2013-08-15T12:16:13-05:00 2012-09-30 990 2011-10-01 042133860 FAIRVIEW HOSPITAL FAIR 4134472508 725 NORTH STREET PITTSFIELD MA 012014109 DARLENE RODOWICZ 4134472809 2013-08-15 0 2011 2016-02-24 21:20:13Z DARLENE RODOWICZ 725 NORTH ST PITTSFIELD MA 012014109 47664668 0 X WWW.BHS1.ORG X 1912 MA THE 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. 24 20 323 50 0 0 511811 618864 41845111 44224749 924885 469864 658321 1204552 43940128 46518029 0 1250 0 0 22365294 25267767 0 0 90244 19708790 19396247 42074084 44665264 1866044 1852765 28000233 31956366 17923149 18152754 10077084 13803612 X THE MISSION OF FAIRVIEW HOSPITAL IS TO IMPROVE THE HEALTH OF ALL PEOPLE IN THE BERKSHIRES AND SURROUNDING COMMUNITIES, REGARDLESS OF THEIR ABILITY TO PAY. 0 0 39569228 45219943 FAIRVIEW 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. 39569228 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 83 0 1 323 1 0 0 0 0 0 1 1 0 0 0 0 X 24 20 0 1 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MA NY X DARLENE RODOWICZ CFO 4134472809 725 NORTH STREET PITTSFIELD MA 012014109 X LORINDA ACKLEY MAZUR 2.00 X 0 0 0 JEROME J ANDERSON 2.00 X 0 0 0 THOMAS O ANDREWS 2.00 X 0 0 0 ALFRED A BARBALUNGA 2.00 X 0 0 0 BRONLY S BOYD 2.00 X X 0 0 0 BRIAN T BURKE MD 50.00 X 196555 0 37753 KIT DOBELLE 2.00 X 0 0 0 TIMOTHY C DOHERTY 2.00 X X 0 0 0 RICHARD M DOHONEY 2.00 X 0 0 0 BRIAN H FAIRBANK 2.00 X 0 0 0 A KING FRANCIS 2.00 X 0 0 0 DENNIS J HOGAN 2.00 X 0 0 0 EDMUND H HORNSTEIN DO 2.00 X 0 74312 0 JOHN R KEARNS MD 2.00 X 0 0 0 ELLEN L KENNEDY 2.00 X 0 0 0 SUSAN M KORMANIK 2.00 X 0 0 0 JOAN M MCFALLS 2.00 X 0 0 0 MICHAEL R MCINERNEY MD 2.00 X 0 0 0 LAURIE NORTON MOFFATT 2.00 X 0 0 0 DAVID E PHELPS 58.00 X X 0 454280 39701 D PHELPS-LIFE INS OTHER BENEFITS 1.00 X X 0 160999 0 BARTON D RASER 2.00 X 0 0 0 CAROLE G SIEGEL 2.00 X 0 0 0 GEORGE T SMITH 2.00 X 0 0 0 MARILYN L SPERLING 2.00 X 0 0 0 ANN H TRABULSI 2.00 X 0 0 0 ROBERT P WESPISER MD 2.00 X 0 130748 0 PAUL E RAVERTA 2.00 X 0 0 0 CHERYL M BOUDREAU 41.00 X 0 87228 13973 EUGENE DELLEA 50.00 X 0 212922 19580 DARLENE RODOWICZ 51.00 X 0 359339 36363 ALEC R BELMAN MD 50.00 X 240829 0 39555 DOREEN HUTCHINSON 50.00 X 163523 0 35842 WILLIAM F DUKE MD 50.00 X 216174 0 21998 CORINNE D KALSER MD 50.00 X 193431 0 27851 GLEN R LOVEJOY MD 50.00 X 228208 0 36083 RAYMOND SABATELLI MD 50.00 X 262092 0 39555 STEPHEN TRACY MD 50.00 X 223078 0 36204 1723890 1479828 384458 34 0 1 0 BERKSHIRE SURGICAL ASSOC PC 777 NORTH ST STE 407 PITTSFIELD MA 012014141 HEALTHCARE SERVICES 292100 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 753972633 HEALTHCARE STAFFING 100595 2 151984 77301 389579 5305 618864 NET PATIENT SVC REVENU 622110 44224749 44224749 44224749 290520 290520 13429 13429 46272 2140 44132 44132 44132 1186569 31090 988126 63618 198443 -32528 165915 165915 92755 151984 92755 0 EHR INCENTIVE PMTS 900099 487126 487126 PHARMACY SALES 446110 370010 370010 CAFETERIA SALES 722514 165226 165226 138058 138058 1160420 46518029 45219943 0 679222 1250 1250 810820 807222 3181 417 19523728 19181106 302939 39683 710191 697572 11158 1461 2951325 2905062 40978 5285 1271703 1249969 19216 2518 4399091 4399091 83 83 12270 12270 18505 18505 3069062 3055150 1357 12555 40123 28025 487 11611 3087926 3049016 29857 9053 339420 339367 53 687829 676529 10300 1000 200661 195251 3396 2014 305410 305410 1562282 1535582 26700 270898 266268 4098 532 BAD DEBT 1645885 1645885 RECIPROCAL/TEACHNG FEES 1269581 1269581 MAINTENANCE & REPAIRS 701602 689827 11775 ARCHITECTURAL & DESIGN 650466 650466 1135153 1008420 122618 4115 44665264 39569228 5005792 90244 11574 6000 1256157 815762 3600 4338011 5162660 30125 19511 278996 354928 150987 110339 26091466 16173399 8705396 9918067 11469349 13583585 1341202 1565677 11811 10292 406625 405945 28000233 31956366 2899111 2994018 29524 26829 6884364 6205719 8110150 8926188 17923149 18152754 X 8079580 11447565 1739262 2097805 258242 258242 10077084 13803612 28000233 31956366 X 1852765 1873763 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 12270 12270 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: LOBBYING 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. 1058317 136721 1195038 1046753 11564 1058317 989912 56841 1046753 1028277 -22233 16132 989912 0.78390 0.21610 0 0 16887 16887 2137042 2012928 124114 12689107 9075317 3613790 11248430 5085154 6163276 9918067 DUE TO AFFILIATES 7005143 DUE TO THIRD PARTY PAYORS 1192815 ACCRUED FIN 47 ACCRETION 605898 DEFERRED COMPENSATION 118307 REBATE FUND LIABILITY 4025 8926188 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. GALA 204939 142538 62401 3805 11214 16915 10000 20467 GOLF TOURNAMENT 39800 9446 30354 4750 11008 6150 8446 244739 151984 92755 8555 22222 23065 10000 28913 92755 0 1 1 1 X 1 X 1 1 1 0 1 1 633656 633656 0.01470 5903096 4511557 1391539 0.03230 2821970 2318427 503543 0.01170 9358722 6829984 2528738 0.05870 208499 208499 0.00480 18800 18800 0.00040 1672 1672 0.00000 228971 228971 0.00520 9587693 6829984 2757709 0.06390 132754 132754 0.00310 235672 235672 0.00550 368426 368426 0.00860 1 1015107 18108792 17949271 159521 X 1 1 1 1 FAIRVIEW HOSPITAL

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X X X X FAIRVIEW HOSPITAL 1 1 1 200.000000000000 1 400.000000000000 1 X X X X 1 1 X X X X 1 0 1 X 0 0 3 FAIRVIEW HSP OUTPATNT PHYSICAL THERAPY

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OUTPATIENT SERVICES FAIRVIEW PHYSICAL & SPORTS THERAPY CTR

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OUTPATIENT SERVICES FAIRVIEW HOSPITAL AQUATIC THERAPY PROG

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OUTPATIENT SERVICES 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. FAIRVIEW HOSPITAL 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. 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. REPORTS FILED WITH STATES PART VI, LINE 7 MA 0 0 0 0 0 0 0 0 0 BRIAN T BURKE MD 178884 0 0 0 17671 0 9223 0 28530 0 234308 0 0 0 DAVID E PHELPS 0 454280 0 0 0 0 0 11025 0 28676 0 493981 0 0 D PHELPS-LIFE INS OTHER BENEFITS 0 0 0 0 0 160999 0 0 0 0 0 160999 0 0 EUGENE DELLEA 0 167218 0 0 0 45704 0 8583 0 10997 0 232502 0 0 DARLENE RODOWICZ 0 305877 0 0 0 53462 0 11025 0 25338 0 395702 0 0 ALEC R BELMAN MD 214210 0 11232 0 15387 0 11025 0 28530 0 280384 0 0 0 DOREEN HUTCHINSON 143674 0 0 0 19849 0 7719 0 28123 0 199365 0 0 0 WILLIAM F DUKE MD 188042 0 7158 0 20974 0 0 0 21998 0 238172 0 0 0 CORINNE D KALSER MD 180110 0 3623 0 9698 0 3513 0 24338 0 221282 0 0 0 GLEN R LOVEJOY MD 198978 0 10764 0 18466 0 8688 0 27395 0 264291 0 0 0 RAYMOND SABATELLI MD 212668 0 12636 0 36788 0 11025 0 28530 0 301647 0 0 0 STEPHEN TRACY MD 168517 0 10764 0 43797 0 9266 0 26938 0 259282 0 0 0 SUPPLEMENTAL INFORMATION PART III SUPPLEMENTAL 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: $1,235 MASS HEALTH & EDUCATION FACIL AUTHORITY SER F 042456011 57586CLN3 2005-07-26 53089428 REFUND SER C & D BONDS;CAPITAL EXP 0 0 0 MASS DEVELOPMENT FINANCE AGENCY BHS ISSUESER G 043431814 57583UQP6 2012-05-23 93491421 REFUND SER A, B, & E; CAPITAL EXP 0 0 0 16460000 54729019 5019000 1003800 898795 73681 9003428 38730315 2008 1 0 0 1 93491584 1245681 6699357 84144509 1402037 2011 1 0 0 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0.00000 0.00000 0.00000 1 1 0 0 0 1 0 1 0 0 0 0 0 X FORM 990, PART VI, SECTION A, LINE 3 FAIRVIEW 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 6 BERKSHIRE HEALTH SYSTEMS, INC. IS THE SOLE CORPORATE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A THE 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 11 BERKSHIRE 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 12C THE 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 15 FAIRVIEW 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 19 THE 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. AVERAGE HOURS PER WEEK 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 1,873,763. BERKSHIRE HEALTH SYSTEMS INC 725 NORTH ST PITTSFIELD MA 01201 042442944 PARENT CORPORATION MA 501(C)(3) 11B N/A 0 BERKSHIRE MEDICAL CENTER INC 725 NORTH ST PITTSFIELD MA 01201 042791396 ACUTE CARE HOSPITAL MA 501(C)(3) 3 N/A 0 BERKSHIRE FACULTY SERVICES INC 725 NORTH ST PITTSFIELD MA 01201 042995053 PHYSICIAN SERVICES MA 501(C)(3) 11B N/A 0 BHS MANAGEMENT SERVICES INC 725 NORTH ST PITTSFIELD MA 01201 222755258 MANAGEMENT SERVICES MA 501(C)(3) 11B N/A 0 TRI-STATE MEDICAL MANAGEMENT CORP 725 NORTH STREET PITTSFIELD MA 01201 042913352 REAL ESTATE MGMT MA FAIRVIEW HOSPITAL C -18079 286747 1.00000 0 1 0 1 0 0 0 0 0 0 1 1 1 1 1 1 1 1 TRI-STATE MEDICAL MANAGEMENT CORP D 278349 FAIR MARKET VALUE