2012-04-11T12:03:33-07:00 2011-09-30 990 2010-10-01 042103581 HENRY HEYWOOD MEMORIAL HOSPITAL HENR 9786323420 242 Green Street Gardner MA 01440 Robert Crosby 9786306157 2012-04-10 2010 2016-02-24 21:20:13Z Robert Crosby 242 Green Street Gardner MA 01440 111217197 0 X www.heywood.org X 1907 MA Heywood Hospital is a community oriented and supported not-for-profit acute care hospital governed by a local Board of Trustees. Our mission is to be our communities' trusted choice for exceptional patient-centered care. 20 19 980 281 0 0 2930001 995825 95394047 98848732 167930 -135263 1133754 1044642 99625732 100753936 50000 231428 0 0 48844530 52620474 1196 21806 112206 45560571 49068941 94456297 101942649 5169435 -1188713 93803027 86669292 47803730 44191517 45999297 42477775 Heywood Hospital is a community oriented and supported not-for-profit acute care hospital governed by a local Board of Trustees. Our mission is to be our communities' trusted choice for exceptional patient-centered care and to be one of the best independent community hospitals in America. 0 0 96152118 231428 98848732 Heywood Hospital is dedicated to the community benefit goals of improving the health status of our community, adressing the specific health care needs of the under-served and collaborating with others to enhance quality and contain the growth of community health care costs. Details to this are published in "The Community Benefit Report of Heywood Hospital - Fiscal Year 2011" filed with the MA Attorney General Office. 0 0 0 96152118 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 1 1 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 1 146 0 1 980 1 0 0 0 0 0 0 X 20 19 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X Robert Crosby 9786306157 242 Green Street Gardner MA 01440 Daniel M Asquino 0 X 0 0 0 Gerald L Bankowski 0 X 0 0 0 JoAnne Parks 0 X 0 0 0 Kenneth J Pierce 0 X 0 0 0 James A Faust MD 0 X 0 0 0 Joyce Fletcher 0 X 0 0 0 John Flick 0 X 0 0 0 James Garrison 0 X 0 0 0 Paul P Harasimowicz DDS 0 X 0 0 0 Stephen Hemman 0 X 0 0 0 Glenn A Hunt 0 X 0 0 0 Brian Knuuttila 0 X 0 0 0 Anthony P Kraskouskas Jr 0 X 0 0 0 Janet Latour 0 X 0 0 0 Michele Parker 0 X 0 0 0 Tina Sbrega 0 X 0 0 0 John Skrzypczak MD 0 X 0 0 0 Karl Sorenson MD 0 X 0 0 0 Edmund Taylor MD 0 X 0 0 0 Winfield Brown 40 X X 0 0 0 Daniel P Moen 40 X X 550766 0 30788 Tina Santos 40 X 0 0 0 Michael Grimmer 40 X 0 0 0 Robert Crosby 40 X 213767 0 24004 Thomas Cady 40 X 150829 0 24316 Rose Kavalchuck 40 X 150399 0 22272 James Mullen 40 X 232463 0 29283 Lorie Martiska 30 X 108398 0 11118 David Gill 40 X 247343 0 26043 Sheila Ebert 24 X 183429 0 14073 Alice Vaine 30 X 146764 0 12707 Dianne Cormier 32 X 140058 0 12253 Tina Griffin 40 X 130199 0 21458 2254415 0 228315 37 0 1 0 William A Berry & Sons Inc 99 Conifer Hill Drive Danvers MA 01923 Construction Services 17502149 Quartulli and Associates Inc PO Box 423 Gardner MA 01440 Physical Therapy 2720684 Bay State Emergency Medical Inc 44 Crosby Road Ashburnham MA 01430 Emergency Room Physicians 2534967 Alliance Healthcare Services 100 Bay View Circle Newport Beach CA 92660 MRI 1221673 Quest Diagnostics Inc 5763 Collection Center Drive Chicago IL 60693 Lab Contracted Services 755533 37 0 0 38032 0 209356 748437 0 995825 Ancillary O/P Service 622110 55018371 55018371 0 0 Ancillary I/P Service 622110 43038691 43038691 0 0 Contracted Services 900099 528918 528918 0 0 HMG Patient Revenue (net) 621111 128848 128848 0 0 Lifeline 624120 71906 71906 0 0 61998 61998 0 0 98848732 209788 0 0 209788 252 0 0 252 0 0 0 0 37596 0 0 0 37596 0 37596 0 0 37596 10072191 7246 10417383 7357 -345192 -111 -345303 0 0 -345303 29600 38032 38521 -8921 0 -8921 0 0 0 0 0 0 0 0 0 0 0 0 Meals Revenue 722212 731844 0 0 731844 Purchase Discounts 900099 193900 0 0 193900 Medical Record Copies 561499 24392 0 0 24392 65831 0 0 65831 1015967 100753936 98848732 0 909379 231428 231428 0 0 0 0 0 0 1615386 546059 1069327 0 0 0 0 41196774 39485794 1647790 63190 648228 614653 32756 819 5920891 5722707 187706 10478 3239195 3106123 128678 4394 241900 0 241900 0 169305 10452 158853 0 100629 0 100629 0 0 0 0 21806 21806 0 0 0 0 11426554 11426554 0 0 98668 92717 5951 0 14694685 14474576 208590 11519 865077 865077 0 0 0 0 0 0 1699110 1679140 19970 0 67051 61524 5527 0 0 0 0 0 18938 16692 2246 0 827777 827777 0 0 0 0 0 0 3919410 3903506 15904 0 795045 754526 40519 0 Professional Fees 5052549 3702742 1349807 0 Provisions for Bad Debt 3889532 3889532 0 0 Free Care 3172834 3172834 0 0 Subscriptions and Dues 592014 186117 405897 0 Laundry and Uniforms 467094 467094 0 0 970769 914494 56275 0 101942649 96152118 5678325 112206 2453099 1853123 0 0 4601826 3023263 9520061 10745265 0 0 0 0 235927 59961 1677640 1366412 1357529 1024514 100861772 44805939 54067784 56055833 15174420 11923586 2306506 493046 2408235 124289 0 0 0 0 93803027 86669292 16865672 13381637 0 0 0 0 26264155 26230945 0 0 0 0 1052456 812024 0 0 3621447 3766911 47803730 44191517 X 38407900 36836852 6585434 4634890 1005963 1006033 45999297 42477775 93803027 86669292 X -1188713 -2332809 X 1 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 17367013 5000 -128702 0 5345880 0 11897431 16786738 4875 958017 0 382617 0 17367013 18164728 5250 -686973 0 696267 0 16786738 0.82 0.08 0.1 0 0 0 125271 125271 0 63327319 19290685 44036634 0 0 0 0 0 36881826 25515254 11366572 0 527356 0 527356 56055833 0 Estimated Settlement with 3rd Party 3766911 3766911 SchD_P05_S00_L04 Schedule D, Part V, Line 4 Perm endow funds are established by donor restricted gifts and maintained to provide a permanent source of income. The principal of which is kept in perpetuity. Board Designated endow funds are established by the governing body to fund capital projects and or improvements of the organization. Temp restricted funds are established by donor restricted gifts that maintain a source of income for a specified period of time. SchD_P10_S00_L02 Schedule D, Part X, Line 2 FIN 48 (ASC 740) Footnote states "The Hospital and HMG have been determined to be not for profit corporations as described in Section 501(c)(3), and the Realty Corp has been determined to be a not for profit corporation as described in Section 501(c)(2) of the IRS code, and are exempt from federal income taxes on related income pursuant to Section 501(a) of the code. The IRS has also previously determined that the Hospital is not a private foundation because it is an organization described under the IRC section 170(i)(A)(iii). Any income not substantialy related to these Organizations' exempt purposes may be considered unrelated business income under IRC Section 511 and, as such, subject to tax at normal corporate rates. In accordance with generally accepted accounting principals, the Organization annually evaluates its tax status and tax positions taken with respect to its operations and financial position. Tax years from 2007 through the current year remain open for examination by federal and state taxing authorities." X X X 0 MA Golf Classic 67632 38032 29600 2060 6174 13485 15207 0 1595 0 0 67632 38032 29600 2060 6174 13485 15207 0 1595 38521 -8921 1 1 X 1 X 1 X 1 1 1 0 1 1 2019098 1014439 1004659 0.0099 14108984 12115212 1993772 0.0195 0 0 0 0 0 0 16128082 13129651 2998431 0.0294 1665992 122071 1543921 0.0152 100634 2792 97842 0.001 0 0 0 0 0 0 0 0 14857 0 14857 0.0001 0 0 1781483 124863 1656620 0.0163 0 0 17909565 13254514 4655051 0.0457 0 0 0 0 0 0 0 0 1240 0 1240 0 74 0 74 0 0 0 0 0 238777 0 238777 0.0023 59515 15400 44115 0.0004 99411 0 99411 0.001 0 0 0 0 0 0 399017 15400 383617 0.0037 1 1735665 111083 27664501 26887397 777104 X 1 1 1 1 Henry Heywood Memorial Hospital

242 Green Street Gardner MA 01440

X X X Henry Heywood Memorial Hospital 1 1 1 100 1 400 1 X X X 1 1 X X X X X 1 X 1 X X X X X X 1 X 0 0 SchH_P01_S00_L06a Schedule H, Part I, Line 6a The organization makes it's annual Community Benefit Report available to the public by transmitting the report electronically to the Attorney General's Community Benefit office which then makes it public on their website. SchH_P01_S00_L07 Schedule H, Part I, Line 7 The costing methodology used to calculate the amounts reported in the table in Part I, for lines 7a through 7c was based on the cost to charge ratio derived from the supplied Worksheet 2, in the IRS schedule H instructions. The costs for lines 7e through 7i were actual costs incurred. SchH_P02_S00_L00 Schedule H, Part II The Heywood Hospital's Community Benefits Mission Statement is "Heywood Hospital is dedicated to the community benefit goals of improving the health status of our community, addressing the special health needs of the underserved and collaborating with others to enhance quality and contain the growth of community healthcare costs." SchH_P02_S00_L03 Schedule H, Part II, Line 3 The Hospital established a Domestic Violence Task Force to help the community in violence prevention. Also, a Substance Abuse Support Group was established for the community to reach out to help. SchH_P02_S00_L04 Schedule H, Part II, Line 4 Heywood Hospital assisted the Gardner Board of Health and Police Department in a state-wide project called "Operation Medicine Cabinet". This was to work on safely removing unused prescription medications from the community. SchH_P02_S00_L06 Schedule H, Part II, Line 6 Heywood's approach to Community Benefits has been to collaborate with others through the Joint Coalition on Health and other coalitions to develop our plan, goals and strategies. Partners include the Joint Coalition on Health, Greater Gardner Interagency Team, the CHNA 9, the Minority Coalition, Montachusetts Opportunity Council, Mount Wachusetts Community College, the Community Health Connections Health Centers, North Central Human Services, Luk, Inc, Community Health Link, Gardner VNA, the Gardner Public Schools, the Winchendon Public Schools, the Health Foundation of Central MA, Kresge Foundation, the Department of Publich Health, AHEC and others. At this time, we continue to focus our efforts on mental health and substance abuse, insuring those without jobs and/or insurance, addressing the needs of underserved populations, focusing on the needs of youth and children, and targeting adults and children with overweight and obesity issues which lead to chronic disease and diabetes. SchH_P02_S00_L07 Schedule H, Part II, Line 7 Heywood Hospital had representation at Career Centers and Unemployment Office Workshops to provide education and knowledge about our Ghap program which provides the community with access for health care services. Additionally, Heywood Hospital's Emergcy department includes a community health promotion advocate under the SBIRT project. This advocate screens emergency room patients and community members for health risks and substance abuse, and makes appropriate referrals. The SBIRT program assisted 1,056 ER patients through Screening and Brief Intervention model. 23% screened were positive and 38% of those were admitted into a substance abuse program. SchH_P02_S00_L08 Schedule H, Part II, Line 8 Heywood Hospital serves a Medically Underserved Population Area. Because of this, the Hospital is constantly working to recruit and search out physicians to serve our community. SchH_P03_S0A_L04 Schedule H, Part III, Section A, Line 4 Footnote "The Organization provides an allowance for doubtful accounts equal to estimated bad debt losses. The estimated losses are based upon historical collection experience together with a review of the current status of the existing receivables." The costing methodology used for line 2 was based on the cost to charge ratio derived from the supplied worksheet 2 in the IRS sch H instructions. The methodology used for line 3 was to take the percentage of financial assistance applications that were denied due to inadequate documentation divided by the total applications received for FY11. This amounted to approximately 6.4percent which was applied against the number on line 2. It is our belief that $110,083 amount of bad debt should be included as community benefit. As a tax exempt hospital, we must provide necessary services regardless of the patient's ability to pay for the service provided. As a not for profit, patient care is provided to all, regardless of ability to pay for that care, making quality patient care available to all in our community, regardless of their economic means, qualifies bad debts as a community benefit. SchH_P03_S0B_L08 Schedule H, Part III, Section B, Line 8 The allowable costs on line 6 were obtained from our FY2011 Medicare Cost Report, worksheet D schedules. SchH_P03_S0C_L09b Schedule H, Part III, Section C, Line 9b Heywood Hospital provides patients with information about financial assistance programs that are available through the Commonwealth of MA or through Heywood Hospital's own financial assistance program, which may cover all or some of their unpaid hospital bills. For those patients that request such assistance, Heywood Hospital assists patients by screening them for eligibility in an available public program and assisting them in applying for the program. These programs include, but are not limited to MassHealth, Commonwealth Care, Children's Medical Security Plan, Healthy Start, Health Safety Net and others. It is the patient's obligation to provide Heywood Hospital with accurate and timely information to determine if the patient is eligible to apply for certain health insurance programs. If the patient or guarantor is unable to provide the necessary information, Heywood Hospital may make reasonable efforts to obtain any additional information from other sources. Information that Heywood obtains will be maintained in accordance with applicable federal and state privacy and security laws. The screening and application process for a public health insurance program is done through the Virtual Gateway, which is an internet portal designed by the MA Executive Office of Health and Human Services. The Virtual Gateway manages the application process from the programs listed above, which is available for children, adults, seniors, veterans, homeless and disabled individuals. Heywood specifically assists the patient in completing the application and securing the necessary documentation required by the applicable financial assistance program. Heywood Hospital will then submit this document to the Commonwealth Office of Medicaid and assist the patient in any additional documentation if such is requested by the Commonwealth after completing the application. All Virtual Gateway applications are reviewed and processed by the Commonwealth of MA, Office of Medicaid. Special circumstance applications are reviewed and approved by the MA division of Health Care Finance and Policy. Hospitals have no role in the determination of program eligibility made by the Commonwealth, but at the patient's request may take a direct role in appealing or seeking information related to the coverage decisions. It is still the patient's responsibility to inform Heywood Hospital of all coverage decisions made by the Commonwealth to ensure accurate and timely adjudication of all hospital bills. If the patient does not comply with the request for documentation, then our standard collection procedures apply. SchH_P05_S0B_L17 Schedule H, Part V, Section B, Line 17 The Hospital posts general notices throughout the hospital about the financial assistance policy. SchH_P06_S00_L02 Schedule H, Part VI, Line 2 Heywood Hospital co chairs the Joint Coalition on Health which undertakes comprehensive assessments of community needs and assets every three to five years. The Steering Committees of the JCOH and the CHNA, with support from the Minority Coalition of North Central MA, collaborated to finalize a comprehensive health assessment of a 27 town region in north central MA. After the addition of pertinent sections to the report originally completed in January 2011, a final report was made available to the public in the fall of 2011. It was published in hard copy and as an electronic file on the web sites of participating organizations. More than 20 focus groups and interviews were conducted by vendors whoe were responsible for teh qualitative portion of the assessment. This data was gathered and analyzed by Blue Cross Blue Shield of MA. The Central MA Area Health Education Center intergrated the results of the qualitative work with the quantitative date to produce a final report. SchH_P06_S00_L03 Schedule H, Part VI, Line 3 Heywood has a very aggressive and comprehensive program called GHAP to inform patients and members of the community about their eligibility for assistance and to assist them with enrollment and access to care. The goal is to inform the community about insurance options before they present to the Hospital for care. Many referrals come from area physicians to the program. The GHAP program was begun at Heywood in 1998 to connect uninsured patients with insurance and care. In addition to postings within the Hospital, the GHAP program is marketed throughout the community and selp-pay patients who present too the eD receive a follow-up call from GHAP staff to offer assistance. In addition, the GHAP program does outreach to community organizations and presents information monthly to the newly unemployed at the local unemployment office. GHAP also works collaboratively with Patient Accounts to assist patients who have difficulty paying their bill. GHAP has been nationally recognized by AHA and is part of a five organization network model for patient access that has received state grant funding. SchH_P06_S00_L04 Schedule H, Part VI, Line 4 The Greater Gardner area, comprised of the City of Gardner and five surrounding towns, has a population of 60,000 people, a median income below the state average, and an unemployment rate above the state average. The community has been affected by the loss of the furniture industry over the past few decades, and by the current economic downturn. Mental Health and Substance Abuse are significant challenges for many residents of the area. The Hospital is the largest employer in the area, with around 1,000 employees. The community is largely white, non hispanic, but has a growing hispanic population. Gardner is one of three cities in teh region, the others are Fitchburg and Leominster, which frequently collaborate for the betterment of the region. Heywood Hospital collaoborates with the competing hospital in the Fitchburg Leominster area, HealthAlliance, on community health improvement activities, and provides the GHAP program onsite at HealthAlliance. SchH_P06_S00_L05 Schedule H, Part VI, Line 5 The Heywood Hospital's Community Benefit Mission Statement states Heywood Hospital is dedicated to the community benefit goals of improving the health status of our community, addressing the special health needs of the underserved and collaborating with others to enhance quality and contain the growth of community healthcare costs. The Hospital dedicates our organization to the community benefit goals by improving the health status of our comminty; addressing the special health problems of minorities, the poor, uninsured and other underserved populations; contianing the growth of community health care costs. Such goals will be undertaken within the framework of a Community Benefit Plan which shall include sugh elements as comitment on the part of the Board of Trustees and CEO; specific goals and objectives; annual evaluation processes; commitment of hospital resources through normal budgeting process; consideration of community served in all operational and policy decisions; defined community; health status and needs assessment; opportunity for public input and comment; the promotion of cooperative and collaborative relationships with other providers and agencies in order to carry out a borad health agenda in our community. Such community benefit goals are elements and are herby adopeted and endorsed by the Board of Trustees of Heywood Hospital. SchH_P06_S00_L06 Schedule H, Part VI, Line 6 not applicable SchH_P06_S00_L07 Schedule H, Part VI, Line 7 Heywood Hospital files an annual Community Benefit Report to the Attorney General's Community Benefit Office in Massachusetts. 1 Montachusett Home Care Corp 680 Mechanic Street Leominster MA 01453 042551175 501(c)(3) 147885 0 not applicable not applicable The funds will be used by the Community Health Network of North Central MA as support and collaborative community health assessment work. Montachusett Opportunity Council 133 Pritchard Street Fitchburg MA 01420 042401111 501(c)(3) 83543 0 not applicable not applicable The funds will be used by Joint Coalition on Health as support of operations, to provide Community Health grants in conjunction with identified priorities of the JCOH service area, and to support the Gardner Area InterAgency Team. 2 0 SchI_P01_S00_L02 Schedule I, Part I, Line 2 Montachusett Home Care Corp and the Community Health Network of MA file an annual report with the office of the Healthy Communities that contains a summary of how the funds are allocated. X X X X X 0 0 0 0 0 0 0 0 0 Robert Crosby 212672 0 0 0 1095 0 0 0 24004 0 237771 0 0 0 Thomas Cady 150041 0 0 0 788 0 1591 0 22725 0 175145 0 182238 0 Rose Kavalchuck 149877 0 0 0 522 0 3100 0 19172 0 172671 0 163810 0 David Gill 246052 0 0 0 1291 0 4900 0 21143 0 273386 0 0 0 Sheila Ebert 182378 0 0 0 1051 0 3668 0 10405 0 197502 0 0 0 Alice Vaine 146560 0 0 0 204 0 3048 0 9659 0 159471 0 0 0 Dianne Cormier 132491 0 7567 0 0 0 2730 0 9523 0 152311 0 0 0 Tina Griffin 129964 0 0 0 235 0 2696 0 18762 0 151657 0 0 0 Daniel P Moen 464254 0 74300 0 12212 0 4900 0 25888 0 581554 0 386126 0 James Mullen 230306 0 0 0 2157 0 4900 0 24383 0 261746 0 225929 0 MA Health and Educational Facilitiy Authority 042456011 57586EGT2 2009-03-31 17785000 Funds used for new Watkins Bldg project 0 0 0 MA Health and Educational Facility Authority 042456011 57586C7E9 2008-06-19 6715000 Refunding and new Watkins Bldg project 0 0 0 0 0 66235 0 0 0 281690 0 0 17569545 0 0 2010 0 0 1 1 0 0 19154 0 0 0 329467 0 3597891 2806796 0 0 2008 1 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 1 1 TD Bank 18.7 0 0 0 0 1 0 1 1 Piper Jaffrey 18.7 0 0 0 0 1 SchK_P01_S00_L00 Schedule K, Part I The bond issued on line B was a bond issued partially to refund a previous bond balance that was issued on November 9, 1999 and to pay for a portion of the new Watkins Building. F990_P06_S0A_L03 Form 990, Part VI, Section A, Line 3 The Heywood Hospital President, Daniel Moen, left the organization in January 2011. During the search for a new CEO/President, the Hospital acquired the services of Leaders for Today, LLC (a management company) to employ an interim CEO. In August 2011 a new CEO, Winfield Brown, was hired and the contract with Leaders for Today was terminated. F990_P06_S0B_L11b Form 990, Part VI, Section B, Line 11b The Accountant at Heywood Hospital prepares the form 990 and provides it to the controller for review. The form is then sent to the CFO for final review. Once approved and signed, copies are provided to the governing body at their monthly meeting. The 990 is then approved for final submission by the accounting department. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c Annually, a Conflict of Interest form is sent out to the managers, trustees and employees with broad discretionary authority. These forms are required to be signed and are monitored by the VP of Professional Services for completion. F990_P06_S0B_L15 Form 990, Part VI, Section B, Line 15 The new CEO's salary was determined by the market data provided to the search committee by our search firm, an independent third party named Philips DiPisa. This data supplemented the first hand knowledge of other comparable facilities in New England that the search firm had based on prior searches. The search committee and the Board of Trustees had in-depth discussions and conversations surrounding this issue. The final vote on what the base compensation would be (predicated on input from Philips DiPisa) in addition to the possibility of a bona fide incentive compensation program was determined by the Board. The new officers salary were determined by existing data for comparable positions. Sources as the Massachusetts Hospital Salary Survey and intimate knowledge of the going salaries for senior executives in healthcare also played a major role in the determination of these salaries. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 The organization makes the governing documents, conflict of interest policy and financial statements available to the public by providing completed copies to the Executive Assistant, who provides copies upon request. F990_P11_S00_L05 Form 990, Part XI, Line 5 The amount that makes up the changes in net assets or fund balances is from gains and losses on investments, discounts on pledge receivables and transfers to Heywood Medical Group to help support the organization as they employ physicians that serve the hospital. Heywood Affiliated Medical Group 242 Green Street Gardner MA 01440 043163589 employ physicians MA 501(c)(3) 9 N/A 1 Heywood Hospital Realty Corporation 242 Green Street Gardner MA 01440 043327447 property holding company MA 501(c)(2) N/A 1 HHMH Aid Association 242 Green Street Gardner MA 01440 042198019 raise funds for the Hospital MA 501(c)(3) 9 N/A 0 Winchendon Health Foundation 87 Central Street Winchendon MA 01475 042113276 supporting organization MA 501(c)(3) 9 N/A 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 1 1 1 1 Heywood Hospital Realty Corporation r 198000 Cash Heywood Affiliated Medical Group p 387557 Actual cost Heywood Affiliated Medical Group q 2284000 Cash Heywood Affiliated Medical Group r 50000 Cash Heywood Affiliated Medical Group o 616768 Actual cost Heywood Hospital Realty Corporation p 207175 Actual cost On January 23, 2012 Heywood Hospital filed a form 8868 requesting an automatic 3 month extension of time, delaying the filing due date to May 15, 2012. An approval notice was submitted to Henry Heywood Memorial Hospital on February 27, 2012 accepting the May 15th deadline.