COMMUNITY BENEFITS REPORTING FORM - New London Hospital

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Section 4: <strong>COMMUNITY</strong> BENEFIT ACTIVITIES Identify the categories of Community Benefit activities provided in the preceding year and planned for the upcoming year (note: some categories may be blank). For each area where your organization has activities, report the past and/or projected unreimbursed costs for all community benefit activities in that category. For each category, also indicate the primary community needs that are addressed by these activities by referring to the applicable number or letter from the lists on the previous page (i.e. the listed needs may relate to only a subset of the total reported costs in some categories). A. Community Health Services Community Need Addressed Unreimbursed Costs (preceding year) Unreimbursed Costs (projected) Community Health Education 3 3 -- $71,525.00 $72,000.00 Community-based Clinical Services 2 2 -- $17,512.00 $18,000.00 Health Care Support Services -- -- -- Other: -- -- -- B. Health Professions Education Community Need Addressed Provision of Clinical Settings for Undergraduate Training Intern/Residency Education -- -- -- Unreimbursed Costs (preceding year) Unreimbursed Costs (projected) 5 -- 7 $19,447.00 $20,000.00 Scholarships/Funding for Health Professions Ed. Other: College Internships -- -- -- 5 -- 7 $4,774.00 $5,000.00 C. Subsidized Health Services Community Need Addressed Type of Service: Primary Care Type of Service: Mental Health Services Type of Service: Prescription Medications Type of Service: -- -- -- Type of Service: -- -- -- Unreimbursed Costs (preceding year) Unreimbursed Costs (projected) 1 2 -- $3,380,561.00 $3,400,000.00 1 2 2 $163,521.00 $164,000.00 1 8 -- $20,227.00 $21,000.00
D. Research Community Need Addressed Clinical Research -- -- -- Community Health Research -- -- -- Unreimbursed Costs (preceding year) Unreimbursed Costs (projected) Other: -- -- -- E. Financial Contributions Community Need Addressed Cash Donations Grants -- -- -- Unreimbursed Costs (preceding year) Unreimbursed Costs (projected) 6 -- -- $5,600.00 $6,000.00 In-Kind Assistance Resource Development Assistance 6 -- -- $7,425.00 $8,000.00 -- -- -- F. Community Building Activities Community Need Addressed Physical Infrastructure -- -- -- Improvement Economic Development -- -- -- Unreimbursed Costs (preceding year) Unreimbursed Costs (projected) Support Systems Enhancement Environmental Improvements Leadership Development; Training for Community Members Coalition Building Community Health Advocacy 6 1 -- $90,072.00 $91,000.00 -- -- -- -- -- -- -- -- -- 6 -- 2 $56,523.00 $57,000.00
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COMMUNITY BENEFITS REPORTING FORM - New London Hospital

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