2021-08-13T07:07:15-05:00 2020-09-30 010523282 Berry Dunn McNeil & Parker LLC PO BOX 1100 Portland ME 041041100 990 2019-10-01 822171549 Athol Memorial Hospital NMTC Holdings ATHO 9786306106 242 Green Street Gardner MA 01440 Michael Abbatiello VP of Finance/CFO 9786306106 2021-08-12 1 Barbara J McGuan CPA P00219457 2077752387 2021-08-12 2019 2022-09-23 18:48:47Z Winfield Brown 242 Green Street Gardner MA 01440 588504 0 X www.heywood.org X 2017 MA 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. 21 19 0 19 0 0 0 155531 26112 100000 0 0 83243 332973 109355 588504 0 0 0 0 0 0 0 0 0 10485 204362 10485 204362 98870 384142 19167348 19611581 17091659 17151750 2075689 2459831 X 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. 0 0 204273 100000 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. 204273 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 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 0 0 0 1 3 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 21 19 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X Michael Abbatiello 9786306157 242 Green Street Gardner MA 01440 Bob Chauvin Chairman 0.20 1.40 X X 0 0 0 Roy Lake Vice Chairman 0.20 1.40 X X 0 0 0 Cheney Castine Treasurer 0.20 1.40 X X 0 0 0 JoAnne Parks Clerk 0.20 1.40 X X 0 0 0 Craig Twohey Trustee 0.20 1.40 X 0 0 0 Thomas Kane Trustee 0.20 1.40 X 0 0 0 Nicole Moorshead Trustee 0.20 1.40 X 0 0 0 Elizabeth Nottleson Trustee 0.20 29.40 X 0 278691 7206 Glenn Hunt Trustee 0.20 1.40 X 0 0 0 David Spackman Trustee 0.20 1.40 X 0 0 0 Jim Meehan Trustee 0.20 1.40 X 0 0 0 Joel Shaughnessy Trustee 0.20 1.40 X 0 0 0 John Flick Trustee 0.20 1.40 X 0 0 0 John Skrzypczak Trustee 0.20 1.40 X 0 0 0 Joyce Fletcher Trustee 0.20 1.40 X 0 0 0 Debra Vescovi Trustee 0.20 1.40 X 0 0 0 Kenneth Pierce Trustee 0.20 1.40 X 0 0 0 Michelle Parker Trustee 0.20 1.40 X 0 0 0 Tina Sbrega Trustee 0.20 1.40 X 0 0 0 Albert Rose Trustee 0.20 1.40 X 0 0 0 Winfield Brown President/CEO 0.20 41.40 X X 0 911200 64820 Michael Abbatiello Chief Financial Officer 0.00 40.00 X 0 20000 42 Robert Crosby Former Chief Financial Officer 0.00 40.00 X 0 346993 31330 0 1556884 103398 0 1 1 0 Hutter Construction Corp PO Box 257 New Ipswich NH 03071 Construction 3659497 SMRT Inc PO Box 618 Portland ME 01404 Architects 167436 A & E Environmental Inc 435 Lancaster Street Leominster MA 01453 Asebestos Removal 117612 3 155531 155531 Rental Income from Aff 531120 100000 100000 100000 332973 0 332973 332973 332973 588504 100000 0 332973 89 89 1178 1178 1 1 130963 130963 72131 72131 204362 204273 89 0 X 214025 554775 19131349 74543 17452367 19056806 1500956 0 19167348 19611581 431659 464002 27748 16660000 16660000 17091659 17151750 X 2075689 2459831 2075689 2459831 19167348 19611581 384142 0 X 0 1 X 1 0 X X X 1 Athol Memorial Hospital 042126583 3 1 204362 0 1 204362 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 18913346 38719 18874627 160014 32683 127331 57989 3141 54848 19056806 X Part X, Line 2: 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. 0 0 0 0 0 0 0 0 0 Elizabeth Nottleson Trustee 0 278691 0 0 0 0 0 5394 0 1812 0 285897 0 0 Winfield Brown President/CEO 0 550259 0 74782 0 286159 0 24600 0 40220 0 976020 0 0 Robert Crosby Former Chief Financial Officer 0 207493 0 12000 0 127500 0 16683 0 14647 0 378323 0 0 Part I, Line 3 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 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). 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 Heywood Healthcare Inc 0 Athol Memorial Hospital 2033 Main Street Athol MA 01331 042126583 Critical Access Hospital MA 501(c)(3) Line 3 Heywood Healthcare Inc 0 Heywood Medical Group 242 Green Street Gardner MA 01440 043163589 Multi-Spec. Physicians MA 501(c)(3) Line 10 Heywood Healthcare Inc 0 Quabbin Healthcare Inc 242 Green Street Gardner MA 01440 812053488 Behavioral Health MA 501(c)(3) Line 12b, II Heywood Healthcare Inc 0 Heywood Realty Corp 242 Green Street Gardner MA 01440 043327447 Prop. Holding Corp MA 501(c)(2) Heywood Healthcare Inc 0 Heywood Healthcare Charitable Foundation Inc 242 Green Street Gardner MA 01440 222720562 Charitable Foundation MA 501(c)(3) Line 7 Heywood Healthcare Inc 0 Winchendon Health Foundation Inc 55 Hospital Drive Winchendon MA 01475 042113276 Community Health Care MA 501(c)(3) Line 12d, III-O N/A 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 1 0 0 0