ATHOL MEMORIAL HOSPITAL NMTC HOLDINGS INC: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- ATHOL MEMORIAL HOSPITAL NMTC HOLDINGS INC (EIN 82-2171549)
- Tax period
- 2019-10-01 to 2020-09-30
- Filed
- 2021-08-13
- IRS object ID
- 202132259349300403
- Schema version
- 2019v5.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-08-13T07:07:15-05:00 | ReturnTs |
| Tax Period End | 2020-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 010523282 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Berry Dunn McNeil & Parker LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 1100 | AddressLine1Txt |
| City | Portland | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 041041100 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2019-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 822171549 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Athol Memorial Hospital NMTC Holdings | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | ATHO | BusinessNameControlTxt |
| Phone | 9786306106 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 242 Green Street | AddressLine1Txt |
| City | Gardner | CityNm |
| State Abbreviation | MA | StateAbbreviationCd |
| ZIP | 01440 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Michael Abbatiello | PersonNm |
| Person Title | VP of Finance/CFO | PersonTitleTxt |
| Phone | 9786306106 | PhoneNum |
| Signature | 2021-08-12 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Barbara J McGuan CPA | PreparerPersonNm |
| PTIN | P00219457 | PTIN |
| Phone | 2077752387 | PhoneNum |
| Preparation | 2021-08-12 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Winfield Brown | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 242 Green Street | AddressLine1Txt |
| City | Gardner | CityNm |
| State Abbreviation | MA | StateAbbreviationCd |
| ZIP | 01440 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $588,504 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.heywood.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2017 | FormationYr |
| Legal Domicile State | MA | LegalDomicileStateCd |
| Activity Or Mission | To support the operations and purposes or Athol Memorial Hospital, including leasing land, constructing a new medical office building and emergency department, and purchasing equipment. | ActivityOrMissionDesc |
| Voting Members Governing Body | 21 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 19 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 19 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $155,531 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $26,112 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $100,000 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $83,243 | PYOtherRevenueAmt |
| CY Other Revenue | $332,973 | CYOtherRevenueAmt |
| PY Total Revenue | $109,355 | PYTotalRevenueAmt |
| CY Total Revenue | $588,504 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $0 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $10,485 | PYOtherExpensesAmt |
| CY Other Expenses | $204,362 | CYOtherExpensesAmt |
| PY Total Expenses | $10,485 | PYTotalExpensesAmt |
| CY Total Expenses | $204,362 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $98,870 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $384,142 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $19,167,348 | TotalAssetsBOYAmt |
| Total Assets EOY | $19,611,581 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $17,091,659 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $17,151,750 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $2,075,689 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $2,459,831 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | To support the operations and purposes of Athol Memorial Hospital, including leasing land, constructing a new medical office building and emergency room, purchasing equipment and leasing office space to medical offices. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $204,273 | ExpenseAmt |
| Revenue | $100,000 | RevenueAmt |
| Desc | The specific purpose of the corporation is limited to the support of the operations and purposes of Athol Memorial Hospital, a MA non-profit tax-exempt hospital. Such support shall include (I) leasing land from AMH, (II) designing, permitting, and constructing a new medical office building on the land, comprised of an emergency department, physician practice space and lobby. Additional commercial office space, parking areas adjacent to the MOB, and utilities and other infrastructure. (III) Renovating the AMH Imaging Department, (IV) aquiring certain medical equipment, (V) leasing the ED, physician practice space, the parking areas and equipment to AMH, (VI) leasing the additional office space and parking areas to a non-profit, tax-exempt corporation, and (VII) all other purposes permitted by law that further the corporation's support of AMH. | Desc |
| Total Program Service Expenses | $204,273 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 3 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 21 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 19 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | MA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Michael Abbatiello | PersonNm |
| Phone | 9786306157 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 242 Green Street | AddressLine1Txt |
| City | Gardner | CityNm |
| State Abbreviation | MA | StateAbbreviationCd |
| ZIP | 01440 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (23 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|
| Bob Chauvin | ||||||||
| Chairman | 0.20 | 1.40 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Roy Lake | ||||||||
| Vice Chairman | 0.20 | 1.40 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Cheney Castine | ||||||||
| Treasurer | 0.20 | 1.40 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JoAnne Parks | ||||||||
| Clerk | 0.20 | 1.40 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Craig Twohey | ||||||||
| Trustee | 0.20 | 1.40 | Yes (X) | $0 | $0 | $0 | ||
| Thomas Kane | ||||||||
| Trustee | 0.20 | 1.40 | Yes (X) | $0 | $0 | $0 | ||
| Nicole Moorshead | ||||||||
| Trustee | 0.20 | 1.40 | Yes (X) | $0 | $0 | $0 | ||
| Elizabeth Nottleson | ||||||||
| Trustee | 0.20 | 29.40 | Yes (X) | $0 | $278,691 | $7,206 | ||
| Glenn Hunt | ||||||||
| Trustee | 0.20 | 1.40 | Yes (X) | $0 | $0 | $0 | ||
| David Spackman | ||||||||
| Trustee | 0.20 | 1.40 | Yes (X) | $0 | $0 | $0 | ||
| Jim Meehan | ||||||||
| Trustee | 0.20 | 1.40 | Yes (X) | $0 | $0 | $0 | ||
| Joel Shaughnessy | ||||||||
| Trustee | 0.20 | 1.40 | Yes (X) | $0 | $0 | $0 | ||
| John Flick | ||||||||
| Trustee | 0.20 | 1.40 | Yes (X) | $0 | $0 | $0 | ||
| John Skrzypczak | ||||||||
| Trustee | 0.20 | 1.40 | Yes (X) | $0 | $0 | $0 | ||
| Joyce Fletcher | ||||||||
| Trustee | 0.20 | 1.40 | Yes (X) | $0 | $0 | $0 | ||
| Debra Vescovi | ||||||||
| Trustee | 0.20 | 1.40 | Yes (X) | $0 | $0 | $0 | ||
| Kenneth Pierce | ||||||||
| Trustee | 0.20 | 1.40 | Yes (X) | $0 | $0 | $0 | ||
| Michelle Parker | ||||||||
| Trustee | 0.20 | 1.40 | Yes (X) | $0 | $0 | $0 | ||
| Tina Sbrega | ||||||||
| Trustee | 0.20 | 1.40 | Yes (X) | $0 | $0 | $0 | ||
| Albert Rose | ||||||||
| Trustee | 0.20 | 1.40 | Yes (X) | $0 | $0 | $0 | ||
| Winfield Brown | ||||||||
| President/CEO | 0.20 | 41.40 | Yes (X) | Yes (X) | $0 | $911,200 | $64,820 | |
| Michael Abbatiello | ||||||||
| Chief Financial Officer | 0.00 | 40.00 | Yes (X) | $0 | $20,000 | $42 | ||
| Robert Crosby | ||||||||
| Former Chief Financial Officer | 0.00 | 40.00 | $0 | $346,993 | $31,330 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,556,884 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $103,398 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (3 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Hutter Construction Corp | |||||
| PO Box 257 | New Ipswich | NH | 03071 | Construction | $3,659,497 |
| SMRT Inc | |||||
| PO Box 618 | Portland | ME | 01404 | Architects | $167,436 |
| A & E Environmental Inc | |||||
| 435 Lancaster Street | Leominster | MA | 01453 | Asebestos Removal | $117,612 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $155,531 | AllOtherContributionsAmt |
| Total Contributions | $155,531 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Rental Income from Aff | Desc |
| Business | 531120 | BusinessCd |
| Total Revenue Column | $100,000 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $100,000 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $100,000 | TotalProgramServiceRevenueAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $332,973 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $332,973 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $332,973 | TotalRevenueColumnAmt |
| Exclusion | $332,973 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $588,504 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $100,000 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $332,973 | ExclusionAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $89 | TotalAmt |
| Management And General | $89 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,178 | TotalAmt |
| Program Services | $1,178 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1 | TotalAmt |
| Program Services | $1 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $130,963 | TotalAmt |
| Program Services | $130,963 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $72,131 | TotalAmt |
| Program Services | $72,131 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $204,362 | TotalAmt |
| Program Services | $204,273 | ProgramServicesAmt |
| Management And General | $89 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part X | Yes (X) | InfoInScheduleOPartXInd |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $214,025 | BOYAmt |
| EOY | $554,775 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $19,131,349 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $74,543 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,452,367 | BOYAmt |
| EOY | $19,056,806 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,500,956 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,167,348 | BOYAmt |
| EOY | $19,611,581 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $431,659 | BOYAmt |
| EOY | $464,002 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $27,748 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,660,000 | BOYAmt |
| EOY | $16,660,000 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,091,659 | BOYAmt |
| EOY | $17,151,750 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,075,689 | BOYAmt |
| EOY | $2,459,831 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,075,689 | BOYAmt |
| EOY | $2,459,831 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,167,348 | BOYAmt |
| EOY | $19,611,581 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $384,142 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type1 | Yes (X) | SupportingOrgType1Ind |
| IRS Written Determination | Yes (X) | IRSWrittenDeterminationInd |
| Supported Organizations | 1 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp
Supported Organization Name SupportedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Athol Memorial Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 042126583 | EIN |
| Organization Type | 3 | OrganizationTypeCd |
| Governing Document Listed | Yes (1) | GoverningDocumentListedInd |
| Support | $204,362 | SupportAmt |
| Other Support | $0 | OtherSupportAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 1 | SupportedOrganizationsTotalCnt |
| Support Sum | $204,362 | SupportSumAmt |
| Other Support Sum | $0 | OtherSupportSumAmt |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | Yes (1) | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | 0 | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | 0 | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | 0 | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | 0 | OrganizationChangeSuprtOrgInd |
| Support Non Supported Org | 0 | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | 0 | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | 0 | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | 0 | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | 0 | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | 0 | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | 0 | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | 0 | ContributionControllerInd |
| Contribution Family | 0 | ContributionFamilyInd |
| Contribution35 Controlled | 0 | Contribution35ControlledInd |
Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Power Appoint Majority Dir Trst | Yes (1) | PowerAppointMajorityDirTrstInd |
| Operate Benefit Non Suprt Org | 0 | OperateBenefitNonSuprtOrgInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $18,913,346 | OtherCostOrOtherBasisAmt |
| Depreciation | $38,719 | DepreciationAmt |
| Book Value | $18,874,627 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $160,014 | OtherCostOrOtherBasisAmt |
| Depreciation | $32,683 | DepreciationAmt |
| Book Value | $127,331 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $57,989 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,141 | DepreciationAmt |
| Book Value | $54,848 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $19,056,806 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part X, Line 2: | FormAndLineReferenceDesc |
| Explanation | Heywood Healthcare, Heywood Hospital, Athol, HMGI, Charitable Foundation, Quabbin, and NMTC have been determined to be not-for-profit corporations as described in Section 501(c)(3) of the Internal Revenue Code (the "Code"), and the Realty Corp. has been determined to be a not-forprofit corporation as described in Section 501(c)(2) of the Code. All of the entities are exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. The Organization annually evaluates its tax status and tax positions taken with respect to its operations and financial position. Under Accounting Standards Codification ("ASC") 740, an organization must recognize the financial statement effects of a tax position taken for tax return purposes when it is more likely than not that the position will not be sustained upon examination by a taxing authority. The Organization does not believe it has taken any material uncertain tax positions, and accordingly, it has not recorded any liability for unrecognized tax benefits. Additionally, the Organization has filed IRS Form 990 information returns, as required, and all other applicable returns in jurisdictions where so required. For the years ended September 30, 2020 and 2019, there were no interest or penalties recorded or included in the consolidated statements of operations. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (3 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Elizabeth Nottleson | ||||||||||||||
| Trustee | $0 | $278,691 | $0 | $0 | $0 | $0 | $0 | $5,394 | $0 | $1,812 | $0 | $285,897 | $0 | $0 |
| Winfield Brown | ||||||||||||||
| President/CEO | $0 | $550,259 | $0 | $74,782 | $0 | $286,159 | $0 | $24,600 | $0 | $40,220 | $0 | $976,020 | $0 | $0 |
| Robert Crosby | ||||||||||||||
| Former Chief Financial Officer | $0 | $207,493 | $0 | $12,000 | $0 | $127,500 | $0 | $16,683 | $0 | $14,647 | $0 | $378,323 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 3 | FormAndLineReferenceDesc |
| Explanation | The related organization, Henry Heywood Memorial Hospital, uses the following methods to establish the compensation of the organization's CEO: - Compensation committee - Independent compensation consultant - Form 990 of other ogranizations - Written employment contract - Compensation survey or study - Approval by the board or compensation committee | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section B, line 11b | The Form 990 is prepared by a third-party accounting firm with the assistance of the Accounting Department. The Form 990 is reviewed by the Controller and CFO. Then the return is uploaded to the Hospital cyber board for the Board of Trustees to review prior to filing. |
| Form 990, Part VI, Section B, line 12c | The Board of Trustees review the Organization's Conflict of Interest policy annually in order to ensure that the Organization's Board of Trustees and Officers are regularly and consistently monitoring and enforcing it. |
| Form 990, Part VI, Section B, line 15 | All Officers and the CEO's salaries are paid by related corporations. The salaries are determined by the Board of Trustees, considering comparable salary information for Officers of other entities of similar size and level of activity. |
| Form 990, Part VI, Section C, line 19 | The Organization makes its governing documents, conflict of interest policy and financial statements available to the public by providing completed copies to the Executive Assistant, who provides copies upon request. |
| Form 990, Part X, Line 10: Land, Buildings, and Equipment: | Section 1.263(a)-3(n) Election: Athol Memorial Hospital NMTC Holdings 242 Green Street Gardner, MA 01440 EIN: 82-2171549 Athol Memorial Hospital NMTC Holdings is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n). |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (8 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Heywood Healthcare Inc | |||||||||||
| 242 Green Street | Gardner | MA | 01440 | 222720658 | Parent Corp | MA | 501(c)(3) | Line 12b, II | 0 | ||
| Henry Heywood Memorial Hospital | |||||||||||
| 242 Green Street | Gardner | MA | 01440 | 042103581 | Acute Care Hospital | MA | 501(c)(3) | Line 3 | 0 | Heywood Healthcare Inc | |
| Athol Memorial Hospital | |||||||||||
| 2033 Main Street | Athol | MA | 01331 | 042126583 | Critical Access Hospital | MA | 501(c)(3) | Line 3 | 0 | Heywood Healthcare Inc | |
| Heywood Medical Group | |||||||||||
| 242 Green Street | Gardner | MA | 01440 | 043163589 | Multi-Spec. Physicians | MA | 501(c)(3) | Line 10 | 0 | Heywood Healthcare Inc | |
| Quabbin Healthcare Inc | |||||||||||
| 242 Green Street | Gardner | MA | 01440 | 812053488 | Behavioral Health | MA | 501(c)(3) | Line 12b, II | 0 | Heywood Healthcare Inc | |
| Heywood Realty Corp | |||||||||||
| 242 Green Street | Gardner | MA | 01440 | 043327447 | Prop. Holding Corp | MA | 501(c)(2) | 0 | Heywood Healthcare Inc | ||
| Heywood Healthcare Charitable Foundation Inc | |||||||||||
| 242 Green Street | Gardner | MA | 01440 | 222720562 | Charitable Foundation | MA | 501(c)(3) | Line 7 | 0 | Heywood Healthcare Inc | |
| Winchendon Health Foundation Inc | |||||||||||
| 55 Hospital Drive | Winchendon | MA | 01475 | 042113276 | Community Health Care | MA | 501(c)(3) | Line 12d, III-O | 0 | N/A | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (1) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
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