2012-08-14T13:08:20-05:00 2011-09-30 BOLLUS LYNCH LLP 89 SHREWSBURY STREET WORCESTER MA 01604 990 2010-10-01 222720658 GREATER QUABBIN HEALTH SYSTEM GREA 9782493511 2033 MAIN STREET ATHOL MA 01331 JAMES MEEHAN 9782493511 2012-08-07 1 BARBARA E KING 5087557107 2012-08-07 2010 2016-02-24 21:20:13Z JAMES MEEHAN 2033 MAIN STREET ATHOL MA 01331 1817778 0 X N/A X 1986 MA TO OPERATE EXCLUSIVELY FOR THE BENEFIT OF ATHOL MEMORIAL HOSPITAL, INC AND TO CONDUCT FUND-RAISING, COORDINATE PLANNING, AND MANAGE STRATEGIC DEVELOPMENT FUNCTIONS FOR THE HOSPITAL. 21 21 0 0 0 0 1240 1980 0 0 51826 228593 0 0 53066 230573 13375 500 0 0 0 0 0 0 0 38950 6074 52325 6574 741 223999 3276379 3406565 12000 0 3264379 3406565 TO BENEFIT ATHOL MEMORIAL HOSPITAL, AN ACUTE CARE, NOT FOR PROFIT COMMUNITY HOSPITAL, FOUNDED TO PROVIDE INPATIENT, OUTPATIENT, EMERGENCY CARE, AND HOME SERVICES FOR RESIDENTS OF NORTH WORCESTER COUNTY. 0 0 6574 TO BENEFIT ATHOL MEMORIAL HOSPITAL, AN ACUTE CARE, NOT FOR PROFIT COMMUNITY HOSPITAL, FOUNDED TO PROVIDE INPATIENT, OUTPATIENT, EMERGENCY CARE, AND HOME SERVICES FOR RESIDENTS OF NORTH WORCESTER COUNTY. 6574 1 0 0 0 0 0 0 0 1 0 0 0 1 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 21 21 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 0 0 0 MA X THE ORGANIZATION 9782493511 2033 MAIN STREET ATHOL MA 01331 X WILLIAM MEEHAN 2.00 X 0 0 0 DOUGLAS A STARRETT 2.00 X 0 0 0 LAUREY KENERSON 2.00 X 0 0 0 CHENEY CASTINE 2.00 X 0 0 0 JAMES MEEHAN JR 2.00 X 0 0 0 MOHSEN NORELDIN MD 2.00 X 0 0 0 DANILO FUNA MD 2.00 X 0 0 0 ROBIN BROOKS 2.00 X 0 0 0 JANET KRAFT 2.00 X 0 0 0 ROY LAKE 2.00 X 0 0 0 DONALD MRUK MD 2.00 X 0 0 0 CURTIS RAND 2.00 X 0 0 0 TIMOTHY SOULE-REGINE MD 2.00 X 0 0 0 YOGENDRA THAKER MD 2.00 X 0 0 0 WAYNE MILLER MD 2.00 X 0 0 0 ROBERT KNIGHT MD 2.00 X 0 0 0 LAWRENCE ESTELLE JR 2.00 X 0 0 0 REBECCA BIALECKI 2.00 X 0 0 0 STEVEN PENKA 40.00 X 125955 0 13084 DEAN FLEMING 40.00 X 108037 0 5284 233992 0 18368 2 0 0 0 0 1980 1980 30909 30909 1784889 1587205 197684 197684 197684 230573 0 0 228593 500 500 6000 6000 FEES/DUES 70 70 MISCELLANEOUS 4 4 6574 6574 0 0 58723 54501 14270 4746 1140476 512427 982910 102026 1080000 2732865 3276379 3406565 12000 0 12000 0 X 2413558 2555744 850821 850821 3264379 3406565 3276379 3406565 X 223999 -81813 X 0 1 1 X 0 X 38000 29349 1240 1980 70569 38000 29349 1240 1980 70569 70569 119266 140163 61330 34488 30909 386156 456725 0.15450 0.59120 X 1662962 30485 54971 1638476 1573920 105254 16212 1662962 1750212 -157893 -18399 1573920 1.00000 0 1 1 0 DUE FROM AFFILIATE 2732865 2732865 230573 6574 223999 -81813 -81813 142186 148760 -81813 -81813 230573 0 230573 6574 0 6574 0 6574 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE ORGANIZATION'S ENDOWMENT INCLUDES BOTH DONOR-RESTRICTED ENDOWMENT FUNDS AND FUNDS DESIGNATED BY THE BOARD TO FUNCTION AS ENDOWMENTS. AS REQUIRED BY GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, NET ASSETS ASSOCIATED WITH ENDOWMENT FUNDS ARE CLASSIFIED AND REPORTED BASED ON THE EXISTENCE OR ABSENCE OF DONOR-IMPOSED OR LEGAL RESTRICTIONS. ENDOWMENT FUNDS INCLUDE INVESTED GIFTS. AS REQUIRED BY GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, THE ORGANIZATION CLASSIFIES AS PERMANENTLY RESTRICTED NET ASSETS (A) THE ORIGINAL VALUE OF GIFTS DONATED TO THE PERMANENT ENDOWMENT, (B) THE ORIGINAL VALUE OF SUBSEQUENT GIFTS TO THE PERMANENT ENDOWMENT, AND (C) ACCUMULATIONS TO THE PERMANENT ENDOWMENT MADE IN ACCORDANCE WITH THE DIRECTION OF THE APPLICABLE DONOR GIFT INSTRUMENT AT THE TIME THE ACCUMULATION IS ADDED TO THE FUND. THE REMAINING PORTION OF THE DONOR-RESTRICTED ENDOWMENT FUND THAT IS NOT CLASSIFIED IN PERMANENTLY RESTRICTED NET ASSETS IS CLASSIFIED AS TEMPORARILY RESTRICTED NET ASSETS UNTIL THOSE AMOUNTS ARE APPROPRIATED FOR EXPENDITURE BY THE ORGANIZATION IN A MANNER CONSISTENT WITH THE STANDARD OF PRUDENCE PRESCRIBED BY STATE LAW. IN ACCORDANCE WITH THE UNIFORM PRUDENT MANAGEMENT OF INSTITUTIONAL FUNDS ACT, THE ORGANIZATION CAN CONSIDER THE FOLLOWING FACTORS IN MAKING A DETERMINATION TO APPROPRIATE OR ACCUMULATE DONOR-RESTRICTED ENDOWMENT FUNDS: -THE DURATION AND PRESERVATION OF THE FUND -THE PURPOSES OF THE ORGANIZATION AND THE DONOR-RESTRICTED ENDOWMENT FUND -GENERAL ECONOMIC CONDITIONS -THE POSSIBLE EFFECT OF INFLATION AND DEFLATION -THE EXPECTED TOTAL RETURN FROM INCOME AND THE APPRECIATION OF INVESTMENTS -OTHER RESOURCES OF THE ORGANIZATION -THE INVESTMENT POLICIES OF THE ORGANIZATION. THE ORGANIZATION HAS ADOPTED INVESTMENT AND SPENDING POLICIES FOR ITS BOARD-DESIGNATED AND OTHER ENDOWMENT ASSETS THAT ATTEMPT TO PROVIDE A PREDICTABLE STREAM OF FUNDING FOR ITS PROGRAMS WHILE SEEKING TO MAINTAIN THE PURCHASING POWER OF THE ENDOWMENT ASSETS. UNDER THIS POLICY, AS APPROVED BY THE BOARD, THE ENDOWMENT ASSETS ARE INVESTED IN A MANNER THAT IS INTENDED TO PRODUCE RESULTS THAT EXCEED THE PRICE AND YIELD RESULTS OF THE S&P 500 INDEX WHILE ASSUMING A MODERATE LEVEL OF INVESTMENT RISK. THE ORGANIZATION EXPECTS ITS ENDOWMENT FUNDS, OVER TIME, TO PROVIDE AN AVERAGE RATE OF RETURN OF APPROXIMATELY 8% ANNUALLY. ACTUAL RETURNS IN ANY GIVEN YEAR MAY VARY FROM THIS AMOUNT. TO SATISFY ITS LONG-TERM RATE-OF-RETURN OBJECTIVES, THE ORGANIZATION RELIES ON A TOTAL RETURN STRATEGY IN WHICH INVESTMENT RETURNS ARE ACHIEVED THROUGH BOTH CAPITAL APPRECIATION (REALIZED AND UNREALIZED) AND CURRENT YIELD (INTEREST AND DIVIDENDS). THE ORGANIZATION HAS INVESTED IN A PORTFOLIO THAT TARGETS A DIVERSIFIED ASSET ALLOCATION, PLACING A GREATER EMPHASIS ON EQUITY-BASED INVESTMENTS TO ACHIEVE ITS LONG-TERM RETURN OBJECTIVES WITHIN PRUDENT RISK CONSTRAINTS. THE ORGANIZATION HAS A POLICY OF APPROPRIATING FOR DISTRIBUTION EACH YEAR 4.5 TO 5% OF ITS ENDOWMENT FUND'S AVERAGE FAIR VALUE OVER THE PRIOR TWELVE QUARTERS OF THE YEAR PROCEEDING THE YEAR IN WHICH THE DISTRIBUTION IS PLANNED. IN ESTABLISHING THIS POLICY, THE ORGANIZATION CONSIDERED THE LONG-TERM EXPECTED RETURN ON ITS ENDOWMENT. ACCORDINGLY, OVER THE LONG TERM, THE ORGANIZATION EXPECTS THE CURRENT SPENDING POLICY TO ALLOW ITS ENDOWMENT TO GROW AT AN AVERAGE OF 2.5 - 3% ANNUALLY. THIS IS CONSISTENT WITH THE ORGANIZATION'S OBJECTIVE TO MAINTAIN THE PURCHASING POWER OF ITS ENDOWMENT. FROM TIME TO TIME, THE FAIR VALUE OF ASSETS ASSOICATED WITH INDIVIDUAL DONOR-RESTRICTED ENDOWMENT FUNDS MAY FALL BELOW THE LEVEL THAT THE DONOR IMPOSED RESTRICTIONS REQUIRE THE ORGANIZATION TO RETAIN AS A FUND OF PERPETUAL DURATION. IN ACCORANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, DEFICIENCIES OF THIS NATURE ARE REPORTED IN UNRESTRICTED NET ASSETS. SUCH DEFICIENCIES AMOUNTS TO $(180,560) AND $(226,988) AS OF SEPTEMBER 30, 2011 AND 2010, RESPECTIVELY. PART X, QUESTION 2: MANAGEMENT ANNUALLY REVIEWS FOR UNCERTAIN TAX POSITIONS ALONG WITH ANY RELATED INTEREST AND PENALTIES AND BELIEVES THAT THE ORGANIZATION HAS NO UNCERTAIN TAX POSITIONS THAT WOULD HAVE A MATERIAL EFFECT, INDIVIDUALLY OR IN THE AGGREGATE, UPON THE ORGANIZATION'S STATEMENT OF FINANCIAL POSITION, OR THE RELATED STATEMENTS OF ACTIVITIES, OR CASH FLOWS. FORM 990, PART VI, SECTION A, LINE 2 JAMES MEEHAN, JR. CHAIRMAN AND WILLIAM MEEHAN, VICE CHAIRMAN ARE BROTHERS. FORM 990, PART VI, SECTION B, LINE 11 FORM 990 WILL BE CIRCULATED TO THE BOARD IN ELECTRONIC FORMAT PRIOR TO FILING. COMMENTS AND QUESTIONS WILL BE ADDRESSED BY THE CFO AND ONCE APPROVED, THE RETURN WILL BE FINALIZED. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF TRUSTEE REVIEW THE ORGANIZATION'S CONFLICT OF INTEREST POLICY ANNUALLY IN ORDER TO ENSURE THAT THE ORGANIZATION BOARD OF TRUSTEES AND OFFICERS ARE REGULARLY AND CONSISTENTLY MONITORING AND ENFORCING IT. FORM 990, PART VI, SECTION C, LINE 19 REQUESTS FOR REVIEW OF THE FORM 990 ARE FORWARDED TO THE CFO WHO MAKES ARRANGEMENTS FOR THE REVIEW. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -81,813. ATHOL MEMORIAL HOSPITAL 2033 MAIN STREET ATHOL MA 01331 042126583 HOSPITAL MA 501(C)(3) 170(B)(1)(A)(VI) GREATER QUABBIN HEALTH SYSTEMS INC 0 QUABBINCARE INC 2033 MAIN STREET ATHOL MA 01331 222720562 INACTIVE MA 501(C)(3) 170(B)(1)(A)(VI) GREATER QUABBIN HEALTH SYSTEMS INC 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ATHOL MEMORIAL HOSPITAL D 2732865 GAAP