most trusted for personalized coordinated care." More specifically, this CHIP is collectively aimed at living our Value of Equity which reminds us all to do the just thing. While a CHIP is designed to address these multiple needs, narrowing the focus to key areas of need and impact with associated key strategies best positions a health system for success. A CHIP is a dynamic rather than a static plan and should be modified and adjusted as external environmental factors change, including market conditions, availability of community resources, and engagement from community partners.Building on 2021 CHNA findings, the 2022 assessment identified the following as priority needs for 2022-25 across all Charlotte Hungerford Hospital geography: *Better Meet the Social and Mental Well-Being Needs of Those We Serve *Expand Access to Culturally Responsive Care *Address Health Through Housing *Reduce Food Insecurity and Increase Access to Healthy Foods *Improve Community Health in Partnership with OthersPrioritized communities: disadvantaged communities, people of color, and others who have historically lacked adequate access to services.2021-2022 CHIP objective/goal progress: 1. Better Meet the Social and Mental Well-Being Needs of Those We Serve*Northwest CT Community Care Team- connecting partners, CBO's and clinical partners to share, discuss and refer high-social needs clients to each other in an informal setting. MOU, meeting cadence and metrics established with 3 patients enrolled.*Harm Reduction activities with Narcan trainings and distribution-in collaboration with Litchfield Opiate Task force increased distribution with 5 Scheduled Rover deployments.*Recovery Coach Program- 350 individuals serviced.*Child and Youth Mental Health- expand system response capacity in school setting. Completed Gap analysis and submitted grant application for 1 FTE.2. Expand Access to Culturally Responsive Care*Homebound Vaccination Program- 111 homebound vaccinations provided.*Neighborhood Health Program- Support clinics in target geographies aimed at target populations, and done in conjunction with key intermediaries (Torrington, Winsted, Thomaston, North Canaan) 689 visits.*Diversity Equity Inclusion and Belonging Council and Celebrate Belonging Festival- 35 community vendors and 200 participants.*DEIB special project addressing inequities in prenatal care among Latina Population community and provider survey development.3. Address Health Through Housing*Gathering Place- Stabilize and expand case management services and access to social and medical services for the highly vulnerable unsheltered individuals and families Behavioral Health RN Director with 1325 visits.4. Reduce Food Insecurity and Increase Access to Healthy Foods*Food is Medicine program development - incorporating the Food Farmacy connecting patients with their clinicians on specific food needs and a food prescription program providing supplemental funds to the most underserved and health challenged patients. Our Food is Medicine Program will allow us to engage and develop a deep and ongoing relationship with patients substantively addressing food insecurity. Our focus is to addressing nutrition insecurity as opposed to a basic food insecurity. Developing programs to address nutrition insecurity is more substantive and impactful.5. Improve Community Health in Partnership with Others*Promoted healthy habits and activities with partners including: Supported Kids Marathon lead sponsor 75 children K-5 participated from 8 schools, Fit Together increased reach to include 4 new elementary schools and 100 children, Coordinated the hire of engineering firm to plan and design multi-purpose trail in Winchester covering up to 7 miles, Live Well Chronic Disease Self-Management 6 week program 5 participants.*More actively seek out opportunities to support and collaborate with organizations that promote health Established Community Health Alliance with community partners with quarterly meeting cadence for CHIP updates and feedback, Health Equity Champions identified and established partnership for ongoing interfaces. *CHH Community Health Team's clinical service fairs. Screenings, COVID vaccines, other services. Provided 5 health Fairs two included provider talks, 340 people served.All needs identified in the CHNA are currently being addressed.
The Charlotte Hungerford Hospital 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.
The Charlotte Hungerford Hospital Part V, Section B, Line 15e: In addition, patients may ask a nurse, physician, chaplain, or staff member from Patient Registration, Patient Financial Services, Case Coordination, or Social Services about initiating the Financial Assistance Application process.Part V, Section B, Line 16a: FAP Website:https://charlottehungerford.org/patients-visitors/billing-insurance/financial-assistance-billingPart V, Section B, Line 16b: FAP Application Website:https://charlottehungerford.org/patients-visitors/billing-insurance/financial-assistance-billingPart V, Section B, Line 16c: FAP Plain Language Summary:https://charlottehungerford.org/patients-visitors/billing-insurance/financial-assistance-billing
The Charlotte Hungerford Hospital Part V, Section B, Line 16j: Patients are informed directly by staff of the availability of the Financial Assistance Policy.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2021
Page 9
Schedule H (Form 990) 2021
Page 9
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?11
Name and address Type of Facility (describe)
1 1 - The Hungerford Center
780 Litchfield Street
Torrington,CT06790 		Cardiac and Pulmonary Rehab Serices
2 2 - The Center for Cancer Care
200 Kennedy Drive
Torrington,CT06790 		Cancer Treatment Center
3 3 - Hungerford Diagnostic Center
220 Kennedy Drive
Torrington,CT06790 		Radiology Services
4 4 - The Center for Youth and Families
50 Litchfield Street
Torrington,CT06790 		Psych Services for Children and Families
5 5 - Winsted Behavioral Health Center
294 Main Street
Torrington,CT06790 		Psych Services
6 6 - Surgical Associates of CHH
538 Litchfield Street
Torrington,CT06790 		Surgical Physicians Practice
7 7 - Neurology PBC
780 Litchfield Street
Torrington,CT06790 		Neurology Physcians Practice
8 8 - CHH Cardiovascular Medicine Service
1215 New Litchfield Street
Torrington,CT06790 		Cardiovascular Physicians Practice
9 9 - CHH Wound Care and Hyperbaric Medicine
7 Felicity Lane
Torrington,CT06790 		Wound Care Physicians Practice
10 10 - CHH Urology Medicine
538 Litchfield Street
Torrington,CT06790 		Adult and Pediatric Urology Physicians Practice
11 11 - Hungerford Emergency and Medical Care
115 Spencer Street
Winsted,CT06098 		Emergency Services
Schedule H (Form 990) 2021
Page 10
Schedule H (Form 990) 2021
Page 10
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: The Charlotte Hungerford Hospital used Federal Poverty Guidelines to determine eligibility. In addition, the hospital takes into consideration, medical indigency, insurance status, underinsurance status and other family eligibility criteria such as family size, employment and financial obligations.Part I, Line 6a:The Organization submits quarterly reports to Connecticut Hospital Association and Form 990 is submitted to the Connecticut Office of Health Strategy (OHS) annually.
Part I, Line 7: The organization utilized an overall cost to charge ratio (RCC), developed from the Medicare Cost Report. Total expense was adjusted for: medicaid provider taxes, directly identified community benefit expense and community building 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. The costs associated with Line 7h, were the actual costs reported in the organization's general ledger less any industry funded studies. These costs were removed from the calculations above to avoid duplication. Costs reported in Part III, Section B6, were calculated from the Medicare cost report and reduced for Medicare costs previously reported on Part I Lines 7f and g. The methodology used to capture costs on Line 7a was updated to better reflect the cost of care provided to our patient population.
Part I, Line 7g: No physician clinic costs were included in the Subsidized Health Services cost calculations.
Part III, Line 3: A pre bad debt financial assistance screening is in place to identify patients that may be 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 FY 2022 would be immaterial.
Part III, Line 4: Please see the text of the footnote that describes bad debt expense beginning on page 26 of the Audited Financial Statement. This note also relates to Part III, Line 2.
Part III, Line 8: Cost Reports were used to report Medicare allowable costs. Medicare defines allowable costs as those appropriate and helpful in developing and maintaining the operation of patient care facilities and activities. It specifically excludes certain costs that are not directly related to patient care. The hospital incurs additional expense related to the provision of care to Medicare patients that Medicare has deemed non-allowable. This additional expense includes costs of physician services (emergency on-call fees, Hospitalist Programs, recruitment, etc.), advertising costs, cafeteria costs for meals sold to visitors, etc. The Hospital attempts to collect coinsurance and deductibles from Medicare beneficiaries. To the extent collection efforts are unsuccessful, Medicare reimburses the hospital at 65% of unpaid amounts. The table reconciles the shortfall or surplus from Line 7 to the actual surplus or shortfall. The additional costs were allocated to Medicare based upon Medicare's percentage of total allowable costs. The unpaid coinsurance/deductibles were estimated using historical collection results. Any shortfall amounts have not been treated as Community Benefits.
Part III, Line 9b: Charlotte Hungerford Hospital has adopted the Financial Assistance Policy of its Parent Company, Hartford HealthCare Corporation. The following is included in the Financial Assistance Policy: Patients who are deemed ineligible for financial assistance or who receive a partial discount and do not pay their bills may be subject to the following Extraordinary Collection Action (ECAs):*Wage Garnishments*Liens on primary and secondary residences, bank or investment accounts, or other assets*Legal actions and reporting the matter to one or more credit rating agencies*Other ECAs not listed aboveIf an individual has not submitted an application within the first 120 days from the date on which Hartford HealthCare first issues its first, post-discharge billing statement, then Hartford HealthCare may begin engaging in the ECAs described above.ECAs may begin after the first 120 days from the date on which Hartford HealthCare issues its first, post-discharge billing statement. If the patient applies for assistance within 240 days from the first notification of the self-pay balance, and is granted assistance, Hartford HealthCare will take all reasonable available measures to remove any collection actions such as negative reporting to a credit bureau or liens that have been filed.Before Hartford HealthCare initiates any collection actions, it will issue a written notice to the last known address of record for the patient (or his/her family) that describes the specific collection activities it intends to initiate (or resume), provides a deadline after which such action(s) will be initiated (or resumed), and includes a plain language summary of this Policy. ECAs can begin no sooner than 30 days from the date written notice is transmitted. Patients who are ineligible for financial assistance, or qualify for partial financial assistance and who are cooperating in good faith to resolve the outstanding accounts, may be offered extended payment plans. No further collection action will be taken as long as the patient continues to meet the terms of the payment plan.
Part VI, Line 2: The Hartford HealthCare Community Health Needs Assessment (CHNA) serves as a component in the overall efforts to improve community health and health equity in each of the seven-hospital service areas. It is a process that provides a means of identifying and collecting community data while engaging community members in both the data collection and the prioritization of collaborative efforts for improving the well-being of the area. The ultimate purpose of the HHC CHNA is to improve community health and to do so in an effective and efficient way. The supporting objectives are to do the following: 1. Enhance Community Engagement and Better Incorporate the Consumer's Voice - CHNA/CHIP process leads to continuous and trusting feedback loops with diverse populations and enhances our methods for on-going engagement with the communities we serve. 2. Grow and Sustain our Community-based Partnerships - CHNA/CHIP process leads to more formalized partnerships with regional and community organizations and collaborations, and more meaningful relationships with key community opinion leaders. 3. Align Community Health with our Equity Value and Across the Regions - CHNA/CHIP process leads to a greater sense of team and purpose within HHC, assures each region is equitably resourced, and that collectively we know and understand more about identifying community health needs and improving health outcomes. 4. Bring Greater Clarity and Social Impact to our Community Health Work - CHNA/CHIP process leads to more effective, justified, measurable, and reportable interventions across our collective CHIPs and inspires and informs our social investment, sponsorship, and donation activities.Approach:The major pieces of the assessment helped to assemble a large list of needs. Major assessment activities are listed below. Note that the survey and qualitative research numbers refer to HHC system CHNA activities not solely this hospital. Data analysis:An extensive set of Hospital Service Area (HSA) data tables reflecting demographics, Social Influencers of Health, lifestyle characteristics, disease incidence (morbidity and mortality) and others Qualitative research: An in-depth series of 100 stakeholder interviews and 30 focus group discussions Survey research: A bilingual community survey with approximately 600 responses Interestingly, ALL of the needs are important, yet to achieve the ultimate goal of the CHNA, HHC leaders deployed a needs prioritization process to identify a granular list of 12 needs. The prioritization process and other assessment activities are described in the body of this CHNA.Categories of needs:In order to truly affect change and address high-priority needs, needs were identified and categorized into the following groups: Ones with the greatest opportunity for immediate impact (i.e., the "low hanging fruit" issues for which HHC can take a leadership role and rapidly deploy activities and resources) Issues supported by the data that have the greatest impact on health outcomes Needs identified by community as urgent or high-priority concerns Issues that present the greatest opportunity for collaboration and policy changeThe CHNA is formulated in a way to ultimately impact individuals and families in the service area. To accomplish this, HHC leaders will take CHNA results and deploy a systematic approach to developing the Community Health Improvement Plan (CHIP) an activity critical to achieving this ultimate goal. Some of the initial, well-defined steps to develop and deploy the CHIP include the following: STEP 1 - Culling the Findings Brainstorming with your local collaboratives by answering the following questions: CHNA Immediate Impact findings where is the low hanging fruit? CHNA Greatest Impact findings -- what will most influence health outcomes? CHNA Most Desired Change findings - what change does the community most want? CHNA Forging Opportunities findings - where are the greatest opportunities for partnership? STEP 2 - Organizing the focus areas and assembling your rationale for action STEP 3 - Selecting your Strategies and Interventions STEP 4 Executing and EvaluationAssessment Approach & Methodology:Hartford HealthCare (HHC) worked with its assessment partners Crescendo Consulting Group and DataHaven to formalize and deploy a highly inclusive assessment framework. The framework was structured to be welcoming to priority communities and others, steeped in best practices, and designed to triangulate insights. At the conclusion of the process, the local stakeholders developed a succinct, prioritized list of community needs. To do this, the methodology included a mixed modality approach quantitative, qualitative, and technology-based techniques to learn about the human stories and voices while weaving them with the best available data. Crescendo engaged community partners, used data analytics, and invited others to join the discovery process to help describe a positive cycle of change. The assessment activities meet the following goals: *Identify community resources, strengths, and barriers. *Develop a deeper understanding of community health equity and inequalities. *Enable the community to coalesce around, and act upon, the opportunities for population health improvement.The assessment involved substantial qualitative data gathering to highlight local knowledge and expertise, and support outreach efforts for community engagement. The primary qualitative mixed-mode approach engaged policy leaders, key stakeholders, non-profit organizations, health care consumers, the criminal justice system, diversity representatives, people experiencing homelessness, and others throughout the hospital service area. Health Equity Champions Outreach Stakeholder One-to-One Interviews Focus Group Discussions Systemwide, 100 interviews and 30 focus group discussions were held. Conversations with community stakeholders helped us identify weaknesses of programs and resources in the community.
Part VI, Line 3: Charlotte Hungerford Hospital provides information about its Financial Assistance Policy as follows: (i) Provides signage, brochures and/or a written plain language summary describing the policy along with financial assistance contact information in the emergency department, labor and delivery areas, discharge paperwork, other patient registration/admission areas, as well as in billing and collection communication; (ii) Makes paper copies of the policy, financial assistance application, and plain language summary of the policy available upon request and without charge, by mail; (iii) Posts the policy, plain language summary and financial assistance application on the website with clear linkage to such documents on the Hartford HealthCare and each affiliated hospital's home page; (iv) Educates all admission and registration personnel, financial counselors, billing and collection specialists and social workers regarding the policy so that they can serve as an informational resource to patients; (v) Includes the tag line 'Please ask about our Financial Assistance Policy" in applicable Hartford HealthCare written publications.
Part VI, Line 4: Charlotte Hungerford Hospital ("the hospital") is a 109-bed acute care facility combined with a well-distributed ambulatory setting serving the regional health care needs of northwest Connecticut and is part of Hartford Healthcare Northwest Region. The hospital is the region's largest employer, with over 1,200 employees and physicians. For over a century, the hospital has served as the premier health care leader in the region. The hospital currently offers a comprehensive range of inpatient and outpatient services including general medicine and surgery, maternity and pediatrics, neurology, radiology, obstetrics, cardiology, urology, orthopedics, and behavioral health. For more information, please visit www.charlottehungerford.org Charlotte Hungerford Hospital is a member of Hartford HealthCare. Hartford HealthCare operates seven acute-care hospitals, air-ambulance services, behavioral health and rehabilitation services, a physician group and clinical integration organization, skilled-nursing and home health services, and a comprehensive range of services for seniors, including senior-living facilities. For more information, please visit https://hartfordhealthcare.org/The Charlotte Hungerford Service Area is a region of 99,932 residents, 16% of whom are people of color. The composite snapshot indicates:*The region's population has decreased by 3.7% since 2010.*Of the regions 40,649 households, 75% are homeowner households.*Thirty-two percent of the Charlotte Hungerford HSAs households are cost burdened, meaning they spend at least 30% of their total income on housing costs.*Among the regions adults ages 25 and up, 33% have earned a bachelors degree or higher.*The Charlotte Hungerford HSA is home to 35,712 jobs, with the largest share in the Health Care and Social Assistance sector. *The median household income in the Charlotte Hungerford HSA is $80,000. The Charlotte Hungerford HSAs average life expectancy is 79.9 years. *Fifty-seven percent of adults in the Charlotte Hungerford HSA say they are in excellent or very good health. In 2020, 44 people in the Charlotte Hungerford HSA died of drug overdoses. *Eighty-five percent of adults in the Charlotte Hungerford HSA are satisfied with their area, and 57% say their local government is responsive to residents needs.*In the 2020 presidential election, 82% of registered voters in the Charlotte Hungerford HSA voted.Forty-six percent of adults in the Charlotte Hungerford HSA report having stores, banks, and other locations in walking distance of their home, and 43% say there are safe sidewalks and crosswalks in their neighborhood.
Part VI, Line 5: The mission of Charlotte Hungerford Hospital is to improve the health and healing of the people and communities we serve. Charlotte Hungerford Hospital is committed and focused on efforts to promote health and wellness.Majority of Charlotte Hungerford Hospital's regional governing board is comprised of persons who either reside or work in its primary service area, and they are neither employees nor contractors of the Hospital. Charlotte Hungerford Hospital extends medical staff privileges to all qualified physicians in its community. The Hospital has partnered with the Community Health Center to provide health services to the underserved in the community. In addition, the Hospital participates in Community Vision to improve community health and well-being.The Hospital 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, as well as for the Hospital's Financial Assistance Program. Additionally, Charlotte Hungerford Hospital provides medical care regardless of patient's ability to pay for services.Charlotte Hungerford Hospital provides specialized services not available at other hospitals. These services are provided regardless of a patient's ability to pay. The hospital uses its surplus funds to provide additional benefits to its patients and the community it serves as detailed in Schedule O.
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 The Charlotte Hungerford Hospital, 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. HHC and its affiliates including all supported 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 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.
Part VI, Line 7, Reports Filed With States CT
Schedule H (Form 990) 2021
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