ATHOL MEMORIAL HOSPITAL INCORPORATED: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- ATHOL MEMORIAL HOSPITAL INCORPORATED (EIN 04-2126583)
- Tax period
- 2012-10-01 to 2013-09-30
- Filed
- 2014-05-08
- IRS object ID
- 201431299349301558
- Schema version
- 2012v2.0
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule H
- Schedule J
- Schedule O
- Schedule R
- Reasonable Cause Explanation
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-05-08T13:11:23-07:00 | Timestamp |
| Tax Period End Date | 2013-09-30 | TaxPeriodEndDate |
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 042126583 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ATHOL MEMORIAL HOSPITAL INCORPORATED | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | ATHO | NameControl |
| Phone | 9782493511 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2033 Main Street | AddressLine1 |
| City | Athol | City |
| State | MA | State |
| ZIP Code | 01331 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Robert Crosby | Name |
| Title | CFO | Title |
| Phone | 9786306157 | Phone |
| Date Signed | 2014-04-25 | DateSigned |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Robert Crosby | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | Heywood Hospital | AddressLine1 |
| Address Line2 | 242 Green Street | AddressLine2 |
| City | Gardner | City |
| State | MA | State |
| ZIP Code | 01440 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 21390846 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.atholhospital.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1918 | YearFormation |
| State Legal Domicile | MA | StateLegalDomicile |
| Activity Or Mission Description | Our vision is to be one of the best independent community hospitals in America. Our mission is to be our communities' trusted choice for exceptional patient-centered care. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 21 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 19 | NbrIndependentVotingMembers |
| Total Nbr Employees | 279 | TotalNbrEmployees |
| Total Nbr Volunteers | 93 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 439362 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 605945 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 20349585 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 20306415 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 119050 | InvestmentIncomePriorYear |
| Investment Income Current Year | 79416 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 416990 | OtherRevenuePriorYear |
| Other Revenue Current Year | 388482 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 21324987 | TotalRevenuePriorYear |
| Total Revenue Current Year | 21380258 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 10987459 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 10501285 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 12730074 | OtherExpensePriorYear |
| Other Expenses Current Year | 10646598 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 23717533 | TotalExpensesPriorYear |
| Total Expenses Current Year | 21147883 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -2392546 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 232375 | RevenuesLessExpensesCY |
| Total Assets BOY | 8058828 | TotalAssetsBOY |
| Total Assets EOY | 9065130 | TotalAssetsEOY |
| Total Liabilities BOY | 8972699 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 7014892 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | -913871 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 2050238 | NetAssetsOrFundBalancesEOY |
| Mission Description | Our mission is to be our communities' trusted choice for exceptional patient-centered care. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 19169740 | Expense |
| Grants | 0 | Grants |
| Revenue | 20306415 | Revenue |
| Description | Athol Memorial Hospital is a critical access hospital (CAH) serving the nine towns of North Quabbin Region. The areas relatively small population is dispersed over a large geographic area. Inherent in the Hospital mission of providing healthcare services are efforts to help improve the health and lives of our community. This intent is the framework for our community benefits activities. | Description |
| Total Of Other Program Service Exp | 0 | TotalOfOtherProgramServiceExp |
| Total Of Other Program Service Grnt | 0 | TotalOfOtherProgramServiceGrnt |
| Total Of Other Program Service Rev | 0 | TotalOfOtherProgramServiceRev |
| Total Program Service Expense | 19169740 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 1 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 1 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 48 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 279 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 21 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 19 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | MA | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Heywood Hospital | BusinessNameLine1 |
| Business Name Line2 | Robert Crosby | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 9786306157 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 242 Green Street | AddressLine1 |
| City | Gardner | City |
| State | MA | State |
| ZIP Code | 01440 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (28 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Average Hours Per Week RelatedAverageHoursPerWeekRelated | OfficerOfficer | FormerFormer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|---|
| Kenneth Pierce | |||||||||
| Chairman | 0 | X | 0 | 0 | 0 | ||||
| Glenn Hunt | |||||||||
| Vice Chairman | 0 | X | 0 | 0 | 0 | ||||
| Rebecca Bialecki MD | |||||||||
| 2nd Vice Chairman | 0 | X | 0 | 0 | 0 | ||||
| Cheney Castine | |||||||||
| Treasurer | 0 | X | 0 | 0 | 0 | ||||
| Tina Sbrega | |||||||||
| Clerk | 0 | X | 0 | 0 | 0 | ||||
| Roy Lake MD | |||||||||
| Director | 0 | X | 0 | 0 | 0 | ||||
| John Skrzypczak MD | |||||||||
| Director | 0 | X | 0 | 0 | 0 | ||||
| Donald Mruk MD | |||||||||
| Director | 0 | X | 0 | 0 | 0 | ||||
| Mohsen Noreldin MD | |||||||||
| Director | 0 | X | 26580 | 0 | 0 | ||||
| Doug Starrett | |||||||||
| Director | 0 | X | 0 | 0 | 0 | ||||
| Daniel Asquino | |||||||||
| Director | 0 | X | 0 | 0 | 0 | ||||
| Winfield Brown | |||||||||
| Director | 0 | X | 0 | 526138 | 50699 | 40 | X | ||
| Robert Chauvin | |||||||||
| Director | 0 | X | 0 | 0 | 0 | ||||
| Laura Chen MD | |||||||||
| Director | 0 | X | 0 | 0 | 0 | ||||
| Joyce Fletcher | |||||||||
| Director | 0 | X | 0 | 0 | 0 | ||||
| John Flick | |||||||||
| Director | 0 | X | 0 | 0 | 0 | ||||
| James Garrison | |||||||||
| Director | 0 | X | 0 | 0 | 0 | ||||
| John Kerney | |||||||||
| Director | 0 | X | 0 | 0 | 0 | ||||
| Michele Parker MD | |||||||||
| Director | 0 | X | 0 | 0 | 0 | ||||
| JoAnne Parks | |||||||||
| Director | 0 | X | 0 | 0 | 0 | ||||
| James Meehan | |||||||||
| CEO | 40 | X | 33400 | 0 | 3247 | 0 | |||
| Paul Dabrody | |||||||||
| Acting CFO - Healthcare Provider Advocates | 40 | 248547 | 0 | 0 | X | X | |||
| Robert Crosby | |||||||||
| CFO | 0 | 0 | 268605 | 48958 | 40 | X | |||
| Lucille Songer | |||||||||
| CNO | 40 | 95684 | 0 | 20568 | 0 | X | |||
| Steven Penka | |||||||||
| CEO | 40 | 101883 | 0 | 15469 | 0 | X | X | ||
| Michael Grimmer | |||||||||
| COO | 0 | 0 | 228187 | 43961 | 40 | X | |||
| Haytham Mohamed | |||||||||
| Physician | 40 | 431879 | 0 | 26146 | 0 | X | |||
| Mark Wu | |||||||||
| Physician | 40 | 345380 | 0 | 12291 | 0 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1283353 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1022930 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 221339 | TotalOtherCompensation |
| Number Individuals GT100 K | 4 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| St Vincent Physician Services | |||||
| 123 Summer Street | Worcester | MA | 01608 | ER & Hospitalist Physicians | 1289078 |
| Healthcare Provider Advocates | |||||
| PO Box 2117 | Amherst | MA | 01004 | Patient Accounts Manager & Consulting | 512706 |
| Labcorp of America Holdings | |||||
| PO Box 12140 | Burlington | NC | 27216 | Lab Services | 449122 |
| Navix Diagnostics | |||||
| PO Box 347203 | Pittsburg | PA | 15251 | Nuclear Medicine Consulting | 194116 |
| LocumTenenscom | |||||
| PO Box 405547 | Atlanta | GA | 30353 | Anesthesia Coverage | 158682 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 6 | NumberOfContractorsGT100K |
| Federated Campaigns | 0 | FederatedCampaigns |
| Membership Dues | 0 | MembershipDues |
| Fundraising Events | 20670 | FundraisingEvents |
| Related Organizations | 0 | RelatedOrganizations |
| Government Grants | 402322 | GovernmentGrants |
| All Other Contributions | 182953 | AllOtherContributions |
| Noncash Contributions | 1200 | NoncashContributions |
| Total Contributions | 605945 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (4 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue | ExclusionExclusionAmount |
|---|---|---|---|---|---|
| Ancillary OP Services | 622110 | 17443417 | 17443417 | 0 | $0 |
| Ancillary IP & Routine Services | 622110 | 2765617 | 2765617 | 0 | $0 |
| MRI/PET Scan Income | 622110 | 89452 | 89452 | 0 | $0 |
| CPR Classes | 622110 | 7929 | 7929 | 0 | $0 |
Total Oth Program Service Revenue TotalOthProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 20306415 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 81127 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $81,127 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 270886 | Real |
| Personal | 0 | Personal |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
| Personal | 0 | Personal |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 270886 | Real |
| Personal | 0 | Personal |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 270886 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $270,886 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 0 | Securities |
| Other | 250 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 0 | Securities |
| Other | 1961 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 0 | Securities |
| Other | -1711 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -1711 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | -$1,711 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 2268 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 20670 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 8627 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -6359 | TotalRevenueColumn |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | -$6,359 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Gaming | 0 | GrossIncomeGaming |
| Gaming Direct Expenses | 0 | GamingDirectExpenses |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | 0 | GrossSalesOfInventory |
| Cost Of Goods Sold | 0 | CostOfGoodsSold |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue | ExclusionExclusionAmount |
|---|---|---|---|---|---|
| Meal Revenue | 722212 | 71793 | 0 | 0 | $71,793 |
| Medical Record Copies | 561499 | 13547 | 0 | 0 | $13,547 |
| Rebates | 900099 | 4418 | 0 | 0 | $4,418 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 34197 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $34,197 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 123955 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 21380258 | TotalRevenueColumn |
| Related Or Exempt Function Income | 20306415 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $467,898 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 138264 | Total |
| Program Services | 95064 | ProgramServices |
| Management And General | 43200 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8520745 | Total |
| Program Services | 8208656 | ProgramServices |
| Management And General | 312089 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1203100 | Total |
| Program Services | 1139047 | ProgramServices |
| Management And General | 64053 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 639176 | Total |
| Program Services | 605869 | ProgramServices |
| Management And General | 33307 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 71411 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 71411 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5078 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 5078 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Fundraising | 0 | Fundraising |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1028199 | Total |
| Program Services | 947267 | ProgramServices |
| Management And General | 80932 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13846 | Total |
| Program Services | 12292 | ProgramServices |
| Management And General | 1554 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2768000 | Total |
| Program Services | 2460630 | ProgramServices |
| Management And General | 307370 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 37010 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 37010 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 581677 | Total |
| Program Services | 581677 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 23338 | Total |
| Program Services | 13588 | ProgramServices |
| Management And General | 9750 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8980 | Total |
| Program Services | 8980 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 19598 | Total |
| Program Services | 19598 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 781188 | Total |
| Program Services | 778261 | ProgramServices |
| Management And General | 2927 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 195913 | Total |
| Program Services | 163966 | ProgramServices |
| Management And General | 31947 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| Professional Fees | 1780456 | 849771 | 930685 | 0 |
| Free Care | 1374961 | 1374961 | 0 | 0 |
| Physician Fees | 1143494 | 1143494 | 0 | 0 |
| Provisions for Bad Debt | 557203 | 476755 | 80448 | 0 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 256246 | Total |
| Program Services | 289864 | ProgramServices |
| Management And General | -33618 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 21147883 | Total |
| Program Services | 19169740 | ProgramServices |
| Management And General | 1978143 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 514085 | BOY |
| EOY | 819734 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2131811 | BOY |
| EOY | 2209386 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 424187 | BOY |
| EOY | 162626 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 109942 | BOY |
| EOY | 27205 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 17514726 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 13439530 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3809455 | BOY |
| EOY | 4075196 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1069348 | BOY |
| EOY | 1770983 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8058828 | BOY |
| EOY | 9065130 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4112296 | BOY |
| EOY | 4113052 | EOY |
Grants Payable GrantsPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 74282 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Escrow Account Liability EscrowAccountLiability
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Loans From Officers Directors LoansFromOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 737415 | BOY |
| EOY | 984621 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4122988 | BOY |
| EOY | 1842937 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8972699 | BOY |
| EOY | 7014892 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -2582242 | BOY |
| EOY | 491051 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 239635 | BOY |
| EOY | 94938 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1428736 | BOY |
| EOY | 1464249 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -913871 | BOY |
| EOY | 2050238 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8058828 | BOY |
| EOY | 9065130 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 232375 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 0 | ReconciliationUnrealizedInvest |
| Reconcilation Donated Services | 0 | ReconcilationDonatedServices |
| Reconcilation Invest Expenses | 0 | ReconcilationInvestExpenses |
| Reconcilation Prior Adjustment | 0 | ReconcilationPriorAdjustment |
| Reconcilation Other Changes | 2731734 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1428736 | BeginningOfYearBalance |
| Contributions | 15816 | Contributions |
| Investment Earnings Or Losses | 1091 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 0 | GrantsOrScholarships |
| Other Expenditures | -113554 | OtherExpenditures |
| Administrative Expenses | 0 | AdministrativeExpenses |
| End Of Year Balance | 1559197 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 968215 | BeginningOfYearBalance |
| Contributions | 359388 | Contributions |
| Investment Earnings Or Losses | 137402 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 0 | GrantsOrScholarships |
| Other Expenditures | 36269 | OtherExpenditures |
| Administrative Expenses | 0 | AdministrativeExpenses |
| End Of Year Balance | 1428736 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1039129 | BeginningOfYearBalance |
| Contributions | 0 | Contributions |
| Investment Earnings Or Losses | -28328 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 0 | GrantsOrScholarships |
| Other Expenditures | 42586 | OtherExpenditures |
| Administrative Expenses | 0 | AdministrativeExpenses |
| End Of Year Balance | 968215 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 992383 | BeginningOfYearBalance |
| Contributions | 0 | Contributions |
| Investment Earnings Or Losses | 46746 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 0 | GrantsOrScholarships |
| Other Expenditures | 0 | OtherExpenditures |
| Administrative Expenses | 0 | AdministrativeExpenses |
| End Of Year Balance | 1039129 | EndOfYearBalance |
Current Year Minus4 Years CurrentYearMinus4Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1013033 | BeginningOfYearBalance |
| Contributions | 0 | Contributions |
| Investment Earnings Or Losses | -20650 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 0 | GrantsOrScholarships |
| Other Expenditures | 0 | OtherExpenditures |
| Administrative Expenses | 0 | AdministrativeExpenses |
| End Of Year Balance | 992383 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 0.9391 | PermanentEndowmentEOYBalance |
| Term Endowment EOY Balance | 0.0609 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 0 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 71990 | OtherCostOrOtherBasis |
| Book Value | 71990 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 0 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 8359992 | OtherCostOrOtherBasis |
| Depreciation | 5567656 | Depreciation |
| Book Value | 2792336 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 0 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 0 | OtherCostOrOtherBasis |
| Depreciation | 0 | Depreciation |
| Book Value | 0 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 0 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 8280713 | OtherCostOrOtherBasis |
| Depreciation | 7871874 | Depreciation |
| Book Value | 408839 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 0 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 802031 | OtherCostOrOtherBasis |
| Depreciation | 0 | Depreciation |
| Book Value | 802031 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 4075196 | TotalOfBookValueLandBuildings |
Other Securities OtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Donor restricted investments | Description |
| Book Value | 1770983 | BookValue |
| Method Of Valuation | F | MethodOfValuation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 1770983 | TotalOfBookValueSecurities |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Estimated Third Party Settlements | Description |
| Amount | $1,842,937 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 1842937 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| SchD_P05_S00_L04 | Schedule D, Part V, Line 4 | The organization's endowment includes both donor restricted endowment funds and funds designated by the Boad of Directors to function as endowments. As required by GAAP, net assets associated with endowment funds, including funds designated by the Board of Directors to function as endowments, are classified and reported based on the existence or absence of donor-imposed restrictions. The organization has interpreted state law as requiring realized and unrealized gains of premanently restricted net assets to be retained in a temporarily restricted net asset classification until appropriated by the Organization's Board of Directors and expended. State law allows the Board to appropriate as much of the net appreciation of premanently restrictednet assets as is prudent considering the Organization's long and short term needs, present and anticipated financial requirements, expected total return on investments, price-level trends, and general economic conditions. |
| SchD_P10_S00_L02 | Schedule D, Part X, Line 2 | Heywood Healthcare, Heywood Hospital, Athol Hospital and HMGI 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-for-profit 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. Any income not substantially related to these Organizations' exempt purposes may be considered unrelated business income under IRC section 511 and, as such, be subject to tax at normal corporate rates. In accordance with GAAP, the Organization annually evaluates its tax status and tax positions taken with respect to its operations and financial position. Tax years 2009 through the current year remain open for examination by federal and state taxing authorities. |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | Golf Tournament | NameOfEvent1 |
| Gross Receipts Event1 | 22938 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 20670 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 2268 | GrossRevenueEvent1 |
| Cash Prizes Event1 | 1330 | CashPrizesEvent1 |
| Non Cash Prizes Event1 | 50 | NonCashPrizesEvent1 |
| Rent Facility Costs Event1 | 5460 | RentFacilityCostsEvent1 |
| Food And Beverage Event1 | 1474 | FoodAndBeverageEvent1 |
| Entertainment Event1 | 0 | EntertainmentEvent1 |
| Other Direct Expenses Event1 | 313 | OtherDirectExpensesEvent1 |
| Food And Beverage Other Events | 0 | FoodAndBeverageOtherEvents |
| Entertainment Other Events | 0 | EntertainmentOtherEvents |
| Gross Receipts Total | 22938 | GrossReceiptsTotal |
| Charitable Contributions Total | 20670 | CharitableContributionsTotal |
| Gross Revenue Total Events | 2268 | GrossRevenueTotalEvents |
| Cash Prizes Total Events | 1330 | CashPrizesTotalEvents |
| Non Cash Prizes Total Events | 50 | NonCashPrizesTotalEvents |
| Rent Facility Costs Total Events | 5460 | RentFacilityCostsTotalEvents |
| Food And Beverage Total Events | 1474 | FoodAndBeverageTotalEvents |
| Entertainment Total Events | 0 | EntertainmentTotalEvents |
| Other Direct Expenses Total Events | 313 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 8627 | DirectExpenseSummaryEvents |
| Net Income Summary | -6359 | NetIncomeSummary |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
Discounted Other DiscountedOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Discounted Other Percentage | 600 | DiscountedOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Benefit Expense | 538505 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 352213 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 186292 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.0091 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Benefit Expense | 4863726 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3807757 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1055969 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.0515 | PercentOfTotalExpense |
Unreimbursed Costs UnreimbursedCosts
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Benefit Expense | 0 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 0 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Benefit Expense | 5402231 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4159970 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1242261 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.0606 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Benefit Expense | 121730 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2268 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 119462 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.0058 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Benefit Expense | 0 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 0 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Benefit Expense | 0 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 0 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0 | PercentOfTotalExpense |
Research Research
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Benefit Expense | 0 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 0 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Benefit Expense | 4896 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 4896 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.0002 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Benefit Expense | 126626 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2268 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 124358 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.0060 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Benefit Expense | 5528857 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4162238 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1366619 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.0666 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $143,408 | BadDebtExpenseAmount |
| Amount Attributable To | 5292 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 3790307 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 5441078 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -1650771 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Athol Memorial Hospital | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2033 Main Street | AddressLine1 |
| City | Athol | City |
| State | MA | State |
| ZIP Code | 01331 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.atholhospital.org | WebsiteAddress |
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Athol Memorial Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 1 | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Information Gaps | X | InformationGaps |
| Needs Assessment Conducted | 12 | NeedsAssessmentConducted |
| Take Into Account | 1 | TakeIntoAccount |
| Other Facilities | 0 | OtherFacilities |
| CHNA Widely Available | 1 | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| On Request | X | OnRequest |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Execute Implement Strategy | X | ExecuteImplementStrategy |
| Develop Community Plan | X | DevelopCommunityPlan |
| Participate Community Plan | X | ParticipateCommunityPlan |
| Include Operational Plans | X | IncludeOperationalPlans |
| Adopt Budget | X | AdoptBudget |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| Prioritize Services | X | PrioritizeServices |
| All Needs Addressed | 1 | AllNeedsAddressed |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 200 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 600 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Permit Other Actions | X | PermitOtherActions |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Medicare Rate | X | MedicareRate |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 1 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (17 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| SchH_P01_S00_L06b | Schedule H, Part I, Line 6b | The Organization makes its annual Community Benefit Report available to the public by transmitting the report electronically to the Attorney General's Community Benefit office which then makes it public on their website. |
| SchH_P01_S00_L07 | Schedule H, Part I, Line 7 | The costing methodology used to calculate the amounts reported in the table in Part I, for lines 7a through 7c were based on the cost to charge ratio derived from the supplied Worksheet 2 in the IRS Sch H instructions. The costs for lines 7e through 7i were actual costs incurred. |
| SchH_P03_S0A_L02 | Schedule H, Part III, Section A, Line 2 | The cost methodology used for line 2 was based on the cost to charge ratio derived from the supplied Worksheet 2 in the IRS sch H instructions. |
| SchH_P03_S0A_L03 | Schedule H, Part III, Section A, Line 3 | The methodology used for line 3 was to take the percent of financial assistance applications that were denied due to inadequate documentation divided by the total applications received for FY13. This amounted to be approximately 3.69% which was applied against the number on line 2. It is our belief that $5,292 in bad debt should be included as community benefits. As a not for profit, patient care is provided to all, regardless of ability to pay for that care. Making quality patient care available to all in our community, regardless of their economic means, qualifies bad debt as a community benefit. |
| SchH_P03_S0A_L04 | Schedule H, Part III, Section A, Line 4 | The footnote on bad debt in the organization's audited financial statements can be found on page 8, allowance for doubtful accounts. |
| SchH_P03_S0B_L08 | Schedule H, Part III, Section B, Line 8 | The allowable costs on line 6 were obtained from our FY 2013 Medicare Cost Report, worksheet D schedules. |
| SchH_P03_S0C_L09b | Schedule H, Part III, Section C, Line 9b | Standard Collection Policies and Procedures for Athol Memorial Hospital are as follows: 1. AMH provides patients with information about financial assistance programs available through the Commonwealth of MA, which may cover all or some of their unpaid hospital bill. For those patients that request assistance, the hospital will assist in eligibility screening for and applying for an available public assistance program. These programs include, but are not limited to MassHealth, Commonwealth Care, Children's Medical Security Plan, Healthy Start and the Health Safety Net. When applicable the hospital will also assist patients in applying for coverage of services as a medical hardship based on the patient's documented family income, current and prior insurance coverage and allowable medical expenses. 2. Financial assistance is intended to assist low income patients who do not otherwise have the ability to pay for their healthcare services. Such assistance takes into account each individual's ability to contribute to the cost of his or her care. AMH will work with those patients that are uninsured or underinsured to assist with applying for available financial assistance programs that may cover all or some of their unpaid hospital bills. This assistance is provided for both residents and non-residents of MA, however there may not be coverage in a state public assistance program for medical services received at a MA hospital by a non resident of MA. 3. An initial itemized bill is sent to the party responsible for the patient's personal financial obligations. 4. AMH uses a 4 week billing cycle. Account statements are issued every 28 days following the initial bill. 5. Issuance of subsequent billings, telephone calls, pre-collection letters and other personal contract notices will follow the initial bill as necessary to constitute a genuine effort to contact the party responsible for the obligation. 6. Document alternative efforts to locate the party responsible for the obligation or the correct address on billing returned by the postal service as incorrect address or undeliverable. 7. Documentation of continuous collection action undertaken on a regular, frequent basis will be maintained via paper or electronic media. 8. Documentation of collection efforts will be maintained until audit is complete. |
| SchH_P05_S0B_L03 | Schedule H, Part V, Section B, Line 3 | The 2011-2012 Community Health Needs Assessment was completed through compilation of area data available from the US Census, Massachusetts Department of Public Health and other related sources within the State. The Assessment includes a community survey intended to calculate the community's perception of health, barriers to care and unmet needs in the North Quabbin area. Focus groups were held to further investigate, including parents, youth, educators, veterans, elders and health care providers. Community-based health related agencies who provided consultation and input included Athol Board of Health, Tobacco Control Alliance, Northeast Quabbin District Dept of Veteran's Services, Franklin County Dept of Veteran's Services, Montachusett's Veteran's Outreach, Community Center of Franklin County, Community Action, Valuing Our Children, Orange Elementary Schools, RC Mahar Regional School, Athol-Royalston Regional School District, MOC Community Partnership, Athol Council on Aging, Franklin County Home Care, Communities That Care Coalition, Community Coalition for Teens and Dial Self. |
| SchH_P05_S0B_L14 | Schedule H, Part V, Section B, Line 14 | Signage is posted throughout the ER, Admissions and Waiting Rooms regarding financial assistance available through the Hospital and are directed to contact the Financial Counselors. |
| SchH_P05_S0B_L16 | Schedule H, Part V, Section B, Line 16 | AMH follows its standard collection practices to attempt to resolve balances of Uninsured Patients. 1. An itemized bill is sent to the patient or guarantor. If initial bill is returned as undeliverable, a Financial Counselor will attempt to contact the patient or Guarantor by telephone to obtain current mailing address. If unsuccessful, the account will be referred to an outside Collection Agency for skip tracing and additional collection action. 2. Financial Counselor attempts to contact patient or guarantor either by telephone or written correspondence to establish third party liability, if any. 3. Verbal or written information is given about MassHealth, HSN and other governmental assistance programs and where to apply for assistance. AMH mails the patient or guarantor two additional statements and two pre-collection letters. Subsequent attempts to reach the patient by telephone are made at the pre-collection stage. AMH maintains electronic notes on the patient's account of mail returned as undeliverable and alternative attempts to contact the patient. AMH will request documentation of collection activity from its outside Collection Agencies for accounts referred to skip tracing prior to the normal 120 day ERBD write off requirements. AMH will send a final notice by certified mail for accounts of $1,000 or more where there have been no prior notices returned as incorrect address or undeliverable. AMH's patient billing system operates on a 4 week cycle. After an initial itemized invoice, account statements are generated every 28 days. Patient Account Representatives or Financial Counselors will review Accounts Receivable reports to identify any account not receiving a statement to ensure there is no gap in continuous collection activity of 120 days or greater. |
| SchH_P05_S0B_L22 | Schedule H, Part V, Section B, Line 22 | All patients are charged the same amount for services regardless of ability to pay or insurance coverage. Insurance companies pay for patients they cover at negotiated rates with the Hospital, these rates are usually less than the gross charge. All uninsured, underinsured or self pay patients are directed to Financial Counselors to determine if they are eligible for government assistance, check for medical hardships, or if they have access to health insurance or are eligible for a discount. |
| SchH_P06_S00_L02 | Schedule H, Part VI, Line 2 | Athol Hospital assesses the health needs of the communities it serves in a variety of ways in addition to the CHNA. The Patient and Family Advisory Council which meets quarterly includes a minimum of 8 patients from Athol and surrounding towns, including Orange, Royalston, Philipston, Petersham, New Salem, Wendell, Warwick and Erving, and two hospital representatives. This council, comprised of former patients and their families, provides general input on community needs, as well asinput on hospital-specific services and opportunities for improvement. In addition, the hospital works closely throughout the year with area social service agencies obtaining input on community health needs including, the Athol Board of Health, Council on Aging, Athol Senior Center, North Quabbin Community Coalition and their Substance Abuse Prevention Taskforce, Erving Board of Health, Erving Senior Center, Royalston Board of Health, Phillipston Board of Health, Athol Area YMCA, Community Health Center of Franklin County, Children's Health and Wellness Taskforce, Tobacco Control Alliance, Montachusetts Veterans Outreach, Athol-Royalston Regional School District, Orange Public Schools and direct community outreach to Athol and surrounding towns, The hospital solicits feedback from social service and nursing staff, as well as physicians regarding patient feedback. The hospital also provides space for/and facilitates support groups which provide feedback on community interests and needs. |
| SchH_P06_S00_L03 | Schedule H, Part VI, Line 3 | Athol Memorial Hospital has financial counselors to assist patients to apply for MassHealth, Commonwealth Care, Healthy Start, Children's Medical Security, EAEDC, the Massachusetts Health Safety Net program, Medical Hardship and any other available financial assistance. Financial counseling staff will assist with the application process as well as address billing concerns and provide pre and post service payment assistance. It is the patient or their guarantor's responsibility to provide all necessary information and documentation to determine eligibility for all financial assistance programs and payment plans. 1. Upon admission to the hospital Emergency Room, AMH Registration staff will, as soon as is reasonably possible, make every effort to obtain the financial information necessary to determine responsibility for payment of the bill from the patient or Guarantor. a. If hospital staff is not able to obtain sufficient information to determine financial responsibility at the time of Emergency Room service, a hospital Financial Counselor will attempt to reach the patient or guarantor via telephone and/or written correspondence sent via the US Postal System. b. In the event that the patient has deceased, the hospital Financial Counselor will make reasonable efforts to reach the guarantor, patient's designated Health Care Proxy, or designated Next of Kin in order to obtain financial information necessary to determine responsibility for payment of the hospital bill. 2. Upon admission to the hospital as an Inpatient, AMH Registration staff will make every reasonable effort to obtain the financial information necessary to determine responsibility for payment of the Hospital bill from the patient or guarantor. a. If the patient or guarantor is unable to provide the information needed at the time of admission as an Inpatient, the Patient Financial Advocate and Social Service Staff, with the patient's consent, will make reasonable efforts to contact the relatives, friends, guarantor, and the patient for additional information while the patient is in the Hospital. b. If sufficient patient financial information has not been obtained to assess the ability of the patient or guarantor to pay for services prior to the date of discharge, the Patient Financial Advocate will make reasonable efforts to obtain the necessary information at the time of the patient's discharge. c. If sufficient patient financial information has not been obtained to assess the ability of the patient or guarantor to pay for services at time of discharge, a Financial Counselor will attempt to reach the patient or guarantor by telephone calls and/or written correspondence sent via the US Postal System. d. In the event that the patient has deceased, the hospital Financial Counselor will make reasonable efforts to reach the guarantor, patient's designated Health Care Proxy, or designated Next of Kin in order to obtain financial information necessary to determine responsibility for payment of the bill. 3. When a patient present at AMH for Urgent Outpatient Services hospital Registration staff, will as soon as possible, make every effort to obtain the financial information necessary to determine responsibility for payment of the bill from the patient or guarantor. a. If hospital registration staff is not able to obtain sufficient informaiton to determine financial responsibility at the time of Urgent Outpatient service, a hospital Financial Counselor will attempt to reach the patient or Guarantor via telephone and/or written correspondence via US Postal System. 4. When a patient presents at AMH for an elective or scheduled Outpatient Service, the patient or guarantor must provide hospital registration staff or staff of the receiving department with sufficient information to determine responsibility for payment of the bill. a. If the patient or guarantor is unable to provide sufficient information to determine responsibility for payment of the bill, AMH may choose to defer elective or scheduled Outpatient Services, with consent from the ordering physician, nurse practitioner, or physician assistant, until the patient or guarantor is able to provide necessary financial information. |
| SchH_P06_S00_L04 | Schedule H, Part VI, Line 4 | Athol Memorial Hospital, an acute care, not-for-profit community hospital, was founded to provide Inpatient, Outpatient, Emergency Care and Home Care Services for residents of Worcester and Franklin counties. The mission of the Community Benefits Program is to encourage healthy lifestyles through outreach, education and support to the communities we serve (Athol, Erving, New Salem, Orange, Petersham, Philipston, Royalston, Warwick and Wendell). This underlying principle of encouraging health lives guides our existing Community Benefits activities and will be carried forward as we formalize our Community Benefits Plan. |
| SchH_P06_S00_L05 | Schedule H, Part VI, Line 5 | Athol Hospital works closely with the community to promote health in areas identified by the 2012 Community Health Needs Assessment (CHNA) through a variety of means. Direct outreach is provided to community members including seniors, shut-ins, and school-aged children through our Community Health Nurse(CHN). The CHN provides a variety of services as needed through local area Health Boards including Athol, Phillipston, Erving and Royalston and through direct services provided at community member homes, senior centers and community health events. Services provided include, but are not limited to, education, blood pressure monitoring, influenza inoculation, prevention efforts for diabetes, behavior health and substance abuse, navigation/access to insurance and community agency assistance and direct care for other chronic conditions. This directly addresses community members with barriers to accessing healthcare as identified in the 2012 CHNA, with barriers including distance and lack of transportation to services, difficulty navigating insurance systems, and management of chronic diseases in adults and children. The hospital also works closely with the Children's Health and Wellness Taskforce addressing poverty-related health issues in children as indicated in the 2012 CHNA including asthma, behavioral health and nutrition, and with the Franklin Hampshire North Quabbin Opiate Prevention Taskforce addressing the highest local priority indicated in the 2012 CHNA - drug abuse in youth and adults. In collaboration with local service agencies, the hospital provides Lifeline systems to 131 subscribers at reduced cost including elderly, disabled, and those with socioeconomic and rural transportation challenges, addressing a significant barrier to care as indicated in the 2012 CHNA. |
| SchH_P06_S00_L06 | Schedule H, Part VI, Line 6 | Community Benefit Plans are determined by the Administrative Team of the affiliated healthcare organization, with input from community health-focused staff at member hospitals including Community Health Nurse, Social Workers, Emergency Department staff, Community Relations, CHNA, local educational institutions and area social service agencies. Each hospital focuses on community health activities specific to the community health needs identified in the CHNA related to its determined service area. Each hospital then carries out Community Benefit Plan addressing the health needs of their target areas as determined in the CHNA. |
| SchH_P06_S00_L07 | Schedule H, Part VI, Line 7 | Athol Memorial Hospital files an annual Community Benefit Report to the Attorney General's Community Benefit Office in Massachusetts. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Form990 Of Other Organizations | X | Form990OfOtherOrganizations |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 1 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (6 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Haytham Mohamed | ||||||||||||||
| Physician | 431879 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 26146 | 0 | 458025 | 0 | 0 | 0 |
| Mark Wu | ||||||||||||||
| Physician | 274997 | 0 | 70383 | 0 | 0 | 0 | 0 | 0 | 12291 | 0 | 357671 | 0 | 0 | 0 |
| Winfield Brown | ||||||||||||||
| Director | 0 | 383569 | 0 | 133569 | 0 | 9000 | 0 | 19261 | 0 | 31438 | 0 | 576837 | 0 | 0 |
| Robert Crosby | ||||||||||||||
| CFO | 0 | 225978 | 0 | 41469 | 0 | 1158 | 0 | 21255 | 0 | 27703 | 0 | 317563 | 0 | 0 |
| Steven Penka | ||||||||||||||
| CEO | 76883 | 0 | 25000 | 0 | 0 | 0 | 0 | 0 | 15469 | 0 | 117352 | 0 | 0 | 0 |
| Michael Grimmer | ||||||||||||||
| COO | 0 | 190066 | 0 | 25621 | 0 | 12500 | 0 | 17000 | 0 | 26961 | 0 | 272148 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| SchJ_P01_S00_L07 | Schedule J, Part I, Line 7 | Dr. Mark Wu has an employment contract with Athol Hospital for a Physician Bonus Award. This Contract states "In each year, your bonus will be calculated based upon Employer receiving net receipts in excess of the Physician Base Salary. In Addition, the Employer will be entitled to recoup up to $30,000 in Personal Insurance Benefits prior to the processing of the Bonus Award. After the Base Salary and the above mentioned Personal Insurance Benefits, the incentive will be split 40% for Hospital and 60% for Physician". For the period of January 1, 2012 through December 31, 2012 Dr. Wu earned $70,383.31 for a bonus incentive. Out of this amount, $40,000 was paid in Fiscal Year 2012 and $30,383.31 was paid in Fiscal Year 2013, with the entire amount being paid in calendar year 2012. |
| SchJ_P02_S00_L00 | Schedule J, Part II | Steven Penka was the former CEO of Athol Memorial Hospital. He terminated on July 16, 2012. |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| F990_P06_S0A_L03 | Form 990, Part VI, Section A, Line 3 | Athol's CFO, Dean Flemming, terminated on October 14, 2011. In October, Athol utilized the services of Healthcare Provider Advocates for an interim CFO, Paul Dabrody. Paul worked with Athol from Oct 2011 through December 2012. |
| F990_P06_S0B_L11b | Form 990, Part VI, Section B, Line 11b | The Accountant for Athol prepares the form 990 and provides it to the Sr. Accountant and Controller for review. The form is then sent to the CFO for final review. Once approved and signed, the 990 is placed on the Hospital Cyber Board for the Board of Trustees' review. The 990 is then approved by the Board and submitted by the Accounting Department. |
| F990_P06_S0B_L12c | 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, Officers and Employees are regularly and consistently monitoring and enforcing it. |
| F990_P06_S0B_L15 | Form 990, Part VI, Section B, Line 15 | Salaries are determined by the Board of Directors considering comparable salary information for Officers of other entities of similar size and level of activity. |
| F990_P06_S0C_L19 | Form 990, Part VI, Section C, Line 19 | The organization makes the 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. |
| F990_P07_S0A_L01a | Form 990, Part VII, Section A, Line 1a | Steven Penka, former CEO of Athol, terminated on July 16,2012. James Meehan was elected as the Interim CEO starting in July 2012 and terminating on December 31, 2012 when Heywood Hospital became affiliated with Athol Hospital. AMH utilized the services of Healthcare Provider Advocates for an interim CFO, Paul Dabrody. The amount listed is what was paid to the company for his services. Paul worked with Athol from October 2011 through October 2012. |
| F990_P11_S00_L09 | Form 990, Part XI, Line 9 | The amount that makes up the other changes in net assets or fund balance is from inter-corporate transfers from related organizations to support the operations of the Hospital. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (9 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Heywood Healthcare Inc | |||||||||||
| 242 Green Street | Gardner | MA | 01440 | 222720658 | Parent Corp | MA | 501(c)(3) | 7 | N/A | 0 | |
| Heywood Healthcare Charitable Foundation Inc | |||||||||||
| 242 Green Street | Gardner | MA | 01440 | 222720562 | Inactive | MA | 501(c)(3) | 7 | 0 | Heywood Healthcare Inc | |
| Henry Heywood Memorial Hospital | |||||||||||
| 242 Green Street | Gardner | MA | 01440 | 042103581 | Hospital | MA | 501(c)(3) | 3 | 0 | Heywood Healthcare Inc | |
| Heywood Affiliated Medical Group | |||||||||||
| 242 Green Street | Gardner | MA | 01440 | 043163589 | Physicians Offices | MA | 501(c)(3) | 9 | 0 | Heywood Healthcare Inc | |
| Henry Heywood Realty Corp | |||||||||||
| 242 Green Street | Gardner | MA | 01440 | 043327447 | Property Holding Corp | MA | 501(c)(2) | 0 | Heywood Healthcare Inc | ||
| HHMH Aid Association | |||||||||||
| 242 Green Street | Gardner | MA | 01440 | 042198019 | raise funds for hospital | MA | 501(c)(3) | 9 | N/A | 0 | |
| AMH Auxillary | |||||||||||
| 2033 Main Street | Athol | MA | 01331 | 042126583 | raise funds for hospital | MA | 501(c)(3) | 9 | N/A | 0 | |
| Winchendon Health Foundation | |||||||||||
| 87 Central Street | Winchendon | MA | 01475 | 042113276 | Support Organization | MA | 501(c)(3) | PF | N/A | 0 | |
| Heywood Physicians Hospital Organization | |||||||||||
| 242 Green Street | Gardner | MA | 01440 | 043153119 | Managed Care Contract | MA | 501(c)(3) | 9 | N/A | 0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 1 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 1 | OtherTransferFromOtherOrg |
Reasonable Cause Explanation ReasonableCauseExplanation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Explanation | Athol Memorial Hospital submitted form 8868 on January 29, 2014 for an extension to file until May 15, 2014. We received notice# CP211A dated March 31, 2014 approving the form 8868. | Explanation |
Comments