2014-08-12T12:25:22-07:00 2013-09-30 990 2012-10-01 042103602 MILFORD REGIONAL MEDICAL CENTER INC MILF 5084731190 14 PROSPECT STREET MILFORD MA 017573090 JEANNE P LYNSKEY 5084731190 2014-08-12 2012 2015-11-30 17:44:51Z Jeanne P Lynskey 14 Prospect Street Milford MA 01757 190299278 0 X WWW.MILFORDREGIONAL.ORG X 1903 MA Milford Regional Medical Center Inc mission statement is to provide quality healthcare services to our community with dignity, compassion, and respect. 20 12 1925 436 666957 0 4465681 3995840 184563697 173162259 592954 651431 13943014 9948085 203565346 187757615 0 0 0 0 107339021 100742405 220246 359441 1447824 73701460 75118382 181260727 176220228 22304619 11537387 210090678 217450156 113400497 112767133 96690181 104683023 Milford Regional Medical Center Inc provides medical and hospital services for the sick and disabled of any race, creed, color, or nationality regardless of an individuals ability to pay. It also carries on such educational, philanthropic and scientific activities and functions as are designed to promote the general health of the communities served. 0 0 62349068 0 54853347 Milford Regional Medical Center (MRMC) serves the healthcare needs of the residents of 19 communities in Central Massachusetts, a population now approaching 250,000. Guided by its mission "to provide quality healthcare services to our community with dignity, compassion and respect," MRMC strives to be responsive to diverse constituencies-individuals and families of all ages, employees and employers of large and small businesses, physicians and other healthcare providers, our school systems, our local and area officials and safety personnel, churches, community organizations, our insurers and payors and our own employees and volunteers. As a charitable hospital, we acknowledge our special concern for the needs of the underserved , especially low-income and minority populations. A full-service community and regional teaching hospital, MRMC is a 145-bed, nonprofit acute-care facility. There are approximately 200 physicians on the active medical staff and an additional 100 courtesy or consulting physicians. MRMC is affiliated with UMass Memorial Health Care as a major teaching hospital. In addition to providing basic acute care services (medical, surgical, emergency medicine, family-centered obstetrics and pediatrics), MRMC has eight state-of-the-art operating suites, consolidated surgical services (including admitting and pre-admission testing) and a medical/surgical floor with private rooms, many with advanced patient monitoring capabilities. MRMC serves approximately 8,800 medical and surgical inpatients annually. In FY2013, MRMC has seen impressive results with our Center for achievement was the introduction of Palliative Care Services under the direction of a physician who is board certified in Hospice and Palliative Medicine. MRMC was recognized for the second consecutive year in US News & World Report's list of Best Hospitals, received a Top 10 Safety Rating from Consumer Reports and an "A" Hospital Safety Score from The Leapfrog Group. Perhaps most important, MRMC completed a feasibility study for a $54-million building expansion, the construction of a new emergency department, ICU and 24 new medical/surgical rooms to eliminate multi-patient rooms. It is estimated that the project will break ground in 2014. 91218206 0 117641955 The Hyman and Shirley Hill Health Center at Milford Regional Medical Center, completed in 1994, is a complete outpatient facility dedicated to the care, education, and wellness of thousands of patients who visit regularly for care, but rarely stay overnight. The Center provides a variety of services including laboratory, cardiac rehabilitation, endoscopic surgery, and other minor surgical services. The Women's Pavilion, opened in 1998, provides a full range of services to meet women's health needs, including digital mammography, ultrasound, bone densitrometry and advanced breast biopsy. Other diagnostic services offered to outpatients throughout the Milford Regional system include radiology, ultrasound, MRI, CT scans, PET services, nuclear medicine, cardiovascular and laboratory/pathology. Testing and rehabilitation services are offered in several locations throughout the hospital's service area to improve access for our patients. In FY 2013, MRMC saw the introduction of the DaVinci Surgical Systems, a sophisticated robotic platform designed to expand the surgeon's capabilities and offers patients a minimally invasive option for major surgery. The benefits for our patients are shorter hospital stays, reduced pain, lower risk of infection, less blood clots, fewer transfusions, less scarring and faster recovery. Robotic surgeons at Milford Regional have been performing gynecological, urological and gall bladder surgeries. FY13 marked the five-year anniversary of Milford Regional's partnership with Dana-Farber/Brigham and Women's Cancer Center. The Cancer Center which openedin 2008 provides to develop a comprehensive cancer treatment in the region. MRMC entered into a collaboration with Cancer Center which includes medical oncology and radiation oncology, laboratory tests, CT scans, MRI's and PET scnas in the care and treatment of Cancer Center patients. This year, the Cancer Center began offering clinical trials in our community. Patient volume has more than doubled in 5 years and the number of patients seen for radiation oncology has increase from 369 in 2009 to more than 10,000 in 2013. The 54,000 square foot facility has made a tremendous difference to the quality of life for residents seeking cancer treatment. Milford Regional forged a new partnership with Boston Children's Hospital to bring the expertise of one of the nation's top-ranked hospitals in pediatric care closer to those living in Metrowest and Central Massachusetts. Children admitted to Milford Regional, as well as newborns in the Maternity Center, now benefit from around-the-clock careprovided by Boston Children's pediatric hospitalists. Plans are underway to expand services to our emergency department. Rehabilitation and sports medicine expanded at MRMC with the opening of a 10,000 square foot facility in Franklin, MA. This tripled the space from a previous location offering the latest treatment in rehab therapies and sports medicine. the site offers 14 treatment rooms, new equipment, a 3000 square foot indoor sports simulation are and industrial conditioning area. Milford Regional Emergency Department: The Milford Regional Emergency Department sees over 55,000 patients per year and the number of those with behavioral health and substance use issues has increased dramatically. A collaboration with Riverside Community Care has been enhanced after 17 years the the hospital to create a formal division of behavioral medicine inside Milford Regional's internal medicine department. This partnership with the Milford Regional department of care management provides the framework for a much more proactive approach to patient care. This new structure allows the behavioral health specialists to do more than provide consultations on a case by case basis as they did in the past. The fully integrated team can now anticipate patient challenges through programs like the Delirium Task Force helping to reduce confusion and disorientation of older patients. In another significant move, they have instituted daily behavoiral health rounds in the Emergency Department and provide individualized management plans to patients to help reduce chronic ED visits by identifying and then addressing underlying emotional issues through community linkages and resources. The Medical Center was awarded two state grants totalling $240,000 to target activity in the Emergency Department. One was to develop a referral relationship with Edward M. Kennedy Health Center for the one in five patients who do not have primary care, and the other was to fund behavioral health nurses in the ED and develop an integrated multidisciplinary team to better meet the needs of patients seen in the Ed with behavioral health issues. The Patient and Family Advisory Council (PFAC) convened a Behavioral Health Task Force to address the high volume and length of stay in the ED of behavioral health patients compared to those with medical and surgical complaints. The Task Force has created strong community linkages with mental health providers, schools and community coalitions to improve the care of individuals with behavioral health and substance abuse needs and advocate for mental health parity. This program has been recognized across the state and by the Secretary of Health and Human Services in his keynote remarks at the statewide PFAC conference. We have employed bilingual community health workers in the ED to address the critical need to connect patients to primary care. Working later hours in the day and on weekends, community health workers help identify patients who come to the ED due to a lack of primary care or health insurance. Patients are helped with enrollment in state-subsidized health care when appropriate, and directed to a primary care physicain. When the health center opens in late 2013, these patients will have an option for affordable, comprehensive primary care close to home. 0 0 0 153567274 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 1 0 0 1 1 1 1 1 0 0 1 1 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 1 0 0 0 1 199 0 1 1925 1 1 1 0 0 0 1 1 1 1 0 0 0 0 0 0 X 20 12 1 0 0 0 1 0 0 1 1 0 1 1 0 1 1 1 1 1 1 1 0 MA X X Jeanne P Lynskey 5084731190 14 PROSPECT STREET MILFORD MA 017573090 Kevin P Meehan 1 0 X 0 0 0 Christine H Burke 1 0 X 0 0 0 Bartholomew R Lawless 1 0 X 0 0 0 M Catherine Burke MD 1 0 X 0 0 0 Francis J Larkin 1 0 X 0 0 0 Vascen J Bogigian 1 0 X 0 0 0 John J Burns 1 0 X 0 0 0 Stephen G Ellis 1 0 X 0 0 0 Patrick R McSweeney MD 1 50 X 0 391057 29085 William G Burrill 1 0 X 0 0 0 Albert A Crimaldi MD 1 0 X 5300 0 0 Warren S Heller 1 0 X 0 0 0 Harold D Gould Jr 1 0 X 0 0 0 John N Pandiscio 1 0 X 15725 0 0 Louis P Bertonazzi 1 0 X 0 0 0 Barbara A Auger 1 0 X 0 0 0 Loriann Baranauskas 1 0 X 0 0 0 Jeff Hopkins MD 1 0 X 4375 0 0 Robert L Kilroy 1 0 X 0 0 0 Delia Vetter 1 0 X 0 0 0 Francis M Saba 50 5 X 492082 0 188869 Edward J Kelly 50 0 X 435440 0 54122 Jeanne P Lynskey 50 0 X 251904 0 24351 Salvatore Perla 50 0 X 209300 0 25669 Linda Yates 50 0 X 181488 0 24793 Martin Richman 50 0 X 166418 0 20263 Nicole Heim 50 0 X 155976 0 23298 Nancy Tomaso 50 0 X 167115 0 5945 Karen Sergi 50 0 X 147822 0 20167 Kamala Murali 50 0 X 143401 0 20373 Donna M Saul 50 0 X 144662 0 24200 Maria DaSilva 50 0 X 147799 0 23615 Judy Kelly 50 0 X 142078 0 21719 Cheryl L Bonasoro 0 0 X 239853 0 7840 3050738 391057 514309 105 1 1 0 Alliance Healthcare Inc PO Box 96485 Chicago IL 60693 MRI Services/PET Services 3832597 Aramark 12483 Collections Center Drive Chicago IL 60693 BioMedical Engineering Services 973002 Milford Anesthesia Associates Inc 113 Water Street 213 Milford MA 01757 Anesthesia Services 1745188 University of Massachusetts Medical 55 Lake Ave North Worcester MA 01655 Fee for Residency Program 1210212 Quest Diagnostics Nichols Institute 12436 Collections Center Drive Chicago IL 60693 Outside lab fees 586659 12 0 0 652360 0 0 3343480 173493 3995840 Outpatient 622000 118308912 117641955 666957 0 Inpatient 622000 54853347 54853347 0 0 0 0 0 0 173162259 361813 0 0 361813 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2502139 11050 2163686 59885 338453 -48835 289618 0 0 289618 323561 0 309854 13707 0 13707 51180 8238 42942 0 0 42942 0 0 0 0 0 0 Cancer Center 900099 3321555 0 0 3321555 Rents 900099 2188309 0 0 2188309 Meaningful Use 900099 1381282 0 0 1381282 3000290 0 0 3000290 9891436 187757615 172495302 666957 10599516 0 0 0 0 0 0 0 0 2094724 0 2094724 0 0 0 0 0 78544874 70156959 7931782 456133 1329263 1169751 146219 13293 12815758 11277867 1409733 128158 5957786 5242851 655356 59579 2046677 1971341 75336 0 -274187 0 -274187 0 67200 0 67200 0 0 0 0 0 359441 359441 0 0 0 0 0 0 0 0 379034 0 379034 0 35104396 33625669 1257137 221590 993781 855812 106976 30993 0 0 0 0 7494157 6006034 1445658 42465 192917 121916 70412 589 0 0 0 0 0 0 0 0 4132937 0 4132937 0 0 0 0 0 9451201 8317057 1039632 94512 1225482 1078424 134803 12255 Contract Services 7776368 7215174 532378 28816 Collection fees 482433 482433 0 0 Physician fees & Community health service initiative 4370806 4370806 0 0 Health Safety Net 1675180 1675180 0 0 0 0 0 0 176220228 153567274 21205130 1447824 3640 3640 69993935 76025082 2848636 4669551 25358673 24125483 3319645 4008426 3971880 4920911 182170446 94349156 85074756 87821290 6039881 6735800 13479632 9139973 210090678 217450156 22107319 23834580 80020640 77848972 7247803 5233888 4024735 5849693 113400497 112767133 X 91030391 95796902 5031849 8258180 627941 627941 96690181 104683023 210090678 217450156 X 11537387 605007 0 0 0 -4149552 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 1 0 0 0 1 0 0 1 30451 30451 0 SchC_P2B_S00_L01 Schedule C, Part II-B, Line 1 Schedule C, Part II-B line 1- Letter D & G -From time to time, the Hospital reaches out to our state and federal legislilators on matters relating to Hospital Operations. Letter H - The $30,451 shown on letter I represents a portion of Massachusetts Hospital and American Hospital Association dues used for lobbying purposes as defined by Medicare. 2004918 0 290165 0 37512 0 2257571 1667003 0 373387 0 35472 0 2004918 1660561 0 25807 0 19365 0 1667003 1561182 0 118549 0 19170 0 1660561 1597614 0 -12267 0 24165 0 1561182 0 0.28 0.72 0 0 3920828 0 3920828 87639968 0 30182092 57457876 1363066 0 432336 930730 82326983 0 60714549 21612434 6919601 0 3020179 3899422 87821290 0 Amounts due to third party payors 5849693 5849693 X SchD_P05_S00_L04 Schedule D, Part V, Line 4 The organization has a Spending Policy which provides a policy with regard to the use of Investment Income and gains on amounts held in the Endowment Funds. Further to provide a consistent, predictable level of support to operations and permit the organization to maintain the purchasing power of the amounts held in the Endowment Fund. The amount to be made available to the operating fund will be calculated at the end of the third quarter of each fiscal year. SchD_P10_S00_L02 Schedule D, Part X, Line 2 A review has been performed of each of the Organization's Revenue Streams in relation to FIN 48. The result of the review is that the following has been identifited as Unrelated Business Income: Non patient laboratory testing provided to nursing homes and non-affiliated (non Tri-County Medical Associates) physician offices. Central America and the Caribbean 0 0 Investments 159578 Europe (including Iceland and Greenland) 0 0 Investments 162551 North America (including Canada and Mexico, but not the United States) 0 0 Investments 31770 East Asia and the Pacific 0 0 Investments 12994 0 0 366893 0 0 0 0 0 0 X X X X X X 1 Ghiorsi & Sorrenti 255 Madison Avenue Wyckoff NJ 07481 Capital Campaign Management 0 956882 280405 676477 956882 280405 676477 MA Golf 275625 231330 44295 0 9600 27701 4174 0 18697 Melange 601125 419325 181800 0 0 0 48624 6550 130763 15 99171 1705 97466 0 0 0 105 1925 61715 975921 652360 323561 0 9600 27701 52903 8475 211175 309854 13707 51180 5590 2648 0 51180 5590 0 0 2648 8238 42942 MA 1 0 1 0 0 1 Martin Richman 14 Prospect Street Milford MA 01747 0 Martin Richman 0 Vice-President of Philanthropy X 0 0 SchG_P01_S00_L01 Schedule G, Part I, Line 1 A total of $10,405 was paid to Ghiorsi & Sorrenti Inc for travel and lodging during FY 13. The agreement distinguishes between professional fund raising and expense payments. 1 1 1 X 1 X 1 1 1 0 1 1 0 0 4744525 1136140 3608385 0.021 0 0 13820291 12845748 974543 0.0055 0 0 3969474 3000572 968902 0.0055 0 0 22534290 16982460 5551830 0.0320 9 0 405472 71824 333648 0.0019 1 0 1588291 685245 903046 0.0051 2 0 3776663 411321 3365342 0.0191 0 0 0 0 0 0 0 0 11900 0 11900 0.0001 12 0 5782326 1168390 4613936 0.0262 12 0 28316616 18150850 10165766 0.0582 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 125700 0 125700 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 125700 0 125700 0 0 2691670 542305 42096540 51271855 -9175315 X 1 1 1 1 Milford Regional Medical Center Inc

14 Prospect Street Milford MA 01757

X X X Milford Regional Medical Center Inc 1 1 X X X X X X X X X 12 1 0 1 X X X X X X X X X X 0 1 1 200 1 400 1 X X X X X X 1 1 X 0 0 1 X 0 1 SchH_P01_S00_L06a Schedule H, Part I, Line 6a Milford Regional Medical Center prepares and distributes a printed community benefits report, made available on the hospital website. In addition, the annual report filed with the Massachusetts Attorney General is published online and available to the public. SchH_P01_S00_L07 Schedule H, Part I, Line 7 Lines 7 a/b/c were calculated using Worksheets 1, 2, 3 provided in the instructions. Line 7f was determined by the cost & reimbursement information on the Medicare Cost Report. It was calculated by dividing Column E, Net Community Benefit Expense by total of Part IX Line 25 of Form 990 Core Form of $175,745,292. SchH_P02_S00_L00 Schedule H, Part II Milford Regional plays an active role in the economic development of our service area, supporting organizations such as 495/MetroWest Partnership for Economic Development and the Blackstone Valley, Hopkinton and Milford Area Chambers of Commerce. Milford Regional continues to be involved in the development of the Edward M Kennedy Community Health Center satellite site in Milford. A Physician Leadership Group has been formed to provide assistance with communication of the new site and the development of access to specialty services and key linkages with the hospital. The health center is under construction with an expected opening date of late 2013. Milford Regional's ongoing support of this project, the first of its kind in Milford, with funding from the Health Foundation of Central Massachusetts and the Metrowest Health Foundation has promoted the common goal of improving access to care for uninsured and underinsured residents of our service area. SchH_P03_S0A_L04 Schedule H, Part III, Section A, Line 4 In Line 2, Worksheet A in the instructions was used by taking bad debt as reported in Milford Regional Medical Center, Inc.'s (the Hospital) audited financial statemetns multiplied by the cost-to-charge ratio calculated in Worksheet 2 in the instructions. SchH_P03_S0B_L08 Schedule H, Part III, Section B, Line 8 The Hospital's Medicare Cost Report was used to determine the amount reported on Line 6. SchH_P03_S0C_L09b Schedule H, Part III, Section C, Line 9b Once it is determined that a patient qualifies for full or partial free care, all collection procedures cease and the full balance, or the amount that qualifies under partial free care, is written off. Massachusetts hospitals are required to adopt a credit and collection policy under the Health Safety Net (HSN) regulations (114.6 CMR 13.08(1)(c)) that outlines the specific process for determining eligibility for public assistance programs and hospital collection practices. Hospitals make reasonable and diligent efforts to collect the patient's insurance and other information to verify other coverage for the health care services provided by the hospital prior to deeming the services to be charity care. The Hospital provides patients with information about financial assistance programs that are available through the Massachusetts Executive Office of Health and Human Services, including charity care services that are provided through HSN, and also assist patients in applying for these services through the State's uniform application. The Hospital credit and collection policy, that outlines its charity care practices, is filed with the Massachusetts Division of Health Care Finance and Policy and also available to patients upon request. SchH_P05_S0B_L03 Schedule H, Part V, Section B, Line 3 Milford Regional Medical Center Inc completed a community health needs assessment in 2012 working with Health Resources in action. Community input was included through a series of key informant interviews and two public Community Health Dialogues conducted by the consultants. Key informants were selected across a broad range of sectors, and included public safety officials, educators, mental health agencies, councils on aging, and the department of transitional assistance. SchH_P05_S0B_L05 Schedule H, Part V, Section B, Line 5 The Needs Assessment report was also made available to the public through a meeting of the Community Health Network in our area that was open to the public, led by Health Resources in Action. SchH_P05_S0B_L07 Schedule H, Part V, Section B, Line 7 CEO Frank Saba chairs the Community Benefits Steering Committee charged with a comprehensive process of data analysis and priority setting that includes continuing dialogue with internal and external stakeholders. The areas of focus identified in the Health Assessment address behavioral health, healthy weight for youth, adolescent health, and chronic disease prevention. Milford Regional stays current with studies conducted by other agencies and institutions including Metrowest Adolescent Helath Survey analyzed by Metrowest Health Foundation, MA Department of Public Health, Health Care for All. Given the scope of issues identified in the assessment, this work will be ongoing. SchH_P05_S0B_L12 Schedule H, Part V, Section B, Line 12 Asset level is used for Medicare patients only. This follows Medicare guidelines. SchH_P05_S0B_L22 Schedule H, Part V, Section B, Line 22 At the Hospital, all patients are charged the gross charges for any services. Upon contact from an uninsured patient, a discussion occurs which may result in the discounting of gross charges. SchH_P06_S00_L02 Schedule H, Part VI, Line 2 Milford Regional stays current with studies by other agencies, particularly the Adolescent Health survey conducted by the MetroWest Health Foundation. Active participation in the community Health Network areas (CHNA) and other community coalitions provides another important source of information on emerging health needs. SchH_P06_S00_L03 Schedule H, Part VI, Line 3 Patients are informed of the availability of financial assistance by way of patient statements printed with financial assistance information. At the time of discharge from the Emergency Department, uninsured patients are encouraged to meet with an on-site Financial Counselor. If unable to see a Financial Counselor at the time of discharge, the patient is given a screening letter that gives contact information for our financial assistance department. The day following an emergency room visit a form is generated on each uninsured patient and sent to the Financial Counselors. At that time, the Financial Counselors contacts the patient to coordinate a meeting to apply for assistance. Scheduled self-pay Surgical Day Care (SDC) & inpatients are reviewed prior to admission to determine payment arrangements or to coordinate a meeting with a Financial Counselor. Insured SDC & inpatients who are unable to leave a deposit or make payment arrangements towards a large out of pocket expense are also encouraged to meet with a Financial Counselor. SchH_P06_S00_L04 Schedule H, Part VI, Line 4 Milford Regional Medical Center serves the healthcare needs of the residents of 19 communitites in Central Massachusetts, spanning 3 separate counties: Worcester, Norfolk and Middlesex. The Hospital's primary service area consists of Milford, Franklin, Bellingham, Northbridge, Whitinsville, Uxbridge, Blackstone, Hopedale, Medway and Mendon, a population of 145,362 according to 2010 US Census data. The Hospital's secondary service area consists of Douglas, Grafton, Hopkinton, Holliston, Millis, Wrentham, Upton, Medfield and Millville, a population of 96,310. The population of the MRMC service area has grown almost 9% over the past decade, as opposed to the statewide average of 3%.The residents of this region are primarily Caucasian, accounting for 93.6% of the population. Hispanics comprise 2.7% iof the population, with Asians also at 2.7% and African Americans at 1.0%. The population is nearly even in terms of gender, with 51% females. The bulk of the adult population (71.6%) is between the ages of 18-54, slightly higher than the state percentage, which is 68%. There has been an influx of Egyptian, Central American and Brazilian immigrants into the area, most likely not represented in these totals, but estimated at several thousand additional residents. SchH_P06_S00_L05 Schedule H, Part VI, Line 5 Milford Regional furthers its exempt purpose by striving to fulfill its mission "to provide quality healthcare services to our community with dignity, compassion and respect." We do this by providing inpatient and outpatient health care services to the residents of our service area without regard to their ability to pay, and through a range of community benefits programs and partnerships. Our corporate board represents the communities we serve, and the majority is comprised of members who reside in our service area and are not employed by Milford Regional. Surplus funds are consistently invested in strategic initiatives designed to improve efficiency and patient care. Our ongoing collaboration with Dana-Farber Cancer Institute and Brigham and Women's Hospital to operate a comprehensive Cancer Center including medical oncology and radiation oncology has made a tremendous difference to the quality of life for residents seeking cancer treatment. We worked with a broad range of community partners to address unmet health needs identified by our community health needs assessment. We maintain an active role in the development of the Edward M. Kennedy Community Health Center in Milford through funding from the Health Foundation of Central Massachusetts and the Metrowest Health Foundation to improve access to care for uninsured and underinsured residents of our service area. The MRMC Community Benefits Steering Committee and a MRMC Physician Leadership Group have continued the work of the Greater Health Access Coalition to guarantee access to primary care for residents of the Milford area and facilitate the planned opening of a satellite location in 2013. SchH_P06_S00_L06 Schedule H, Part VI, Line 6 The Organization consists of Milford Regional Medical Center, Inc. (the "Hospital" or "Parent"), Tri-County Medical Associates("Tri-County"), and Milford Regional Healthcare Foundation, Inc. (the "Foundation"), collectively referred to as the "Organization". The Hospital provides medical and hospital services for the sick and disabled of any race, creed, color, or nationality regardless of an individual's ability to pay. Tri-County, a large multi-specialty group practice, operates for the benefit of the Hospital by assisting the Hospital in carrying out its charitable mission purpose of promoting healthcare in its service area. Tri-County's vision is to consistently meet the changing healthcare needs and expectations of the communities it serves. The Foundation supports the mission of both the Hospital and Tri-County through fund raising activities. SchH_P06_S00_L07 Schedule H, Part VI, Line 7 Massachusetts X 1 1 X X X X X 1 1 0 0 0 0 0 0 0 Jeff Hopkins MD 0 0 0 0 4375 0 0 0 0 0 4375 0 0 0 Patrick R McSweeney MD 0 391057 0 0 0 0 0 0 0 29085 0 420142 0 0 Albert A Crimaldi MD 0 0 0 0 5300 0 0 0 0 0 5300 0 0 0 John N Pandiscio 0 0 0 0 15725 0 0 0 0 0 15725 0 0 0 Francis M Saba 432082 0 60000 0 0 0 165182 0 23687 0 680951 0 0 188925 Edward J Kelly 382940 0 52500 0 0 0 27324 0 26798 0 489562 0 0 32717 Jeanne P Lynskey 229328 0 22576 0 0 0 0 0 24351 0 276255 0 0 0 Salvatore Perla 209300 0 0 0 0 0 0 0 25669 0 234969 0 0 0 Cheryl L Bonasoro 227801 0 0 0 12052 0 0 0 7840 0 247693 0 0 0 Linda Yates 181488 0 0 0 0 0 0 0 24793 0 206281 0 0 0 Martin Richman 166418 0 0 0 0 0 0 0 20263 0 186681 0 0 0 Nicole Heim 155976 0 0 0 0 0 0 0 23298 0 179274 0 0 0 Nancy Tomaso 167115 0 0 0 0 0 0 0 5945 0 173060 0 0 0 Kamala Murali 143401 0 0 0 0 0 0 0 20373 0 163774 0 0 0 Donna M Saul 144662 0 0 0 0 0 0 0 24200 0 168862 0 0 0 Judy Kelly 142078 0 0 0 0 0 0 0 21719 0 163797 0 0 0 Karen Sergi 147822 0 0 0 0 0 0 0 20167 0 167989 0 0 0 Maria DaSilva 145799 0 0 0 0 0 0 0 23615 0 169414 0 0 0 SchJ_P01_S00_L01a Schedule J, Part I, Line 1a Payments made to some members of senior management for insurance premiums are grossed up. SchJ_P01_S00_L04 Schedule J, Part I, Line 4 Cheryl Bonasoro received sevrance pay in 2012 for $12,051.60. Francis M Saba and Edward J Kelly had deposits to their SERPs of $165,182 and $27,324, respectively. A Massachusetts Health & Education Facilities Authority 042456011 57586CXJ9 2007-02-21 70279953 See Supplemental Information 0 0 0 A 4230000 0 70279953 2664107 1509967 30555914 823473 0 0 34726492 0 0 2008 0 1 1 1 A 0 1 1 1 0 0.018 0 0.018 1 0 0 A 0 0 0 1 0 0 0 0 0 SchK_P01_S00_L00f Schedule K, Part I, Column f The proceeds of the Series E Bonds were applied to the following (1) Constructing, furnishing and equipping an approximately 54,013 gross square feet, two story building on the Milford campus across the street from the Hospital building. The Cancer Center will be owned and partially occupied by the Hospital for diagnostic imaging services (including MRI, CT scan and diagnostic radiology), laboratory services and other administrative space. In addition, the Hospital has executed leases with two tenants for the Cancer Center. Dana-Farber Cancer Institute to provide medical/oncology services and Brigham and Women's Physicians Organization to provide radiation/oncology services. (2) Purchasing of four properties and demolishing three existing structures located thereon for the purpose of constructing the Cancer Center. (3) Renovating, constructing, furnishing and equipping for the approximately 2,438 gross square feet of existing space for a Cardiac Catheterization Lab on the Milford Campus. (4) Renovating approximately 8,800 square feet of existing space which previously served as the Hospital's operating room area (prior to the issuance of the Series D Bonds in 2002), to relocate outpatient and other administrative spaces. (5) Renovating the Gannett Inpatient Unit consisting of approximately 9,569 gross square feet. (6) Renovating and expanding the Cardiovascular Department consisting of approximately 1,982 gross square feet. (7) Various renovations, improvements, equipment and furnishings at the Milford Campus and the Whitinsville Division. (8) Refinancing the Series D Bonds, the proceeds of which were applied primarily for the purpose of modernizing and expanding surgical services and expanding the maternity unit. SchK_P04_S00_L02c Schedule K, Part IV, Line 2c The rebate calculation has been performed annually in July of each year. M Catherine Burke MD Trustee 441129 Payments were made to Orion Emergency Services Inc for services provided to the Hospital. Dr Burke is President of Orion Emergency Services, Inc. 0 Albert Crimaldi MD Trustee 431750 Payments were made to Milford Gastroenterology Associates Inc which provides services to the Hospital. Dr. Crimaldi is part owner of Milford Gastroenterology Associates Inc. Payments were also made to Milford Gastroenterology Realty with which the Hospital has entered into a lease agreement. Dr. Crimaldi is part owner of Milford Gastroenterology Realty. 0 Jeffrey Hopkins MD Trustee 0 Payments of $441,129 were made to Orion Emergency Services for services rendered to the Hospital. Dr. Hopkins is an employee of Orion Emergency Services, Inc. 0 X 0 FMV X 5 173493 FMV X 2 0 FMV X Food and supplies for charitable fund raising event 3 0 FMV X Tickets to sporting events or entertainment for fund raising event 13 0 FMV X Travel packages for fund raising events 9 0 FMV X Gift certificates and gift baaskets for fund raising event 11 0 FMV X Dinner packages and beverages for fund raising event 13 0 FMV X Miscellaneous toys 4 0 FMV X Freezer for fund raising event 1 0 FMV X 2 Motorcycle helmets 1 0 FMV X Recumbent bicycle for fund raising event 1 0 FMV X Coolpix camera 1 0 FMV X Wurlitzer piano 1 0 FMV X Cordless drill 1 0 FMV 0 0 1 0 SchM_P01_S00_L33 Schedule M, Part I, Line 33 Schedule M, Part I, Line 33 - MRMC Inc. does not currently account for certain non-cash contributions or in-kind donations as revenue. F990_P06_S0A_L02 Form 990, Part VI, Section A, Line 2 Three board of trustee members have disclosed via the organization's conflict of interest disclosure process that they have business relationships with other board members. F990_P06_S0A_L06 Form 990, Part VI, Section A, Line 6 The organization is governed by a Board of Trustees. In addition, the organization has incorporators who serve in an advisory capacity to the Board of Trustees. F990_P06_S0B_L11b Form 990, Part VI, Section B, Line 11b The FORM 990 was reviewed with the Chairman of the Board. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c The organization has a written Code of Business Conduct which states its conflict of interest policy. A conflict of interest disclosure statement is mailed annually to members of the Board of Trustees and senior management. They are required to complete the form and submit it to the Corporate Compliance Officer. The forms are reviewed and monitored. The organization also has established a hotline for any staff member who may wish to discuss a potential violation of the code, our policy, or law on an annonymous basis. F990_P06_S0B_L15 Form 990, Part VI, Section B, Line 15 The Compensation Committee reviews the compensation of the President and CEO. The committee may consult with a nationally recognized consultant to assist it in determining that the organization's compensation structure and ranges are reasonable. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 The organization makes it governing documents available to the public, such as it's bylaws which include the organizaion's conflict of Interest policy, through the annual filing of the Massachusetts Division of Public Charities Form PC. The Form PC is available for viewing by the public on the Massachusetts Attorney General's website and is also attached to the annual filing of the Massachusetts Form 3ABC which is submitted to town offices where the organization owns or leases property. The organization's financial statements are included in the Form PC filing and are also included in a quarterly filing to the organization's bond holders. F990_P11_S00_L09 Form 990, Part XI, Line 9 The Change in Net Assets results from transferring to affiliates ($4,330,114), Auxiliary activitiy $8,453, change in market value $172,109. Tri-County Medical Associates Inc 9 Industrial Road Suite 5 Milford MA 01757 043159969 Physician Group MA 501(C)(3) 11A N/A MWRH Management Services Inc 14 Prospect Street Milford MA 01757 311631252 Provides office space, support to satellite clinics MA 501(C)(3) 11A N/A Milford Regional Healthcare Foundation Inc 14 Prospect Street Milford MA 01757 200773697 Fundraising MA 501(C)(3) 11A N/A Milford Whitinsville Healthcare Consortium Inc 14 Prospect Street Milford MA 01757 043248004 Physician Hospital Organization MA N/A C 0 366 0.5 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 1 0 1 0 Tri-County Medical Associates Inc i 186396 Market value Tri-County Medical Associates Inc k -77941 Market value Tri-County Medical Associates Inc q 7550000 Cost Tri-County Medical Associates Inc o -3417327 Cost Tri-County Medical Associates Inc h -1035 Market Value