2016-08-15T13:35:23-05:00 2015-09-30 135381590 BDO USA LLP 200 PORTLAND STREET BOSTON MA 02114 990 2014-10-01 042103577 HARRINGTON MEMORIAL HOSPITAL INC HARR 5087658130 100 SOUTH STREET SOUTHBRIDGE MA 015508002 TOM SULLIVAN CFO 5087658130 2016-08-11 1 JEFFREY T ROGERS P01074284 6177427788 2014 2016-09-27 15:27:22Z TOM SULLIVAN 100 SOUTH STREET SOUTHBRIDGE MA 015508002 133477292 0 X WWW.HARRINGTONHOSPITAL.ORG X 1928 MA CHARITABLE - TO PROVIDE HIGH QUALITY MEDICAL SERVICES IN A COST EFFICIENT AND COST EFFECTIVE MANNER TO THE RESIDENTS OF SOUTH CENTRAL MASSACHUSETTS. 13 11 1391 491 1485177 417513 4964421 1626816 110540735 119960677 3591634 2208069 2674206 3874777 121770996 127670339 0 0 0 0 66856699 68697874 0 0 319205 46745362 48178353 113602061 116876227 8168935 10794112 127115186 124620585 52906925 60380929 74208261 64239656 THE PRIMARY MISSION OF THE HOSPITAL IS TO PROVIDE HIGH QUALITY MEDICAL SERVICES IN A COST EFFICIENT MANNER TO THE RESIDENTS OF SOUTH CENTRAL MASSACHUSETTS. 0 0 47395911 71074279 THE OPERATION OF AN ACUTE CARE HOSPITAL, WHICH HAD OVER 250,000 OUTPATIENT VISITS DURING THE YEAR ENDED SEPTEMBER 30, 2015. 31281250 23381930 THE OPERATION OF AN ACUTE CARE HOSPITAL, WHICH PROVIDED 17,381 DAYS OF INPATIENT CARE DURING THE YEAR ENDED SEPTEMBER 30, 2015. IN FY 2015, THE HOSPITAL HAD 113 BEDS AND 12 NURSERIES. 15897852 27925301 THE OPERATION OF AN ACUTE CARE HOSPITAL, WHICH PROVIDED TREATMENT FOR 41,703 EMERGENCY ROOM VISITS DURING THE YEAR ENDED SEPTEMBER 30, 2015. 94575013 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 0 0 0 1 78 0 1 1391 1 1 1 0 0 0 0 0 0 0 0 0 X 13 11 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 MA X X TOM SULLIVAN 5087658130 100 SOUTH STREET SOUTHBRIDGE MA 015508002 JOSE DINGUI DIRECTOR 1.00 X 0 0 0 KAREN SPIEWAK DIRECTOR 1.00 X 0 0 0 THERESA COLOGNESI PAST CHAIRWOMAN 1.00 X 0 0 0 DAVID TURNER DIRECTOR 1.00 X 0 0 0 ANTHONY M DETARANDO DIRECTOR 1.00 X 0 0 0 PIOTR GRABIAS MD DIRECTOR 1.00 X 0 0 0 ANTHONY JAY DETARANDO VICE CHAIRMAN 1.00 X 0 0 0 JOHN G STAGIAS MD DIRECTOR 1.00 X 0 0 0 FRANCIS POWERS DIRECTOR 1.00 X 0 0 0 JAMES WADDICK CHAIRMAN 1.00 X 0 0 0 LAURANCE MORRISON DIRECTOR 1.00 X 0 0 0 RONALD VAIRO DIRECTOR 1.00 X 0 0 0 MARK PALMERINO SECRETARY 1.00 X 0 0 0 EDWARD MOORE PRESIDENT/CEO 40.00 X 532695 0 316553 THOMAS SULLIVAN VICE PRESIDENT / CFO, TREA 40.00 X 330379 0 12734 DOUGLAS CRAPSER EXECUTIVE VP 40.00 X 216110 0 19574 ARTHUR RUSSO MD VP OF MEDICAL AFFAIRS 32.00 X 294993 0 11540 THOMAS HIJECK VP OF NURSING 40.00 X 199737 0 8541 JAMES SULLIVAN PHYSICIAN 30.00 X 480523 0 34612 JAMES STEPHENS PHYSICIAN 30.00 X 349756 0 20378 JARRETT BURNS PHYSICIAN 30.00 X 366644 0 17532 GIZA HIGH PHYSICIAN 30.00 X 345753 0 23202 MICHAEL GRAY PHYSICIAN 30.00 X 337791 0 12645 3454381 0 477311 85 0 1 0 MONITOR BUILDERS 225 FRIEND STREET BOSTON MA 02114 CONSTRUCTION 7224164 ARAMARK 118 BEACON ST BOSTON MA 02116 BIO-MED/DIETARY/ENVIRO SERVICE 2041768 UMASS MEMORIAL MEDICAL GROUP 91 WATER STREET MILFORD MA 01757 PHYSICIANS 653249 VERSATILE 450 DONALD LYNCH BLVD MARLBOROUGH MA 01752 IT SERVICES 514474 HARVARD MEDICAL FACULTY PHYS INC 1101 BEACON ST 3W BROOKLINE MA 02446 DIAG IMAGING SERVICES 497010 45 1626816 1626816 NET PATIENT SERVICE REVENUE 900099 116776017 115290840 1485177 CONTRACT REVENUE 900099 2516532 2516532 OTHER CLINICAL REVENUE 900099 668128 668128 119960677 2096831 2096831 394330 425563 -31233 -31233 -31233 4939224 553404 4750700 630690 188524 -77286 111238 111238 PHARMACY 900099 2181782 2181782 INCENTIVE PAYMENTS 900099 845776 845776 CAFETERIA REVENUE 900099 674006 674006 204446 204446 3906010 127670339 122381510 1485177 2176836 1608387 1608387 54247747 46993934 7171087 82726 1174668 988294 184634 1740 7942529 6682358 1248408 11763 3724543 3133603 585424 5516 99795 99795 152757 152757 8477396 4346139 4073550 57707 131668 4458 13705 113505 940063 284424 654386 1253 1759620 114747 1644873 6253504 4573259 1665331 14914 157168 127173 29702 293 114746 37740 77006 669813 9252 660561 5827133 4687567 1122575 16991 855033 631898 223135 MEDICAL/SURGICAL SUPPLI 9042627 8979108 63519 PHARMACEUTICALS 6279018 6279018 PHYSICIAN FEES 3599757 3589757 10000 UNRELATED BUSINESS INCO 178260 178260 3639995 3112284 514914 12797 116876227 94575013 21982009 319205 3702232 2254643 14347747 15023894 688989 512309 1759945 2193272 1602585 1603218 133103179 86720739 46195800 46382440 58205760 55613206 612128 1037603 127115186 124620585 21429753 24055826 18320000 17860000 56663 43255 2250000 1155000 10850509 17266848 52906925 60380929 X 66383428 57606780 1159950 535562 6664883 6097314 74208261 64239656 127115186 124620585 X 10794112 -3366388 -17396329 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 63350 63350 0 PART II-B, LINE 1: THE HOSPITAL PAYS DUES TO THE MASSACHUSETTS HOSPITAL ASSOCIATION. THE PORTION OF THE HOSPITAL'S ANNUAL DUES ALLOCATED TO LOBBYING BY THE ASSOCIATION WAS $21,350 FOR THE YEAR ENDED SEPTEMBER 30, 2015. THE HOSPITAL ALSO UTILIZES THE SERVICES OF A CONSULTANT, GOVERNMENT RELATIONS GROUP, FOR GENERAL LOBBYING ON ITS BEHALF AS AN ACUTE CARE COMMUNITY HOSPITAL. TOTAL FEES PAID TO THE GROUP WERE $42,000 FOR THE YEAR ENDED SEPTEMBER 30, 2015. 56747795 1740261 -1790459 1730134 54967463 58646800 4960824 6859829 56747795 52651885 6355235 360320 58646800 44179103 8561095 88313 52651885 48013237 -620226 3213908 44179103 0.88000 0.11000 0.01000 1 0 1032436 1032436 51279706 28652396 22627310 13887331 2466153 11421178 63047754 52821051 10226703 3855952 2781139 1074813 46382440 INVESTMENTS 55613206 F 55613206 ESTIMATED SETTLEMENTS WITH THIRD-PARTY PAYORS 4018996 PENSION LIABILITY 11030114 INTEREST RATE SWAPS 1375151 CAPITAL LEASE OBLIGATION 842587 17266848 X PART V, LINE 4: TO SUPPORT THE OPERATIONS AND FUNCTIONS OF THE ORGANIZATION. PART X, LINE 2: THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AND HAS BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE"), AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. ACCORDINGLY, NO PROVISION FOR FEDERAL INCOME TAXES HAS BEEN RECORDED IN THE ACCOMPANYING FINANCIAL STATEMENTS. IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, THE ORGANIZATION ANNUALLY EVALUATES ITS TAX STATUS AND TAX POSITIONS TAKEN WITH RESPECT TO ITS OPERATIONS AND FINANCIAL POSITION. 1 1 X 1 X 1 X 1 1 1 0 1 1 2372986 821872 1551114 0.01330 27328379 26000566 1327813 0.01140 2568807 2742007 -173200 0.00000 32270172 29564445 2705727 0.02470 2276830 1574052 702778 0.00600 1130359 954183 176176 0.00150 3407189 2528235 878954 0.00750 35677361 32092680 3584681 0.03220 4138 4138 0.00000 137275 137275 0.00120 141413 141413 0.00120 1 1395387 23547558 25880394 -2332836 X 1 1 1 10 N MAIN STREET MEDICAL OFFICE SPACE 0.50000 0.00000 0.00000 2 CENTRAL MASS COMPREHENSIVE CANCER CENTER MEDICAL FACILITY 0.22000 0.00000 0.00000 3 CHARLTON MRI MRI FACILITY 0.50000 0.00000 0.00000 1 1 HARRINGTON MEMORIAL HOSPITAL 100 SOUTH STREET SOUTHBRIDGE MA 015508002 X X X SEE SCHED. O NOTE HARRINGTON MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X 13 1 0 0 1 X WWW.HARRINGTONHOSPITAL.ORG X 1 14 1 HTTP://HARRINGTONHOSPITAL.ORG/FOR-PATIENTS/PATIENT-HEALTH/HEALTH_ASSESSMENT 0 0 1 X 200.000000000000 400.000000000000 X X X 1 1 X X X 1 X WWW.HARRINGTONHOSPITAL.ORG X X X X 1 X X 1 X X X X X X 1 X 0 1 HARRINGTON MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: A TOTAL OF THREE FOCUS GROUPS WERE CONDUCTED WITH INDIVIDUALS REPRESENTING THREE POPULATIONS OF INTEREST IN THE HARRINGTON CATCHMENT AREA: (1) SENIOR CITIZENS (OLDER ADULTS), (2) LATINOS, AND (3) SUBSTANCE USERS IN RECOVERY. HARRINGTON LEADERSHIP CHOSE THESE POPULATIONS BASED ON THEIR IDENTIFICATION AS PARTICULARLY VULNERABLE POPULATIONS IN THE HOSPITAL CATCHMENT AREA. THE SENIOR AND RECOVERY GROUPS WERE COMPRISED OF LAY COMMUNITY MEMBERS, WHILE THE LATINO GROUP CONSISTED OF KEY STAKEHOLDERS REPRESENTING COMMUNITY ORGANIZATIONS SERVING THE LATINO POPULATION. REFER TO THE CHNA FOR FURTHER INFORMATION. HARRINGTON MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: AS NOTED ON ITS WEBSITE, THE HOSPITAL DEVELOPED A STRATEGIC PLAN TO IDENTIFY PROGRAMS AND FUTURE PROJECTS THAT WILL ENABLE THE HOSPITAL TO ADDRESS THE SIGNIFICANT NEEDS IN ITS CHNA. HARRINGTON MEMORIAL HOSPITAL PART V, SECTION B, LINE 18D: REFERRAL TO COLLECTION AGENCY. HARRINGTON MEMORIAL HOSPITAL PART V, SECTION B, LINE 19D: COLLECTION AGENCY ACTIVITIES. HARRINGTON MEMORIAL HOSPITAL PART V, SECTION B, LINE 22D: PATIENT RESPONSIBLE AMOUNTS ARE BASED ON FAMILY SIZE AND RELATIONSHIP OF THE FAMILY'S INCOME TO THE FEDERAL POVERTY GUIDELINES, PER THE HOSPITAL'S UNINSURED RELIEF POLICY. RELIEF IS AVAILABLE FOR INDIVIDUALS WHOSE FAMILY INCOME IS 400% OR LESS OF THE FEDERAL POVERTY GUIDELINES. RELIEF PROVIDED TO THE PATIENT RANGES FROM 100% RELIEF TO 20% RELIEF OF OUTSTANDING AMOUNTS DEPENDING ON FAMILY SIZE AND INCOME LEVEL. HARRINGTON MEMORIAL HOSPITAL PART V, SECTION B, LINE 24: ALL HOSPITAL PATIENTS ARE CHARGED ACCORDING TO THE HOSPITAL'S ESTABLISHED CHARGES FOR SERVICES. IT IS INCUMBENT UPON THE PATIENT TO AVAIL HIMSELF/HERSELF OF RELIEF THROUGH THE HOSPITAL'S UNINSURED RELIEF PROGRAM. PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY HARRINGTON MEMORIAL HOSPITAL PART V, SECTION B, LINE 16A WEBSITE: WWW.HARRINGTONHOSPITAL.ORG PART II, COMMUNITY BUILDING ACTIVITIES: AFTER-CARE NURSES & HOME VISITING PROGRAMSFREE-CARE VANINTERPRETER SERVICESMENTAL HEALTH CLINICPREVENTIVE HEALTH DEPARTMENT (HEALTH EDUCATION, MAMMOGRAMS, ETC.)PROVISION OF MEETING SPACES FOR RECOVERY COMMUNITY MEETINGSSENIOR CITIZEN LUNCHESVETERANS MEALSVOLUNTEER PROGRAM PART III, LINE 2: THE ORGANIZATION USED A RATIO OF ITS TOTAL COSTS TO CHARGES APPLIED TO ITS TOTAL BAD DEBT EXPENSE. PART III, LINE 4: THE ORGANIZATION PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS EQUAL TO ESTIMATED BAD DEBT LOSSES. THE ESTIMATED LOSSES ARE BASED ON HISTORICAL COLLECTION EXPERIENCE TOGETHER WITH A REVIEW OF THE CURRENT STATUS OF EXISTING RECEIVABLES.THE ORGANIZATION USED A RATIO OF ITS TOTAL COSTS TO CHARGES TO CALCULATE THE AMOUNT OF BAD DEBT EXPENSE AT COST. PART III, LINE 8: THE SHORTFALL EXPERIENCED BY THE ORGANIZATION FROM PROVIDING CARE TO MEDICARE BENEFICIARIES SHOULD BE TREATED AS A COMMUNITY BENEFIT AS IT REPRESENTS THE ORGANIZATION'S CONTRIBUTION TO PROVIDING CARE TO THE FRAIL AND ELDER CITIZENS OF THE COMMUNITY IT SERVES BEYOND THE AMOUNT IT RECEIVES FROM THE MEDICARE PROGRAM. THIS CONTRIBUTION LEVEL IS CONSISTENT WITH THE ORGANIZATION'S OVERALL CHARITABLE MISSION TO PROVIDE CARE TO ALL INDIVIDUALS, REGARDLESS OF THE LEVEL OF PAYMENT RECEIVED FOR PROVIDING THAT CARE.THE ORGANIZATION USED A RATIO OF ITS TOTAL COSTS TO CHARGES TO CALCULATE THE ALLOWABLE COSTS RELATED TO MEDICARE REVENUE RECEIVED. PART III, LINE 9B: CO-PAYMENT AND/OR DEDUCTIBLE AMOUNTS FOR NON-EMERGENT OR NON-URGENT SERVICES IN ACCORDANCE WITH EMTALA SHALL BE COLLECTED AT TIME OF SERVICES OR REQUESTED BY SENDING A DAY AFTER LETTER. THE FIRST STATEMENT WILL INCLUDE INFORMATION ABOUT THE AVAILABILITY OF A FINANCIAL ASSISTANCE, MEDICAL HARDSHIP, BUDGETS, AND THE HOSPITAL'S UNINSURED RELIEF PROGRAM THAT MIGHT BE ABLE TO COVER THE COST OF THE HOSPITAL'S BILL, ALONG WITH NOTICE OF A PROMPT PAYMENT DISCOUNT FOR UNINSURED PATIENTS OF 20% IF PAID IN FULL WITHIN 10 BUSINESS DAYS OF RECEIVING THE FIRST STATEMENT. A TOTAL OF 3 STATEMENTS AND A FINAL NOTICE LETTER, TELEPHONE CALL ON ALL ACCOUNTS OVER $500.00, COLLECTION LETTERS, PERSONAL CONTACT NOTICES, DAY AFTER LETTER TO COLLECT COPAY AND/OR DEDUCTIBLE AT TIME OF SERVICES, COMPUTER NOTIFICATIONS, OR ANY OTHER NOTIFICATION METHOD THAT CONSTITUTES A GENUINE EFFORT TO CONTACT THE PARTY RESPONSIBLE FOR THE OBLIGATION. DOCUMENTATION OF ALL COLLECTION EFFORTS TO LOCATE THE PARTY RESPONSIBLE FOR THE OBLIGATION OR THE CORRECT ADDRESS ON BILLINGS. SENDING A FINAL NOTICE BY CERTIFIED MAIL FOR UNINSURED PATIENTS (THOSE WHO ARE NOT ENROLLED IN A PUBLIC PROGRAM SUCH AS THE HEALTH SAFETY NET OR MASSHEALTH). THE HOSPITAL SHALL NOT ASSIGN A PATIENT'S ACCOUNTS FOR COLLECTION TO AN OUTSIDE AGENCY PRIOR TO 120 DAYS AFTER THE INITIAL BILL. CHECKING THE ELIGIBILITY VERIFICATION SYSTEM (EVS) TO ENSURE THAT THE PATIENT IS NOT A LOW INCOME PATIENT AS DETERMINED BY THE OFFICE OF MEDICAID AND HAS NOT SUBMITTED AN APPLICATION TO THE VIRTUAL GATEWAY SYSTEM FOR COVERAGE OF THE SERVICES UNDER A PUBLIC PROGRAM, PRIOR TO SUBMITTING CLAIMS TO THE HEALTH SAFETY NET OFFICE FOR EMERGENCY BAD DEBT COVERAGE OF AN EMERGENCY LEVEL OR URGENT CARE SERVICE. THE FOLLOWING INDIVIDUALS AND PATIENT POPULATIONS ARE EXEMPT FROM ANY COLLECTION OR BILLING PROCEDURES BEYOND THE INITIAL BILL PURSUANT TO STATE REGULATIONS: PATIENTS ENROLLED IN A PUBLIC HEALTH INSURANCE PROGRAM, INCLUDING BUT NOT LIMITED TO, MASSHEALTH, EMERGENCY AID TO THE ELDERLY, DISABLED AND CHILDREN, HEALTHY START, CHILDREN'S MEDICAL SECURITY PLAN, "LOW INCOME PATIENTS" AS DETERMINED BY THE OFFICE OF MEDICAID, SUBJECT TO CERTAIN EXCEPTIONS AS DESCRIBED IN ITS CREDIT AND COLLECTION POLICY. PART VI, LINE 2: IN NEEDING TO CREATE A NEW HEALTH ASSESSMENT FOR 2011-2013, AN EXTERIOR COMMITTEE WAS FORMED IN 2009 - CONSISTING OF SEVEN MEMBERS, RANGING FROM THOSE IN THE MEDICAL FIELD TO COMMUNITY LIAISONS AND TOWN/LEAGUE REPRESENTATIVES, INCLUDING A CURRENT HARRINGTON HOSPITAL BOARD MEMBER. MEETINGS WERE HELD APPROXIMATELY ONCE PER MONTH FROM JANUARY-DECEMBER 2010, NOT INCLUDING ADDITIONAL EMAIL COMMUNICATION.SURVEY DESIGNED AND IMPLEMENTED IN 2010. COMMITTEE UTILIZED THIRD-PARTY RESOURCES TO ORIGINATE INITIAL DATA ON REGION. 20 QUESTION SURVEY DESIGNED AND DISTRIBUTED TO SEVEN OF THE MAJOR TOWNS HARRINGTON SERVICES. THE SURVEY INCLUDED DEMOGRAPHIC INDICATORS (AGE, INCOME, HOUSEHOLD MEMBERS, ETHNICITY, ZIP CODE OF RESIDENCE, GENDER, EDUCATION LEVEL) AND COMMUNITY HEALTH INDICATORS. MOST QUESTIONS RANKED HEALTH CONDITIONS ON A 1-5 SCALE AND INCLUDED RATING CONDITIONS/ISSUES IN ORDER OF PRIORITY FOR FUNDING, AND A SEPARATE HEALTH CONDITION ANALYSIS FOR YOUTH AND SENIORS.IN 2013, HARRINGTON RECOGNIZED THE NEED TO UPDATE ITS ASSESSMENT DATA AND COMMUNITY INFORMATION FROM THE PREVIOUS STUDY. A FIVE MEMBER COMMITTEE WAS ORGANIZED IN EARLY 2013. THE GROUPS' LEADERSHIP CAME FROM THE HARRINGTON MARKETING DEPARTMENT. MEMBERS REPRESENTED COMMUNITY LIAISONS, HEALTH PROFESSIONALS AND TOWN/LEAGUE REPRESENTATIVES, INCLUDING CURRENT HARRINGTON HOSPITAL BOARD MEMBER. MEETINGS WERE HELD FROM JANUARY TO DECEMBER.THE COMMITTEE ENLISTED THE ASSISTANCE OF THE INSTITUTE FOR COMMUNITY HEALTH OUT OF BOSTON TO COLLECT, ANALYZE AND PRODUCE A WRITTEN REPORT ON THE HEALTH DEFICITS IN HARRINGTON'S TWENTY ZIP CODE CATCHMENT AREA. THIS ASSESSMENT INVOLVED A MIXED-METHODS APPROACH INCLUDING EXTENSIVE REVIEW OF SECONDARY COMMUNITY DATA SOURCES ACROSS A VARIETY OF SOCIO-DEMOGRAPHIC AND HEALTH INDICATORS FOR THE CATCHMENT AREA COMPARED TO THE STATE OF MASSACHUSETTS, AS WELL AS THREE FOCUS GROUPS WITH A TOTAL OF 24 COMMUNITY RESIDENTS AND KEY STAKEHOLDERS BELONGING TO KEY POPULATIONS OF INTEREST: SENIOR CITIZENS, LATINOS, AND SUBSTANCE USERS IN RECOVERY. FOR SECONDARY DATA GATHERING, TOP HEALTH CONCERNS FOR THE CATCHMENT AREA WERE PRIORITIZED BASED ON THE AVERAGE PERCENT DIFFERENCE COMPARED TO MASSACHUSETTS ACROSS SECONDARY DATA INDICATORS. KEY THEMES IDENTIFIED THROUGH THE THREE FOCUS GROUPS WERE ALSO CONSIDERED. TOP HEALTH CONCERNS THAT EMERGED INCLUDED CARDIOVASCULAR DISEASE/RESPIRATORY HEALTH, DIABETES, OBESITY, CANCER MORTALITY, MENTAL HEALTH, AND TEEN PREGNANCY. ADDITIONAL COMMUNITY-WIDE CONCERNS WERE ALSO IDENTIFIED THROUGH THE THREE FOCUS GROUPS CONDUCTED: CRIME AND SAFETY, ESPECIALLY AMONGST YOUTH; SOCIAL CONCERNS AFFECTING YOUTH, ESPECIALLY LACK OF POSITIVE COMMUNITY ACTIVITIES FOR YOUTH; AND SUBSTANCE ABUSE, INCLUDING PRESCRIPTION DRUG ABUSE AND NEWER DRUG USE AMONGST YOUTH. PART VI, LINE 3: FOR THOSE PATIENTS WHO ARE UNINSURED OR UNDERINSURED, THE HOSPITAL AND ITS FINANCIAL COUNSELORS WILL WORK WITH THEM TO ASSIST WITH APPLYING FOR AVAILABLE FINANCIAL ASSISTANCE PROGRAMS THAT MAY COVER SOME OR ALL OF THEIR UNPAID HOSPITAL BILLS. IN ORDER TO HELP UNINSURED AND UNDERINSURED PATIENTS FIND AVAILABLE AND APPROPRIATE FINANCIAL ASSISTANCE PROGRAMS, THE HOSPITAL WILL PROVIDE ALL PATIENTS WITH A GENERAL NOTICE OF THE AVAILABILITY OF PROGRAMS IN BOTH THE INITIAL BILL THAT IS SENT TO PATIENTS AS WELL AS IN GENERAL NOTICES THAT ARE POSTED THROUGHOUT THE HOSPITAL. THE GOAL OF THESE NOTICES IS TO ASSIST PATIENTS IN APPLYING FOR COVERAGE WITHIN A FINANCIAL ASSISTANCE PROGRAM, SUCH AS MASSHEALTH, COMMONWEALTH CARE, CHILDREN'S MEDICAL SECURITY PLAN, HEALTHY START, HEALTH SAFETY NET, OR MEDICAL HARDSHIP THROUGH THE HEALTH SAFETY NET. THE HOSPITAL WILL PROVIDE, UPON REQUEST, SPECIFIC INFORMATION ABOUT THE ELIGIBILITY PROCESS TO BE A LOW INCOME PATIENT UNDER EITHER THE MASSACHUSETTS HEALTH SAFETY NET PROGRAM OR ADDITIONAL ASSISTANCE FOR PATIENTS WHO ARE LOW INCOME THROUGH THE UNINSURED RELIEF PROGRAM. THE HOSPITAL WILL ALSO NOTIFY THE PATIENT ABOUT AVAILABLE PAYMENT PLANS THAT MAY BE AVAILABLE TO THEM BASED ON THEIR FAMILY SIZE AND INCOME. THE HOSPITAL SHALL POST A NOTICE (SIGNS) OF AVAILABILITY OF FINANCIAL ASSISTANCE IN THE FOLLOWING LOCATIONS:I. INPATIENT, CLINIC, AND EMERGENCY DEPARTMENT ADMISSION AND/OR REGISTRATION AREAS;II. PATIENT FINANCIAL COUNSELOR AREAS;III. CENTRAL ADMISSION/REGISTRATION AREAS; ANDIV. BUSINESS OFFICE AREAS THAT IS OPEN TO PATIENTS. PART VI, LINE 4: THE HARRINGTON HEALTHCARE SYSTEM CATCHMENT AREA FOCUSED ON FOR THE ASSESSMENT IS LOCATED PRIMARILY IN THE SOUTHERN REGION OF CENTRAL MASSACHUSETTS, AND INCLUDES 17 MASSACHUSETTS COMMUNITIES (BRIMFIELD, BROOKFIELD, CHARLTON, DOUGLAS, DUDLEY, EAST BROOKFIELD, HOLLAND, NORTH BROOKFIELD, OXFORD, PALMER, SOUTHBRIDGE, SPENCER, STURBRIDGE, WALES, WARREN, WEBSTER, WEST BROOKFIELD) AS WELL AS TWO COMMUNITIES (THOMPSON AND WOODSTOCK) IN NORTHERN CONNECTICUT. PART VI, LINE 5: REFER TO THE CHNA AND HOSPITAL WEBSITE FOR FURTHER DETAILS. PART VI, LINE 6: NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM PART VI, LINE 7, REPORTS FILED WITH STATES MA X X 0 1 0 0 0 0 0 0 0 EDWARD MOORE PRESIDENT/CEO 438795 0 70463 0 23437 0 303553 0 13000 0 849248 0 0 0 THOMAS SULLIVAN VICE PRESIDENT / CFO, TREA 279050 0 33421 0 17908 0 10400 0 2334 0 343113 0 0 0 DOUGLAS CRAPSER EXECUTIVE VP 201803 0 14307 0 0 0 6965 0 12609 0 235684 0 0 0 ARTHUR RUSSO MD VP OF MEDICAL AFFAIRS 253047 0 23933 0 18013 0 10081 0 1459 0 306533 0 0 0 THOMAS HIJECK VP OF NURSING 181841 0 17896 0 0 0 7262 0 1279 0 208278 0 0 0 JAMES SULLIVAN PHYSICIAN 455523 0 25000 0 0 0 10400 0 24212 0 515135 0 0 0 JAMES STEPHENS PHYSICIAN 349756 0 0 0 0 0 7800 0 12578 0 370134 0 0 0 JARRETT BURNS PHYSICIAN 338644 0 28000 0 0 0 10400 0 7132 0 384176 0 0 0 GIZA HIGH PHYSICIAN 314753 0 31000 0 0 0 10312 0 12890 0 368955 0 0 0 MICHAEL GRAY PHYSICIAN 310791 0 27000 0 0 0 10385 0 2260 0 350436 0 0 0 PART I, LINE 4B EDWARD MOORE PARTICIPATES IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN, WHICH WAS CREDITED WITH $293,153 IN DEFERRED COMPENSATION FOR CALENDAR YEAR 2014. THOMAS SULLIVAN PARTICIPATES IN A 457F PLAN, WHICH WAS CREDITED WITH $9,300 IN DEFERRED COMPENSATION FOR CALENDAR YEAR 2014. ARTHUR RUSSO PARTICIPATES IN A 457F PLAN, WHICH WAS CREDITED WITH $2,053 IN DEFERRED COMPENSATION FOR CALENDAR YEAR 2014. A MASSACHUSETTS HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 042456011 57586C7U3 2008-06-26 20000000 CONSTRUCTION AND RENOVATIONS 0 0 0 A 20950278 2037221 306250 20497287 94106 358885 0 0 0 1 A 0 0 0 0 0 0 1 A 0 0 0 0 1 1 PIPER JAFFRAY FINANCIAL PRODUCTS 15.000000000000 0 0 0 1 0 A 0 JRD REALTY TRUST TRUSTEES OF THE TRUST ARE INDIVIDUAL BOARD MEMBERS OF THE HOSPITAL. 279478 THE HOSPITAL LEASED SPACE OWNED BY THE JRD REALTY TRUST, THE TRUSTEES OF WHICH ARE ANTHONY M. DETARANDO AND ANTHONY J. DETARANDO, BOTH OF WHOM ARE INDIVIDUAL BOARD MEMBERS OF THE HOSPITAL. 0 FORM 990, PART VI, SECTION A, LINE 2 BOARD MEMBERS ANTHONY M. DETARANDO AND ANTHONY JAY DETARANDO ARE RELATED AS FATHER AND SON. FORM 990, PART VI, SECTION A, LINE 6 THE HOSPITAL'S SOLE CORPORATE MEMBER IS HARRINGTON HEALTHCARE SYSTEM, INC. FORM 990, PART VI, SECTION A, LINE 7A THE HOSPITAL'S SOLE CORPORATE MEMBER IS HARRINGTON HEALTHCARE SYSTEM, INC. FORM 990, PART VI, SECTION A, LINE 7B THE HOSPITAL'S SOLE CORPORATE MEMBER IS HARRINGTON HEALTHCARE SYSTEM, INC. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PREPARED BY THE HOSPITAL'S OUTSIDE INDEPENDENT ACCOUNTANT WITH INFORMATION GIVEN TO THEM BY THE HOSPITAL STAFF. AFTER COMPLETION, IT IS REVIEWED BY THE HOSPITAL'S CONTROLLER AND VP OF FINANCE BEFORE BEING PRESENTED TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 12C THE CORPORATION REQUIRES THAT ALL EMPLOYEES, AND MEMBERS AND OFFICERS OF THE BOARD OF DIRECTORS OF THE CORPORATION AND ANY MEMBER OF ANY COMMITTEE DISCLOSE IN WRITING (AND UPDATE ANNUALLY) ALL BUSINESS AND OTHER RELATIONSHIPS WHICH MIGHT POTENTIALLY CREATE A CONFLICT OF INTEREST AND ALL CONFLICTS OF INTEREST AS DEFINED BY THE POLICY. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS REVIEW AND APPROVE THE COMPENSATION OF THE CEO AND TOP MANAGEMENT. THE CEO REVIEWS AND APPROVES TOP MANAGEMENT SALARIES. TOP MANAGEMENT WILL THEN REVIEW AND APPROVE KEY EMPLOYEE SALARIES. FORM 990, PART VI, SECTION C, LINE 18 THE HOSPITAL MAKES ITS FORM 990 AND 990-T AVAILABLE TO THE PUBLIC UPON REQUEST. ADDITIONALLY, THE HOSPITAL'S FORM 990 AND 990-T ARE AVAILABLE ON THE PUBLIC CHARITIES WEBSITE MAINTAINED BY THE COMMONWEALTH OF MASSACHUSETTS ATTORNEY GENERAL. FORM 990, PART VI, SECTION C, LINE 19 THE HOSPITAL MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. ADDITIONALLY, THE HOSPITAL'S FINANCIAL STATEMENTS ARE AVAILABLE ON THE PUBLIC CHARITIES WEBSITE MAINTAINED BY THE COMMONWEALTH OF MASSACHUSETTS ATTORNEY GENERAL. FORM 990, PART XI, LINE 9: ADJUSTMENT TO MINIMUM PENSION LIABILITY -6,812,576. EQUITY TRANSFERS TO AFFILIATE -10,432,861. UNREALIZED LOSS ON INTEREST RATE SWAP AGREEMENT -150,892. HARRINGTON PHYSICIAN SERVICES INC 100 SOUTH STREET SOUTHBRIDGE MA 015508002 134366504 HEALTHCARE SERVICES MA 501(C)(3) 9 HARRINGTON HEALTHCARE SYSTEM INC 0 HARRINGTON HEALTHCARE SYSTEM INC 100 SOUTH STREET SOUTHBRIDGE MA 015508002 800518491 HEALTHCARE SUPPORT MA 501(C)(3) 9 0 CHARLTON MRI SERVICES LLC 10 NORTH MAIN STREET CHARLTON MA 01507 000993849 HEALTHCARE SERVICES MA BIH RADIOLOGIC FOUNDATION INC RELATED 0 0 CENTRAL MASSACHUSETTS COMPREHENSIVE CANCER CENTER LLC 55 SAYLES STREET SOUTHBRIDGE MA 01550 261795998 HEALTHCARE SERVICES MA NEW ENGLAND RADIATION THERAPY MANAGEMENT SERVICES INC RELATED 157262 547309 0 0 10 NORTH MAIN STREET LLC 10 NORTH MAIN STREET CHARLTON MA 01507 000000001 HEALTHCARE SERVICES MA COMPASS DEVELOPMENT LLC RELATED 193873 2654458 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 HARRINGTON PHYSICIAN SERVICES INC R 10432861 COST