FAIRVIEW HOSPITAL: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
FAIRVIEW HOSPITAL (EIN 04-2133860)
Tax period
2011-10-01 to 2012-09-30
Filed
2013-08-15
IRS object ID
201332279349302553
Schema version
2011v1.5
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-08-15T12:16:13-05:00Timestamp
Tax Period End Date2012-09-30TaxPeriodEndDate
Return Type990ReturnType
Tax Period Begin Date2011-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN042133860EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1FAIRVIEW HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlFAIRNameControl
Phone4134472508Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1725 NORTH STREETAddressLine1
CityPITTSFIELDCity
StateMAState
ZIP Code012014109ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDARLENE RODOWICZName
TitleCFOTitle
Phone4134472809Phone
Date Signed2013-08-15DateSigned
Authorize Third Party0AuthorizeThirdParty
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonDARLENE RODOWICZNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1725 NORTH STAddressLine1
CityPITTSFIELDCity
StateMAState
ZIP Code012014109ZIPCode
FieldValueIRS element (for citing)
Gross Receipts47664668GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.BHS1.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1912YearFormation
State Legal DomicileMAStateLegalDomicile
Activity Or Mission DescriptionTHE MISSION OF FAIRVIEW HOSPITAL IS TO IMPROVE THE HEALTH OF ALL PEOPLE IN THE BERKSHIRES AND... (CONTINUED FROM FORM 990)...SURROUNDING COMMUNITIES, REGARDLESS OF THEIR ABILITY TO PAY.ActivityOrMissionDescription
Nbr Voting Members Governing Body24NbrVotingMembersGoverningBody
Nbr Independent Voting Members20NbrIndependentVotingMembers
Total Nbr Employees323TotalNbrEmployees
Total Nbr Volunteers50TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year511811ContributionsGrantsPriorYear
Contributions Grants Current Year618864ContributionsGrantsCurrentYear
Program Service Revenue Prior Year41845111ProgramServiceRevenuePriorYear
Program Service Revenue CY44224749ProgramServiceRevenueCY
Investment Income Prior Year924885InvestmentIncomePriorYear
Investment Income Current Year469864InvestmentIncomeCurrentYear
Other Revenue Prior Year658321OtherRevenuePriorYear
Other Revenue Current Year1204552OtherRevenueCurrentYear
Total Revenue Prior Year43940128TotalRevenuePriorYear
Total Revenue Current Year46518029TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY1250GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year22365294SalariesEtcPriorYear
Salaries Etc Current Year25267767SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year90244TotalFundrsngExpCurrentYear
Other Expense Prior Year19708790OtherExpensePriorYear
Other Expenses Current Year19396247OtherExpensesCurrentYear
Total Expenses Prior Year42074084TotalExpensesPriorYear
Total Expenses Current Year44665264TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1866044RevenuesLessExpensesPriorYear
Revenues Less Expenses CY1852765RevenuesLessExpensesCY
Total Assets BOY28000233TotalAssetsBOY
Total Assets EOY31956366TotalAssetsEOY
Total Liabilities BOY17923149TotalLiabilitiesBOY
Total Liabilities EOY18152754TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY10077084NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY13803612NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTHE MISSION OF FAIRVIEW HOSPITAL IS TO IMPROVE THE HEALTH OF ALL PEOPLE IN THE BERKSHIRES AND SURROUNDING COMMUNITIES, REGARDLESS OF THEIR ABILITY TO PAY.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense39569228Expense
Revenue45219943Revenue
DescriptionFAIRVIEW HOSPITAL, A 24 BED CRITICAL ACCESS COMMUNITY HOSPITAL, IS THE PRIMARY PROVIDER OF HEALTH CARE & ACCESS TO HEALTH CARE SERVICES IN SOUTHERN BERKSHIRE COUNTY, MA. THE HOSPITAL SERVES A RURAL AREA WHICH INCLUDES TOWNS IN MA, NORTHWEST CT, & COLUMBIA COUNTY, NY WITH A FULL RANGE OF PRIMARY CARE SERVICES, INCLUDING PREVENTATIVE, DIAGNOSTIC & THERAPEUTIC CARE, ON BOTH AN IN- & OUT-PATIENT BASIS. THE PRIMARY SERVICE AREA HAS A RESIDENT POPULATION OF APPROXIMATELY 30,000. THE HOSPITAL PLAYS AN ACTIVE ROLE IN MEETING THE HEALTH NEEDS OF THE COMMUNITY OUTSIDE THE HOSPITAL WALLS IN ITS PROACTIVE COMMUNITY OUTREACH, EDUCATION, & SCREENING INITIATIVES, WHICH ARE DESIGNED TO IMPROVE THE HEALTH STATUS OF THE COMMUNITY. THROUGH COLLABORATION WITH NUMEROUS HEALTH & SOCIAL SERVICE AGENCIES, (CONTINUED ON SCHEDULE O) (CONTINUED FROM FORM 990)...FAIRVIEW HOSPITAL PROMOTES ACCESS TO INFORMATION & SERVICES, & DRAWS EXTENSIVE MEDICAL, TECHNOLOGICAL, & FINANCIAL RESOURCES TO THE AREA THROUGH ITS AFFILIATION WITH BERKSHIRE MEDICAL CENTER & BERKSHIRE HEALTH SYSTEMS. AS A RESULT, THE SOUTHERN BERKSHIRE COMMUNITY ENJOYS A COMPLETE CONTINUUM OF CARE SERVICES INCLUDING EDUCATION, PREVENTION, SCREENING, DIAGNOSTIC, THERAPEUTIC, REHABILITATIVE, & LONG-TERM CARE SERVICES, AN UNUSUALLY HIGH LEVEL OF HEALTH SERVICES WHEN COMPARED WITH SIMILAR RURAL COMMUNITIES. PLEASE SEE THE FY2012 "COMMUNITY BENEFITS REPORT" AT WWW.CBSYS.AGO.STATE.MA.US/CBPUBLIC/PUBLIC/ANNUAL_REPORTS_START.ASPX FOR MORE DETAILS.Description
Total Program Service Expense39569228TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities1FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity1TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109683NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees323NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions1QuidProQuoContributions
Quid Pro Quo Disclosure1QuidProQuoDisclosure
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members24NbrVotingGoverningBodyMembers
Number Independent Voting Members20NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledMAStatesWhereCopyOfReturnIsFiled
States Where Copy Of Return Is FiledNYStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1DARLENE RODOWICZ CFOBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number4134472809TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1725 NORTH STREETAddressLine1
CityPITTSFIELDCity
StateMAState
ZIP Code012014109ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (38 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
LORINDA ACKLEY MAZUR
TRUSTEE2.00X000
JEROME J ANDERSON
TRUSTEE2.00X000
THOMAS O ANDREWS
TRUSTEE2.00X000
ALFRED A BARBALUNGA
TRUSTEE2.00X000
BRONLY S BOYD
TRUSTEE/CHAIRMAN2.00X000X
BRIAN T BURKE MD
TRUSTEE/PHYSICIAN50.00X196555037753
KIT DOBELLE
TRUSTEE2.00X000
TIMOTHY C DOHERTY
TRUSTEE/CHAIRMAN UNTIL 02/122.00X000X
RICHARD M DOHONEY
TRUSTEE2.00X000
BRIAN H FAIRBANK
TRUSTEE/NOT SERVING AT YEAR-END2.00X000
A KING FRANCIS
TRUSTEE2.00X000
DENNIS J HOGAN
TRUSTEE2.00X000
EDMUND H HORNSTEIN DO
TRUSTEE/CONTRACT PHYSICIAN2.00X0743120
JOHN R KEARNS MD
TRUSTEE/NOT SERVING AT YEAR-END2.00X000
ELLEN L KENNEDY
TRUSTEE2.00X000
SUSAN M KORMANIK
TRUSTEE2.00X000
JOAN M MCFALLS
TRUSTEE2.00X000
MICHAEL R MCINERNEY MD
TRUSTEE2.00X000
LAURIE NORTON MOFFATT
TRUSTEE2.00X000
DAVID E PHELPS
PRESIDENT/TRUSTEE58.00X045428039701X
D PHELPS-LIFE INS OTHER BENEFITS
PRESIDENT1.00X01609990X
BARTON D RASER
TRUSTEE2.00X000
CAROLE G SIEGEL
TRUSTEE2.00X000
GEORGE T SMITH
TRUSTEE2.00X000
MARILYN L SPERLING
TRUSTEE2.00X000
ANN H TRABULSI
TRUSTEE2.00X000
ROBERT P WESPISER MD
TRUSTEE/CONTRACT PHYSICIAN2.00X01307480
PAUL E RAVERTA
TRUSTEE/NOT SERVING AT YEAR-END2.00X000
CHERYL M BOUDREAU
CLERK41.0008722813973X
EUGENE DELLEA
PRESIDENT, FAIRVIEW HOSPITAL50.00021292219580X
DARLENE RODOWICZ
TREASURER51.00035933936363X
ALEC R BELMAN MD
DIRECTOR, EMERGENCY DEPT.50.00240829039555X
DOREEN HUTCHINSON
VICE PRESIDENT, OPERATIONS50.00163523035842X
WILLIAM F DUKE MD
PHYSICIAN50.00216174021998X
CORINNE D KALSER MD
PHYSICIAN50.00193431027851X
GLEN R LOVEJOY MD
PHYSICIAN50.00228208036083X
RAYMOND SABATELLI MD
PHYSICIAN50.00262092039555X
STEPHEN TRACY MD
PHYSICIAN50.00223078036204X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1723890TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1479828TotalReportableCompFrmRltdOrgs
Total Other Compensation384458TotalOtherCompensation
Number Individuals GT100 K34NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (2 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
BERKSHIRE SURGICAL ASSOC PC
777 NORTH ST STE 407PITTSFIELDMA012014141HEALTHCARE SERVICES292100
WEATHERBY LOCUMS INC
PO BOX 972633DALLASTX753972633HEALTHCARE STAFFING100595
FieldValueIRS element (for citing)
Number Of Contractors GT100 K2NumberOfContractorsGT100K
Fundraising Events151984FundraisingEvents
Government Grants77301GovernmentGrants
All Other Contributions389579AllOtherContributions
Noncash Contributions5305NoncashContributions
Total Contributions618864TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionNET PATIENT SVC REVENUDescription
Business Code622110BusinessCode
Total Revenue Column44224749TotalRevenueColumn
Related Or Exempt Function Income44224749RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue44224749TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column290520TotalRevenueColumn
Exclusion$290,520ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column13429TotalRevenueColumn
Exclusion$13,429ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real46272Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real2140Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real44132Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column44132TotalRevenueColumn
Exclusion$44,132ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities1186569Securities
Other31090Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities988126Securities
Other63618Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities198443Securities
Other-32528Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column165915TotalRevenueColumn
Exclusion$165,915ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events92755GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events151984CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses92755FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeExclusionExclusionAmount
EHR INCENTIVE PMTS900099487126487126
PHARMACY SALES446110370010370010
CAFETERIA SALES722514165226$165,226

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column138058TotalRevenueColumn
Related Or Exempt Function Income138058RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue1160420TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column46518029TotalRevenueColumn
Related Or Exempt Function Income45219943RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$679,222ExclusionAmount

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total1250Total
Program Services1250ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total810820Total
Program Services807222ProgramServices
Management And General3181ManagementAndGeneral
Fundraising417Fundraising

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total19523728Total
Program Services19181106ProgramServices
Management And General302939ManagementAndGeneral
Fundraising39683Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total710191Total
Program Services697572ProgramServices
Management And General11158ManagementAndGeneral
Fundraising1461Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total2951325Total
Program Services2905062ProgramServices
Management And General40978ManagementAndGeneral
Fundraising5285Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1271703Total
Program Services1249969ProgramServices
Management And General19216ManagementAndGeneral
Fundraising2518Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total4399091Total
Management And General4399091ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total83Total
Management And General83ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total12270Total
Program Services12270ProgramServices

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total18505Total
Management And General18505ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total3069062Total
Program Services3055150ProgramServices
Management And General1357ManagementAndGeneral
Fundraising12555Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total40123Total
Program Services28025ProgramServices
Management And General487ManagementAndGeneral
Fundraising11611Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total3087926Total
Program Services3049016ProgramServices
Management And General29857ManagementAndGeneral
Fundraising9053Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total339420Total
Program Services339367ProgramServices
Management And General53ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total687829Total
Program Services676529ProgramServices
Management And General10300ManagementAndGeneral
Fundraising1000Fundraising

Travel Travel

FieldValueIRS element (for citing)
Total200661Total
Program Services195251ProgramServices
Management And General3396ManagementAndGeneral
Fundraising2014Fundraising

Interest Interest

FieldValueIRS element (for citing)
Total305410Total
Program Services305410ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1562282Total
Program Services1535582ProgramServices
Management And General26700ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total270898Total
Program Services266268ProgramServices
Management And General4098ManagementAndGeneral
Fundraising532Fundraising

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
BAD DEBT16458851645885
RECIPROCAL/TEACHNG FEES12695811269581
MAINTENANCE & REPAIRS70160268982711775
ARCHITECTURAL & DESIGN650466650466

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total1135153Total
Program Services1008420ProgramServices
Management And General122618ManagementAndGeneral
Fundraising4115Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total44665264Total
Program Services39569228ProgramServices
Management And General5005792ManagementAndGeneral
Fundraising90244Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY11574BOY
EOY6000EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1256157BOY
EOY815762EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
EOY3600EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY4338011BOY
EOY5162660EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY30125BOY
EOY19511EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY278996BOY
EOY354928EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY150987BOY
EOY110339EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis26091466LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec16173399LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY8705396BOY
EOY9918067EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY11469349BOY
EOY13583585EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY1341202BOY
EOY1565677EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY11811BOY
EOY10292EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY406625BOY
EOY405945EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY28000233BOY
EOY31956366EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY2899111BOY
EOY2994018EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY29524BOY
EOY26829EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY6884364BOY
EOY6205719EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY8110150BOY
EOY8926188EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY17923149BOY
EOY18152754EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY8079580BOY
EOY11447565EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1739262BOY
EOY2097805EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY258242BOY
EOY258242EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY10077084BOY
EOY13803612EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY28000233BOY
EOY31956366EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses1852765ReconcilationRevenueExpenses
Reconcilation Other Changes1873763ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required1FederalGrantAuditRequired
Federal Grant Audit Performed1FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$12,270OtherActivitiesAmount
Total Lobbying Expenditures IIB12270TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF LOBBYING ACTIVITIES:Identifier
Return ReferencePART II-B, LINE 1:ReturnReference
ExplanationLOBBYING ACTIVITIES EXPENDITURES FAIRVIEW HOSPITAL PAYS ANNUAL MEMBERSHIP DUES TO THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE MASSACHUSETTS HOSPITAL ASSOCIATION (MHA). A PORTION OF THESE DUES ARE USED BY THE AHA AND THE MHA TO CONDUCT LOBBYING ACTIVITIES. FOR THE FYE 09/30/2012, THE PORTION OF THE DUES PAID TO THE AHA FOR LOBBYING ACTIVITIES WAS $2,972, AND THE PORTION OF THE DUES PAID TO THE MHA FOR LOBBYING ACTIVITIES WAS $9,298, FOR A TOTAL OF $12,270.Explanation

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance1058317BeginningOfYearBalance
Investment Earnings Or Losses136721InvestmentEarningsOrLosses
End Of Year Balance1195038EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance1046753BeginningOfYearBalance
Investment Earnings Or Losses11564InvestmentEarningsOrLosses
End Of Year Balance1058317EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance989912BeginningOfYearBalance
Investment Earnings Or Losses56841InvestmentEarningsOrLosses
End Of Year Balance1046753EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance1028277BeginningOfYearBalance
Investment Earnings Or Losses-22233InvestmentEarningsOrLosses
Other Expenditures16132OtherExpenditures
End Of Year Balance989912EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.78390BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.21610PermanentEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis16887OtherCostOrOtherBasis
Book Value16887BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis2137042OtherCostOrOtherBasis
Depreciation2012928Depreciation
Book Value124114BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis12689107OtherCostOrOtherBasis
Depreciation9075317Depreciation
Book Value3613790BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis11248430OtherCostOrOtherBasis
Depreciation5085154Depreciation
Book Value6163276BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings9918067TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (5 entries)

DescriptionDescriptionAmountAmount
DUE TO AFFILIATES$7,005,143
DUE TO THIRD PARTY PAYORS$1,192,815
ACCRUED FIN 47 ACCRETION$605,898
DEFERRED COMPENSATION$118,307
REBATE FUND LIABILITY$4,025
FieldValueIRS element (for citing)
Total Of Amounts8926188TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS:PART V, LINE 4:INTENDED USES OF THE ORGANIZATION'S ENDOWMENT FUNDS FAIRVIEW HOSPITAL HAS FIVE PERMANENT ENDOWMENT FUNDS. THE BALDWIN FUND'S INCOME IS TO BE USED FOR THE CARE OF PEOPLE WITHOUT OR OF LIMITED MEANS. THE BEECHER FUND'S INCOME IS TO BE USED TO OFFSET THE HEALTHCARE COSTS OF AGING WOMEN OR UNWED MOTHERS. THE BRANDI FUND'S INCOME HAS THREE PURPOSES: (1) TO PROVIDE SCHOLARSHIPS FOR THE CONTINUING EDUCATION OF NURSES OR PROSPECTIVE NURSES ASSOCIATED WITH THE HOSPITAL; (2) TO SERVE AS A SOURCE OF EMERGENCY LOANS TO RETIRED NURSES OR CERTAIN NURSES WHO ARE CURRENTLY WORKING FOR THE HOSPITAL; AND (3) FOR THE PURCHASE OF EQUIPMENT, FURNISHINGS, OR OTHER ITEMS FOR THE BENEFIT OF THE NURSES OR THE MATERNITY SECTION OF THE HOSPITAL. THE MOSKOWITZ FUND'S INCOME IS TO BE USED TO PROVIDE FOR SCHOLARSHIPS TO EMPLOYEES AND CHILDREN OF EMPLOYEES OF THE HOSPITAL WHO ARE ADVANCING THEIR EDUCATION OR TECHNICAL SKILLS AT A RECOGNIZED LEARNING INSTITUTION. THE STANLEY FUND'S INCOME IS TO BE USED FOR THE REPAIR, UPKEEP, AND ADDITIONS TO THE HOSPITAL'S X-RAY EQUIPMENT.
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:PART X:THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS AND SUPPLEMENTARY FINANCIAL INFORMATION OF BERKSHIRE HEALTH SYSTEMS, INC. AND AFFILIATES (INCLUDING FAIRVIEW HOSPITAL) FOR THE YEARS ENDED SEPTEMBER 30, 2012 AND 2011 DOES NOT CONTAIN A FOOTNOTE ADDRESSING ANY LIABILITY FOR UNCERTAIN TAX PROVISIONS UNDER FIN 48.

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1GALANameOfEvent1
Gross Receipts Event1204939GrossReceiptsEvent1
Charitable Contributions Event1142538CharitableContributionsEvent1
Gross Revenue Event162401GrossRevenueEvent1
Non Cash Prizes Event13805NonCashPrizesEvent1
Rent Facility Costs Event111214RentFacilityCostsEvent1
Food And Beverage Event116915FoodAndBeverageEvent1
Entertainment Event110000EntertainmentEvent1
Other Direct Expenses Event120467OtherDirectExpensesEvent1
Name Of Event2GOLF TOURNAMENTNameOfEvent2
Gross Receipts Event239800GrossReceiptsEvent2
Charitable Contributions Event29446CharitableContributionsEvent2
Gross Revenue Event230354GrossRevenueEvent2
Non Cash Prizes Event24750NonCashPrizesEvent2
Rent Facility Costs Event211008RentFacilityCostsEvent2
Food And Beverage Event26150FoodAndBeverageEvent2
Other Direct Expenses Event28446OtherDirectExpensesEvent2
Gross Receipts Total244739GrossReceiptsTotal
Charitable Contributions Total151984CharitableContributionsTotal
Gross Revenue Total Events92755GrossRevenueTotalEvents
Non Cash Prizes Total Events8555NonCashPrizesTotalEvents
Rent Facility Costs Total Events22222RentFacilityCostsTotalEvents
Food And Beverage Total Events23065FoodAndBeverageTotalEvents
Entertainment Total Events10000EntertainmentTotalEvents
Other Direct Expenses Total Events28913OtherDirectExpensesTotalEvents
Direct Expense Summary Events92755DirectExpenseSummaryEvents
Net Income Summary0NetIncomeSummary

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent400XPcent400
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense633656TotalCommunityBenefitExpense
Net Community Benefit Expense633656NetCommunityBenefitExpense
Percent Of Total Expense0.01470PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense5903096TotalCommunityBenefitExpense
Direct Offsetting Revenue4511557DirectOffsettingRevenue
Net Community Benefit Expense1391539NetCommunityBenefitExpense
Percent Of Total Expense0.03230PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Total Community Benefit Expense2821970TotalCommunityBenefitExpense
Direct Offsetting Revenue2318427DirectOffsettingRevenue
Net Community Benefit Expense503543NetCommunityBenefitExpense
Percent Of Total Expense0.01170PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense9358722TotalCommunityBenefitExpense
Direct Offsetting Revenue6829984DirectOffsettingRevenue
Net Community Benefit Expense2528738NetCommunityBenefitExpense
Percent Of Total Expense0.05870PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense208499TotalCommunityBenefitExpense
Net Community Benefit Expense208499NetCommunityBenefitExpense
Percent Of Total Expense0.00480PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense18800TotalCommunityBenefitExpense
Net Community Benefit Expense18800NetCommunityBenefitExpense
Percent Of Total Expense0.00040PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense1672TotalCommunityBenefitExpense
Net Community Benefit Expense1672NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense228971TotalCommunityBenefitExpense
Net Community Benefit Expense228971NetCommunityBenefitExpense
Percent Of Total Expense0.00520PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense9587693TotalCommunityBenefitExpense
Direct Offsetting Revenue6829984DirectOffsettingRevenue
Net Community Benefit Expense2757709NetCommunityBenefitExpense
Percent Of Total Expense0.06390PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Total Community Building Expense132754TotalCommunityBuildingExpense
Net Community Building Expense132754NetCommunityBuildingExpense
Percent Of Total Expense0.00310PercentOfTotalExpense

Workforce Development WorkforceDevelopment

FieldValueIRS element (for citing)
Total Community Building Expense235672TotalCommunityBuildingExpense
Net Community Building Expense235672NetCommunityBuildingExpense
Percent Of Total Expense0.00550PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense368426TotalCommunityBuildingExpense
Net Community Building Expense368426NetCommunityBuildingExpense
Percent Of Total Expense0.00860PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$1,015,107BadDebtExpenseAmount
Amount Reimbursed By Medicare18108792AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare17949271CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall159521MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
OtherXOther
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1FAIRVIEW HOSPITALBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line129 LEWIS AVEAddressLine1
CityGREAT BARRINGTONCity
StateMAState
ZIP Code012301796ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Critical Access HospitalXCriticalAccessHospital
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1FAIRVIEW HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free1UsesFPGFree
FPG Free Percent200.000000000000FPGFreePercent
Uses FPG Discounted1UsesFPGDiscounted
FPG Discount Percent400.000000000000FPGDiscountPercent
Explains Basis1ExplainsBasis
Income LevelXIncomeLevel
Medical IndigencyXMedicalIndigency
Insurance StatusXInsuranceStatus
Uninsured DiscountXUninsuredDiscount
Explains Application Method1ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Attached To InvoicesXAttachedToInvoices
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Available On RequestXAvailableOnRequest
Actions On Nonpayment1ActionsOnNonpayment
Collection Activities0CollectionActivities
Nondiscrim Emergency Care Policy1NondiscrimEmergencyCarePolicy
Used Other MethodXUsedOtherMethod
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges0GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities3NumberOfOtherFacilities

Other Facilities OtherFacilities (3 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
FAIRVIEW HSP OUTPATNT PHYSICAL THERAPY
10 MAPLE AVEGREAT BARRINGTONMA01230OUTPATIENT SERVICES
FAIRVIEW PHYSICAL & SPORTS THERAPY CTR
710 STOCKBRIDGE RD STE 1LEEMA01238OUTPATIENT SERVICES
FAIRVIEW HOSPITAL AQUATIC THERAPY PROG
15 CHRISSEY RDGREAT BARRINGTONMA01230OUTPATIENT SERVICES

Form990 Schedule H Part VI Form990ScheduleHPartVI (14 entries)

ExplanationExplanationIdentifierIdentifierReturn ReferenceReturnReference
PART I, LINE 6A: FAIRVIEW HOSPITAL AND BERKSHIRE MEDICAL CENTER EACH FILE A SEPARATE COMMUNITY BENEFITS REPORT WITH THE STATE OF MASSACHUSETTS. FAIRVIEW'S FISCAL YEAR 2012 COMMUNITY BENEFITS REPORT CAN BE ACCESSED AT WWW.CBSYS.AGO.STATE.MA.US/CBPUBLIC/PUBLIC/ANNUAL_REPORTS_START.ASPX.
PART I, LINE 7: THE TOTAL COMMUNITY BENEFIT EXPENSE REPORTED ON PART I, LINES 7A, 7B, & 7C HAS BEEN CALCULATED USING THE RATIO OF PATIENT CARE COST TO CHARGES AS COMPUTED USING WORKSHEET 2 IN THE SCHEDULE H INSTRUCTIONS. THE TOTAL COMMUNITY BENEFIT EXPENSE REPORTED ON PART I, LINE 7G HAS BEEN CALCULATED USING A COST ACCOUNTING METHOD. BAD DEBT EXPENSE HAS BEEN EXCLUDED FROM THE COMPUTATION OF ALL COMMUNITY BENEFIT EXPENSE SHOWN IN PART I, LINE 7.
PART I, L7 COL(F): BAD DEBT EXPENSE OF $1,645,885 ATTRIBUTABLE TO PATIENT ACCOUNTS HAS BEEN EXCLUDED FROM THE COMPUTATION OF ALL COMMUNITY BENEFIT EXPENSE SHOWN IN PART I, LINE 7, COLUMN F.
PART II: COMMUNITY BUILDING ACTIVITIES - AS SUMMARIZED IN PART II, EXPENDITURES BY FAIRVIEW HOSPITAL TO PROTECT OR IMPROVE THE COMMUNITY'S HEALTH OR SAFETY INCLUDE THE FOLLOWING:LINE 3 COMMUNITY SUPPORT: EMERGENCY PREPAREDNESS - COMMUNITY BENEFIT EXPENSE $57,380. THE HOSPITAL PARTICIPATED IN EMERGENCY PREPAREDNESS ACTIVITIES SUCH AS CONTINUING EDUCATION, PARTNERSHIP BUILDING, AND SUSTAINABILITY PURCHASES TO STRENGTHEN THE HOSPITAL'S ALL-HAZARD RESPONSE TO LOCAL, REGIONAL AND NATIONAL EVENTS. LINE 3 COMMUNITY SUPPORT: BIOTERRORISM PREPAREDNESS - COMMUNITY BENEFIT EXPENSE $44,298. THE HOSPITAL PARTICIPATED IN BIOTERRORISM PREPAREDNESS EFFORTS SUCH AS MAINTAINING A PHARMACEUTICAL CACHE, TRAINING WITH COMMUNITY PARTNERS AND CONTINUING EDUCATION.LINE 3 COMMUNITY SUPPORT: MEDICAL RESERVE CORPS - COMMUNITY BENEFIT EXPENSE $31,076. THE HOSPITAL SUPPORTS THE BERKSHIRE MEDICAL RESERVE CORPS WHO ARE A GROUP OF LICENSED MEDICAL PROFESSIONALS AND NON-LICENSED INDIVIDUALS WHO ARE TRAINED TO RESPOND TO A PUBLIC HEALTH EMERGENCY SUCH AS A PANDEMIC OR SHELTERING SITUATION.LINE 8 WORKFORCE DEVELOPMENT: PHYSICIAN RECRUITMENT - COMMUNITY BENEFIT EXPENSE $235,672. THIS IS IN RESPONSE TO CRITICAL PHYSICIAN SHORTAGES IN THE HOSPITAL'S SERVICE AREA AND THE EXPENDITURES REPORTED ARE AN INVESTMENT IN INCREASING ACCESS TO PRIMARY CARE AND SPECIALTY PHYSICIANS AVAILABLE TO THE COMMUNITY BY ASSISTING IN ESTABLISHING NEW PHYSICIANS IN THE SERVICE AREA.
PART III, LINE 4: FOOTNOTE 4 ("CHARITY CARE") TO THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS AND SUPPLEMENTARY FINANCIAL INFORMATION OF BERKSHIRE HEALTH SYSTEMS, INC. AND AFFILIATES (INCLUDING FAIRVIEW HOSPITAL) FOR THE YEARS ENDED SEPTEMBER 30, 2012 AND 2011 CONTAINS THE FOLLOWING REGARDING BAD DEBT EXPENSE: "THE HEALTH SYSTEM PROVIDES CARE TO PATIENTS WHO MEET CHARITY CARE POLICY CRITERIA WITHOUT CHARGE OR AT AMOUNTS LESS THAN ESTABLISHED RATES." "IF A PATIENT IS INELIGIBLE FOR CHARITY CARE OR CARE AT REDUCED RATES BECAUSE THE PATIENT'S INCOME EXCEEDS THE ELIGIBILITY GUIDELINES, SERVICES RENDERED ARE RECORDED AT ESTABLISHED RATES AND ANY UNPAID ACCOUNT RECEIVABLE BALANCE IS WRITTEN OFF TO BAD DEBTS AFTER A REASONABLE COLLECTION EFFORT HAS BEEN MADE."THE ESTIMATED COST OF BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS REPORTED ON LINE 2, PART III WAS CALCULATED USING THE RATIO OF PATIENT CARE COST TO CHARGES AS COMPUTED USING WORKSHEET 2 IN THE SCHEDULE H INSTRUCTIONS. NO BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER FAIRVIEW HOSPITAL'S CHARITY CARE POLICY HAS BEEN REPORTED ON LINE 3, PART III BECAUSE ALL GROSS PATIENT CHARGES ATTRIBUTABLE TO THESE PATIENTS THAT WERE NOT PAID FROM UNCOMPENSATED CARE POOLS OR PROGRAMS WERE WRITTEN OFF AS "FREE CARE" EXPENSE.
PART III, LINE 8: THE AMOUNT REPORTED ON LINE 6, PART III WAS DETERMINED USING THE COST ALLOCATION METHODOLOGY USED FOR THE MEDICARE COST REPORTS.
PART III, LINE 9B: THE FOLLOWING INDIVIDUALS AND PATIENT POPULATIONS ARE EXEMPT FROM ANY COLLECTION OR BILLING PROCEDURES PURSUANT TO STATE REGULATIONS: PATIENTS ENROLLED IN A STATE HEALTH INSURANCE PROGRAM, INCLUDING BUT NOT LIMITED TO, MASSHEALTH, EMERGENCY AID TO THE ELDERLY, DISABLED AND CHILDREN, HEALTHY START, CHILDREN'S MEDICAL SECURITY PLAN, AND "LOW INCOME PATIENTS" AS DETERMINED BY THE OFFICE OF MEDICAID. PLEASE NOTE THAT FAIRVIEW HOSPITAL (FVH) MAY SEEK COLLECTION ACTION AGAINST ANY PATIENT ENROLLED IN THE ABOVE MENTIONED PROGRAMS FOR THEIR REQUIRED CO-PAYMENTS AND DEDUCTIBLES THAT ARE SET FORTH BY EACH SPECIFIC PROGRAM. FVH MAY ALSO INITIATE BILLING OR COLLECTION FOR A PATIENT WHO ALLEGES THAT HE OR SHE IS A PARTICIPANT IN A FINANCIAL ASSISTANCE PROGRAM THAT COVERS THE COSTS OF THE HOSPITAL SERVICES, BUT FAILS TO PROVIDE PROOF OF SUCH PARTICIPATION. UPON RECEIPT OF SATISFACTORY PROOF THAT A PATIENT IS A PARTICIPANT IN A FINANCIAL ASSISTANCE PROGRAM (INCLUDING RECEIPT OR VERIFICATION OF SIGNED APPLICATION), FVH SHALL CEASE ITS BILLING OR COLLECTION ACTIVITIES. FVH MAY CONTINUE COLLECTION ACTION ON ANY LOW INCOME PATIENT FOR SERVICES RENDERED PRIOR TO THE LOW INCOME PATIENT DETERMINATION, PROVIDED THAT THE CURRENT LOW INCOME PATIENT STATUS HAS BEEN TERMINATED OR EXPIRED. HOWEVER, ONCE A PATIENT IS DETERMINED ELIGIBLE AND ENROLLED IN THE HEALTH SAFETY NET, MASSHEALTH, OR CERTAIN COMMONWEALTH CARE PROGRAMS, FVH WILL CEASE COLLECTION ACTIVITY FOR SERVICES, PREVIOUSLY BILLED, THAT NOW FALL INTO THE ELIGIBILITY PERIOD. FVH MAY SEEK COLLECTION ACTION AGAINST ANY OF THE PATIENTS PARTICIPATING IN THE PROGRAMS LISTED ABOVE FOR NON-COVERED SERVICES THAT THE PATIENT HAS AGREED TO BE RESPONSIBLE FOR, PROVIDED THAT THE HOSPITAL OBTAINED THE PATIENT'S PRIOR WRITTEN CONSENT TO BE BILLED FOR THE SERVICE. FVH WILL NOT UNDERTAKE COLLECTION ACTION AGAINST AN INDIVIDUAL THAT HAS BEEN APPROVED FOR MEDICAL HARDSHIP UNDER THE MASSACHUSETTS HEALTH SAFETY NET PROGRAM WITH RESPECT TO THE AMOUNT OF THE BILL THAT EXCEEDS THE MEDICAL HARDSHIP CONTRIBUTION.FVH DOES NOT GARNISH A PATIENT'S OR THE PATIENT'S GUARANTOR'S WAGES OR EXECUTE A LIEN ON THE PATIENT'S OR THE PATIENT'S GUARANTOR'S PERSONAL RESIDENCE OR MOTOR VEHICLE.FVH AND ITS AGENTS SHALL NOT CONTINUE COLLECTION OR BILLING ON A PATIENT WHO IS A MEMBER OF A BANKRUPTCY PROCEEDING EXCEPT TO SECURE ITS RIGHTS AS A CREDITOR IN THE APPROPRIATE ORDER.
PART V, SECTION B, LINE 19D: THE MAXIMUM AMOUNT THAT CAN BE CHARGED TO A PATIENT ELIGIBLE FOR FINANCIAL ASSISTANCE IS 95% OF THE FACILITY'S STANDARD CHARGES.FAIRVIEW HOSPITAL
PART VI, LINE 2: FAIRVIEW HOSPITAL PLACES A PRIORITY ON MAINTAINING CLOSE ALLIANCES WITH ALL SOCIAL, HEALTH, SAFETY, LAW ENFORCEMENT AND WELFARE AGENCIES IN THE SOUTHERN BERKSHIRE COMMUNITY. OUR PARTNERSHIPS WITH SCHOOLS, BUSINESSES, AS WELL AS CIVIC AND OTHER COMMUNITY ORGANIZATIONS KEEP FAIRVIEW HOSPITAL ABREAST OF THE HEALTH STATUS OF THE SOUTHERN BERKSHIRES. FAIRVIEW ENGAGES A BROAD RANGE OF OUR CONSTITUENTS (INCLUDING PHYSICIANS, TOWN LEADERS, HEALTH OFFICIALS, SPECIAL INTEREST GROUPS, AND IMMIGRANT COMMUNITIES) TO RECEIVE DIRECT FEEDBACK AND INFORMATION. IN ADDITION, COMMUNITY MEMBERS SERVE ON MANY HOSPITAL COMMITTEES, INCLUDING OUR PATIENT FAMILY ADVISORY COUNCIL WHICH PROVIDES FEEDBACK ON HOW FAIRVIEW HOSPITAL CAN BETTER SERVE OUR COMMUNITY.STATISTICAL EVIDENCE SUPPORTS OUR COMMUNITY NEEDS ASSESSMENT. FAIRVIEW UTILIZES IN-PATIENT, EMERGENCY AND MAJOR DIAGNOSTIC CATEGORIES DATA AND ONGOING POST-STAY SURVEYS. FEDERAL, STATE AND LOCAL REPORTING ALERTS FAIRVIEW TO IMPORTANT TRENDS AND IDENTIFICATION OF AREAS THAT ARE ABOVE THE STATE NORM.FAIRVIEW PARTICIPATES WITH THE WORK OF OUR PARTNER ORGANIZATIONS AND UTILIZES MANY ASSESSMENTS THAT ARE MADE AVAILABLE ON BEHALF OF SPECIFIC COMMUNITIES. AMONG THE ORGANIZATIONS THAT HAVE PROVIDED SURVEY DATA ARE THE BERKSHIRE HEALTH SYSTEMS COMMUNITY HEALTH ASSESSMENT SURVEY, SOUTHERN BERKSHIRE YOUTH COALITION YOUTH SURVEY, UNITED WAY COMMUNITY IMPACT BASELINE REPORT, MASSACHUSETTS PREVENTION NEEDS ASSESSMENT SURVEY, CROSS-CULTURAL ACTION NETWORK, SOUTHERN BERKSHIRE EDUCATIONAL COLLABORATIVE, MASSACHUSETTS COUNTY HEALTH RANKINGS (UNIVERSITY OF WISCONSIN POPULATION HEALTH INSTITUTE), MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH DEMOGRAPHIC DATA AND HEALTH REGIONALIZATION STATUS REPORTS, BERKSHIRE HILLS REGIONAL SCHOOL DISTRICT BMI REPORTS, AND BERKSHIRE COUNTY BOARDS OF HEALTH ASSOCIATION BERKSHIRE COMMUNITY HEALTH ASSESSMENT.
PART VI, LINE 3: FAIRVIEW HOSPITAL HELPS PATIENTS ACCESS COVERAGE AND CONSISTENTLY PROMOTES ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE AND LOCAL GOVERNMENT PROGRAMS INSIDE AND OUTSIDE THE HOSPITAL. THE ADVOCACY FOR ACCESS OFFICE, EASILY ACCESSIBLE AT THE MAIN ENTRANCE OF FAIRVIEW HOSPITAL, FACILITATES ASSISTANCE TO THOSE WHO NEED IMMEDIATE CARE AS WELL AS THOSE WHO ARE UNINSURED OR UNDERINSURED. THE ADVOCACY TEAM HAS TRAINED STAFF AT ENTRY POINTS AS WELL AS CAREGIVERS THROUGHOUT THE HOSPITAL KNOWLEDGEABLE ABOUT THE IMPORTANT ROLE THEY CAN PROVIDE TO PATIENTS. THE ADVOCACY TEAM REGULARLY VISITS PATIENTS IN THE HOSPITAL TO ANSWER QUESTIONS THE PATIENTS MAY HAVE AS WELL AS FACILITATING ENROLLMENT IN THE APPROPRIATE PLAN. IN ADDITION, A FINANCIAL ADVISOR IS AVAILABLE DURING BUSINESS HOURS TO ASSIST PATIENTS IN EXPLAINING BILLING ISSUES AND CREATING FLEXIBLE BILLING ARRANGEMENTS TO MEET THE PATIENTS' NEEDS.
PART VI, LINE 4: FAIRVIEW HOSPITAL SERVES A RURAL AREA OF TWELVE TOWNS IN THE SOUTHWESTERN CORNER OF MASSACHUSETTS IN ADDITION TO NEARBY COMMUNITIES IN NEW YORK STATE AND CONNECTICUT. PRIMARY RESIDENTS OF THE SOUTHERN BERKSHIRES FACE THE SOCIAL AND ECONOMIC CHALLENGES OF RURAL COMMUNITIES ACROSS THE NATION. THESE ARE SOME OF THE STATE'S REMOTEST COMMUNITIES. THE SOUTHERN BERKSHIRE COMMUNITY IS PREDOMINATELY CAUCASIAN WITH A GROWING MULTI-CULTURAL COMMUNITY. TWENTY-FIVE PERCENT OF FAMILIES ARE LIVING BELOW 200% OF THE POVERTY LEVEL (MORE THAN 3% OVER STATE AVERAGES) AND THE AVERAGE PER CAPITA INCOME IS $3,297 LOWER THAN THE STATE AVERAGE. OVER 25% OF THE STUDENTS IN THE LOCAL DISTRICT ARE ON FREE OR REDUCED PRICED LUNCHES.THE ELDER POPULATION IN THE SOUTHERN BERKSHIRES IS SIGNIFICANTLY ABOVE THE STATE POPULATION, REACHING OVER 20% IN SOME COMMUNITIES (MASSACHUSETTS RATES ARE 13%) WITH MANY ELDERS LIVING ALONE. THERE ARE TWO SENIOR HOUSING UNITS AND THREE NURSING HOMES IN THE AREA, AND SENIOR CENTERS IN MOST AREA TOWNS.BECAUSE THE SOUTHERN BERKSHIRES IS A MAJOR TOURIST DESTINATION FOR THE NEW YORK METROPOLITAN AREA, IN MANY COMMUNITIES MORE THAN HALF THE HOMES ARE OWNED BY PART-TIME RESIDENTS. SEASONAL AND PART-TIME SERVICE JOBS ARE A MAJOR SOURCE OF INCOME FOR PRIMARY RESIDENTS. HOWEVER, THE HOUSING MARKET REFLECTS THE SECONDARY MARKET WITH HIGHER VALUES THAT ARE NOT WITHIN REACH OF THE INCOME OF MOST LOCAL FAMILIES. RURAL HOMELESSNESS IS A HIDDEN, BUT PERVASIVE SOCIAL AND ECONOMIC ISSUE. PUBLIC TRANSPORTATION IS LIMITED AND NOT EASILY ACCESSIBLE. AS A RESULT, TRANSPORTATION IS AN OBSTACLE TO CARE FOR MANY, PARTICULARLY AMONG THE ELDERLY. A PUBLIC TRANSPORTATION AGENCY RUNS A LIMITED BUS ROUTE WITH LIMITED HOURS. ADDITIONAL ELDERLY TRANSPORTATION IS AVAILABLE BUT LIMITED. PEOPLE WHO NEED TO ACCESS HEALTHCARE MUST RELY ON FAMILY OR FRIENDS TO GET TO MEDICAL CARE. SPECIALTY CARE IS A PARTICULAR CHALLENGE TO OBTAIN. FAIRVIEW HOSPITAL COLLABORATES WITH AREA ORGANIZATIONS TO HELP MAKE TRANSPORTATION OPTIONS AVAILABLE. HEALTHCARE AND EDUCATION ARE THE PRIMARY EMPLOYMENT SECTORS. THE SOUTHERN BERKSHIRE ECONOMY'S PRIMARY ECONOMIC ENGINE IS TOURISM, WITH A HIGH NUMBER OF HOTELS, BED AND BREAKFASTS, RESTAURANTS, AND RETAIL SHOPS AND SERVICES CATERING TO THE TOURIST COMMUNITY. THE LOCAL CONSTRUCTION INDUSTRY WAS SEVERELY IMPACTED BY THE ECONOMIC DOWNTURN. ALTHOUGH THESE ARE OFTEN SEASONAL AND SERVICE BASED JOBS, THEY ARE A SIGNIFICANT PART OF THE ECONOMY.
PART VI, LINE 5: FAIRVIEW HOSPITAL VALUES THE COMMUNITY'S VITAL ROLE AS STEWARDS OF THEIR COMMUNITY HOSPITAL. MEMBERS OF THE COMMUNITY, REPRESENTING VARIOUS DEMOGRAPHIC AND CONSTITUENCY GROUPS, SERVE ON OUR GOVERNING BOARDS AS WELL AS VARIOUS COMMITTEES WHICH ASSURE THE INPUT AND INTERESTS OF THE COMMUNITY ARE REPRESENTED AT THE HIGHEST LEVELS. HOSPITAL STAFF ALSO PLAY AN ACTIVE ROLE IN MANY LOCAL AND REGIONAL ORGANIZATIONS, SUPPORTING THEIR EFFORTS AND, BY ENGAGING WITH THEIR MISSION AND INTERESTS, CREATING NEW AVENUES OF COLLABORATION AND OPPORTUNITY TO BETTER MEET OUR COMMUNITY'S HEALTH NEEDS.THE GOVERNING BODY OF FAIRVIEW HOSPITAL CONSISTS OF 20 COMMUNITY VOLUNTEERS, THREE PHYSICIAN REPRESENTATIVES, AND AS AN EX-OFFICIO MEMBER, THE CHIEF EXECUTIVE OFFICER. THE COMMUNITY VOLUNTEERS ARE ELECTED FOR TERMS OF UP TO THREE YEARS, ARE SUBJECT TO TERM LIMITS AND REPRESENT A WIDE SPECTRUM OF COMMUNITY INTERESTS - INCLUDING SOCIAL SERVICE PROVIDERS, LOCAL BUSINESS LEADERS, FINANCIAL PROFESSIONALS, CONSUMER ADVOCATES AND EDUCATIONAL LEADERS. MOST COMMITTEES OF THE BOARD OF TRUSTEES INCLUDE ADDITIONAL COMMUNITY REPRESENTATIVES. FAIRVIEW MAINTAINS A PATIENT AND FAMILY COUNCIL TO PROVIDE INPUT AND ADVICE ON A WIDE RANGE OF SERVICE TOPICS.THE MEDICAL STAFF OF FAIRVIEW HOSPITAL IS OPEN TO ALL PHYSICIANS WHO MEET CLINICAL AND PATIENT SERVICE CRITERIA, ALTHOUGH CERTAIN HOSPITAL BASED SERVICES - RADIOLOGY, ANESTHESIA, EMERGENCY DEPARTMENT AND PATHOLOGY - ARE FUNCTIONALLY CLOSED BECAUSE OF THE MANNER IN WHICH THOSE DEPARTMENTS ARE STRUCTURED.FAIRVIEW REGULARLY EXPENDS PERSONNEL AND FINANCIAL RESOURCES IN SUPPORT OF COMMUNITY INITIATIVES THAT PROMOTE IMPROVEMENTS IN COMMUNITY HEALTH AND WELL-BEING AND FOR WHICH IT DOES NOT EXPECT REIMBURSEMENT. THE HOSPITAL UTILIZES SURPLUS FUNDS FOR CAPITAL IMPROVEMENTS, TO MAINTAIN ACCESS TO PATIENT SERVICES, TO EXPAND ACCESS TO POINTS OF CARE, AND FOR SERVICES THAT SUPPORT COMMUNITY BENEFIT PRIORITIES FOR PATIENTS THROUGHOUT THE COMMUNITY. FAIRVIEW HOSPITAL'S SERVICE AREA IS A DESIGNATED MEDICALLY UNDERSERVED COMMUNITY AND IT HAS PLACED HIGH PRIORITY ON RECRUITING PHYSICIANS TO OUR RURAL COMMUNITY TO ASSURE THAT THE PRIMARY HEALTH NEEDS ARE MET. THE BERKSHIRE COUNTY COMMUNITY HAS LONG LABORED UNDER A CRITICAL PHYSICIAN SHORTAGE IN VARIOUS SPECIALTIES AND BERKSHIRE MEDICAL CENTER AND FAIRVIEW HOSPITAL HAVE IN RECENT YEARS EXPENDED SIGNIFICANT PERSONNEL TIME AND FINANCIAL RESOURCES IN RECRUITING PHYSICIANS TO THE AREA AS DIRECT EMPLOYEES OF BMC, FAIRVIEW, OR THEIR AFFILIATES. MOREOVER, BMC AND FAIRVIEW HAVE, IN APPROPRIATE WAYS, PROVIDED SUBSTANTIAL ASSISTANCE TO COMMUNITY MEDICAL PRACTICES TO RECRUIT AND SUPPORT THE PRACTICE START-UP OF NEW PHYSICIANS IN NEEDED SPECIALTIES. FAIRVIEW HAS EXTENSIVE COMMUNITY OUTREACH PROGRAMS AND SUPPORT WHICH ARE COMPREHENSIVE AND COMMUNITY-BASED TO ADDRESS SUCH DIVERSE HEALTHCARE CHALLENGES AS DIABETES, HEART FAILURE, CHRONIC PAIN MANAGEMENT, AND NARCOTICS MISUSE AND DIVERSION.AS STEWARD OF THE COMMUNITY'S PRIMARY HEALTH ORGANIZATION, AND A NOT-FOR-PROFIT ORGANIZATION, FAIRVIEW HOSPITAL UTILIZES ANY SURPLUS FUNDS TO MEET THE HIGHEST PRIORITY NEEDS INCLUDING PATIENT CARE, SERVICE AND PROGRAM DEVELOPMENT, MEDICAL EDUCATION OF ALL STAFF, COMMUNITY SUPPORT AND EDUCATION AND RESEARCH.BECAUSE FAIRVIEW HOSPITAL'S SERVICE AREA IS THE RURAL SOUTHERN CORNER OF THE REGION, FAIRVIEW HOSPITAL HAS ALSO ESTABLISHED A FAIRVIEW COMMUNITY BENEFITS ADVISORY COMMITTEE (FCBAC), WHICH ENGAGES COMMUNITY PROFESSIONALS ON THE SPECIFIC NEEDS OF OUR GEOGRAPHIC DISTRICT. THE FCBAC MEETS TWICE TIMES A YEAR INCLUDING THE PRESIDENT, TWO VICE PRESIDENTS, AND LEADERS OF THE HOSPITAL DEPARTMENTS AND STAFF WHO ARE DIRECTLY INVOLVED WITH PATIENTS, ALLOWING A GREATER FOCUS ON THE SPECIFIC NEEDS OF THIS GEOGRAPHIC DISTRICT THROUGH A MULTIDISCIPLINARY APPROACH TO IDENTIFY EMERGING HEALTH ISSUES IN THE COMMUNITY.AS THE CENTER OF THE HEALTH CARE COMMUNITY IN THE SOUTHERN BERKSHIRES, FAIRVIEW HOSPITAL IS AN ACTIVE LEADER IN THE PROMOTION OF BETTER HEALTH IN OUR COMMUNITY. FAIRVIEW OFFERS:PRIMARY SERVICES TO ALL WHO SEEK CARE, REGARDLESS OF ABILITY TO PAY;FREE OR LOW-COST EDUCATIONAL PROGRAMS, SUPPORT GROUPS AND SCREENINGS TO PROVIDE VALUABLE INFORMATION TO OUR COMMUNITY, WITH PARTICULAR FOCUS ON VULNERABLE POPULATIONS;ONGOING MEDIA COMMUNICATION FOR IMPORTANT HEALTH ACCESS INFORMATION INCLUDING FLU PREVENTION, VACCINATIONS, COMMONWEALTH CARE DEADLINES;HEALTHY MENUS, MORE SUSTAINABLE OR ENVIRONMENTALLY FRIENDLY POLICIES, DISCONTINUATION OF SUGAR DRINKS IN THE HOSPITAL TO SERVE AS A ROLE MODEL FOR A HEALTHIER COMMUNITY; ANDLEADERSHIP AND COLLABORATION IN PUBLIC HEALTH INITIATIVES INCLUDING EMERGENCY PLANNING, BOARDS OF HEALTH AND OTHER COMMUNITY-WIDE INITIATIVES.
PART VI, LINE 6: FAIRVIEW HOSPITAL IS A PART OF AN INTEGRATED, NON-PROFIT HEALTHCARE SYSTEM THAT INCLUDES (A) A TEACHING HOSPITAL, (B) A CRITICAL ACCESS COMMUNITY HOSPITAL [FAIRVIEW], (C) A LARGE, MULTISPECIALTY FACULTY PRACTICE ORGANIZATION, (D) A HOME HEALTH AGENCY, AND (E) BY CONTRACT AND CLOSE COORDINATION, A NON-PROFIT SENIOR CARE ORGANIZATION THAT INCLUDES SUB-ACUTE SERVICES IN REHABILITATION AND LONG-TERM CARE FACILITIES, ASSISTED LIVING FACILITIES, HOSPICE CARE SERVICES, SENIOR DAY CARE AND OTHER ELDERCARE SERVICES. FAIRVIEW ENGAGES IN HEALTHCARE NEEDS ASSESSMENT AND PLANNING ON A SYSTEM-WIDE BASIS, WITH A GOAL OF A SEAMLESS TRANSITION OF PATIENT-CENTERED CARE ACROSS THE SPECTRUM OF SERVICES OFFERED BY EACH OF THE SYSTEM'S COMPONENT ENTITIES. FAIRVIEW, ALONG WITH ITS AFFILIATES, CONTINUES TO DEVELOP INTEGRATED CLINICAL AND INFORMATION SYSTEMS ACROSS THE ENTIRE ORGANIZATION SO AS TO RENDER CARE EFFICIENTLY, EFFECTIVELY AND CONSISTENTLY AT EVERY CARE SITE. THE VARIOUS AFFILIATES, SUCH AS THE FACULTY PRACTICE ORGANIZATION, ARE FULLY INTEGRATED INTO THE COMMUNITY BENEFIT PROCESS AND SUPPORT THE HOSPITAL'S PRIORITIES BY HONORING OUR FREE CARE GUIDELINES AND ENGAGING IN SPECIFIC PROGRAMS AND INITIATIVES DESIGNED TO MEET COMMUNITY NEEDS.
MAREPORTS FILED WITH STATESPART VI, LINE 7

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (12 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
BRIAN T BURKE MD
17888400017671092230285300234308000
DAVID E PHELPS
04542800000011025028676049398100
D PHELPS-LIFE INS OTHER BENEFITS
000001609990000016099900
EUGENE DELLEA
01672180004570408583010997023250200
DARLENE RODOWICZ
030587700053462011025025338039570200
ALEC R BELMAN MD
2142100112320153870110250285300280384000
DOREEN HUTCHINSON
14367400019849077190281230199365000
WILLIAM F DUKE MD
18804207158020974000219980238172000
CORINNE D KALSER MD
1801100362309698035130243380221282000
GLEN R LOVEJOY MD
198978010764018466086880273950264291000
RAYMOND SABATELLI MD
2126680126360367880110250285300301647000
STEPHEN TRACY MD
168517010764043797092660269380259282000

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierSUPPLEMENTAL INFORMATIONIdentifier
Return ReferencePART IIIReturnReference
ExplanationSUPPLEMENTAL COMPENSATION INFORMATION IN REFERENCE TO SCHEDULE J PART II, NO COMPENSATION IS PAID BY THE FILING ENTITY TO ANY DIRECTOR (TRUSTEE) FOR HIS OR HER ROLE AS DIRECTOR (TRUSTEE), WITH THE EXCEPTION OF BRIAN T. BURKE, MD, WHOSE COMPENSATION RELATES SOLELY TO SERVICES RENDERED FOR TAX-EXEMPT PURPOSES AND NOT TO HIS ROLE AS DIRECTOR (TRUSTEE). A PORTION OF THE COMPENSATION AMOUNT PAID TO OFFICERS OF THE FILING ENTITY IS ALLOCATED INTERNALLY AMONG THE FILING ENTITY AND ITS 26 ASSOCIATED NON-PROFIT, TAX-EXEMPT ENTITIES IN ORDER TO PROPERLY REFLECT THE DIVISION OF THE OFFICERS' TIME AND EFFORT AMONG THOSE VARIOUS ENTITIES AND EACH ENTITY'S RELATIVE CONTRIBUTION TO THE OFFICERS' TOTAL COMPENSATION (SEE BELOW). COMPENSATION OF THE CHIEF EXECUTIVE OFFICER IS REVIEWED AND ESTABLISHED AT LEAST BIANNUALLY BY THE INDEPENDENT VOLUNTEER GOVERNING BODY, BASED ON PERFORMANCE REVIEWS AND COMPARISON TO INDEPENDENTLY ESTABLISHED, REGIONALLY APPROPRIATE BENCHMARKS FOR SIMILAR POSITIONS IN SIMILARLY SIZED HEALTHCARE ORGANIZATIONS, AS VERIFIED BY INDEPENDENT, NATIONALLY RECOGNIZED COMPENSATION CONSULTANTS. COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES IS SET IN ACCORDANCE WITH GOVERNING BODY-ESTABLISHED PRINCIPLES BASED ON COMPARABLE BENCHMARKS IDENTIFIED BY SUCH INDEPENDENT CONSULTANTS. IN THE REPORTING YEAR, THE GOVERNING BODY TARGETED TOTAL COMPENSATION FOR MANAGEMENT EMPLOYEES AT THE 50TH PERCENTILE OF APPROPRIATE BENCHMARKS. THE FOLLOWING LIST SHOWS THE ENTITIES TO WHICH THE IDENTIFIED OFFICER PROVIDED SERVICES, THE AVERAGE WEEKLY HOURS ALLOCATED TO EACH ENTITY, AND THE RESPECTIVE ALLOCABLE SHARE OF HIS OR HER ANNUAL COMPENSATION (REPORTABLE COMPENSATION AND OTHER COMPENSATION) FOR CALENDAR 2011: DAVID E. PHELPS, PRESIDENT BERKSHIRE MEDICAL CENTER, INC: 30 WEEKLY HOURS/58 WEEKLY HOURS $339,022 FAIRVIEW HOSPITAL: 4 HOURS/58 HOURS $45,194 BERKSHIRE FACULTY SERVICES, INC: 10 HOURS/58 HOURS $112,919 BERKSHIRE INDEMNITY CO, SPC, LTD: 2 HOURS/58 HOURS $22,597 BHS MANAGEMENT SERVICES, INC (12 HOURS/58 HOURS) FOR BENEFIT OF: BERKSHIRE HEALTHCARE SYSTEMS, INC: $33,863 BOURNE MANAGEMENT SYSTEMS, INC: $2,685 GREENFIELD MANAGEMENT SYSTEMS, INC: $2,685 NEW BEDFORD MANAGEMENT SYSTEMS, INC: $2,685 NORTHAMPTON MANAGEMENT SYSTEMS, INC: $2,685 EAST LONGMEADOW MANAGEMENT SYSTEMS, INC: $2,685 DANVERS MANAGEMENT SYSTEMS, INC: $2,685 PEABODY MANAGEMENT SYSTEMS, INC: $2,685 SOUTH YARMOUTH MANAGEMENT SYSTEMS, INC: $2,685 BERKSHIRE PENNSYLVANIA, INC: $2,685 XENIA EAST MANAGEMENT SYSTEMS, INC: $2,685 WILLOWOOD OF GREAT BARRINGTON, INC: $5,436 WILLOWOOD OF NORTH ADAMS, INC: $4,061 WILLOWOOD OF WILLIAMSTOWN, INC: $4,061 HILLCREST EXTENDED CARE SERVICES, INC: $9,497 BERKSHIRE RETIREMENT COMMUNITY, INC: $13,558 BERKSHIRE EXTENDED CARE SERVICES, INC: $9,497 INTEGRINURSE, INC: $4,061 INTEGRISCRIPT, INC: $4,061 HOSPICECARE IN THE BERKSHIRES, INC: $13,558 PITTSFIELD MANAGEMENT SYSTEMS, INC: $6,746 DARLENE RODOWICZ, TREASURER BERKSHIRE MEDICAL CENTER, INC: 37 WEEKLY HOURS/51 WEEKLY HOURS $292,819 FAIRVIEW HOSPITAL: 3 HOURS/51 HOURS $23,742 BERKSHIRE FACULTY SERVICES, INC: 7 HOURS/51 HOURS $55,398 BERKSHIRE INDEMNITY CO, SPC, LTD: 3 HOURS/51 HOURS $19,785 BHS MANAGEMENT SERVICES, INC FOR BENEFIT OF BERKSHIRE HEALTHCARE SYSTEMS, INC: 1 HOUR/51 HOURS $3,957 CHERYL BOUDREAU, CLERK BERKSHIRE MEDICAL CENTER, INC: 20 WEEKLY HOURS/41 WEEKLY HOURS $49,342 FAIRVIEW HOSPITAL: 2 HOURS/41 HOURS $4,939 BERKSHIRE FACULTY SERVICES, INC: 8 HOURS/41 HOURS $19,744 BERKSHIRE INDEMNITY CO, SPC, LTD: 1 HOUR/41 HOURS $2,469 BHS MANAGEMENT SERVICES, INC (10 HOURS/41 HOURS) FOR BENEFIT OF: BERKSHIRE HEALTHCARE SYSTEMS, INC: $6,163 BOURNE MANAGEMENT SYSTEMS, INC: $496 GREENFIELD MANAGEMENT SYSTEMS, INC: $496 NEW BEDFORD MANAGEMENT SYSTEMS, INC: $496 NORTHAMPTON MANAGEMENT SYSTEMS, INC: $496 EAST LONGMEADOW MANAGEMENT SYSTEMS, INC: $496 DANVERS MANAGEMENT SYSTEMS, INC: $496 PEABODY MANAGEMENT SYSTEMS, INC: $496 SOUTH YARMOUTH MANAGEMENT SYSTEMS, INC: $496 BERKSHIRE PENNSYLVANIA, INC: $496 XENIA EAST MANAGEMENT SYSTEMS, INC: $496 WILLOWOOD OF GREAT BARRINGTON, INC: $992 WILLOWOOD OF NORTH ADAMS, INC: $739 WILLOWOOD OF WILLIAMSTOWN, INC: $739 HILLCREST EXTENDED CARE SERVICES, INC: $1,731 BERKSHIRE RETIREMENT COMMUNITY, INC: $2,469 BERKSHIRE EXTENDED CARE SERVICES, INC: $1,731 INTEGRINURSE, INC: $739 INTEGRISCRIPT, INC: $739 HOSPICECARE IN THE BERKSHIRES, INC: $2,469 PITTSFIELD MANAGEMENT SYSTEMS, INC: $1,235Explanation

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)

Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
MASS HEALTH & EDUCATION FACIL AUTHORITY SER F
04245601157586CLN32005-07-2653089428REFUND SER C & D BONDS;CAPITAL EXP000
MASS DEVELOPMENT FINANCE AGENCY BHS ISSUESER G
04343181457583UQP62012-05-2393491421REFUND SER A, B, & E; CAPITAL EXP000

Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)

Amount RetiredAmountRetiredTotal ProceedsTotalProceedsAmount In Reserve FundAmountInReserveFundIssuance Costs From ProceedsIssuanceCostsFromProceedsCredit EnhancementCreditEnhancementWorking Capital ExpendituresWorkingCapitalExpendituresCapital ExpendituresCapitalExpendituresOther Spent ProceedsOtherSpentProceedsYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaindAmount UnspentAmountUnspent
1646000054729019501900010038008987957368190034283873031520081001
934915841245681669935784144509201110011402037

Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyAny Research AgreementsAnyResearchAgreementsPrcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthersPercentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBITotal Private Business UseTotalPrivateBusinessUsePost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
00000.000000.000000.000001
00000.000000.000000.000001

Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebate
100010
100000
FieldValueIRS element (for citing)
Fed Tax Requirements ComplianceXFedTaxRequirementsCompliance

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (9 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 3FAIRVIEW HOSPITAL RELIES ON BHS MANAGEMENT SERVICES, INC. TO PROVIDE MANAGEMENT AND SUPPORT SERVICES FOR THE CHIEF EXECUTIVE OFFICER, CHIEF FINANCIAL OFFICER, VP GENERAL COUNSEL, AND VP OF HUMAN RESOURCES.
FORM 990, PART VI, SECTION A, LINE 6BERKSHIRE HEALTH SYSTEMS, INC. IS THE SOLE CORPORATE MEMBER.
FORM 990, PART VI, SECTION A, LINE 7ATHE BOARD OF TRUSTEES IS COMPOSED OF THE INCUMBENT MEMBERS OF THE BOARD OF TRUSTEES OF BERKSHIRE HEALTH SYSTEMS, INC.
FORM 990, PART VI, SECTION B, LINE 11BERKSHIRE HEALTH SYSTEMS, INC. WILL MAKE THE FORMS 990 FOR BHS AND AFFILIATES AVAILABLE TO THE MEMBERS OF THE RESPECTIVE GOVERNING BODIES FOR THEIR REVIEW BY (A) SENDING COPIES TO THEM PHYSICALLY OR ELECTRONICALLY, OR (B) NOTIFYING THE MEMBERS THAT THE FORMS 990 CAN BE ACCESSED BY A SECURE WEB-BASED FOLDER BEFORE THEY ARE FILED WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12CTHE ORGANIZATION ENFORCES & MONITORS ITS CONFLICT OF INTEREST POLICY BY REQUIRING ALL MEMBERS OF THE GOVERNING BODY & SENIOR MANAGEMENT TO DISCLOSE POTENTIAL CONFLICTS OF INTEREST (A) ANNUALLY & (B) AS POTENTIAL CONFLICTS ARISE. SENIOR EMPLOYEES ARE NOT PERMITTED TO HAVE MATERIAL CONFLICTS OF INTEREST. MEMBERS OF THE GOVERNING BODY ARE TO ABSTAIN FROM ACTIONS THAT MAY BE INFLUENCED BY THEIR CONFLICT OR POTENTIAL CONFLICT BY: (A) NOT VOTING, OR (B) NOT VOTING & LEAVING THE ROOM, OR (C) LEAVING THE GOVERNING BODY, AS DETERMINED BY THE GOVERNING BODY.
FORM 990, PART VI, SECTION B, LINE 15FAIRVIEW HOSPITAL RELIES ON BHS MANAGEMENT SERVICES, INC. TO SUPPLY ITS CHIEF EXECUTIVE OFFICER. THE COMPENSATION OF CEO DAVID PHELPS IS REVIEWED AND ESTABLISHED AT LEAST BIANNUALLY BY THE INDEPENDENT VOLUNTEER BHS GOVERNING BODY, BASED ON PERFORMANCE REVIEWS AND COMPARISON TO INDEPENDENTLY ESTABLISHED, REGIONALLY APPROPRIATE BENCHMARKS FOR SIMILAR POSITIONS IN SIMILARLY SIZED HEALTHCARE ORGANIZATIONS, AS VERIFIED BY INDEPENDENT, NATIONALLY RECOGNIZED COMPENSATION CONSULTANTS. COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES IS SET IN ACCORDANCE WITH GOVERNING BODY-ESTABLISHED PRINCIPLES BASED ON COMPARABLE BENCHMARKS IDENTIFIED BY SUCH INDEPENDENT CONSULTANTS. IN THE REPORTING YEAR, THE GOVERNING BODY TARGETED TOTAL COMPENSATION FOR MANAGEMENT EMPLOYEES AT THE 50TH PERCENTILE OF APPROPRIATE BENCHMARKS.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC AT THE OFFICES OF (A) THE CHIEF FINANCIAL OFFICER & (B) THE VICE PRESIDENT, GENERAL COUNSEL AT 725 NORTH STREET, PITTSFIELD, MASSACHUSETTS 01201.
FORM 990, PART VII, SECTION A, COLUMN (B)EDMUND H. HORNSTEIN, DO'S HOURS SHOWN ARE FOR SERVICES AS A TRUSTEE, FOR WHICH HE RECEIVES NO COMPENSATION. DR. HORNSTEIN RECEIVES PAYMENT FROM BERKSHIRE MEDICAL CENTER FOR PHYSICIAN SERVICES. ROBERT P. WESPISER, MD'S HOURS SHOWN ARE FOR SERVICES AS A TRUSTEE, FOR WHICH HE RECEIVES NO COMPENSATION. DR. WESPISER RECEIVES PAYMENT FROM BERKSHIRE MEDICAL CENTER FOR PHYSICIAN SERVICES. ALL TRUSTEES (BOARD MEMBERS) RECEIVE NO COMPENSATION FOR SERVICES AS TRUSTEES.AVERAGE HOURS PER WEEK
FORM 990, PART XI, LINE 5:NET UNREALIZED GAINS ON INVESTMENTS: 1,873,763.CHANGES IN NET ASSETS OR FUND BALANCES:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrg
BERKSHIRE HEALTH SYSTEMS INC
725 NORTH STPITTSFIELDMA01201042442944PARENT CORPORATIONMA501(C)(3)11BN/A0
BERKSHIRE MEDICAL CENTER INC
725 NORTH STPITTSFIELDMA01201042791396ACUTE CARE HOSPITALMA501(C)(3)3N/A0
BERKSHIRE FACULTY SERVICES INC
725 NORTH STPITTSFIELDMA01201042995053PHYSICIAN SERVICESMA501(C)(3)11BN/A0
BHS MANAGEMENT SERVICES INC
725 NORTH STPITTSFIELDMA01201222755258MANAGEMENT SERVICESMA501(C)(3)11BN/A0

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1TRI-STATE MEDICAL MANAGEMENT CORPBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1725 NORTH STREETAddressLine1
CityPITTSFIELDCity
StateMAState
ZIP Code01201ZIPCode
FieldValueIRS element (for citing)
EIN042913352EIN
Primary ActivityREAL ESTATE MGMTPrimaryActivity
Legal Domicile StateMALegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1FAIRVIEW HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Type Of EntityCTypeOfEntity
Share Of Total Income-18079ShareOfTotalIncome
Share Of EOY Assets286747ShareOfEOYAssets
Percentage Ownership1.00000PercentageOwnership
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org1LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org1OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable

Name Of Other Organization NameOfOtherOrganization

FieldValueIRS element (for citing)
Business Name Line1TRI-STATE MEDICAL MANAGEMENT CORPBusinessNameLine1
FieldValueIRS element (for citing)
Transaction TypeDTransactionType
Amount Involved278349AmountInvolved
Method Of Amt DeterminationFAIR MARKET VALUEMethodOfAmtDetermination

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