2023-11-13T15:56:04-06:00 2022-12-31 111986323 MARCUM LLP 555 LONG WHARF DRIVE NEW HAVEN CT 06511 990 2022-01-01 060655139 SILVER HILL HOSPITAL INC SILV 2038012230 208 VALLEY ROAD NEW CANAAN CT 06840 ANDREW GERBER MD PHD PRESIDENT & MEDICAL DIRECTOR 2038012230 2023-11-10 1 ANDREW GERBER MD PHD XXX-XX-XXXX 1 MARY ANTONETTI P00431862 2037819600 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z ANDREW GERBER MD PHD 208 VALLEY ROAD NEW CANAAN CT 06840 72460459 0 X WWW.SILVERHILLHOSPITAL.ORG X 1934 CT TO PROVIDE OUR PATIENTS WITH THE BEST AVAILABLE TREATMENT OF MENTAL ILLNESS. SEE SCHEDULE O. 11 10 538 105 0 0 5901459 5412854 34035056 46407550 1999275 2034390 2482075 3293649 44417865 57148443 91025 103553 0 0 24630511 34699483 0 0 1321554 12810358 18304105 37531894 53107141 6885971 4041302 73348940 71199634 14282517 12697465 59066423 58502169 THE MISSION OF SILVER HILL HOSPITAL IS TO PROVIDE OUR PATIENTS WITH THE BEST AVAILABLE TREATMENT OF MENTAL ILLNESS AND ADDICTION; AND TO OFFER CONTINUING SUPPORT, COUNSELING AND EDUCATION TO OUR PATIENTS AND THEIR FAMILIES IN EVERY PHASE OF ILLNESS AND RECOVERY. 0 0 20160833 12942470 INPATIENT TREATMENT IS THE MOST INTENSIVE FORM OF CARE, INDICATED FOR A PHASE OF ILLNESS THAT REQUIRES A GREAT DEAL OF NURSING AND MEDICAL INTERVENTION. BECAUSE PATIENTS ARE USUALLY ACUTELY ILL DURING THIS PHASE OF CARE, OUR INPATIENT TREATMENT PLANS EMPHASIZE DIAGNOSTIC ASSESSMENT, SYMPTOM REDUCTION, AND STABILIZATION. THE HOSPITAL TREATED APPROXIMATELY 752 INPATIENTS DURING THE PERIOD OF 1/1/2022 TO 12/31/2022. 20533818 103553 34114854 THE HOSPITAL'S TRANSITIONAL LIVING PROGRAMS PROVIDE HIGHLY STRUCTURED INTENSIVE TREATMENT FOR PATIENTS WHO ARE READY FOR MORE PSYCHOLOGICAL AND BEHAVIORAL INTERVENTIONS. SET IN RESIDENTIAL, HOME-LIKE SETTINGS, THE TRANSITIONAL PROGRAMS HELP PATIENTS CONTINUE THEIR RECOVERY PROCESS UNTIL THEY ARE READY TO RETURN HOME FOR FURTHER COMMUNITY-BASED TREATMENTS. PATIENTS FOCUS ON DEVELOPING A PSYCHOLOGICAL UNDERSTANDING OF THEIR ILLNESS, OBTAINING INFORMATION ABOUT THEIR ILLNESS, AND DEVELOPING NEW BEHAVIORAL SKILLS TO MANAGE THEIR RECOVERY PROCESS. THE HOSPITAL TREATED APPROXIMATELY 754 TRANSITIONAL LIVING PATIENTS DURING THE PERIOD OF 1/1/2022 TO 12/31/2022. 2599203 2478848 THE HOSPITAL OFFERS SPECIALIZED INTENSIVE OUTPATIENT PROGRAMS (IOPS) FOR ADOLESCENTS AND ADULTS WHO ARE ABLE TO LIVE AT HOME AND DESIRE SUBSTANCE ABUSE TREATMENT AND/OR PSYCHOLOGICAL TREATMENT TO LIVE FULL AND INDEPENDENT LIVES. THE IOPS MEET THREE TIMES A WEEK FOR EIGHT WEEKS GUIDING INDIVIDUALS TOWARD FURTHER INDEPENDENCE. THE HOSPITAL TREATED APPROXIMATELY 450 PATIENTS DURING THE PERIOD OF 1/2/2022 TO 12/31/2022. 43293854 1 1 0 0 0 0 0 0 0 1 1 0 1 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 1 164 0 1 538 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 CT NY X THOMASA HOLLEY 2038012268 208 VALLEY ROAD NEW CANAAN CT 06840 RICHARD CANNING CHAIR 3.00 X X 0 0 0 PETER ORTHWEIN CHAIR EMERITUS 1.00 X X 0 0 0 WARD F CLEARY ESQ CHAIR EMERITUS 1.00 X X 0 0 0 DEBORAH SHABECOFF DIRECTOR 1.00 X 0 0 0 LINDA AUTORE DIRECTOR 1.00 X 0 0 0 MICHAEL HOLMES DIRECTOR 1.00 X 0 0 0 PETER FONAGY DIRECTOR 1.00 X 0 0 0 SUSAN SALICE DIRECTOR 1.00 X 0 0 0 RICHARD GANNON DIRECTOR, TREASURER 1.00 X X 0 0 0 CHERYL WIESENFELD SECRETARY 1.00 X X 0 0 0 ANDREW GERBER MD PHD PRESIDENT & MEDICAL DIRECTOR 40.00 X X 649586 0 41646 ROSS MARKELLO CHIEF FINANCIAL OFFICER 40.00 X 464046 0 29029 MICHAEL D GROAT PHD CHIEF CLINICAL OFFICER 40.00 X 419634 0 45789 KRISTEN WOLFE CHIEF BUSINESS OFFICER 40.00 X 293833 0 33725 TIMOTHY DOUGHERTY CHIEF ADVANCEMENT OFFICER 40.00 X 352840 0 46569 LISA BENTON CHIEF QUALITY OFFICER 40.00 X 313992 0 37358 AYANA THOMAS CHIEF INFORMATION OFFICER 40.00 X 286134 0 20236 SHARON KOWALCHUK CHIEF NURSING OFFICER 40.00 X 210152 0 33946 RYAN RICHARD WADE PHYSICIAN 40.00 X 465328 0 3959 HOWARD K WEINER PHYSICIAN 40.00 X 450866 0 36718 ELIZABETH ORTIZ-SCHWARTZ PHYSICIAN 40.00 X 305292 0 42904 ANRI KISSILENKO PHYSICIAN 40.00 X 305802 0 61260 PETRA M PILGRIM PHYSICIAN 40.00 X 315079 0 19239 4832584 0 452378 64 0 1 0 UNIDINE CORPORATION PO BOX 102289 ATLANTA GA 303682289 FOOD SERVICES 2498708 YALE NEW HAVEN HEALTH PO BOX 788327 PHILADELPHIA PA 191788327 LAB SERVICES & CLINICAL CONTRACTUAL SERV 756456 PHARMACY & THERAPEUTICS CONS POB 487 ATTN AMY VEIVIA CHESHIRE CT 06410 PHARMACEUTICAL SERVICES 544933 SOUND CONSTRUCTION INC 52 FLAT ROCK RD EASTON CT 06612 LANDSCAPE PROJECT 440298 LAUREN MUSE 78 EAST PUTNUM AVENUE COS COB CT 06807 INTERIOR DESIGNER (RENOVATION PROJECTS) 338253 10 2000000 3412854 28845 5412854 TRANSITIONAL LIVING 623000 30986232 30986232 INPATIENT 623000 12942470 12942470 OUTPATIENT 623000 2478848 2478848 46407550 613133 613133 177905 115503 62402 62402 62402 16601994 15180737 1421257 1421257 1421257 17381 15776 1605 1605 SH-YNHHS TL-GAIN EQUITY INVESTMEN 623000 2677282 2677282 GUEST MEALS 722514 101020 101020 WELLNESS 624100 80593 80593 370747 370747 3229642 57148443 49536172 0 2199417 103553 103553 3278517 1020576 1789409 468532 25787090 24259016 1039346 488728 3676809 2957421 659525 59863 1957067 1874475 20942 61650 371924 10635 361289 167289 167289 38667 38667 3871471 3664372 106509 100590 312027 908 258332 52787 3990945 1794536 2154344 42065 214370 12709 200687 974 1184411 698687 485724 261268 21248 228674 11346 124640 35812 87995 833 15227 15227 3681396 3366433 314659 304 1647215 1647215 SUPPLIES 1323988 729516 563115 31357 CREDIT CARD FEES 510505 507980 2525 BAD DEBTS 381333 381333 MEDICATION 207429 207429 53107141 43293854 8491733 1321554 1499 1500 7908740 3801044 1293545 1825309 3705367 9052763 128403 145552 491662 787321 87688142 46530242 40903608 41157900 14631578 7470109 4284538 6958136 73348940 71199634 4060465 2791593 0 125000 3277243 0 6944809 9780872 14282517 12697465 X 54745867 55850329 4320556 2651840 59066423 58502169 73348940 71199634 4041302 -4605556 0 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 313000 100000 13564 13564 413000 213000 100000 29 29 313000 213000 7619 7619 213000 213000 6210 6210 213000 245559 1894 34453 213000 0.00000 1.00000 0.00000 0 0 1766721 1766721 55803475 29645917 26157558 15907620 10957716 4949904 14210326 5926609 8283717 41157900 THE SH-YNHHS TRANSITIONAL LIVING TREATMENT PROGRAM PARTNERSHIP 6958136 C 6958136 DUE TO PATIENTS AND THIRD PARTIES 2877192 PROFESSIONAL LIABILITY RESERVE 6806724 OTHER LIABILITIES 96956 9780872 X 52138663 -4605556 -381333 -4986889 57125552 38667 -15776 22891 57148443 52702917 15776 15776 52687141 38667 381333 420000 53107141 PART V, LINE 4: DONORS HAVE STIPULATED THAT ANY INCOME FROM THE ENDOWMENT FUNDS IS TO BE USED FOR ADOLESCENT AND CHEMICAL DEPENDENCY PROGRAMS. PART X, LINE 2: THE HOSPITAL IS QUALIFIED AS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE), AND AS SUCH, NO PROVISION FOR INCOME TAXES HAS BEEN RECORDED. THE INTERNAL REVENUE SERVICE INFORMED THE HOSPITAL BY A LETTER DATED JUNE 23, 1937 THAT THE HOSPITAL'S OPERATIONS ARE DESIGNED IN ACCORDANCE WITH SUCH SECTION OF THE CODE. CERTAIN TRANSACTIONS COULD BE DEEMED "UNRELATED BUSINESS INCOME AND WOULD RESULT IN A TAX LIABILITY. MANAGEMENT REVIEWS TRANSACTIONS TO ESTIMATE POTENTIAL TAX LIABILITIES. THE HOSPITAL RECOGNIZES INCOME TAX POSITIONS WHEN IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINABLE BASED ON THE MERITS OF THE POSITION. MANAGEMENT HAS CONCLUDED THAT THERE ARE NO UNCERTAIN TAX POSITIONS THAT NEEDED TO BE RECORDED AT DECEMBER 31, 2022. THE HOSPITAL RECOGNIZES INTEREST AND/OR PENALTIES RELATED TO INCOME TAX MATTERS WITHIN INTEREST. AS OF DECEMBER 31, 2022, THE HOSPITAL DID NOT RECORD ANY PENALTIES OR INTEREST ASSOCIATED WITH UNCERTAIN TAX POSITIONS. THE HOSPITAL'S PRIOR THREE TAX YEARS ARE OPEN AND SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. THE HOSPITAL IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. PART XI, LINE 2D - OTHER ADJUSTMENTS: BAD DEBTS -381,333. PART XI, LINE 4B - OTHER ADJUSTMENTS: LITTLE SHOP INVENTORY EXPENSE -15,776. PART XII, LINE 2D - OTHER ADJUSTMENTS: LITTLE SHOP INVENTORY EXPENSE 15,776. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DETS 381,333. 1 1 1 X 600.000000000000 1 X 900.000000000000 0 1 0 0 1056800 1056800 1056800 1056800 0 0.00000 230142 230142 0.00420 85872 85872 0.00160 18544657 12942470 5602187 0.10270 95833 95833 0.00180 18956504 12942470 6014034 0.11030 20013304 13999270 6014034 0.11030 1 163810 78575 29920 48655 X 1 1 1 1 SILVER HILL HOSPITAL 208 VALLEY ROAD NEW CANAAN CT 06840 WWW.SILVERHILLHOSPITAL.ORG H-0006 X SILVER HILL HOSPITAL 1 0 0 1 X X X X X X X X X 22 1 0 0 1 X WWW.SILVERHILLHOSPITAL.ORG 1 20 1 WWW.SILVERHILLHOSPITAL.ORG 0 1 X 600.000000000000 900.000000000000 X X 1 1 X X X 1 X WWW.SILVERHILLHOSPITAL.ORG X WWW.SILVERHILLHOSPITAL.ORG X WWW.SILVERHILLHOSPITAL.ORG X X X X X 1 X 0 X 1 X 0 0 SILVER HILL HOSPITAL PART V, SECTION B, LINE 5: COMMUNITY ENGAGEMENT AND FEEDBACK WERE AN INTEGRAL PART OF THE CHNA PROCESS. SILVER HILL HOSPITAL SOUGHT COMMUNITY INPUT THROUGH KEY INFORMANT INTERVIEWS WITH COMMUNITY LEADERS AND PARTNERS. PUBLIC HEALTH AND HEALTH CARE PROFESSIONALS AS WELL AS LEADERS AND REPRESENTATIVES OF NON-PROFIT AND COMMUNITY-BASED ORGANIZATIONS SHARED KNOWLEDGE ABOUT MENTAL HEALTH AND SUBSTANCE ABUSE AND PROVIDED INSIGHT ON THE COMMUNITY, INCLUDING UNDERSERVED POPULATIONS. SEE APPENDIX D OF THE COMMUNITY NEEDS ASSESSMENT FOR A LIST OF KEY INFORMANTS.THE HOSPITAL TOOK INTO ACCOUNT INPUT FROM 20 KEY INFORMANTS, INCLUDING PUBLIC HEALTH AND HEALTHCARE PROFESSIONALS, SOCIAL SERVICE PROVIDERS, NOT-PROFIT LEADERS, BUSINESS LEADERS, FAITH BASED ORGANIZATIONS AND OTHER COMMUNITY LEADERS. PARTICIPANTS INCLUDED PUBLIC HEALTH ORGANIZATION PROFESSIONALS, YOUTH AND SOCIAL SERVICE PROVIDERS, EDUCATION/SCHOOL SPECIALISTS, MENTAL HEALTH/SUBSTANCE ABUSE CLINICIANS, GOVERNMENT HOUSING/TRANSPORTATION AGENGIES, AND COMMUNITY MEMBERS. SILVER HILL HOSPITAL PART V, SECTION B, LINE 11: BASED ON FEEDBACK FROM COMMUNITY PARTNERS, INCLUDING MENTAL HEALTH AND SUBSTANCE ABUSE PROVIDERS, PUBLIC HEALTH EXPERTS, SOCIAL SERVICE ORGANIZATIONS, EDUCATION/SCHOOL ORGANIZATIONS, AND OTHER COMMUNITY REPRESENTATIVES, SILVER HILL HOSPITAL PLANS TO FOCUS COMMUNITY HEALTH IMPROVEMENT EFFORTS ON THE FOLLOWING PRIORITIES OVER THE NEXT THREE-YEAR CYCLE: (1) MENTAL HEALTH AND SUBSTANCE ABUSE; (2) ADOLESCENT MENTAL HEALTH; (3) SUBSTANCE MISUSE; (4) ADULT MENTAL HEALTH.THE HOSPITAL PLANS TO ADDRESS:PRIORITIZED HEALTH ISSUE #1: ACCESSING MENTAL HEALTH AND SUBSTANCE ABUSE CARETHE GOAL IS TO ADDRESS ISSUES AROUND ACCESSING MENTAL HEALTH AND SUBSTANCE ABUSE CARE WITH A FOCUS ON AVAILABILITY OF SERVICES, NAVIGATING THE SYSTEM, AND STIGMA REDUCTION. THIS WILL BE DONE BY MEETING THE FOLLOWING OBJECTIVES:1) GROW THE CAPACITY OF THE NEW CANAAN URGENT ASSESSMENT PROGRAM THROUGH THE PARTICIPATIONOF ADDITIONAL TOWNS2) EXPAND CAPACITY OF NEW OUTPATIENT SERVICES TREATING MOOD DISORDERS.3) PANEL WITH MEDICAID FOR IMPROVED ACCESS TO INPATIENT AND INTENSIVE OUTPATIENT SERVICES.4) COMPLETE HOSPITAL LICENSURE OF CURRENT TRANSITIONAL LIVING PROGRAMS AS RESIDENTIAL PROGRAMS FORIMPROVED OUT OF NETWORK BENEFIT REIMBURSEMENT.5) PROMOTE AWARENESS AND UNDERSTANDING OF MENTAL HEALTH AND ADDICTION ISSUES THROUGHPARTICIPATION IN EDUCATIONAL PROGRAMS, MENTAL HEALTH FAIRS AND WALKS, MEDIA INTERVIEWS, ANDSOCIAL MEDIA TO REDUCE STIGMA. PRIORITIZED HEALTH ISSUE #2: ADOLESCENT MENTAL HEALTHTHE GOAL IS TO ADDRESS ADOLESCENT MENTAL HEALTH WITH A FOCUS ON ANXIETY, DEPRESSION, AND SUICIDALITY. THIS WILL BE DONE BY MEETING THE FOLLOWING OBJECTIVES:1) INCREASE PARTNERSHIPS WITH FAIRFIELD COUNTY SCHOOL SYSTEMS ON THE URGENT ASSESSMENTPROGRAM2) INCREASE CAPACITY OF ADOLESCENT INTENSIVE OUTPATIENT PROGRAMS3) PARTNER WITH ALLIED COMMUNITY ORGANIZATIONS TO DEVELOP AND DELIVER PROGRAMMING FOCUSED ONEDUCATION, AWARENESS, AND SUICIDE PREVENTION.4) HOST MEDICAL GRAND ROUNDS TO INCREASE CLINICIAN KNOWLEDGE AND UNDERSTANDING OF THESETOPICS. PRIORITIZED HEALTH ISSUE #3: SUBSTANCE MISUSETHE GOAL IS TO ADDRESS SUBSTANCE USE WITH A FOCUS ON ALCOHOL MISUSE; UNDERAGE SUBSTANCE USE; MARIJUANA, THC, AND CANNABINOIDS. THIS WILL BE DONE BY MEETING THE FOLLOWING OJECTIVES:1. PARTNER WITH ALLIED COMMUNITY ORGANIZATIONS TO DEVELOP AND DELIVER PROGRAMMING FOCUSED ONEDUCATION, AWARENESS, AND ADVOCACY.2. HOST MEDICAL GRAND ROUNDS TO ENHANCE CLINICIAN KNOWLEDGE AND UNDERSTANDING ON THESETOPICS.3. OFFER RECOVERY SUPPORT GROUPS THAT ARE OPEN TO THE COMMUNITY.4. PROVIDE ACCESS TO SILVER HILL HOSPITAL PROGRAMS FOR THOSE REQUIRING INPATIENT, RESIDENTIAL, ORINTENSIVE OUTPATIENT TREATMENT.5. EXPAND INTENSIVE OUTPATIENT SERVICES FOR ADULTS WITH SUBSTANCE USE DISORDERS.PRIORITIZED HEALTH ISSUE #4: ADULT MENTAL HEALTHTHE GOAL IS TO ADDRESS ADULT MENTAL HEALTH WITH A FOCUS ON ANXIETY, DEPRESSION, AND SUICIDALITY. THIS WILL BE DONE BY MEETING THE FOLLOWING OBJECTIVES:1. INCREASE CAPACITY OF THE URGENT ASSESSMENT PROGRAMSILVER HILL HOSPITAL KEY INFORMANT SURVEY DECEMBER 2022PAGE 362. INCREASE TARGETED OUTREACH TO INDIVIDUAL ADULT POPULATIONS (E.G. YOUNG ADULTS, SENIOR CITIZENS,MOTHERS, PROFESSIONALS) ON THE URGENT ASSESSMENT PROGRAM3. OPEN KETAMINE CLINIC (EMPIRICALLY PROVEN MODALITY FOR THE TREATMENT OF MEDICATION RESISTANTDEPRESSION)4. INCREASE CAPACITY OF MOOD DISORDER AND WOMEN'S INTENSIVE OUTPATIENT PROGRAMS5. PARTNER WITH ALLIED COMMUNITY ORGANIZATIONS TO DEVELOP AND DELIVER PROGRAMMING FOCUSED ONEDUCATION, AWARENESS, AND SUICIDE PREVENTION.6. HOST MEDICAL GRAND ROUNDS TO INCREASE CLINICIAN KNOWLEDGE AND UNDERSTANDING OF THESETOPICS. SILVER HILL HOSPITAL PART V, SECTION B, LINE 13H: SILVER HILL HOSPITAL, INC. OFFERS FINANCIAL ASSISTANCE, IN THE FORM OF REDUCED RATES, TO QUALIFYING PATIENTS RECEIVING EMERGENCY OR MEDICALLY NECESSARY SERVICES (I.E. INPATIENT LEVEL OF CARE). THE POLICY APPLIES TO PATIENTS THAT HAVE NO INSURANCE OR HAVE EXHAUSTED THEIR INSURANCE BENEFITS, AND HAVE INCOME OF LESS THAN 300% OF THE FEDERAL POVERTY GUIDELINES. COINSURANCE, COPAYMENTS AND DEDUCTIBLES ARE EXCLUDED FROM THE POLICY.THE HOSPITAL ALSO OFFERS FINANCIAL ASSISTANCE TO PATIENTS RECEIVING TREATMENT IN ITS TRANSITIONAL LIVING PROGRAMS. TRANSITION LIVING PROGRAM SERVICES ARE NOT CONSIDERED AN INPATIENT LEVEL OF CARE. TRANSITIONAL LIVING PATIENTS ARE ELIGIBLE FOR DISCOUNTED CARE IF THEY ARE CLINICALLY APPROPRIATE AND MOTIVATED FOR TREATMENT AND HAVE INCOME LEVELS EQUAL TO OR LESS THAN 900% OF THE FEDERAL POVERTY GUIDELINES.THIS POLICY IS AVAILABLE ATHTTPS://SILVERHILLHOSPITAL.ORG/RESOURCES SILVER HILL HOSPITAL PART V, SECTION B, LINE 16J: THE HOSPITAL MAINTAINS A FORMAL, WRITTEN FINANCIAL ASSISTANCE POLICY FOR ITS TRANSITIONAL LIVING PROGRAM. THE POLICY IS AVAILABLE UPON REQUEST. PATIENTS WHO DO NOT HAVE THE FINANCIALABILITY TO PAY FOR SERVICES, MAY APPLY FOR FINANCIAL ASSISTANCE UPON ADMISSION INTO THE PROGRAM. SILVER HILL HOSPITAL PART V, SECTION B, LINE 21D: IT IS THE POLICY OF THE HOSPITAL THAT PATIENTS ASSESSED TO BE SUFFERING FROM A BEHAVIORAL EMERGENCY MEDICAL CONDITION WILL BE ADMITTED, REGARDLESS OF THEIR INSURANCE STATUS OR ABILITY TO PAY, AS REQUIRED BY THE EMERGENCY MEDICAL TREATMENT AND ACTIVE LABOR ACT (EMTALA). SCHEDULE H, PART V, LINE 22 THE HOSPITAL OFFERS FINANCIAL ASSISTANCE, IN THE FORM OF REDUCED RATES, TO QUALIFYING PATIENTS RECEIVING EMERGENCY OR MEDICALLY NECESSARY SERVICES. THE FULL TEXT VERSION OF THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY IS AVAILABLE ONLINE AT:HTTPS://SILVERHILLHOSPITAL.ORG/RESOURCES PART I, LINE 3C: THE HOSPITAL USED A FPG OF 300% AS A FACTOR FOR DETERMINING ELIGIBILITY FOR PROVIDING DISCOUNTED CARE FOR MEDICALLY NECESSARY SERVICES. MEDICALLY NECESSARY SERVICES ARE DEFINED BY THE HOSPITAL AS INPATIENT SERVICES.THE HOSPITAL USED A FPG OF 600% AS A FACTOR FOR DETERMINING ELIGIBILITY FOR PROVIDING FREE CARE FOR TRANSITIONAL LIVING SERVICES (NON-INPATIENT SERVICES), AND A FPG OF 900% FOR DETERMINING ELIGIBILITY FOR PROVIDING DISCOUNTED CARE FOR TRANSITIONAL LIVING SERVICES (NON-INPATIENT SERVICES). PART I, LINE 7: A COST TO CHARGE RATIO, DERIVED FROM WORKSHEET 2 RATIO OF PATIENT CARE COST TO CHARGES, WAS USED TO DETERMINE FINANCE ASSISTANCE COSTS REPORTED. A COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2 WAS USED TO DETERMINE THE AMOUNT OF INPATIENT CARE THAT WAS SUBSIDIZED IN THE TAX YEAR ENDING 12/31/2022. ALL OTHER EXPENSES REPORTED ARE ACTUAL COSTS. PART III, LINE 2: BAD DEBT EXPENSE IS ESTIMATED BASED ON HISTORICAL AND EXPECTED WRITE-OFFS AND NET COLLECTIONS, AS WELL AS AGING STATUS. A COST TO CHARGE RATIO FROM WORKSHEET 2 WAS APPLIED TO BAD DEBT EXPENSE REPORTED IN THE AUDITED FINANCIAL STATEMENTS IN ORDER TO DETERMINE THE BAD DEBT EXPENSE REPORTED ON PART III, LINE 2. PART I, LINE 7(F) - THE AMOUNT OF TOTAL EXPENSES IN COLUMN (F) WAS REDUCED BY $381,333. PART III, LINE 3: BAD DEBT EXPENSE IS MAINLY COMPRISED OF UNCOLLECTIBLE CO-PAYS AND DEDUCTIBLES FROM PATIENTS WITH INSURANCE. CO-INSURANCE AND DEDUCTIBLE BALANCES ARE EXCLUDED FROM THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. PART III, LINE 4: SEE FOOTNOTE 2 OF THE AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: N/A PART III, LINE 9B: THE HOSPITAL'S COLLECTION POLICY STATES THE FOLLOWING: PATIENT ACCOUNTS WILL WORK WITH PATIENTS THAT QUALIFY FOR FINANCIAL ASSISTANCE TO DEVELOP A REASONABLE BUDGET/PAYMENT PLAN. DELINQUENT SELF-PAY BALANCES FOR PATIENTS THAT QUALIFY FOR FINANCIAL ASSISTANCE MAY BE SENT TO OUTSIDE COLLECTION AGENCIES; HOWEVER THE HOSPITAL WILL NOT PURSUE EXTRAORDINARY COLLECTION ACTIONS (ECA) AGAINST THESE PATIENTS. PART VI, LINE 2: IN ADDITION TO THE CHNA, THE SILVER HILL HOSPITAL STAFF ASSESSES THE NEED FOR ADDITIONAL PROGRAMMING BASED ON SERVICE AVAILABILITY FOR OUR DISCHARGING PATIENT POPULATION. THE HOSPITAL ALSO RECEIVES INPUT FROM COMMUNITY-BASED CLINICIANS TO IDENTIFY NEEDS WITHIN THE COMMUNITY. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: SOCIAL WORKERS HAVE A COMPREHENSIVE VIEW OF A PATIENT'S FINANCIAL AND SOCIAL SITUATION AND ARE KNOWLEDGEABLE ABOUT THE ELIGIBILITY CRITERIA FOR ENTITLEMENT PROGRAMS. IT IS THE ASSIGNED RESPONSIBILITY OF THE SOCIAL WORKER TO INFORM PATIENTS AND THEIR FAMILIES ABOUT ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS.PATIENTS WHO DO NOT HAVE THE FINANCIAL ABILITY TO PAY FOR SERVICES, ARE EDUCATED ABOUT SILVER HILL HOSPITAL'S FINANCIAL ASSISTANCE AND SCHOLARSHIP PROGRAMS BY A SPECIALLY TRAINED STAFF MEMBER. THE STAFF MEMBER PROVIDES PATIENTS AND THEIR FAMILIES WITH THE FINANCIAL GUIDELINES AND SUPPORTING DOCUMENTATION REQUIRED FOR OBTAINING FINANCIAL ASSISTANCE/ SCHOLARSHIPS. PART VI, LINE 4: COMMUNITY INFORMATION: APPROXIMATELY 29% OF THE PATIENT POPULATION IS FROM CONNECTICUT, 38% FROM NEW YORK AND 33% FROM OTHER AREAS. PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTH: SILVER HILL HOSPITAL FURTHERS ITS EXEMPT PURPOSE OF PROMOTING HEALTH OF THE COMMUNITY THROUGH A DIVERSE BOARD OF DIRECTORS WHOSE MEMBERS CONTRIBUTE THROUGH THEIR UNIQUE TALENTS AND RESOURCES TOWARD THE HOSPITAL'S MISSION OF HEALING AND THE CARE OF ITS PATIENTS. PART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEM: N/A FORM 990, PART VI, LINE 7 STATE FILING OF THE COMMUNITY BENEFIT REPORT: DURING TAX YEAR ENDING 12/31/2022, THE HOSPITAL WAS NOT REQUIRED TO FILE A COMMUNITY BENEFIT REPORT WITH THE STATE OF CONNECTICUT. 1 FRIENDS OF LAUREL HOUSE INC 1616 WASHINGTON BLVD STAMFORD CT 06902 061189773 501(C)(3) 25833 0 SPONSORSHIP-SUPPORTING RESOURCES TO RECOVERY GROUP FOR ADVANCEMENT OF PSYCHIATRY PO BOX 570218 DALLAS TX 75357 046040048 501(C)(3) 25000 0 FUNDING FOR A FELLOWSHIP, SUPPORTING PSYCHIATRY NEW CANAAN FIRE DEPARTMENT PO BOX 963 NEW CANAAN CT 06840 066062229 501(C)(3) 10000 0 LOCAL SERVICE PROVIDERS, SUPPORTING ELOPEMENTS AND PATIENT WELL BEING NEW CANAAN POLICE DEPARTMENT 174 SOUTH AVE NEW CANAAN CT 06840 066002043 GOVT 10000 0 LOCAL SERVICE PROVIDERS, SUPPORTING ELOPEMENTS AND PATIENT WELL BEING NEW CANNAAN VOLUNTEER AMBULANCE CORPORATION PO BOX 598 NEW CANAAN CT 06840 237300265 501(C)(3) 10000 0 LOCAL SERVICE PROVIDERS, SUPPORTING ELOPEMENTS AND PATIENT WELL BEING THE ACE CONFERENCE LLC 700 VILLAGE SQUARE CROSSING 101 PALM BEACH GARDENS FL 33410 880688461 10000 0 ADOLESCENT CLINICAL CONFERENCE 5 1 PART I, LINE 2: A. THE AMOUNTS REPORTED ON SCHEDULE I ARE ASSISTANCE TO SUPPORT LOCAL GOVERNMENT DEPARTMENTS AND 501(C )(3) ORGANIZATIONS. DUE TO THE NATURE OF THESE PAYMENTS TO TRUSTEE GRANTEES, ELIGIBILITY DETERMINATION AND POST-GRANT MONITORING IS NOT APPLICABLE. X 0 1 X X X X 0 0 0 0 0 0 0 1 0 ANDREW GERBER MD PHD PRESIDENT & MEDICAL DIRECTOR 539310 0 110000 0 276 0 7978 0 33668 0 691232 0 0 0 ROSS MARKELLO CHIEF FINANCIAL OFFICER 382646 0 81400 0 0 0 0 0 29029 0 493075 0 0 0 HOWARD K WEINER PHYSICIAN 450310 0 0 0 556 0 3050 0 33668 0 487584 0 0 0 RYAN RICHARD WADE PHYSICIAN 465219 0 0 0 109 0 3959 0 0 0 469287 0 0 0 MICHAEL D GROAT PHD CHIEF CLINICAL OFFICER 361003 0 58350 0 281 0 6821 0 38968 0 465423 0 0 0 TIMOTHY DOUGHERTY CHIEF ADVANCEMENT OFFICER 292174 0 60150 0 516 0 7613 0 38956 0 399409 0 0 0 ANRI KISSILENKO PHYSICIAN 305246 0 0 0 556 0 22347 0 38913 0 367062 0 0 0 LISA BENTON CHIEF QUALITY OFFICER 264075 0 49125 0 792 0 8994 0 28364 0 351350 0 0 0 ELIZABETH ORTIZ-SCHWARTZ PHYSICIAN 304736 0 0 0 556 0 2936 0 39968 0 348196 0 0 0 PETRA M PILGRIM PHYSICIAN 314947 0 0 0 132 0 7616 0 11623 0 334318 0 0 0 KRISTEN WOLFE CHIEF BUSINESS OFFICER 244098 0 49625 0 110 0 6442 0 27283 0 327558 0 0 0 AYANA THOMAS CHIEF INFORMATION OFFICER 244951 0 41000 0 183 0 4952 0 15284 0 306370 0 0 0 SHARON KOWALCHUK CHIEF NURSING OFFICER 200609 0 7594 0 1949 0 10582 0 23364 0 244098 0 0 0 PART I, LINE 1B THE CHIEF CLINICAL OFFICER RECEIVED IMPUTED INCOME OF 39,908 RELATED TO RESIDENCE FOR PERSONAL USE WHICH IS RECORDED IN HIS BASE COMPENSATION. THE PAYMENT WAS INCLUDED IN TAXABLE COMPENSATION AND ARE REPORTED IN SCHEDULE J, PART II, COLUMN B(I). PART I, LINE 7 THE CHIEF EXECUTIVE OFFICER, CHIEF FINANCIAL OFFICER, CHIEF CLINICAL OFFICER, CHIEF ADVANCEMENT OFFICER, CHIEF BUSINESS OFFICER, CHIEF QUALITY OFFICER, CHIEF NURSING OFFICER, AND CHIEF INFORMATION OFFICER WERE ELIGIBLE FOR INCENTIVE COMPENSATION BASED ON THE ACHIEVEMENT OF PERFORMANCE GOALS ESTABLISHED AND APPROVED BY THE BOARD OF DIRECTORS. IN CALENDAR YEAR 2022, THE AFOREMENTIONED INDIVIDUALS RECEIVED COMPENSATION FOR ACHIEVEMENT OF INCENTIVE GOALS RELATED TO THE YEAR ENDING DECEMBER 31, 2022. THESE AMOUNTS ARE REPORTED IN SCHEDULE J, PART II, COLUMN (B)(II). X 4 28845 FMV 0 1 0 PART I, COLUMN (B): THE AMOUNT IN COLUMN (B) REPRESENTS THE NUMBER OF CONTRIBUTORS. FORM 990, PART 1, LINE 1 THE MISSION OF SILVER HILL HOSPITAL IS TO PROVIDE OUR PATIENTS WITH THE BEST AVAILABLE TREATMENT OF MENTAL ILLNESS AND ADDICTION; AND TO OFFER CONTINUING SUPPORT, COUNSELING AND EDUCATION TO OUR PATIENTS AND THEIR FAMILIES IN EVERY PHASE OF ILLNESS AND RECOVERY. FORM 990, PART VI, SECTION B, LINE 11B 990 REVIEW BY ORGANIZATION THE FORM 990 OF THE ORGANIZATION IS PREPARED BY THE FINANCE DEPARTMENT OF SILVER HILL HOSPITAL BASED ON THE BOOKS AND RECORDS OF THE ORGANIZATION. THE DRAFT RETURN AND ALL SUPPORTING DOCUMENTATION ARE PROVIDED TO THE ORGANIZATION'S INDEPENDENT ACCOUNTANTS FOR REVIEW AND FINAL PREPARATION OF THE RETURN. THE FINAL VERSION OF THE FORM 990 IS THEN REVIEWED BY THE INTERIM CFO AND PRESDIENT & MEDICAL DIRECTOR. THE FINAL VERSION OF THE FORM 990 IS PROVIDED TO ALL MEMBERS OF THE GOVERNING BODY FOR THEIR REVIEW AND COMMENTS BEFORE FILING THE FORM WITH THE INTERNAL REVENUE SERVICES. FORM 990, PART VI, SECTION B, LINE 12C COMPLIANCE WITH CONFLICT OF INTEREST POLICY THE HOSPITAL REQUIRES THE BOARD OF DIRECTORS AND OFFICERS TO COMPLETE A NOTIFICATION OF COMPLIANCE QUESTIONNAIRE AT THE END OF EACH TAX YEAR. THE FINANCE DEPARTMENT REVIEWS THE QUESTIONNAIRES FOR DETERMINATION OF POTENTIAL CONFLICTS OF INTEREST. ANY POTENTIAL CONFLICTS OF INTEREST ARE MADE KNOWN TO THE BOARD FOR RESOLUTION. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION DETERMINATION EACH YEAR, OR WHEN OTHERWISE REQUIRED, THE BOARD OF DIRECTORS APPOINTS A COMPENSATION SUB-COMMITTEE OF INDEPENDENT DIRECTORS TO REVIEW THE COMPENSATION OF THE PRESIDENT AND MEDICAL DIRECTOR. THE SUB-COMMITTEE REVIEWS THE FORM 990'S OF SIMILAR ORGANIZATIONS AS WELL AS AMERICAN HOSPITAL ASSOCIATION SURVEYS, AND MAKES RECOMMENDATIONS TO THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. ANY DELIBERATIONS AND DECISIONS OF THE COMPENSATION SUB-COMMITTEE ARE DOCUMENTED IN THE MEETING MINUTES OF THE COMPENSATION SUB COMMITTEE. THE HOSPITAL ENGAGES A THIRD PARTY TO CONDUCT A SALARY SURVEY OF ALL OTHER HOSPITAL POSITIONS. THE SURVEY IS CONDUCTED EVERY TWO YEARS. THE MOST RECENT SURVEY WAS CONDUCTED IN 2021. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS AVAILABILITY THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC ON REQUEST. FORM 990, PART XII, LINE 2C: THERE WAS NO CHANGE IN THE PROCESS FROM THE PRIOR YEAR. THE SH-YNHHS TRANSITIONAL LIVING TREATMENT PROGRAM PARTNERSHIP 208 VALLEY ROAD NEW CANAAN CT 06840 843028517 HEALTHCARE SERVICES CT SILVER HILL HOSPITAL RELATED 2321171 7169385 0 1 0.75000 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1