2024-08-13T09:20:43-05:00 2023-09-30 990 2022-10-01 460886367 Hartford HealthCare Accountable Care Organization Inc HART 8606963563 1290 Silas Deane Highway 2nd Floor Wethersfield CT 06109 Mark A Keise Authorized Signer 8606966282 2024-08-13 0 0 P00670158 2022 2024-08-08 14:25:15Z Gerald J Boisvert 1290 Silas Deane Highway Wethersfield CT 06109 0 0 X See Schedule O X 2012 CT The Hartford HealthCare Accountable Care Organization, Inc. (HHC ACO) will ensure that your providers are working together to help you get the right care at the right time in the right setting. 6 2 0 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2642360 2531849 2642360 2531849 -2642360 -2531849 0 0 18014376 20546225 -18014376 -20546225 X Hartford HealthCare ACO works closely with other doctors and healthcare providers in the ACO to coordinate care for Medicare beneficiaries who have traditional Medicare. 0 0 2531849 Providing the best possible health care often goes beyond an exam and a prescription refill. Often, especially as we age, we develop more complex needs that might involve multiple conditions, many prescriptions, numerous providers, visits to the hospital and even situations outside of the health system, such as financial stresses, that can impact our ability to get well and stay well. That's why Medicare is working with many doctors, hospitals and other health care providers to promote better, more coordinated health care. To allow this coordination, Hartford HealthCare Medical Group has created a team-based approach to medicine known as an accountable care organization. The Hartford HealthCare Accountable Care Organization, Inc. (HHC ACO) works to ensure that your providers are working together to help you get the right care at the right time in the right setting. That adds up to a healthier you.HHC ACO believes, being part of the broader Hartford HealthCare Corporation (HHC) family, it has the opportunity of bringing together several delivery system strengths and capabilities in a well-orchestrated way. HHC's broad delivery system will help facilitate coordinated care across the continuum for Medicare Fee-for-Service beneficiaries.The HHC entities that are part of HHC include: Hartford Hospital, MidState Medical Center, The Hospital of Central Connecticut, Windham Community Memorial Hospital, Natchaug Hospital, Hartford HealthCare Senior Services, Inc., Rushford Center, Inc., Hartford HealthCare At Home, Inc., Hartford HealthCare Rehabilitation Network, LLC, William W. Backus Hospital, Hartford HealthCare Medical Group, Inc., Charlotte Hungerford Hospital and St. Vincent Medical Center Holdings, Inc. dba St. Vincent's Medical Center. 2531849 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 6 2 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 X Carol Wardell 8606963563 9 Farm Springs Road Farmington CT 06032 James Cardon MD Director 2.00 58.00 X 0 1194539 55823 Wilner Samson MD Director, Chair Start 1/23 2.00 58.00 X X 0 344976 55348 Cara Riddle MD Director Start 1/23 2.00 58.00 X 0 322108 22114 David Santoro Director 2.00 58.00 X 0 278469 50902 Jack Schmetterling MD Director, Chair Thru 1/23 2.00 58.00 X 0 116419 23169 George Goldfarb MD Director Start 6/23 1.00 X 0 0 0 Ian Kleinhen MD Director Start 1/23 1.00 X 0 0 0 David Simon MD Director Thru 1/23 1.00 X 0 0 0 Anuraddha Walaliyadda MD Director Thru 1/23 1.00 X 0 0 0 0 2256511 207356 0 0 1 0 0 0 0 0 0 X 2009404 2009404 522445 522445 2531849 2531849 0 0 0 0 18014376 20546225 18014376 20546225 X 0 0 0 0 -18014376 -20546225 -18014376 -20546225 0 0 -2531849 0 X X 0 1 X 1 0 X 0 0 0 0.00000 X 0 Due to Affiliate 20546225 20546225 0 1 0 0 0 0 0 1 0 James Cardon MD Director 0 567465 0 512947 0 114127 0 21350 0 34473 0 1250362 0 0 Wilner Samson MD Director, Chair Start 1/23 0 303449 0 40975 0 552 0 21350 0 33998 0 400324 0 0 Cara Riddle MD Director Start 1/23 0 285931 0 35817 0 360 0 21350 0 764 0 344222 0 0 David Santoro Director 0 210181 0 66271 0 2017 0 18659 0 32243 0 329371 0 0 Part I, Line 3 The Independent Executive Compensation Committee (Committee) of the Board of Directors of Hartford HealthCare on behalf of Hartford HealthCare Accountable Care Organization, Inc. hires an outside consultant, Human Resources and Compensation Consulting Practice of Gallagher, to determine best practices in governing executive compensation. Please refer to compensation narrative reported on Schedule O. Part I, Line 4b Hartford HealthCare Corporation, a related organization, maintains a 457(f) Supplemental Executive Retirement Plan (SERP). Participants include certain officers and key employees at the President & CEO, Executive Vice President and Senior Vice President levels that are reported by Hartford HealthCare Accountable Care Organization, Inc. on its 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, upon reaching age 65 or the occurrence of a change in control. 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. 2022 SERP Payout was made on behalf of the following individual: James Cardon, MD $60,954* *For this individual, vesting occured, causing taxable income. A portion of the vested amount was used to pay the associated tax liability. The remaining balance was deposited into the employee SERP account. Part I, Line 7 Hartford HealthCare Corporation, a related organization, has a Compensation At Risk Plan that encourages and rewards achievements of significant functional goals. These goals contribute to the 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. Form 990, Part VI, Section A, line 6 Hartford HealthCare Accountable Care Organization is organized as a non-stock not for profit entity. Hartford HealthCare Medical Group, Inc. 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 body. Form 990, Part VI, Section A, line 7b The sole member of the organization has the right to review, approve, disapprove and deny significant transactions such as mergers, acquisitions, dissolutions etc. Form 990, Part VI, Section B, line 11b The Form 990 was prepared by Hartford HealthCare's Tax Department and reviewed by the Tax Director. The Form was not provided to the Board prior to filing because the organization is currently functioning as a data warehouse and its transactions are minimal. Form 990, Part VI, Section B, line 12c The ACO'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 and Integrity (OCI). Employee and physician disclosures are reviewed by OCI in collaboration with the Covered Individuals' supervisor, when deemed appropriate, to determine if there is a potential conflict. Conflict mitigation plans are developed by OCI. Other individuals who may review potential conflicts of interest and approve conflict management plans include: the SVP/EVP of the department/area in which the individual works, the Institute Physician-In-Chief, the Medical Group Physician-In-Chief, the Regional Vice President of Medical Affairs, and/or the HHC Legal Department. 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 Hartford HealthCare Accountable Care Organization, Inc., hires an outside consultant, Human Resources and Compensation Consulting Practice of Gallagher, to determine best practices in governing executive compensation. The following steps were taken: - The use of an Independent Executive Compensation Committee (Committee) of the Board of Directors of Hartford HealthCare, on behalf of Hartford HealthCare Accountable Care Organization, Inc., 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 market data analysis to ensure appropriate competitive positioning within parameters of compensation philosophy; -The President & CEO compensation is reviewed by the Committee and is based on comparative market information and organizational performance; - All changes are reviewed and approved by the Executive Compensation Committee; The compensation determination process for the President & CEO 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 Organization's governing documents including the Conflict of Interest Policy are available upon request. Form 990, Part VI, Section C, line 19 The Organization's financial statements, Form 990, Form 1023 and its attachments are available upon request. Form 990, Part IX, line 11g Professional Fees: Program service expenses 522,445. Management and general expenses 0. Fundraising expenses 0. Total expenses 522,445. Form 990, Part XII, Line 2c The activity of Hartford HealthCare Accountable Care Organization, Inc. is included in the consolidated financial statements of Hartford HealthCare Corporation and Subsidiaries. The finance and audit committee of Hartford HealthCare Corporation's board assumes responsibility for the consolidated organization as a whole. Page 1, Item J - Company Website The website for Hartford HealthCare Accountable Care Organization, Inc. is: https://hartfordhealthcaremedicalgroup.org/about-us/accountable-care-org anization Backus HealthCare Inc 326 Washington Street Norwich CT 06360 222481794 Supporting Organization CT 501(c)(3) 12 (a) Hartford HealthCare Corporation 1 Connecticut Health System Inc 80 Seymour Street Hartford CT 06102 222779421 Coordination of Health Care Delivery CT 501(c)(3) 12 (c) Hartford HealthCare Corporation 1 Hartford HealthCare at Home Inc 1290 Silas Deane Hwy Suite 4B Wethersfield CT 06109 060646938 Home Healthcare CT 501(c)(3) 10 Hartford HealthCare Corporation 1 Hartford HealthCare Corporation 100 Pearl Street Hartford CT 06103 222672834 Support & Management Svcs. To HH and Affiliates CT 501(c)(3) 12 (c) N/A 0 Hartford HealthCare Endowment LLC 80 Seymour Street Hartford CT 06102 454181103 Investment Management CT 501(c)(3) 12 (a) Hartford HealthCare Corporation 1 Hartford HealthCare Independence at Home Inc 1290 Silas Deane Hwy Suite 4B Wethersfield CT 06109 061161422 Home Healthcare CT 501(c)(3) 10 Hartford HealthCare at Home Inc 1 Hartford Healthcare Medical Group Specialists PLLC 1290 Silas Deane Highway 2nd Floor Wethersfield CT 06109 371911194 Medical Services CT 501(c)(3) 10 Hartford HealthCare Medical Group Inc 1 Hartford HealthCare Medical Group Inc 1290 Silas Deane Highway 2nd Floor Wethersfield CT 06109 454456939 Medical Services CT 501(c)(3) 10 Hartford HealthCare Corporation 1 Hartford HealthCare Senior Services Inc 45 Meriden Avenue Southington CT 06489 222635676 Sub-Acute & Long Term Healthcare CT 501(c)(3) 10 Hartford HealthCare Corporation 1 Hartford Hospital 80 Seymour Street Hartford CT 06106 060646668 Healthcare Services CT 501(c)(3) 3 Hartford HealthCare Corporation 1 Hartford Hospital Auxiliary co Hartford Hospital 80 Seymour Street Hartford CT 06102 066040747 Fundraising CT 501(c)(3) 10 Hartford Hospital 1 Midstate Medical Center 435 Lewis Avenue Meriden CT 06451 060646715 Healthcare Services CT 501(c)(3) 3 Hartford HealthCare Corporation 1 Midstate Medical Center Auxiliary 435 Lewis Avenue Meriden CT 06451 066063082 Fundraising CT 501(c)(3) 12 (a) Midstate Medical Center 1 Mulberry Gardens of Southington LLC 58 Mulberry Street Plantsville CT 06479 820586577 Assisted Living & Adult Day Care Facility CT 501(c)(3) 10 Hartford HealthCare Senior Services Inc 1 Natchaug Hospital Inc 189 Storrs Road Mansfield Center CT 06226 060966963 Behavioral Health CT 501(c)(3) 3 Hartford HealthCare Corporation 1 Rushford Center Inc 883 Paddock Avenue Meriden CT 06450 060932875 Substance Abuse Healthcare Services CT 501(c)(3) 7 Hartford HealthCare Corporation 1 Rushford Foundation Inc 883 Paddock Avenue Meriden CT 06450 061432692 Supporting Organization CT 501(c)(3) 12 (a) Rushford Center Inc 1 St Vincent's Development Inc 95 Merritt Boulevard Trumbull CT 06611 222554128 Holding Company CT 501(c)(25) St Vincent's Health Services Corp 1 St Vincent's Health Services Corp 2800 Main Street Bridgeport CT 06606 222558134 Supporting Organization CT 501(c)(3) 12 (a) SVMC Holdings Inc dba St Vincent's Medical Center 1 St Vincent's Multispecialty Group Inc 2800 Main Street Bridgeport CT 06606 800458769 Healthcare Services CT 501(c)(3) 12 (a) SVMC Holdings Inc dba St Vincent's Medical Center 1 St Vincent's Medical Center Foundation Inc 2800 Main Street Bridgeport CT 06606 222558132 Fundraising CT 501(c)(3) 7 SVMC Holdings Inc dba St Vincent's Medical Center 1 St Vincent's Special Needs Center Inc 95 Merritt Boulevard Trumbull CT 06611 060702617 Residential Services for Handicapped CT 501(c)(3) 10 St Vincent's Health Services Corp 1 SVMC Holdings Inc dba St Vincent's Medical Center 2800 Main Street Bridgeport CT 06606 832550272 Hospital CT 501(c)(3) 3 Hartford HealthCare Corporation 1 The Charlotte Hungerford Hospital 540 Litchfield Street PO Box 988 Torrington CT 06790 060646678 Healthcare Services CT 501(c)(3) 3 Hartford HealthCare Corporation 1 The Hospital of Central CT and Bradley Memorial 100 Grand Street New Britian CT 06052 060646768 Healthcare Services CT 501(c)(3) 3 Hartford HealthCare Corporation 1 The Orchards of Southington 34 Hobart Street Southington CT 06489 061490803 Residential Services for Senior Citizens CT 501(c)(3) 10 Hartford HealthCare Senior Services Inc 1 The William W Backus Hospital 326 Washington Street Norwich CT 06360 060250773 Hospital CT 501(c)(3) 3 Hartford HealthCare Corporation 1 WCMH Women's Auxiliary Inc 112 Mansfield Avenue Willimantic CT 06226 060677728 Fundraising CT 501(c)(3) 12 (a) Windham Community Memorial Hospital 1 Windham Community Memorial Hospital 112 Mansfield Avenue Willimantic CT 06226 060646966 Healthcare Services CT 501(c)(3) 3 Hartford HealthCare Corporation 1 Windham Hospital Foundation Inc 112 Mansfield Avenue Willimantic CT 06226 562546632 Supporting Organization CT 501(c)(3) 12 (a) Windham Community Memorial Hospital 1 Advanced Medical Imaging of NW CT LLC 57 Commercial Blvd Torrington CT 06790 061594854 Magnetic Resonance Imaging CT N/A 0 0 Ambulance Service of Manchester LLC PO Box 300 Manchester CT 06450 061557358 Ambulatory Service CT N/A 0 0 Central Connecticut Endoscopy Center 440 New Britain Avenue Plainville CT 06062 141855010 Endoscopy Svcs CT N/A 0 0 Connecticut Imaging Partners LLC 1500 Concord Terrace Sunrise FL 33323 134298940 Imaging Services CT N/A 0 0 Connecticut Orthopaedic Surgery Center LLC 100 Avon Meadow Lane Avon CT 06001 832570191 Surgery Svcs CT N/A 0 0 Connecticut Proton Therapy Center LLC 789 Howard Ave Suite CB 230 New Haven CT 06519 871371777 Proton Therapy Services CT N/A 0 0 Constitution Surgery Center East LLC 174 Cross Road Waterford CT 06385 061574704 Surgery Svcs CT N/A 0 0 CT GI Endoscopy Center LLC ( Bloomfield) 4 Northwestern Drive Bloomfield CT 06002 061573358 GI Services CT N/A 0 0 Glastonbury Endoscopy Center LLC 300 Western Blvd Suite B Glastonbury CT 06033 261721234 Endoscopy Svcs CT N/A 0 0 Glastonbury Surgery Center LLC 195 Eastern Boulevard Glastonbury CT 06033 262600828 Surgery Svcs CT N/A 0 0 Hartford-Middlesex Clinical System LLC 80 Seymour Street Hartford CT 06110 061543605 Affiliate Support Services CT N/A 0 0 HHC Hartford Surgery Center LLC 100 Avon Meadow Lane Avon CT 06001 812637261 Surgery Svcs CT N/A 0 0 HHC Southington Surgery Center LLC 100 Avon Meadow Lane Avon CT 06001 465500829 Surgery Svcs CT N/A 0 0 Hartford HealthCare-GoHealth Urgent Care LLC 5555 Glenridge Connector Suite 700 Atlanta GA 30342 815112698 Urgent Care Services DE N/A 0 0 Med East Assoc LLC 1703 West Main Street Willimantic CT 06226 061469575 Outpatient Care Clinic CT N/A 0 0 New Britain MRI Limited Partnership 100 Grand Street New Britain CT 06050 061271349 Magnetic resonance imaging CT N/A 0 0 Rocky Hill Surgery Center LLC 1111 Cromwell Avenue Building 1 Rocky Hill CT 06067 833096156 Surgery Svcs CT N/A 0 0 The Endoscopy Center of Northwest Connecticut LLC 245 Alvord Park Road Torrington CT 06790 061609993 Endoscopy Svcs CT N/A 0 0 Wallingford Endoscopy Center LLC 863 North Main Street Ext Suite 300 Wallingford CT 06492 824601730 Endoscopy Svcs CT N/A 0 0 Aetna Ambulance Service Inc PO Box 1150 Manchester CT 06045 060795431 Ambulance Services CT N/A C 1 American Ambulance Services Inc One American Way Norwich CT CT 06360 061028857 Ambulance Services CT N/A S 1 American Professional Educational Services Inc One American Way Norwich CT CT 06360 061459930 Educational Services CT N/A S 1 Backus Medical Center Condo Assoc Inc 330 Washington Street Norwich CT 06360 061542647 Condo Association CT N/A C 1 CenConn Services Inc 100 Grand Street New Britain CT 06050 222836001 Billing Services CT N/A C 1 ConnCare Inc 326 Washington Street Norwich CT 06360 061387598 Health Care Services CT N/A C 1 HHMOB Corporation 80 Seymour Street PO Box 5037 Hartford CT 06102 061140244 Real Estate & Parking CT N/A C 1 Hartford HealthCare Indemnity Services Ltd FB Perry Bld 40 Church Street Hamilton BD Captive Insurance BD N/A C 1 Hartford Physician Services PC 80 Seymour Street Hartford CT 06102 061254082 Medical Services CT N/A C 1 Hunter's Ambulance Service Inc 450 West Main Street Meriden CT 06451 060789464 Ambulance Services CT N/A S 1 Meriden Imaging Center Inc 101 North Plains Industrial Road Meriden CT 06429 061541468 Imaging CT N/A S 1 Metro Wheelchair Service Inc PO Box 300 Manchester CT 06045 060878432 Wheelchair Services CT N/A C 1 The Cancer Care Fund Of The Litchfield Hills Inc 200 Kennedy Drive Torrington CT 06790 510474072 Cancer Care Fund CT N/A C 1 Windham Professional Office Condo Assoc 112 Mansfield Avenue Willimantic CT 06226 061090041 Condo Association CT N/A C 1 WWB Corporation 326 Washington Street Norwich CT 06360 061094838 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