2015-08-13T07:46:31-05:00 2014-09-30 010494526 BAKER NEWMAN & NOYES PO BOX 507 PORTLAND ME 04112 990 2013-10-01 222520073 Holyoke Medical Center Inc HOLY 4135342667 575 Beech Street Holyoke MA 010402223 Paul M Silva Chief Financial Officer 4135342667 2015-08-07 Nicholas E Porto P01310283 2078792100 2015-08-07 2013 2016-02-25 16:41:14Z Spiridon E Hatiras 575 Beech Street Holyoke MA 010402223 128697422 0 X www.holyokehealth.com X 1984 MA Acute care hospital, providing medical and other healthcare services to residents of Holyoke, MA and the surrounding areas. 14 9 1376 211 2290207 84076 257497 763167 106746805 125026193 185001 260089 13609288 2441109 120798591 128490558 4500 4500 0 0 77514201 79378511 0 0 0 38826147 42701027 116344848 122084038 4453743 6406520 65122039 64985353 56483031 61011284 8639008 3974069 X To serve the health needs of the community in a high quality and efficient manner. 0 0 98782032 4500 125026193 Holyoke Medical Center, Inc. (HMC) strives to serve the health needs of their medical service community in a high quality and efficient manner. See Schedule O for additional information.To this end, HMC shall: (1) provide compassionate care to all of whom it serves with a commitment to developing cultural diversity and competencies in our programs and workforce so that we may better serve our patients; (2) identify and serve those needs which are prevalent and substantial in the community as a whole, or within major population groups, and which can be adequately met by the provision of basic primary and secondary health care services; (3) provide information, education, and expertise to our community in order to promote the general health of its citizens; (4) provide an environment of excellence and growth in which health care professionals can use their skills and abilities to the fullest extent possible; (5) provide competitive wages and benefits, as well as safe and dignified working conditions, for all employees; (6) ensure financial responsibility in the operation of the medical center in order to guarantee the future viability of our mission; (7) provide a formal, public, and ongoing program of community benefits, in cooperation with community individuals and organizations, to improve the health status of the public including especially the medically and economically vulnerable. Holyoke Medical Center, Inc. provided inpatient, outpatient, and emergency healthcare services and certain physician services to the residents of Holyoke, Massachusetts and the surrounding communities. Inpatient healthcare services included medical, surgical, critical care, cardiac, obstetrical, psychiatric, and oncology services. During FY 2014, HMC provided 24,019 patient days of inpatient services with 5,591 discharges. Outpatient healthcare services included a full array of diagnostic, therapeutic, and behavioral health services. During FY 2014, HMC had 235,085 outpatient visits. Emergency services were provided by a 24-hour emergency department. During FY 2014, HMC had 41,987 emergency department visits. 98782032 1 1 0 1 0 0 0 0 0 1 1 0 1 0 1 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 1 0 0 0 1 187 0 1376 1 1 1 0 0 0 0 0 0 0 0 0 X 14 9 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X Paul M Silva 4135342667 575 Beech Street Holyoke MA 010402223 X William Andrews Director (part year) 0.50 0.50 X 0 0 0 M Saleem Bajwa MD Director 0.50 X 0 0 0 Deborah A Buckley Director 0.50 1.00 X 0 0 0 Shannon Gurek Director 0.50 X 0 0 0 Kathleen Hankel Director 0.50 0.50 X 0 0 0 Marc Joyce Director 0.50 0.50 X 0 0 0 Priscilla Mandrachia Director 0.50 2.00 X 0 0 0 Mary Jo Maydew Director 0.50 X 0 0 0 Doris Ransford Director 0.50 0.50 X 0 0 0 Richard J Wells Director (part year) 0.50 0.50 X 0 0 0 Robert Byrne MD Director 0.50 X 0 0 0 Martin Schoenemann CPA Director (part year) 0.50 0.50 X 0 0 0 Vijay V Gandevia MD Director (part year) 50.00 X 410827 0 18877 Joseph Peters Director (part year) 0.50 X 0 0 0 Anthony Soto Director (part year) 0.50 1.00 X 0 0 0 Donald Graham Director (part year) 0.50 0.50 X 0 0 0 Karen Ferroni MD Director/Medical Director 50.00 X 274245 0 18761 Theodore Mlapah MD Director/VP, Medical Staff 50.00 X 411065 0 19093 Peter C Connor Chair 1.00 2.00 X X 0 0 0 Idelia Smith Vice Chair 1.00 X X 0 0 0 Spiridon E Hatiras President & CEO, Clerk 40.00 6.50 X X 0 179133 4392 Paul M Silva Treasurer, VP of Finance 40.00 6.50 X 251776 0 16289 Noah J Epstein MD Orthopedic Surgeon 50.00 X 571020 0 19548 Nirav R Sheth MD Cardiologist 50.00 X 496263 0 19413 Anthony L Rhodes MD Orthopedic Surgeon 50.00 X 459720 0 19347 Khaled A Instrum Orthopedic Surgeon 50.00 X 456869 0 19342 Mary E Norris MD Gastroenterologist 50.00 X 450042 0 19330 Hank J Porten Former President & CEO 0.00 X 0 961972 20790 Antonio Correia Former Treasurer 22.00 8.00 X 0 284908 16890 Kathleen M Buckley Former Key Employee 50.00 X 209668 0 14205 Clark A Fenn Former Key Employee 50.00 X 224529 0 16492 James M Keefe Former Key Employee 50.00 X 220386 0 16270 Kevin F Neill Former Key Employee 50.00 X 251534 0 16670 Michael A Zwirko Former Key Employee 50.00 X 244893 0 16626 4932837 1426013 292335 98 1 1 0 H-C Management Services Inc 20 Hospital Drive Holyoke MA 01040 Management Services 1316006 Quest Diagnostics Nichols Institute 14225 Newbrook Drive Chantilly VA 201512228 Laboratory Services 706295 Executive Health Resources Inc 3797 Momentum Place Chicago IL 606895337 Physician Advisory Services 627174 PST Services Inc 5995 Windward Parkway Alpharetta GA 300054184 Billing Services 517648 A&P Coat Apron & Linen Supply 161 South Macquesten Parkway Mount Vernon NY 10550 Laundry Services 511236 31 500000 263167 763167 Patient Service Revenue 621110 112308862 112308862 Miscellaneous Revenue 621110 10448915 10448915 Meaningful Use Revenue 621110 1373128 1373128 Affiliate Rent 531110 563067 563067 Food Services/Coffee Shop 561000 332221 332221 125026193 254814 254814 375458 206864 168594 168594 17692 150902 5275 0 5275 5275 5275 Non-Patient Lab Revenue 621500 2272515 2272515 2272515 128490558 125026193 2290207 410991 4500 4500 1404644 521559 883085 65511034 56378775 9132259 68637 58341 10296 7730744 6562623 1168121 4663452 3963934 699518 1316006 1316006 72627 23435 49192 134892 134892 46670 46670 7891156 3344222 4546934 175385 9183 166202 4244135 3368023 876112 1323138 685665 637473 2275259 2025949 249310 110230 69924 40306 467394 467394 3926762 2286756 1640006 2086273 1160352 925921 Medical Supplies 11469501 11469501 Bad Debt Expense 5488034 5488034 Laboratory Tests 983477 983477 690088 377779 312309 122084038 98782032 23302006 0 8094151 133640 11805455 13899141 12780591 730996 762064 1207375 974044 132207579 103458498 30574726 28749081 2562927 2858895 6496159 4187879 0 17389 1556564 2716315 65122039 64985353 18111978 19240157 3092833 0 7162010 6034468 28116210 35736659 56483031 61011284 X 4073142 -833964 2118510 2400148 2447356 2407885 8639008 3974069 65122039 64985353 X 6406520 214417 -11285876 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 46670 0 0 0 46670 0 Part II-B, Line 1: The Hospital hires outside consultants from time to time to perform services to further the Hospital's and the other System organizations' mission. A portion of those consulting fees paid to each firm was designated for lobbying endeavors. Smith & Rauschenbach was paid a total of $2,500 by the Hospital related to lobbying activities for the System. Ellen Murphy & Associates was paid a total of $25,500 by the Hospital related to lobbying activities for the System. The Hospital was also a member of the American Hospital Association and the Massachusetts Hospital Association during the fiscal year. A portion of the dues paid to the Massachusetts Hospital Association was available for lobbying expenditures on behalf of the Hospital and the other System organizations in furtherance of their exempt purposes. The portion of dues used for lobbying were $18,670. The Hospital did not pay any dues to the American Hospital Association in FY 2014. 1392894 108387 420 1500861 1315055 165085 86886 360 1392894 1105474 209881 300 1315055 1154521 -18890 29827 330 1105474 1087014 95984 28477 1154521 0.00000 0.30630 0.69370 0 1 1 2772196 2772196 58871324 41273908 17597416 68915384 60852395 8062989 1648675 1332195 316480 28749081 Beneficial Interest - VHS 4187879 F 4187879 Accrued Pension Cost 35555988 Asset Retirement Obligation 180671 35736659 X 114582930 214417 315856 530273 114052657 14437901 14437901 128490558 116802869 206865 206865 116596004 5488034 5488034 122084038 Part V, Line 4: The endowment funds are held and administered by Valley Health Systems, Inc. The intended use of the funds is to provide a predictable, stable, and consistent stream of earnings for Holyoke Medical Center, Inc. to be used for free care and general operations. Part X, Line 2: The Medical Center is exempt from federal and state income taxes under Section 501(c)(3) of the Internal Revenue Code. Accordingly, no provision has been made for income taxes within the financial statements. Tax-exempt organizations could be required to record an obligation for income taxes as a result of a tax position they have historically taken on various tax exposure items including unrelated business income or tax status. Under guidance issues by the Financial Accounting Standards Board (FASB), assets and liabilities are established for uncertain tax positions taken or positions expected to be taken in income tax returns when such positions are judged to not meet the "more-likely-than-not" threshold, based upon the technical merits of the position. Estimated interest and penalties, if applicable, related to uncertain tax positions are included as a component of income tax expense. Part XI, Line 2d - Other Adjustments: Change in Beneficial Interest - VHS 108,991. Rental Expenses 206,865. Part XI, Line 4b - Other Adjustments: Pension Related Charges 8,949,867. Bad Debt Expense 5,488,034. Part XII, Line 2d - Other Adjustments: Rental Expenses 206,865. Part XII, Line 4b - Other Adjustments: Bad Debt Expense 5,488,034. 1 1 1 X 1 X 1 1 0 1 1 7285 2658388 818749 1839639 0.01580 71749 36580364 33453227 3127137 0.02680 79034 39238752 34271976 4966776 0.04260 55 18936 870522 870522 0.00750 1 26 241 241 0.00000 4 528 4158874 3066127 1092747 0.00940 1 2375000 2375000 0.02040 61 19490 7404637 3066127 4338510 0.03730 61 98524 46643389 37338103 9305286 0.07990 2 40 47213 47213 0.00040 2 40 47213 47213 0.00040 1 2475103 0 34901539 31704167 3197372 X 1 1 1 1 Holyoke Medical Center Inc 575 Beech Street Holyoke MA 01040 www.holyokehealth.com 2145 X X X Holyoke Medical Center Inc 1 1 X X X X X X X X X 13 1 1 1 X see Part V, Section C X X X X X X 0 0 1 1 200.000000000000 1 400.000000000000 1 X X X X X X 1 1 X X X X 1 0 X X X X 1 X X 0 1 Holyoke Medical Center, Inc. Part V, Section B, Line 3: Verite Healthcare Consulting met with community stakeholders, including 11 public health officials and experts; 16 individuals affiliated with Health Departments or Agencies; and various other community leaders and HMC-affiliated clinicians, administrators, and staff during a series of interviews and "listening sessions" to review and respond to preliminary findings.Additionally, HMC collaborated with organizations that participated in a "Design Team" established to develop the CHNA. Representatives from community organizations, regional government, and public health departments particiated in this Team.Finally, a community survey was conducted as a major element of the CHNA, garnering responses from 1,083 community members. Survey results were post-stratified to accurately reflect the community's demographics. Responses were also assessed by race, insurance status, and education status. Holyoke Medical Center, Inc. Part V, Section B, Line 4: Holyoke Medical Center, Inc. is a member of the Coalition of Western Massachusetts Hospitals, which also includes Baystate Medical Center, Baystate Mary Lane Hospital, Baystate Franklin Medical Center, Mercy Medical Center, Cooley Dickinson Hospital, and Wing Memorial Hospital. The Coalition hospitals collaborated in preparing their CHNAs. Holyoke Medical Center, Inc. Part V, Section B, Line 7: Holyoke Medical Center, Inc. prioritized services based on resources and duplication of services from other community organizations. The following needs identified in HMC's most recently conducted community health needs assessment that have not been addressed and the reasons why are: 1. Dental health - lack of access to dental care: this service is being provided by the Holyoke Health Center; 2. Health behaviors - high rates of alcohol and drug use/high rates of unsafe sex, teen pregnancy, and chlamydia: these needs are being met by HMC's sister organization, River Valley Counseling Center, Inc.; 3. Maternal and child health - prevalent infant health risk factors: HMC has not discovered an avenue to capture pre-natal patients at this time; 4. Maternal and child health - pediatric disability: HMC does not offer in-house pediatric services; 5. Physical environment - poor community safety/poor built environment and environmental quality: these issues are already addressed by the Holyoke Safe Neighborhoods Initiative; 6. Social and economic factors - basic needs insecurity: financial hardship, housing, and food access: many of these issues are already addressed by the South Holyoke Safe Neighborhoods Initiative. Holyoke Medical Center, Inc. Part V, Section B, Line 20d: It is the policy of Holyoke Medical Center to charge all patients with and without insurance its standard rates on file with the Commonwealth of Massachusetts Division of Heathcare and Policy. The amount ultimately collected will vary depending on the Federal or State financial assistance program for which the patient qualifies or under the terms of the contract negotiated with the patient's insurance company. The amount ultimately collected from patients without insurance is handled on a case-by-case basis. Effective July 1, 2012, Holyoke Medical Center implemented a hospital specific financial assistance program which provides a discount to qualified patients (patients that meet certain financial requirements and do not qualify for a Federal or State program) and provides a discount consistent with Medicare. Holyoke Medical Center, Inc. Part V, Section B, Line 22: It is the policy of Holyoke Medical Center to charge all patients with and without insurance its standard rates on file with the Commonwealth of Massachusetts Division of Healthcare and Policy. Schedule H, Part V, Section B, line 5a: The CHNA is available at the Hospital facility's website: http://www.holyokehealth.com/uploadedFiles/Content/Holyoke%20Medical%20Center%20CHNA%205%2022%2013%20Final.pdf Part I, Line 3c: Not Applicable. Part I, Line 6a: Not Applicable. Part I, Line 7: Holyoke Medical Center, Inc. used the cost-to-charge ratio method in determining the cost of health services provided. Holyoke Medical Center, Inc. derived this cost-to-charge ratio based on the total patient care expense, after step-down adjustment, divided by gross patient charges per the Medicare 2552 cost report. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 5,488,034. Part II, Community Building Activities: Holyoke Medical Center, Inc. provides a variety of community sponsorships and ongoing relationships with local community organizations. Our goals for those sponsorships and/or team building are to help support cultural and healthy lifestyle events, whether it be to support youth sports teams, celebrate youth academic leaders and their families and teachers, or support of a community celebration. Our intended outcome is to make this a healthier and more lively community.The majority of our community support is a result of requests from civic, social, and athletic groups within our community. As an example, working with three community partners, Holyoke Medical Center, Inc. staff help coordinate a children's grant to specifically assist speech and language screening and education for children and parents in the community for children with speech and hearing difficulties. Working with our partners, this program helps assist families with obtaining public school services for their children. Our ongoing involvement helps oversee budgets and assure flow to appropriate allocation of funds to those community services which will support those children and their families for speech, occupational and physical therapy, behavioral counseling, therapeutic play, hearing screenings, family literacy, and nutrition. In addition, HMC also partners with a variety of local community agencies to help oversee specific grants that have been awarded for the broader community for children with childhood developmental delays in their cognitive speech and hearing. Family support and teaching pre-school and grammar school educational programs for teachers are held to assist in minimizing the delays that these children would otherwise undergo without this service. Part III, Line 2: Holyoke Medical Center, Inc. utilizes a costing methodology in which the ratio of patient care cost to charges is applied to the bad debt expense attributable to patient accounts to calculate the estimated cost of bad debt attributable to patient accounts that is reported on Line 2. Discounts and payments on patient accounts are recorded as adjustments to revenue, not bad debt expense. Part III, Line 3: Not Applicable. Part III, Line 4: See Page 9 of the attached audited financial statements. Part III, Line 8: Holyoke Medical Center, Inc. utilizes generally accepted accounting principles in the preparation of its financial statements.Holyoke Medical Center, Inc. used the cost-to-charge ratio method in determining the cost of health services provided. Holyoke Medical Center, Inc. derived this cost-to-charge ratio based on the total patient care expense, after step-down adjustment, divided by gross patient charges per the Medicare 2552 Cost Report. Part III, Line 9b: Populations Exempt from Collection Action - The following individuals and patient populations are exempt from any collection actions pursuant to the Massachusetts Health Safety Net Program (HSN) regulations:a. Patients enrolled in, receiving benefits from, or participating in a public health insurance program, including but not limited to MassHealth, Emergency Aid to the Elderly, Disabled and Children (EAEDC), Healthy Start, Children's Medical Security Plan (CMSP (provided the patient's family income is equal to or less than 400% of the FPL)), and low income patients subject to the following:(1) Holyoke Medical Center, Inc. may initiate Collection Action against any patient enrolled in, receiving benefits from, or participating in MassHealth, EAEDC or Healthy Start, and any low income patient, for their required co-payments and deductibles as set forth by each specific program.(2) Holyoke Medical Center, Inc. may also initiate collection action for a patient who alleges that he or she is a participant in MassHealth, EAEDC, Health Start or CMSP but fails to provide proof of such participation. Upon receipt of satisfactory proof that a patient is a participant in such a program (including, in the case of MassHealth, EAEDC or Healthy Start, receipt or verification of a signed application), Holyoke Medical Center, Inc. shall cease billing or collection activities.(3) Low income patients are exempt from Collection Action for Eligible Services (as defined by HSN regulations from time-to-time) they receive during the period for which they have low income patient status.(4) Low income patients with family income between 200% and 400% of FPL are exempt from collection action for the portion of their Holyoke Medical Center, Inc. bill that exceeds the patient's deductible. However, Holyoke Medical Center, Inc. may initiate collection action against patients for their required co-payments and deductibles.(5) Holyoke Medical Center, Inc. may continue collection action on any low income patient for services rendered prior to the low income patient determination, provided that the patient's low income patient status has been terminated or expired. However, once a patient is determined to be eligible and enrolled in the Health Safety Net, MassHealth or certain Commonwealth Care programs, Holyoke Medical Center, Inc. will cease collection action for services rendered prior to the beginning of their eligibility.(6) Holyoke Medical Center, Inc. may pursue collection action against low income patients for services other than eligible services for which the patient has agreed to be responsible, provided Holyoke Medical Center, Inc. obtained the patient's prior written consent to be billed for the services. Holyoke Medical Center, Inc. will not bill low income patients for claims denied by the patient's primary insurer resulting from an administrative or billing error unless the error was initiated by patient/ guarantor.(7) Holyoke Medical Center, Inc. will not undertake collection action against an individual who has been approved for ER Bad Debt Medical Hardship or medical hardship under the Massachusetts Health Safety Net Program with respect to the amount of the bill that exceeds the medical hardship contribution.b. With respect to low income patients injured in motor vehicle accidents, Holyoke Medical Center, Inc. will: (1) investigate whether the patient, driver and/or vehicle owner had a motor vehicle liability policy; (2) make every effort to obtain the third party payor information from the patient; (3) if the hospital has prior knowledge and is legally able, attempt to secure assignment on a patient's right to third party coverage on services provided due to an accident; (4) advise patient of duty to notify HSN/MassHealth within 10 days of filing TPL claim/lawsuit, (5) retain documentation of those efforts; (6) where applicable, submit a claim for payment to the motor vehicle liability insurer; and (7) if any portion of the claim was previously billed to the HSN, report any recovery to the HSN.c. Holyoke Medical Center, Inc. will not garnish a low income patient's or their guarantor's wages or execute a lien on the low income patient's or their guarantor's personal residence or motor vehicle unless: (1) Holyoke Medical Center, Inc. can show that the patient or their guarantor has the ability to pay; (2) the patient/guarantor did not respond to HMC requests for information or the patient/guarantor refused to cooperate with HMC to seek an alternative financial assistance program; or (3) for purposes of a lien, it was approved by Holyoke Medical Center, Inc.'s Board of Trustees on an individual case-by-case basis.d. Holyoke Medical Center, Inc. may cease any collection or billing actions against a patient who is unable to pay Holyoke Medical Center, Inc.'s bill at any time during the billing process, if the patient is eligible for assistance under financial assistance programs that HMC may, in its discretion, make available from time-to-time. Holyoke Medical Center, Inc. will keep any and all documentation that shows a patient met the criteria for such programs.e. Holyoke Medical Center, Inc. and its agents shall not continue collection or billing on a patient who is party to bankruptcy proceedings except to secure its rights as a creditor in the appropriate order.f. Holyoke Medical Center, Inc. and its agents will not charge interest on an overdue balance for a low income patient or for patients who are eligible for financial assistance programs that HMC may in its discretion make available from time-to-time. Part VI, Line 2: Holyoke Medical Center, Inc. conducts a needs assessment of the communities it serves in conjunction with numerous community agencies. These include the United Way of Pioneer Valley, Holyoke Health Center, Inc., our sister organizations River Valley Counseling Center, Inc. and Holyoke Visiting Nurse Association, Inc., as well as Holyoke Community College and a wide variety of education institutions in the Holyoke/ Springfield area, including the University of Massachusetts Medical School in Worcester. Partnering with these organizations has allowed HMC to utilize our expertise and assessment of the population we serve to better formulate our community benefit initiatives. Based on the needs assessment, HMC determines which initiatives to continue and which programs to implement within our financial means. This includes a focus on community education and community outreach. It is important not to overlook the substantial contribution that the hospital makes to the community through our many educational programs, free flu shots, and our support of community events. HMC will continue to monitor these programs for their need and effectiveness in the community, and, working with our community partners, assess for gaps in the needs of the community that are not being filled. The formal needs assessment done in 2010 by the United Way of Pioneer Valley, combined with our own data and information of our patient population including what is publicly reported by the Department of Public Health - Massachusetts Community Health Information Profiles and other public sources has enabled us to focus our limited resources to better serve our community. Part VI, Line 3: 1) General Principles:Holyoke Medical Center, Inc. or its agents will assist uninsured and underinsured patients with the process of applying for available financial assistance programs that may pay for some or all of their hospital bills. In order to help uninsured and underinsured patients find and apply for available financial assistance, HMC will provide all patients with a general notice of the availability of programs by way of posted notices throughout HMC and by way of individual notices to patients. The goal of these notices is to inform patients regarding the availability of financial assistance, as well as assistance with the application process. Holyoke Medical Center, inc. will assist patients with the application process for the following Massachusetts programs: MassHealth, Commonwealth Care, CMSP, Healthy Start, Health Safety Net, and Medical Hardship through the Health Safety Net. Holyoke Medical Center, Inc. will provide, upon request, specific information about: (a) the eligibility criteria to be a low income patient under the Massachusetts Health Safety Net program or (b) additional financial assistance programs that HMC may in its discretion make available to low income patients from time-to-time. Holyoke Medical Center, Inc. will also notify the patient about available payment plans that may be available to them pursuant to HSN regulations.2) Role of Hospital Patient Financial Counselors and Other Finance Staff:Holyoke Medical Center, Inc. will attempt to identify available coverage options for patients who may be uninsured or underinsured when the patient is scheduling services, while the patient is at HMC, upon discharge and for a reasonable time following discharge. Holyoke Medical Center, Inc. will direct all patients seeking available coverage options to HMC's Patient Financial Counseling office for eligibility screening and assistance with the application process, including the application process for financial assistance programs that HMC may in its discretion make available to low income patients from time-to-time.Holyoke Medical Center, Inc. will also provide information on how to contact the appropriate staff within the hospital's Finance Department to verify the accuracy of the hospital bill or to dispute certain charges.3) Notification Practices:Holyoke Medical Center, Inc. will post a notice (signs) of availability of financial assistance in the following locations:a. Service delivery areas (e.g., inpatient, clinic, emergency department admission and/or registration areas);b. Patient financial counselor areas;c. Central admission/registration areas; and/ord. Business office areas that are open to patients.Posted signs will be clearly visible and legible to patients visiting these areas. The hospital will also include a notice about the availability of financial assistance in all initial bills.When a patient contacts the hospital, the hospital finance staff will attempt to identify if a patient qualifies for a public financial assistance program or a payment plan. A patient who is enrolled in a public financial assistance program (e.g., MassHealth or the Health Safety Net) may qualify for certain plans. Patients may also qualify for additional assistance based on the hospital's own internal criteria for financial assistance or qualify for coverage of services as a medical hardship based on the patient's documented income and allowable medical expenses.For cases in which the hospital is using the Virtual Gateway application, the hospital will assist the patient in completing the application for MassHealth, Commonwealth Care, Children's Medical Security Plan, Health Start, Health Safety Net, or other forms of financial assistance programs as they become part of the Virtual Gateway program.All signs and notices shall be translated into languages other than English if such language is primarily spoken by 10% or more of the residents in the hospital service area, which is based on the hospital admissions and/or discharge information. Part VI, Line 4: While the geographic boundary includes cities and towns in Hampden and Hampshire counties, our organization focuses its resources on the eight cities and towns in our primary service area: Holyoke, Chicopee, South Hadley, Granby, Easthampton, Belchertown, West Springfield, and Southampton, with a total population of about 185,000 people. Within this population are subsets of individuals with specific needs such as elderly, poor, and those who exhibit a health profile with higher-than-average morbidity.For example, statistics from the 2013 Massachusetts Department of Public Health Massachusetts Community Health Information Profile show that for the city of Holyoke, where the majority of our patients reside, indicate that:- per capita income is 61% of the state average;- Adults over 65-years-old are 103% of the state average;- AFDC Medicaid recipients are 383% of the state average;- Hispanic persons are 504% of the state average;- Births to adolescent mothers are 394% of the state average;- Asthma is 262% of the state average;- Gonorrhea is 173% of the state average;- Chlamydia is 378% of the state average;- AIDS/HIV-related deaths are 278% of the state average;- Cardiovascular disease deaths are 124% of the state average;- Alcohol and other drug related hospital discharge rate is 273% of the state average.Prioritizing the needs is an ongoing process and is dependent upon a multitude of factors such as the Mission of the organization, the scope and depth of the specific need, and available resources. As the sole acute care provider in this area, we attempt to include the needs of all residents in our decisions, without regard to demographic or health status. Part VI, Line 5: The impact of Holyoke Medical Center, Inc.'s outreach efforts are evidenced by the fact that countless service agencies rely on HMC to ensure their own success. Among the key accomplishments this year was:- Oversaw emergency ambulance services for the City of Holyoke in conjunction with American Medical Response;- Operated the only Emergency Department in the City of Holyoke, providing emergency medical and behavioral health services to the community 24 hours a day, 7 days a week, 365 days per year;- Provided a variety of behavioral health services, including community liaison work with agencies in the mental health community in order to improve the provision of behavioral health/psychiatric services for community members, education lectures and provided transportation to members of the community who do not have their own transportation and are in need of partial hospitalization or intensive outpatient levels of care for mental health treatment;- Provided numerous outreach classes and services, through the Medical Center's Speech and Hearing department, to members of the community with hearing and speech difficulties. The department has also worked with a variety of long-term care facilities and elder communities to educate elders on hearing loss, hearing aids, medical conditions, speech, and swallowing issues.- Promoted health care career education throughout the community, such as hosting site visits to high school students to expand their knowledge of community hospitals and encourage youth to enter healthcare professions;- Provided numerous educational programs to promote healthy behaviors, encourage routine medical screenings to prevent a variety of common diseases in our community. For example, conducted diabetes education classes, conducted programs that provided information regarding the recognition, treatment, and prevention of stroke, and conducted CPR classes for the community;- Provided education on infectious disease and flu vaccine clinics which administered free flu vaccines to the general public;- Educated and implemented programs to promote access to primary and preventative care, utilizing medical and professional staff to educate the community to encourage routine medical screenings, education on speech and hearing issues, preventing pulmonary disease, and behavioral health issues;- Provided birthing, lactation and parenting skill education classes. Part VI, Line 6: Holyoke Medical Center, Inc. (HMC) is an affiliate of Valley Health Systems, Inc. (VHS). The mission of VHS is to enhance the delivery of broadly diverse, high-quality and coordinated healthcare services and products to consumers in a fiscally-sound, efficient and effective manner. To this end, VHS maintains a network of systems, facilities, services, and products that provide compassionate care consistent with its philanthropic purposes. This will be achieved in an environment of growth, dignity, and respect for its employees.VHS is a tax-exempt organization which, through its affiliated organizations, operates a healthcare delivery system in the greater Holyoke/Chicopee area. The services provided by the system include:- Acute inpatient and outpatient services- Inpatient and Outpatient psychiatric services- Home health services- Occupational health services- Primary care services- Hospice services Part VI, Line 7, Reports Filed With States MA 1 0 0 0 0 0 0 0 0 Vijay V Gandevia MD Director (part year) 393327 0 0 0 17500 0 0 0 18877 0 429704 0 0 0 Karen Ferroni MD Director/Medical Director 251745 0 0 0 22500 0 0 0 18761 0 293006 0 0 0 Theodore Mlapah MD Director/VP, Medical Staff 393565 0 0 0 17500 0 0 0 19093 0 430158 0 0 0 Spiridon E Hatiras President & CEO, Clerk 0 173748 0 0 0 5385 0 0 0 4392 0 183525 0 0 Paul M Silva Treasurer, VP of Finance 234276 0 0 0 17500 0 0 0 16289 0 268065 0 0 0 Noah J Epstein MD Orthopedic Surgeon 554380 0 0 0 16640 0 0 0 19548 0 590568 0 0 0 Nirav R Sheth MD Cardiologist 479467 0 0 0 16796 0 0 0 19413 0 515676 0 0 0 Anthony L Rhodes MD Orthopedic Surgeon 437256 0 0 0 22464 0 0 0 19347 0 479067 0 0 0 Khaled A Instrum Orthopedic Surgeon 438292 0 0 0 18577 0 0 0 19342 0 476211 0 0 0 Mary E Norris MD Gastroenterologist 427042 0 0 0 23000 0 0 0 19330 0 469372 0 0 0 Hank J Porten Former President & CEO 0 938972 0 0 0 23000 0 0 0 20790 0 982762 0 0 Antonio Correia Former Treasurer 0 261908 0 0 0 23000 0 0 0 16890 0 301798 0 0 Kathleen M Buckley Former Key Employee 190206 0 0 0 19462 0 0 0 14205 0 223873 0 0 0 Clark A Fenn Former Key Employee 201529 0 0 0 23000 0 0 0 16492 0 241021 0 0 0 James M Keefe Former Key Employee 197386 0 0 0 23000 0 0 0 16270 0 236656 0 0 0 Kevin F Neill Former Key Employee 228534 0 0 0 23000 0 0 0 16670 0 268204 0 0 0 Michael A Zwirko Former Key Employee 225431 0 0 0 19462 0 0 0 16626 0 261519 0 0 0 Part I, Line 3 The compensation for the Organization's CEO was established by a related organization, H-C Management Services, Inc. That organization established the CEO's compensation by using a compensation committee and a compensation study. The compensation was also approved by the System's compensation committee. Part I, Line 4a Michael A. Zwirko and Kathleen A. Buckley each continued to receive compensation until shortly after their employment with the Hospital in the amount of $55,435 and $70,419, respectively. These amounts are considered severance. The System's former President & CEO, Hank J. Porten, resigned from this role effective 9/3/13. He continued to receive compensation and benefits after that year end and into the calendar year 2014. This compensation did not represent severance or change of control payments to him in his capacity as former President & CEO. Instead, he was compensated for his services in his role as Senior Advisor to the Hospital System. Goss and McLain Insurance Agency Inc Board Member(s) are Officers 629486 Deborah A. Buckley, Board of Directors Member of Holyoke Medical Center, Inc., is President/Owner of Goss & McLain Insurance Agency, Inc. Holyoke Medical Center, Inc. made "pass-through" premium payments to insurance companies for personal lines of insurance coverage purchased by employees of Holyoke Medical Center, Inc. and also for some insurance coverage purchased by Holyoke Medical Center, Inc., obtained through the broker services of Goss & McLain Insurance Agency, Inc. Such "pass-through" premium payments are passed on by Goss & McLain Insurance Agency, Inc. to the insurance companies writing the coverage. Holyoke Medical Center, Inc. Also made other insurance premium payments directly to insurance companies for which Goss & McLain Insurance Company, Inc. served as the broker/agent. Peter C. Connor, Chair and Board of Directors Member is secretary of Goss & McLain Insurance Agency, Inc. 0 Wandana Joshi DO Family Member Salary 393723 Wandana Joshi, D.O., the wife of Vijay V. Gandevia, M.D., a Board of Directors Member of Holyoke Medical Center, Inc., received compensation as an employee (anesthesiologist) of Holyoke Medical Center, Inc. 0 Trisha L Neill Family Member Salary 92656 Trisha L. Neill, the wife of Holyoke Medical Center, Inc. key employee Kevin F. Neill, received compensation as an employee (physical therapy manager) of Holyoke Medical Center, Inc. 0 Patrick J Keefe Family Member Salary 60100 Patrick J. Keefe, the son of Holyoke Medical Center, Inc. key employee, James M. Keefe, received compensation as an employee (registered nurse) of Holyoke Medical Center, Inc. 0 Form 990, Part VI, Section A, line 2 Peter Connor and Richard Wells have a business relationship. Certain officers and directors of Holyoke Medical Center, Inc. are employed by a related tax-exempt organization which has common officers and/or directors. By virtue of this arrangement, certain individuals listed in Form 990, Part VII have a business relationship with one another. Form 990, Part VI, Section A, line 6 The sole member of Holyoke Medical Center is Valley Health Systems, Inc. Form 990, Part VI, Section A, line 7a Valley Health Systems, Inc. elects the members of the governing body of Holyoke Medical Center, Inc. Valley Health Systems, Inc. also has the power to remove any member of the governing body, with or without cause, at any time by giving written notice to such governing body member. Form 990, Part VI, Section A, line 7b Significant decisions of the governing body of Holyoke Medical Center, Inc. are subject to the approval of Valley Health Systems, Inc. as specified in the Organization's bylaws. Form 990, Part VI, Section B, line 11 A copy of the Hospital's Form 990 was provided to each voting member of the governing body prior to its filing with the Internal Revenue Service. The Form 990 was prepared with the assistance of an independent public accounting firm and thoroughly reviewed by the Senior Vice President of Finance and CFO and key financial staff of the Hospital prior to distibuting it to the governing body for review. Form 990, Part VI, Section B, line 12c The conflict of interest policy of Holyoke Medical Center, Inc. (HMC) is monitored and enforced as part of the Valley Health Systems, Inc. System and is reviewed annually by the System's conflict of interest committee. HMC board members, officers, and key employees complete and sign a conflict of interest questionnaire annually. All signed questionnaires are then submitted to HMC and to Valley Health Systems, Inc. (parent) for review and monitoring. Form 990, Part VI, Section B, line 15 The compensation committee of the Valley Health System, Inc. utilizes a market compensation survey to recommend to the Board the approval of its determination of the appropriate compensation of the Chief Executive Officer. During that process, the Committee also reviews the compensation levels of other senior management and key employees of the System. These individuals are not members of the compensation committee and do not participate in this process. The CEO, as a member of the Board of VHS, does not participate in the approval process of that office's compensation. Form 990, Part VI, Section C, line 19 The governing documents, conflict of interest policy, and financial statements of Valley Health Systems and Affiliates, which includes supplemental information of the filing entity, are available to the public upon request at the Organization's administrative office at 575 Beech Street, Holyoke, MA. Form 990, Part VII: Antonio Correia, though no longer an officer of the filing organization, remains employed by the H-C Management Services, Inc. as Chief Strategy Officer. Compensation and hours reflected on Form 990, Part VII is for his services as Chief Strategy Officer and does not reflect compensation in his capacity as a former officer of the organization. Karen M. Ferroni, MD, Vijay V. Gandevia, MD, and Theodore K. Mlapah, MD are listed on Form 990, Part VII as voting members of the Hospital's board of directors. In accordance with IRS instructions, each has reportable compensation and benefit information disclosed on Part VII. However, each are licensed physician employees of the Hospital and their compensation and benefits represents remuneration in their capacity as such. No part of their reportable compensation or benefits is paid in their capacity as board members of the Hospital. Certain individuals are listed as former key employees of the Hospital. All except Michael A. Zwirko and Kathleen A. Buckley are still employees of the Hospital in the same or similar capaicities as in prior years. However, due to IRS reporting thresholds, they no longer qualify as current key employees. In accordance with IRS instructions, they have been listed as former key employees. The System's former President & CEO, Hank J. Porten, resigned from this role effective 9/3/13. He continued to receive compensation and benefits after that year end and into the calendar year 2014. This compensation did not represent severance or change of control payments to him in his capacity as former President & CEO. Instead, he was compensated for his services in his role as Senior Advisor to the Hospital System. Form 990, Part XI, line 9: Equity Transfer to Affiliates -2,445,000. Change in Beneficial Interest - VHS 108,991. Pension Related Charges -8,949,867. Form 990, Part XII, Line 2c: The audit process has not changed from the prior year. Form 990, Part IV, Line 24a: The Organization redeemed its MHEFA Revenue, Series B, tax-exempt bonds on July 1, 2014. In accordance with IRS instructions, Part IV, Line 24a has been marked "no" and Schedule K not prepared as there were no tax-exempt bond issues outstanding as of the last day of the Hospital's fiscal year. Community Health Foundation of Western Mass Inc 113 Hampden Street Holyoke MA 01040 222568962 Raise & Invest Funds for Affiliates MA 501(c)(3) Line 7 Valley Health Systems Inc 0 HCHAR Inc - Workers' Compensation Trust 20 Hospital Drive Holyoke MA 01040 046635116 Workers' Compensation Benefits MA 501(c)(3) Line 11a, I Valley Health Systems Inc 0 H-C Management Services Inc 20 Hospital Drive Holyoke MA 01040 222515981 Management Services MA 501(c)(3) Line 11b, II Valley Health Systems Inc 0 Holyoke Visiting Nurse Association Inc 113 Hampden Street Holyoke MA 01040 042104310 Home Health Care MA 501(c)(3) Line 9 Valley Health Systems Inc 0 MassWest Services Inc 575 Beech Street Holyoke MA 01040 222515964 Health Care MA 501(c)(3) Line 11b, II Valley Health Systems Inc 0 River Valley Counseling Center Inc 319 Beech Street Holyoke MA 01040 042174657 Outpatient Mental Health MA 501(c)(3) Line 9 Valley Health Systems Inc 0 Valley Health Systems Inc 20 Hospital Drive Holyoke MA 01040 042103583 Healthcare MA 501(c)(3) Line 7 N/A 0 Western Mass Physician Associates Inc 15 Hospital Drive Holyoke MA 01040 043202198 Medical Care Services MA 501(c)(3) Line 3 MassWest Services Inc 0 William Skinner TUA-Holyoke Hospital Trust PO Box 1802 Providence RI 029011802 046035855 Grantmaking MA 4797(a)(1) PF Valley Health Systems Inc 0 1 1 0 1 0 0 0 0 0 1 0 1 1 0 0 0 0 0 1 Schedule R, Part II: Certain control relationships disclosed in Schedule R, Part II have been changed from prior year representations. However, there have been no modifications to the System's governing documents regarding control relationships between the related parties. Valley Health Systems, Inc. has been, and continues to be, the sole member of the affiliated tax-exempt entities disclosed in Schedule R, Part II, collectively referred to as "the System", with the exception of Western Mass Physicians Association whose direct controlling parent is MassWest Services, Inc. In accordance with IRS instructions for Schedule R, the 512(b)(13) control disclosures have been modified to conform to IRS definitions and more accurately represent the governance and control relationships of the System.