2011-07-15T10:05:32-05:00 2010-09-30 FEELEY & DRISCOLL PC 200 PORTLAND STREET BOSTON MA 02114 990 2009-10-01 912155626 UMASS MEMORIAL HEALTH CARE INC & AFFILIATES - GROUP RETURN UMAS 5088561104 328 shrewsbury street WORCESTER MA 01604 TODD A KEATING 5088561104 2011-06-24 1 Alan Garofalo 6177427788 2009 2016-02-24 21:20:13Z TODD A KEATING 328 SHREWSBURY STREET WORCESTER MA 01604 2807134786 1 1 3642 X WWW.UMASSMEMORIAL.ORG UMass Memorial Health Care is committed to improving the health of the people of Central New England through excellence in clinical care, service, teaching and research. 212 151 16399 1137 41179847 0 12756094 15161118 2342685177 2521334903 -4226714 8545452 44489331 49436143 2395703888 2594477616 2090000 2060000 0 1082724336 1173766137 2068001 2082186 2841812 1231518264 1350886524 2318400601 2528794847 77303287 65682769 1773540294 1964348828 1182071877 1317539288 591468417 646809540 UMASS MEMORIAL HEATLH CARE IS COMMITTED TO IMPROVING THE HEALTH OF THE PEOPLE OF CENTRAL NEW ENGLAND THROUGH EXCELLENCE IN CLINICAL CARE, SERVICE, TEACHING AND RESEARCH. 0 0 1096338433 2000000 1339602147 UMass Memorial Medical CenterUMass Memorial Medical Center is committed to improving the health of the people of central New England through excellence in clinical care, service, teaching and research. UMass Memorial Medical center does this by providing inpatient and outpatient health care services to the residents of central New England without regard to their ability to pay.FY2010 key statistics - total discharges: 42,112 TOTAL SURGICAL CASES: 31,074 TOTAL ER VISITS: 137,795 291532592 342362734 UMass Memorial Community Hospitals The UMass Memorial community hospitals (Clinton Hospital, Health Alliance Hospitals Inc., Marlborough Hospital, Wing Memorial Hospital and Medical Centers) are committed to improving the health of the people of the communities that they serve through excellence in clinical care and service. Each of these hospitals accomplishes this goal by providing inpatient and outpatient health care services to the residents of their communities without regard to their ability to pay.FY2010 key statistics - total discharges: 16,969 TOTAL SURGICAL CASES: 10,030 TOTAL ER VISITS: 125,134 396196021 420196420 UMass Memorial Medical GroupThe UMass Memorial Medical Group is a multispecialty group practice of physicians whose mission and purpose is to support the clinical, educational, research and community service missions of UMass Memorial Health Care and UMass Memorial Medical Center. UMass Memorial Medical Group accomplishes this mission by providing medical care to residents of central New England without regard to their ability to pay. 351195865 60000 419173602 Other UMass Memorial Entities - UMass Memorial has a number of subsidiary entities that function primarily to deliver health care to patients or to support the delivery of health care to patients of UMass Memorial. They accomplish this through the delivery of health care services without regard to the patient's ability to pay. They also accomplish this by providing support, oversight, administrative services or patient advocacy services to the patients of UMass Memorial, central New England, and other geographies. 351195865 60000 419173602 2135262911 1 1 0 1 0 0 0 0 1 1 0 1 0 0 0 0 0 1 1 0 1 1 1 1 1 0 0 0 0 0 1 0 1 1 1 1 0 0 0 0 1 1 1 0 1 1735 0 16399 1 1 1 1 CJ 0 0 0 0 0 0 0 212 151 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 0 MA X robert feldmann 5088561104 328 shrewsbury street worcester MA 01604 Aronson Michael P MD 25.00 X 129731 0 30159 Arous Elias J MD 32.00 X 630856 0 34826 Ayers David MD 33.00 X 526626 0 37367 Bagley Peter H MD 27.00 X 332649 0 119364 Brown Alan P MD 29.00 X 164378 0 29974 Cavagnaro Charles III MD 40.00 X X 387139 0 150062 Cheshire Bryan MD 36.00 X 232239 0 32613 Cirillo Bettyann MD 40.00 X 241623 0 25879 Cofone Michael J 40.00 X X 235227 0 17755 Corbett William MD 40.00 X 381845 0 64486 Daly Sheila 40.00 X X 260385 0 110228 Felice Marianne E MD 22.00 X 221148 0 45144 Ferrucci Joseph MD 24.00 X 390092 0 36644 Gundersen Jason MD 40.00 X 394407 0 33169 Kaur Shubjeet MD 27.00 X 286752 0 37279 Keating Todd A 40.00 X X 636000 0 212229 Lapidas Gary N 40.00 X X 495080 0 176304 Lindholm Mary S MD 36.00 X 134311 0 27633 Maguire David L MD 40.00 X 198203 0 9278 Manning Gordon MD 40.00 X 199984 0 74726 Muldoon Patrick L 40.00 X X 477668 0 161547 O'Brien John G 40.00 X X 1211974 0 374497 Okike O Nsidinanya MD 40.00 X 362235 0 55291 Pappas Arthur MD 16.00 X 207898 0 36563 Polanowicz John 40.00 X X 356989 0 129521 Power Diane MD 40.00 X 249727 0 27612 Slayton Val MD 40.00 X 269908 0 23988 Swenson Dana 40.00 X 307868 0 100316 Tosi Stephen E MD 40.00 X 862461 0 192539 Umanzor Rene M MD 32.00 X 232765 0 31818 Volturo Gregory MD 24.00 X 345648 0 37380 Wesolowski Paul 40.00 X 160532 0 14784 Ziedonis Douglas MD 20.00 X X 222494 0 36612 Allen Gail 1.00 X 0 0 0 Anderson Elaine 1.00 X 0 0 0 Antonioni Robert 1.00 X 0 0 0 Babineau Robert Jr MD 1.00 X 0 0 0 Bennett David L 1.00 X 0 0 0 Bennett Richard K 1.00 X 0 0 0 Bergeron Arthur 1.00 X 0 0 0 Berkey Dennis D 1.00 X 0 0 0 Berry Sarah G 1.00 X 0 0 0 Boudreau Norman 1.00 X 0 0 0 Bovenzi Leslie 1.00 X 0 0 0 Budd John H 1.00 X 0 0 0 Carlson Mary 1.00 X 0 0 0 Carlucci Daniel MD 1.00 X 0 0 0 Carroll Brian K 1.00 X 0 0 0 Catalina Fernando MD 1.00 X 0 0 0 Cherubini Paul 1.00 X 0 0 0 Christensen Ronald 1.00 X 0 0 0 Clementi John 1.00 X 0 0 0 Collins Michael MD 1.00 X 0 0 0 Coolidge Katherine 1.00 X 0 0 0 Cornell Lois D 1.00 X 0 0 0 Crocker Frederick G 1.00 X 0 0 0 D'Alelio Edward 1.00 X 0 0 0 Davis Dix F 1.00 X 0 0 0 Delrosario Gene MD 1.00 X 0 0 0 Dennehy Raymond III 1.00 X 0 0 0 Desrochers Roland 1.00 X 0 0 0 DiGeronimo Arthur P Jr 1.00 X 0 0 0 DiTullio Daniel 1.00 X 0 0 0 D'Onfro Paul 1.00 X 0 0 0 Ferris Cornelius A 1.00 X 0 0 0 Fitch Roger 1.00 X 0 0 0 Flotte Terence MD 1.00 X 0 0 0 Giblin David R 1.00 X 0 0 0 Gray Jennifer 1.00 X 0 0 0 Greenberg Barbara 1.00 X 0 0 0 Gregorius Patrick 1.00 X 0 0 0 Haley Kevin 1.00 X 0 0 0 Haveles Robert 1.00 X 0 0 0 Henebry Clark 1.00 X 0 0 0 Hewitt Frank 1.00 X 0 0 0 Hollister Matt 1.00 X 0 0 0 Howard John 1.00 X 0 0 0 Jacobson M Howard 1.00 X 0 0 0 Jefferson Philip W Jr 1.00 X 0 0 0 Johnson Joanne 1.00 X 0 0 0 Katsounakis Thea 1.00 X 0 0 0 Kelleher William D Jr 1.00 X 0 0 0 Lenhardt Stephen W Sr 1.00 X 0 0 0 Lyons Cynthia 1.00 X 0 0 0 MacNeill Harris L 1.00 X 0 0 0 Manzi Edward 1.00 X 0 0 0 McGrail William Esquire 1.00 X 0 0 0 McMullen Cynthia M EdD 1.00 X 0 0 0 McNamara Mary Ellen 1.00 X 0 0 0 Mendoza Steven 1.00 X 0 0 0 Mercadante Anthony J 1.00 X 0 0 0 Mitchell Linda 1.00 X 0 0 0 Molloy Ann K 1.00 X 0 0 0 Morrilly Darlene 1.00 X 0 0 0 Murphy Michael D 1.00 X 0 0 0 Noonan Edward J 1.00 X 0 0 0 O'Leary Daniel MD 1.00 X 0 0 0 Paen Genaro 1.00 X 0 0 0 Parry Edward J III 1.00 X 0 0 0 Paulino Jeanne 1.00 X 0 0 0 Pederson Thoru 1.00 X 0 0 0 Perez Judge Luis 1.00 X 0 0 0 Phaneuf James 1.00 X 0 0 0 Purcell Philip E 1.00 X 0 0 0 Raher Marina 1.00 X 0 0 0 Richer Gerald P 1.00 X 0 0 0 Rivard Michael 1.00 X 0 0 0 Scully Paul 1.00 X 0 0 0 Seymour-Route Paulette PhD 1.00 X 0 0 0 Shea James P 1.00 X 0 0 0 Shea John Esquire 1.00 X 0 0 0 Simmons Irina 1.00 X 0 0 0 St Amand James 1.00 X 0 0 0 Starr Stanley B Jr 1.00 X 0 0 0 Stecyk Markian MD 1.00 X 0 0 0 Sullivan William F Sr 1.00 X 0 0 0 Taylor Harvey MD 1.00 X 0 0 0 Turley Patrick 1.00 X 0 0 0 Whitney Mary 1.00 X 0 0 0 Young James 1.00 X 0 0 0 Young Lynda M 1.00 X 0 0 0 Allicon Keary T 40.00 X 159786 0 39897 Bergan Thomas 40.00 X 307950 0 154130 Brown Douglas S 40.00 X 506328 0 126174 D'Ambra Ann-Maria 40.00 X 46496 0 8730 Dickson Eric MD 40.00 X 309469 0 51616 Dion Jeffrey 40.00 X 184597 0 50944 Ekstrom Deborah 40.00 X 240605 0 107653 Feldmann Robert 40.00 X 339498 0 137439 Fraker Muriel E Esquire 40.00 X 173936 0 84942 Lasser Daniel H MD 20.00 X 319763 0 122155 McCue Steven 40.00 X 155164 0 28260 Miller Lauren B 40.00 X 78945 0 11184 Morabito Nancy E 40.00 X 57773 0 1342 Morin Lynn A 40.00 X 70096 0 4177 O'Brien William H 40.00 X 113432 0 55346 Smith Francis W 40.00 X 182712 0 46932 Streeter Michele M 40.00 X 377190 0 114007 Brenckle George PhD 40.00 X 401364 0 124991 Chandler Willis 40.00 X 271916 0 57173 Diamond Victoria 40.00 X 358779 0 113878 Ettinger Walter H MD 40.00 X 994803 0 277214 Fisher Barbara 40.00 X 306619 0 86205 Hylka Sharon 40.00 X 407946 0 283101 Klugman Robert MD 40.00 X 524606 0 243818 Kruger Nancy 40.00 X 385934 0 122266 Phillips Robert A 40.00 X 947278 0 226314 Randolph John T 40.00 X 256522 0 134076 Webb Patricia 40.00 X 425485 0 113510 Sussman Andrew J 40.00 X 350352 0 98433 blute michael 40.00 X 0 0 0 daley jennifer 40.00 X 0 0 0 Maykel Justin MD 30.00 X 595076 0 33691 Busconi Brian D MD 33.00 X 554451 0 34826 Hussain Sarwat MD 31.00 X 499768 0 37380 Lapinsky Anthony MD 28.00 X 483936 0 34769 Tam Stanley MD 30.00 X 483185 0 36643 23618602 0 5730803 2089 0 1 1 ACS CORPORATE HEADQUARTERS 2828 NORTH HASKELL DALLAS TX 75204 I/S MANAGEMENT SERVICES 20735606 ARUP INC PO BOX 27964 SALT LAKE CITY UT 84127 Lab Services 5738001 CONSIGLI CONSTRUCTION 72 SUMMER STREET MILFORD MA 01757 SEE Schedule O - Footnote A 5509553 MORRISON MANAGEMENT SPECIALISTS PO BOX 102289 ATLANTA GA 303682289 FOOD Management SERVICES 4831778 STANDARD BUILDERS 52 HOLMES RD NEWINGTON CT 061111708 SEE Schedule O - Footnote A 4717849 125 670459 841338 6659402 6989919 191877 15161118 NET PATIENT SERVICE RE 900099 1931044790 1931044790 special MEDICAID PAYME 900099 214375042 214375042 affiliate related prog 900099 151643169 151643169 system allocaTION REVE 900099 135855509 135855509 fees & CONTRACTS FROM 900099 18045229 18045229 70371164 69056049 1315115 2521334903 12791642 -15463 12807105 66222 66222 2318551 1260887 1057664 1057664 1057664 206721592 210776680 191102 -4055088 -191102 -4246190 -4246190 412934 670459 428501 -15567 -15567 lab outreach program & 621500 41287222 91912 41195310 1500 MD BILLING 900099 2501151 2501151 sublease income 900099 1586751 1586751 2952700 2170329 782371 48327824 2594477616 2522282029 41179847 15854622 2000000 2000000 60000 60000 26751875 11787909 14963966 895086595 769810628 124968096 307871 63921304 54955554 8959965 5785 125700942 105238100 20436802 26040 62305421 53173995 9116456 14970 483488 483488 1954707 23368 1931339 1165488 1165488 1734397 1734397 2082186 2082186 779404 779404 132534719 120569811 11839774 125134 2394300 1911575 407555 75170 40973452 28696599 12220645 56208 34770596 34105307 665067 222 69953775 58381076 11558461 14238 4168156 4012870 150792 4494 1847091 1521881 284224 40986 21570739 20413984 1156755 88974905 69228125 19739883 6897 55850694 53447155 2402351 1188 PURCHASED SERVICES 260122988 218745379 41370912 6697 medical supplies 214419393 179162966 35256427 medical education servi 167341702 167341702 system overhead activit 154212484 90250681 63960157 1646 BAD DEBTS 62837649 62837649 32796397 25852200 6872117 72080 2528794847 2135262911 390690124 2841812 207143565 131106074 70715287 101239034 3645791 3487300 234039357 248778348 5137541 4888284 29935458 22721737 20960383 21961266 18622296 24952745 1501640794 839165095 631516182 662475699 343377848 381254136 110674015 122472718 10931195 12020740 123146 657706 86718230 226333041 1773540294 1964348828 245416378 263376871 3522571 4075556 400460021 395209096 57303137 46412288 29865535 22615340 445504235 585850137 1182071877 1317539288 X 453883291 500785067 62719705 69497127 74865421 76527346 591468417 646809540 1773540294 1964348828 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 848985 0 1 885412 0 1734397 0 98561352 1245442 5785214 1574250 104017758 97341571 172660 510787 -536334 98561352 0.74000 0.26000 1 0 7393075 7393075 782005371 402403890 379601481 33459456 17142415 16317041 624482433 413514304 210968129 54300459 6104486 48195973 662475699 tiff absolute return pool (6,289 SHARES) 21446907 F tiff private equity partners 2006 (1,971,570 SHARES) 1971570 F frank russell global private equity fund (1,072,676 SHARES) 1072676 F gmo multi-strategy fund (offshore) lp (11,042,014 SHARES) 11042014 F beneficial interest in trusts 61526677 F AETOS CAPITAL LONG/SHORT STRATEGIES (73,397 SHARES) 6366441 F AETOS CAPITAL DISTRESSED INV STRATEGIES (26,690 SHARES) 3101954 F AETOS CAPITAL MULTI-STRATEGY ARBITRAGE (20,017 SHARES) 2778461 F AETOS CAPITAL OPPORTUNITIES (13,345 SHARES) 1259230 F MPPLTD/KENSICO MARCH 2009 (14,651 SHARES) 1587510 F MPPLTD MARCH 2009 SEGREGATED (7,272 SHARES) 650553 F tiff absolute return pool class c (3,870 SHARES) 6144617 F met west enhanced talf strategy fund (3,524,108 shares) 3524108 F 122472718 due from related parties 46951553 CSV LIFE INSURANCE 631420 MALPRACTICE TAIL COVERAGE 24822618 DUE FROM CLINTON HOSPITAL FOUNDATION 162084 LONG TERM SECURITY DEPOSITS 207722 DUE FROM UMASS MEDICAL SCHOOL 213083 bond issue costs 63206 receivable from medicaid 152480139 other non-current assets 41216 receivable from joint venture 760000 226333041 DUE TO UMASS MEDICAL SCHOOL 126979271 THIRD PARTY LIABILITIES 55107471 DUE TO RELATED PARTIES 50120633 Accrued Pension POST RETIREMENT BENEFITS 284536494 O/S LOSS RESERVES 27610529 ESTIMATED MALPRACTICE COSTS 24822618 OTHER 1125691 ANNUITY PAYABLE 1200712 LT LIABILITY ARO 10675715 accrued lt liabilities 3671003 585850137 2594477616 2528794847 65682769 20640581 -30982227 -10341646 55341123 Part V, Line 4: Description of Intended Use of Endowment Funds: Part V Endowment Funds Question 4: The Intended use of the organization's endowment funds are directed in accordance with the donor's intent including the perservation of the original gift and various purposes including charity care, medical education, research, health care services, buildings and equipment. Part V Endowment Funds Line 3a(i): Bank of America, an unrelated org., holds 3 trust funds for Wing Memorial Hospital. Part XI, Line 8 - Other Adjustments: NET ASSETS RELEASED FROM RESTRICTIONS: 6671010. pension related changes other than net periodic benefit cost: -36642308. OTHER CHANGES IN NET ASSETS: -1010929. FIN 48 FOOTNOTE: Income Taxes - The System follows a two-step approach for the financial statement recognition and measurement of a tax position taken or expected to be taken on a tax return. The substantial majority of UMass Memorial and its affiliate entities are recognized by the Internal Revenue Service as tax-exempt under Section 501 (c) (3) of the Internal Revenue Code. Accordingly, these entities will not incur any liability for federal income taxes except for tax on unrelated business income. Certain affiliates are taxable entities. The measurement of the amounts recorded as a provision for income taxes based upon the aforementioned approach is not material and is recorded as supplies and other expense in the accompanying consolidated statement of operations. The System does not believe it has any significant uncertain tax positions. X X X X X 0 umass memorial foundation inc fundraising 1 4379942 2082186 2297756 4379942 2082186 2297756 MA NH HOSP. GOLF TOURNEY 364394 182483 181911 44957 113998 13232 winter ball 224513 159121 65392 65392 7 489520 323889 165631 465 15693 37621 12928 124215 1078427 665493 412934 465 60650 151619 12928 202839 428501 -15567 1 1 X 1 X 1 X 500.000000000000 1 1 1 0 1 1 56951102 21294106 35656996 0.02180 259938380 243421194 16517186 0.01010 34001574 33853352 148222 0.00010 350891056 298568652 52322404 0.03200 6869699 5419179 1450520 0.00090 188860464 132248183 56612281 0.03460 73236830 67355414 5881416 0.00360 0 0 4647166 553508 4093658 0.00250 273614159 205576284 68037875 0.04160 624505215 504144936 120360279 0.07360 0 0 0 0 0 0 0 0 6 1504 34244 0 34244 0.00000 1 0 15410 0 15410 0.00000 1 24 11660 0 11660 0.00000 1 6 36424 0 36424 0.00000 2 18 12227 0 12227 0.00000 7 185 396440 0 396440 0.00020 0 0 0 0 18 1737 506405 506405 0.00020 1 8349963 2094245 358519464 382221681 -23702217 X 1 1 Commonwealth Professional Assurance Company Ltd Provides insurance 1.00000 0.00000 0.00000 UMass Memorial Investment Partnership LLP Manages pooled investments 1.00000 0.00000 0.00000 UMass Memorial Health Alliance MRI Center LLC Magnetic resonance imaging center 0.60000 0.00000 0.00000 UMass Memorial MRI of Marlborough LLC Magnetic resonance imaging center 0.56000 0.00000 0.00000 Memorial Office Condominium Trust Condo association that owns medical office building 0.53690 0.00000 0.00000 UMass Memorial MRI & Imaging Center LLC Magnetic resonance imaging center 0.50000 0.00000 0.00000 New England Rehabilitation Services of Central Massachusetts Inc Acute care rehabilitation facility 0.50000 0.00000 0.00000 Bio Labs Inc Clinical laboratory 1.00000 0.00000 0.00000 HealthAlliance with Physicians Inc Physician alliance 0.50000 0.00000 0.00000 Shields Imaging of Massachusetts LLC Management company for PET imaging 0.25000 0.00000 0.00000 UMass Memorial Medical Center Inc

55 Lake Ave Worcester MA 01605

X X X X X X UMass Memorial Medical Center - Memorial

119 Belmont Street Worcester MA 01605

X X X X X X UMass Memorial Medical Center - Hahneman

281 Lincoln Street Worcester MA 01605

X Satellite - outpatient services Tri-River Family Health

281 E Hartford Ave uxbridge MA 01569

X Satellite - health center Simonds-Sinon Regional Cancer Center

275 Nichols Road fitchburg MA 01420

X Satellite - cancer center Regional Family Health Center - Barre

151 Worcester Road barre MA 01005

X Satellite - health center UMass Memorial Rehab Group

15 Belmont Street Worcester MA 01605

X Satellite - rehab clinic Anticoagulation Clinic Lincoln Square Pa

15 Belmont Street Worcester MA 01605

X Satellite - outpatient anticoagulation clinic Hahnemann Family Health Center

279 Lincoln Street Worcester MA 01609

X Satellite - health center 3 PTC

305 Belmont Street Worcester MA 01604

X Satellite - outpatient psychiatric treatment center Westboro Radiology

154 East Main Street westboro MA 01581

X Satellite - health center Shrewsbury Radiology

26 Julio Drive shrewsbury MA 01545

X Satellite - health center Psychiatric Outpatient Services

361 Plantation Street Worcester MA 01605

X Satellite - outpatient psychiatric treatment center Molecular Diagnostics Laboratory

222 Maple Avenue shrewsbury MA 01545

X Satellite - diagnostics lab Plumley Village

116 Belmont Street Worcester MA 01608

X Satellite - outpatient physician clinic UMass Memorial Hospice

650 Lincoln Street Worcester MA 01605

X Satellite - hospice services UMass Memorial Endoscopy Center

21 Eastern Avenue Worcester MA 01605

X Satellite - outpatient endoscopy services Ronald McDonald Mobile Care Van

55 Lake Avenue Worcester MA 01655

X Satellite - roaming outpatient physician clinic UMass Memorial Home Health

650 Lincoln Street Worcester MA 01605

X Satellite - home health services HealthAlliance Hospital Inc

60 Hospital Road leominster MA 01453

X X X X HealthAlliance Hospital Inc

326 Nichols Road fitchburg MA 01420

X Outpatient cancer treatment center, Inpatient mental health HealthAlliance Home Health and Hospice

25 Tucker Road leominster MA 01453

X Visiting nurse association PT Plus Whitney Fields

21 Cinema Blvd leominster MA 01453

X Outpatient physical therapy center PT Plus Orchard Hills

100 Duval Road lancaster MA 01523

X Outpatient physical therapy center Marlborough Hospital

157 Union Street marlborough MA 01752

X X X X Joint venture in on-site MRI facility Marlborough Hospital Rehabilitation Serv

340 Maple Street marlborough MA 01752

X Rehab Clinic Clinton Hospital Association

201 Highland Street clinton MA 01510

X X X None Wing Memorial Hospital Corporation

40 Wright Street palmer MA 01069

X X X Belchertown Medical Center

20 Daniel Shays Highway belchertown MA 01007

X Satellite - health center Ludlow Medical Center

34 Hubbard Street ludlow MA 01056

X Satellite - health center Monson Medical Center

2 Main Street monson MA 01057

X Satellite - health center Wilbraham Medical Center

2344 Boston Road wilbraham MA 01095

X Satellite - health center VNA

42 Wright Street palmer MA 01069

X Home Health and Hospice UMass Memorial Laboratories

Biotech One 365 plantation street Worcester MA 01605

X Satellite - lab services Milford Ambulatory Care Center

91 water street milford MA 01757

X satellite - outpatient & radiology UMass Memorial Ambulatory Care Center

55 Lake Ave north worcester MA 01605

X satellite - outpatient & radiology Marlborough Hospital

28 newton street southborough MA 01772

X outpatient women's imaging & endoscopy, medworks Part I, Line 6a: Part I, Line 7: The Eclipsys cost accounting data was applied for the patient care that sustained a loss. Care is billed at a procedure (charge code) level and this is applied to the patient utilization. This data includes all patient segments of care. Exclusions were applied as directed in the Schedule. The cost to charge was achieved by taking the expenses (excluding bad debt) and applying them against the gross charges. A cost charge ratio was applied to the patient care that was not billed to Health Safety Net (HSN), i.e. Ambulance services, Mobile van patient care, and primary care where the patient did not fully complete the free care application. Part I, Line 7g: The organization reviewed programs that were provided but which incurred a financial loss. The loss is obtained after reducing the charges to cost, less the payments. These losses are not included in Part I or as bad debt in Part III. Medicaid, Self-pay and free care cases and visits were removed from the total per the instructions. The services provided have been identified as a community need and if the organization no longer offered the service, the service would be unavailable. The services recognized are: psychiatry, family and community medicine and nephrology, Barre primary care, pediatric primary care, and maternity services provided for deliveries and normal newborns. The data represents the UMass Memorial Medical Center and the member hospitals, Clinton, Marlborough, HealthAlliance and Wing Memorial. Part I, Line 7f: Bad Debt expense included on Form 990, Part IX, line 5, column (A) which was subtracted for purposes of calculating the percentage amounts to $41,192,302. Part III, Line 4: Costing methodology - multiplied the gross patient service revenue by the ratio of costs to charges calculated as reported in hospitals DHCFP 403 Hospital Statement of Costs, Revenues and Statistics. The organization's audited financial statements do not include a footnote pertaining to bad debt expense, accounts receivable, or the alllowance for doubtful accounts. Amounts recorded as bad debt expense and the allowance for doubtful accounts are presented directly on the consolidated statement of operations and consolidated balance sheets respectively. Part III, Line 8: The Medicare shortfall is the subsidized amount of care provided to patients and is considered a community benefit. This shortfall includes low reimbursement for capital due to timing differences as major investments are made, programs related to emergency and other ambulatory programs. Part III, Line 9b: Exemption From Self-Pay Billing and Collection Action - The Organization will not initiate Self-Pay billing and collection activity:a. Upon sufficient proof that a patient is a recipient of Emergency Aid to the Elderly, Disabled and Children (EAEDC), or enrolled in the Health Safety Net (HSNO) or MassHealth, Healthy Start, or the Children's Medical Security Plan whose family income is equal or less than 400% of the FPL, with the exception of co-pays and deductibles required under the Program of Assistance.b. If the Hospital has placed the account in legal or administrative hold status and/or specific payment arrangements have been made with the patient or guarantor.c. For Medical Hardship bills that exceed the medical hardship contribution.d. Unless UMMMC has checked the EVS system to determine if the patient has filed an application for MassHealth.e. For Partial Health Safety Net eligible patients, with the exception of any deductibles required.Note: The Organization may bill for Health Safety Net eligible and Medical Hardship patients for non-medically necessary services provided at the request of the patient and for which the patient has agreed by written consent. Part I, Line 7b - Under the Medicaid State Plan, UMMHC is one of two hospital systems in the state that qualify as Essential MassHealth Hospitals, which permits the state to pay it supplemental payments in addition to UMMHC's standard Medicaid payment. The standard Medicaid payment reimburses UMMHC approximately 65% of the cost of providing services to MassHealth patients. Medicaid supplemental funds provide additional revenue to the UMMHC health care system in recognition and support of UMMHC's special relationship and obligations to the state's only public medical school to further its public mission as well as its commitment to its community as the regions only safety net hospital. These supplemental payments are made pursuant to a specific provision on the Medicaid State Plan.Part V - List number of each type of facility, other than those licensed, registered, etc - Medical Center - 14 Administrative Space; 2 Ambulance Services Wing Memorial - 2 Administrative Space HealthAlliance Hospital - 10 Physician Offices; 10 Administrative Space Part VI, Line 2: Each of our hospitals has a designated Community Benefits program that has joined efforts with their respective community and taken into account input from community experts/stakeholders in the development of their Community Needs Assessment. In addition, each hospital has a community-based Community Benefits Advisory Committee that provides guidance on their community benefits activities. The following strategies are utilized by the hospitals to conduct the assessment: - Conducting interviews and focus groups with community-based organizations and residents- Conducting outreach efforts to medically underserved populations and convening meetings with neighborhood/community groups - Reviewing primary and secondary data - Organizing community forums to share findings and release of final report- Organizing task forces for further actionThe following sources inform and enhance our efforts to identify priorities and unmet needs:- Central Massachusetts Oral Health Report- Healthy People 2010 and 2020- Massachusetts Department of Education Reports including local enrollment and language data- Massachusetts Department of Employment and Training- Outpatient surveys and hospital utilization data- Massachusetts Department of Public Health/Mass CHIP- Cities and towns data from various departments including, but not limited, to the local Department of Public Health, Neighborhood Services, Police- Information collected from health care providers, community groups/underserved populations and individuals who have expertise on community health issues UMass Memorial Medical Center UMass Memorial Medical Center has assembled a diverse team that is in the process of updating the community needs assessment. The last community health needs assessment, The Worcester Indicators Report, was announced to the public in the presence of 100+ community leaders in 2008 and was the final product of a collaborative effort and an extensive community engagement process that had UMass Memorial leadership staff working closely with Common Pathways CHNA 8, a citywide Healthy Communities Initiative.Clinton HospitalIn 2011, Clinton Hospital completed their community needs assessment, the Community Needs Assessment of Central Massachusetts. The hospital worked with the following organizations to complete the assessment: Community Health Network of North Central Massachusetts (CHNA 9), The Joint Coalition on Health of North Central Massachusetts and the Minority Coalition of North Central Massachusetts. HealthAlliance Hospital In 2011, HealthAlliance completed their community needs assessment, the Community Needs Assessment of Central Massachusetts. The hospital worked with the following organizations to complete the assessment: Community Health Network of North Central Massachusetts (CHNA 9), The Joint Coalition on Health of North Central Massachusetts and the Minority Coalition of North Central Massachusetts. Marlborough Hospital Marlboro Hospital completed its most recent needs assessment in FY 2010 with input from a wide array of community stakeholders and is updating its plan. Wing Memorial HospitalWing Memorial completed its community needs assessment in FY 2010 with input from a wide array of community stakeholders and is working with its Community Benefits Advisory Committee in updating its plan. Part VI, Line 3: Patient Ed of eligibility for assistance - UMass Memorial informs and educates patients/others about eligibility for available coverage and/or charity care by employing a large (25+) staff of Financial Counselors, expert in matching patients to available coverage and charity care options and assisting patients through the application process. Further, UMass Memorial works to connect potentially eligible patients to our Financial Counselors through- widely distributed brochures- signs posted in high traffic patient areas- education of our clinicians- attendance at numerous community outreach events- referral of all self-pay patients at the point of outpatient scheduling/registration- visits to inpatients without health insurance or with coverage gaps- billboards posted in the community- messages on all patient bills and statements- mailings to patients- convenient Financial Counselor locations within or contiguous to Clinical areas. Part VI, Line 4: Geographical Reach - UMass Memorial Health Care serves approximately one million residents of Central New England. Our Central Massachusetts service area includes all sixty cities and towns in Worcester County from the New Hampshire border in the north to the Connecticut and Rhode Island borders in the south. It extends to the west into seven towns in Hampden County and three towns in Hampshire County, and includes ten towns in Middlesex County to the north and east. Regional Description - The Central New England region is a mix of cities and urbanized centers, suburbs, small towns, and rural areas with some agriculture. Seven towns in our service area are defined by the U.S Department of Health, Health Resources and Services Administration (HRSA) as rural based on their Rural Urban Commuting Area (RUCA) codes. HRSA has designated the City of Worcester a health professional shortage area (HPSA) in primary care, mental health, and dental services due to its low income population. Several towns and cities in the north county are designated by HRSA as HPSAs and as having medically underserved populations (MUPs), another designation indicating need because their residents face economic, linguistic and cultural barriers to care. The City of Worcester has several neighborhoods with a shortage of health providers and HRSA has determined that many census tracts in the city are medically underserved areas (MUAs). Economic Characteristics - Income levels vary widely across the region. The census data for 2006-2008 indicated the median household income for Worcester County was $64,471; for the City of Worcester, the largest urban area, it was considerably less at $44,794. Overall, 9 percent of Worcester County residents are below the poverty level, but that rate doubles to 18 percent in the urban cities of Worcester and Fitchburg, and in these communities, one of every four children lives in poverty. For example, the Worcester Public Schools system reports that in the 2010 school year, 71 percent of their students are eligible for free or reduced lunch. The December 2009 unemployment rate for the county was 9.8 percent, slightly above the state and national average. Many cities and towns in our region have unemployment rates between 11 and 13 percent. Central Massachusetts has been hard-hit by the foreclosure crisis over the past two years, with little improvement to date. In a report released in January 2010, Worcester County led the state in the number of new foreclosure filings, with most of that volume in the City of Worcester. Demographic and Health Factors - The demographics of the region vary by location, with minorities and foreign born residents concentrated in the cities. Ten percent of people living in Worcester County are foreign born, 89 percent are White, 3 percent are Black or African American, 4 percent are Asian; 8 percent are Hispanic (any race). In the City of Worcester, 20 percent are foreign born, 79 percent are White, 9 percent are Black or African American; 19 percent are Hispanic (any race). In recent years, this area has become home to a rapidly increasing number of immigrants from around the world, and in 2010 our hospital interpreter services provided well over 75,000 medical interpretation encounters. The federal government is also now settling hundreds of refugees a year in the Worcester area from Iraq, Burundi, Burma, and other African and Asian countries. Refugees are a vulnerable population with high health needs, and the Massachusetts Department of Public Heath reports that this settlement trend will continue in future years due to the lower cost of living in the Worcester area compared to other parts of the state. A new analysis of the nation's health status by county indicates that our service area has a larger health burden than other parts of Massachusetts. Worcester County ranks 10 out of 14 counties for mortality and morbidity and 11th for health behaviors.Chronic Disease OverviewWorcester County Chronic Disease and Obesity data shared at regional health forums hosted by the state Department of Public Health in 2007 revealed the following:- From 1995 to 2005, the rate of residents classified as overweight in Worcester County climbed from 45.7% to 57.5%- From 2003 to 2005 the heart disease mortality rate (deaths per 100,000) was the second highest in the state, at 196.8. The highest number was among White, non-Hispanic (198.3) followed by Black, non-Hispanic (186.2) and then Hispanic (152.2), a number strikingly higher than the state rate for this ethnicity (103.7). Asians had the lowest rate at 76.7, still a good deal higher than the state rate of 68.4.Worcester County has the highest diabetes mortality rate of any county in the state with 22.6 deaths per 100,000, compared to the Massachusetts rate of 18.4. The rate for Hispanics is strikingly high compared to other ethnicities in the region (49), while Black, non-Hispanic rate and Asian non-Hispanic rate are 37, White non-Hispanic rate is 22. The rate for White, non-Hispanic is still higher than the state rate of 17.Worcester County deaths due to all cancers age adjusted rates per 100,000 are higher than the state rate (181.5 compared to 178.9). Lung cancer deaths are 54 compared to the state rate of 50.8, and Breast Cancer rates are 23.1 compared to 20.1. Note on Teen Birth Rate: For several Worcester County communities, the teen birth rate climbed significantly between 2006 and 2007: In Leominster it rose from 30.3% to 36.7, a 21.1% increase; in Southbridge, there was an increase of 19.5% over the same period (64.5 to 77.1); and in Worcester it rose from 34.4 to 35.7, an increase of 3.8%.Key Health Observations in Central Massachusetts from Regional Health Forums in 2011- Racial and Ethnic disparities are major factors: - Latinos' and Blacks' health disparities across several indicators are a major concern- Overweight/obesity is an increasing health risk - contributes to rising diabetes incidence- The region's residents are disproportionately affected by: -Infant mortality rates for Blacks and Latinos (particularly in the city of Worcester) -Smoking rates -AIDS/HIV and Hepatitis C (particularly in the cities of Worcester, Fitchburg and Southbridge) -Heroin/Opiods related incidents/deaths (same cities as above) -Motor vehicle injuries Health Care Safety Net - UMass Memorial provides care to the largest number of low income patients in the region. Part VI, Line 5: UMass Memorial Health Care recognizes community building activities as being a part of those 'social determinants of health' that impact the health of the community. We invest in workforce development and leadership training programs that support youth who are at risk of developing risky health behaviors and experiencing violence due to poverty. We also invest in environmental and physical improvement programs such as beautification of low income neighborhood parks because children will have access to safe playgrounds, thus promoting physical activities and reducing obesity. These programs are based on our Community Benefits Mission which was recommended by a Community Benefits Advisory Committee and draws inspiration from the World Health Organization's broad definition of health, as 'a state of complete, physical, mental, and social well being and not merely the absence of disease.' By adopting this definition, UMass Memorial Health Care has expanded its strategy to include the social, economic, and political obstacles that prevent people from achieving optimal health. All of our community building activities are the result of an identified need and engage the community. They include collaborative efforts, advocacy activities and partnerships that engage a broad array of community stakeholders in addressing these unmet social determinants of health (community building activities). Part VI, Line 6: In addition to the many community benefit programs described in other sections, UMass Memorial serves as the region's only Level I trauma center and operates Life Flight helicopter service to transport the region's sickest patients to appropriate facilities. It has a majority of independent, community trustees on its boards, a medical staff that is open to all those who meet the eligibility requirements, and of course UMass Memorial meets all other requirements of the community benefit requirement adopted by the IRS in 1969, including having an ER open to all, participation in Medicare and Medicaid, and the use of all surplus funds to improve patient care, expand facilities and advance education and training. Finally, UMass Memorial prides itself on being a national leader with regard to community benefits and implementing innovative programs that focus on the full array of the social determinants of health for our communities. UMass Memorial makes this a priority at the highest levels of the organization, and has been one of the first hospital systems in the state to create a community benefits committee of the board to establish goals, measures and monitor progress of the program. Part VI, Line 7: UMass Memorial Health Care is the largest not-for-profit health care system in Central New England. Through the collective efforts of UMass Memorial Medical Center and four community hospitals - Clinton Hospital, HealthAlliance Hospital, Marlborough Hospital and Wing Memorial Hospital and Medical Centers, we are improving the health of the people of Central New England through excellence in clinical care, service, teaching and research. Our five hospitals work closely with their respective communities to identify and prioritize community needs. Our community benefits mission was developed and recommended by a Community Benefits Advisory Committee and approved by the Board of Trustees of the clinical system and has been adopted by all five hospitals. A standing Community Benefits Committee has been established at the Board of Trustee level to oversee the clinical system's responsibilities to the community and to strengthen our organizational commitment and accountability. Each hospital community benefits program focuses on the needs of underserved populations and support unmet health needs. In addition, each hospital has its own community benefits program and as such has developed strong linkages within their service area with community leaders and community based organizations that have resulted in partnerships and collaborative efforts that are addressing the health needs of their respective community. MA 1 edward m kennedy community health center inc 19 tacoma street worcester MA 01605 042513817 501 (c) (3) 1000000 SUPPORT FOR HEALTH CENTER'S MISSION family health center of worcester inc 26 queen street worcester MA 01610 042485308 501 (c) (3) 1000000 SUPPORT FOR HEALTH CENTER'S MISSION 2 0 scholarships 30 60000 Other Information: Part IV: Part I Line 2: Grants - At reasonable intervals, re-evaluation of the Grants will occur to ensure that the arrangements are expected to continue to satisfy the standard set forth. The Health Centers will document the re-evaluation contemporaneously. Part I Line 2: Scholarships - Prior to the distribution of any and all scholarship funds, HealthAlliance requires verification of program enrollment from all recipients. Part II Line 1(h): The standard set forth is a reasonable expectation that the Grants will contribute meaningfully to each of the Health Center's ability to maintain or increase the availability, or enhance the quality, of services provided to a medically underserved population serviced by the Health Centers. Each Health Center has documented the basis for said reasonable expectation. X 1 1 X X X X X X 1 1 0 0 0 0 0 0 0 Aronson Michael P MD 109384 0 17350 0 2997 0 6832 0 23327 0 159890 0 0 0 Arous Elias J MD 562524 0 65335 0 2997 0 12250 0 22576 0 665682 0 0 0 Ayers David MD 483629 0 40000 0 2997 0 12250 0 25117 0 563993 0 0 0 Bagley Peter H MD 289404 0 40248 0 2997 0 94234 0 25130 0 452013 0 0 0 Brown Alan P MD 149953 0 11428 0 2997 0 8448 0 21526 0 194352 0 0 0 Cavagnaro Charles III MD 297158 0 86231 0 3750 0 121536 0 28526 0 537201 0 0 0 Cheshire Bryan MD 196517 0 32725 0 2997 0 11762 0 20851 0 264852 0 0 0 Cirillo Bettyann MD 191381 0 15100 0 35142 0 4631 0 21248 0 267502 0 0 0 Cofone Michael J 234043 0 0 0 1184 0 2348 0 15407 0 252982 0 0 0 Corbett William MD 277332 0 90275 0 14238 0 45708 0 18778 0 446331 0 14238 0 Daly Sheila 194996 0 48933 0 16456 0 93104 0 17124 0 370613 0 8812 0 Felice Marianne E MD 187131 0 31020 0 2997 0 19568 0 25576 0 266292 0 0 0 Ferrucci Joseph MD 367095 0 20000 0 2997 0 12250 0 24394 0 426736 0 0 0 Gundersen Jason MD 252224 0 139186 0 2997 0 12250 0 20919 0 427576 0 0 0 Kaur Shubjeet MD 268755 0 15000 0 2997 0 12250 0 25029 0 324031 0 0 0 Keating Todd A 464171 0 140937 0 30892 0 198526 0 13703 0 848229 0 23248 0 Lapidas Gary N 359693 0 102441 0 32946 0 166420 0 9884 0 671384 0 25302 0 Lindholm Mary S MD 130261 0 1053 0 2997 0 6930 0 20703 0 161944 0 0 0 Maguire David L MD 163076 0 34723 0 404 0 7798 0 1480 0 207481 0 0 0 Manning Gordon MD 169515 0 27472 0 2997 0 51108 0 23618 0 274710 0 0 0 Muldoon Patrick L 382025 0 64150 0 31493 0 132056 0 29491 0 639215 0 23849 0 O'Brien John G 867954 0 296660 0 47360 0 355741 0 18756 0 1586471 0 0 0 Okike O Nsidinanya MD 362235 0 0 0 0 0 41511 0 13780 0 417526 0 0 0 Pappas Arthur MD 106873 0 0 0 101025 0 25200 0 11363 0 244461 0 0 0 Polanowicz John 269670 0 70441 0 16878 0 98593 0 30928 0 486510 0 9234 0 Power Diane MD 191094 0 19856 0 38777 0 4768 0 22844 0 277339 0 0 0 Slayton Val MD 268264 0 250 0 1394 0 4900 0 19088 0 293896 0 0 0 Swenson Dana 233071 0 74797 0 0 0 81008 0 19308 0 408184 0 0 0 Tosi Stephen E MD 498763 0 135669 0 228029 0 168788 0 23751 0 1055000 0 24025 0 Umanzor Rene M MD 124160 0 108544 0 61 0 9319 0 22499 0 264583 0 0 0 Volturo Gregory MD 241739 0 100912 0 2997 0 12250 0 25130 0 383028 0 0 0 Wesolowski Paul 160196 0 0 0 336 0 0 0 14784 0 175316 0 0 0 Ziedonis Douglas MD 184497 0 35000 0 2997 0 11482 0 25130 0 259106 0 0 0 Allicon Keary T 143770 0 16016 0 0 0 20421 0 19476 0 199683 0 0 0 Bergan Thomas 231923 0 66369 0 9658 0 143738 0 10392 0 462080 0 9658 0 Brown Douglas S 368987 0 111450 0 25891 0 105466 0 20708 0 632502 0 25891 0 Dickson Eric MD 263695 0 45000 0 774 0 32849 0 18767 0 361085 0 0 0 Dion Jeffrey 159772 0 24825 0 0 0 31822 0 19122 0 235541 0 0 0 Ekstrom Deborah 184334 0 38401 0 17870 0 84062 0 23591 0 348258 0 9624 0 Feldmann Robert 245725 0 76864 0 16909 0 117336 0 20103 0 476937 0 16909 0 Fraker Muriel E Esquire 163344 0 10592 0 0 0 57989 0 26953 0 258878 0 0 0 Lasser Daniel H MD 213863 0 102903 0 2997 0 98784 0 23371 0 441918 0 0 0 McCue Steven 140471 0 14693 0 0 0 10618 0 17642 0 183424 0 0 0 O'Brien William H 110435 0 0 0 2997 0 33050 0 22296 0 168778 0 0 0 Smith Francis W 172501 0 10211 0 0 0 28154 0 18778 0 229644 0 0 0 Streeter Michele M 280249 0 87020 0 9921 0 95216 0 18791 0 491197 0 9921 0 Brenckle George PhD 295817 0 93714 0 11833 0 97949 0 27042 0 526355 0 11833 0 Chandler Willis 216492 0 55424 0 0 0 38395 0 18778 0 329089 0 0 0 Diamond Victoria 258301 0 83796 0 16682 0 87772 0 26106 0 472657 0 16682 0 Ettinger Walter H MD 694618 0 243907 0 56278 0 257700 0 19514 0 1272017 0 37286 0 Fisher Barbara 235917 0 60488 0 10214 0 67162 0 19043 0 392824 0 10214 0 Hylka Sharon 293622 0 87543 0 26781 0 261032 0 22069 0 691047 0 19137 0 Klugman Robert MD 388076 0 117462 0 19068 0 221869 0 21949 0 768424 0 15462 0 Kruger Nancy 292197 0 83555 0 10182 0 110222 0 12044 0 508200 0 10182 0 Phillips Robert A 593899 0 305135 0 48244 0 199940 0 26374 0 1173592 0 48244 0 Randolph John T 196052 0 60470 0 0 0 113042 0 21034 0 390598 0 0 0 Webb Patricia 310718 0 107123 0 7644 0 88235 0 25275 0 538995 0 0 0 Sussman Andrew J 328957 0 0 0 21395 0 67987 0 30446 0 448785 0 20051 0 blute michael 0 0 0 0 0 0 0 0 0 0 0 0 daley jennifer 0 0 0 0 0 0 0 0 0 0 0 0 Maykel Justin MD 300431 0 291648 0 2997 0 12250 0 21441 0 628767 0 0 0 Busconi Brian D MD 501454 0 50000 0 2997 0 12250 0 22576 0 589277 0 0 0 Hussain Sarwat MD 385747 0 111024 0 2997 0 12250 0 25130 0 537148 0 0 0 Lapinsky Anthony MD 362503 0 118455 0 2978 0 12250 0 22519 0 518705 0 0 0 Tam Stanley MD 480188 0 0 0 2997 0 12250 0 24393 0 519828 0 0 0 Part I, Line 1a Split dollar gross up calculations to John O'Brien and Walter Ettinger which are treated as taxable compensation. Part I, Lines 4a-b: Part I, Lines 4a-b: Val Slayton's position was terminated effective 7/28/2010. In recognition of his years of service at HealthAlliance Hospital, Val was awarded severance compensation equal to 26 weeks of his salary and wages. During fiscal year 2010 Val was paid $45,855 as a result of this arrangement. During fiscal year 2011 he is scheduled to receive an additional $90,644 in severance compensation. Line 4b: Name of participants in or receiving payment from a supplemental nonqualified retirement plan Todd A. Keating $23,248 John G. O'Brien $0 Douglas S. Brown $25,891 Walter H. Ettinger, M.D. $37,286 Nancy Kruger $10,182 George Brenckle, Ph.D. $11,833 Robert Phillips $48,244 Patricia Webb $0 Andrew Sussman $20,051 John Randolph $0 Sharon Hylka $19,137 Victoria Diamond $16,682 Robert Klugman $15,462 Barbara Fisher $10,214 Willis Chandler $0 Thomas Bergan $9,658 Charles Cavagnaro, III, MD $0 William Corbett, MD $14,238 Sheila Daly $8,812 Eric Dickson, MD $0 Deborah Ekstrom $9,624 Robert Feldmann $16,909 Gary N. Lapidas $25,302 Patrick L. Muldoon $23,849 John Polanowicz $9,234 Michele M. Streeter $9,921 Dana Swenson $0 Stephen E. Tosi, MD $24,025 Supplemental Information Part III Part II - Disclosures: 1) John O'Brien's retirement and other deferred compensation amount includes a contingent deferred compensation accrual of $302,000 which remains the property of UMass Memorial until and unless the terms of the deferred agreement are fulfilled. 2) The above directors receive no compensation for their role as directors. All compensation received relates to their position as a physician/administrator. Part II - Unrelated Organization: The Officers, Directors and Highest Compensated Employees listed in Part II that received compensation from an unrelated organization were paid for their services related to medical research, education of medical students and resident training. Amounts include their base compensation and deferred compensation for calendar year 2009. The name of the unrelated organization is UMass Medical School. DANIEL LASSER, M.D. $256,684 MARIANNE E. FELICE, M.D. $208,647 ELIAS J. AROUS, M.D. $149,750 PETER H. BAGLEY, M.D. $153,169 ALAN P. BROWN, M.D. $69,341 SHUBJEET KAUR, M.D. $152,503 MARY LINDHOLM, M.D. $20,035 DAVID AYERS, M.D. $139,980 GREGORY VOLTURO, M.D. $33,120 MICHAEL P. ARONSON, M.D. $75,028 BRYAN CHESHIRE, M.D. $27,929 DOUGLAS ZIEDONIS, M.D. $199,198 JOSEPH FERRUCCI, M.D. $252,202 BRIAN D. BUSCONI, M.D. $122,750 justin maykel, m.d. $117,290 sarwat hussain, m.d. $132,750 anthony lapinsky, m.d. $172,466 stanley tam, m.d. $176,644 MHEFA-UMASS MEMORIAL SERIES D 042456011 57586clq6 2005-08-18 107450000 SEE SCHEDULE O 0 0 MHEFA-UMASS MEMORIAL VARIABLE RATE SERIES E 042456011 57586eh27 2009-05-22 30000000 SEE SCHEDULE O 0 0 MHEFA-UMASS MEMORIAL VARIABLE RATE SERIES F 042456011 57586eh27 2009-05-22 30000000 SEE SCHEDULE O 0 0 MHEFA-MARLBOROUGH HOSPITAL VARIABLE RATE series a 042456011 2009-11-24 9420000 SEE SCHEDULE O 0 0 MHEFA-UMASS MEMORIAL MASTER LEASE 042456011 2005-12-07 10000000 CAPITAL EQUIPMENT 0 0 109879830 10709415 1384731 2785684 95000000 2006 0 0 1 1 30051532 6816052 205455 23030025 2011 0 0 0 1 30051535 6807810 118700 23125025 2011 0 0 0 1 9420000 78458 9341542 2009 1 0 1 1 10000000 10000000 2006 0 0 1 1 0 0 1 0 0 0.01030 0.01030 1 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 0 1 1 1 0 0 0 1 1 0 0 0 0 1 MHEFA-UMASS MEMORIAL MASTER LEASE 042456011 2006-12-27 20000000 CAPITAL EQUIPMENT 0 0 MHEFA-UMASS MEMORIAL MASTER LEASE 042456011 2008-04-24 20000000 CAPITAL EQUIPMENT 0 0 MHEFA-UMASS MEMORIAL MASTER LEASE 042456011 2009-07-24 20000000 CAPITAL EQUIPMENT 0 0 mhefa-umASS MEMORIAL varIABLE RATE SERIES g 042456011 57586eus8 2010-05-27 60445000 sEE SCHEDULE O 0 0 20717238 26965 717238 19973035 2007 0 0 1 1 20152952 29072 152952 19970928 2009 0 0 1 1 20024254 28500 19995754 2010 0 0 0 1 63277953 62178915 71123 1027915 2010 1 0 1 1 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 0 1 VARIOUS-CASH VALUE OF LIFE INSUR POLICIES X 5588900 4887451 0 1 1 dr jason gundersen X 30000 833 0 1 1 4888284 Gordon Manning MD Current Director 16000 Rental of Property - Income 0 Robert Klugman MD Key Employee 16000 Rental of Property - Income 0 Daniel Carlucci MD Current Director 12234 Rental of Property - income 0 Gordon Manning MD Current Director 213121 Rental of Property - Expense 0 Robert Klugman MD Key Employee 213121 Rental of Property - Expense 0 John Clementi Current Director 129026 Rental of Property - Expense 0 Edward Manzi Current Director 193320 rental of property - expense 0 Edward Manzi Current Director 350000 sale of assets 0 Edward Manzi Current Director 32051 rental of property - expense 0 Markian Stecyk MD Current Director 25083 employment Arrangement 0 William F Sullivan Sr Current Director 316761 Independent Contactor Arrangement 0 Robert Haveles Current Director 114879 Independent Contactor Arrangement 0 Paul D'Onfro Current Director 654636 Independent Contactor Arrangement 0 Daniel Carlucci MD Current Director 109573 Independent Contactor Arrangement 0 Anthony J Mercadante Current Director & Family Member of Nicholas Mercadante 253709 Independent Contactor Arrangement 0 Susan Ettinger Family Member of Walter Ettinger, Key Employee 27506 Employment Arrangement 0 Cheryl Swenson Family Member of Dana Swenson, Director 37233 Employment Arrangement 0 Kathleen Hylka Family Member of Sharon Hylka, Key Employee 98509 Employment Arrangement 0 Kathryn C May Family Member of Deborah Ekstrom, Officer 75097 Employment Arrangement 0 Eileen Henrickson RN Family Member of Deborah Ekstrom, Officer 98268 Employment Arrangement 0 Joanne D'Onfro Family Member of Paul D'Onfro, Director 43990 Employment Arrangement 0 Elizabeth Gundersen MD Family Member of Jason Gundersen, MD, Director 215322 Employment Arrangement 0 Kenneth Stillman MD Family Member of Ann Molloy, Director 39434 Employment Arrangement 0 X 2191 191877 fmv/selling price X DOOR PRIZES 99 54011 COST 0 1 1 Third Party Use: Part I, Line 32b: UMass Memorial Health Care, Inc. utilizes the services of UMass Memorial Foundation, Inc. to solicit donor contributions, on occasion, the organization receives gifts of publicly traded stock. All gifts of publicly traded stock are immediately sold upon receipt through an investment services firm. Line 25: Door prizes included were from the Health Alliance Hospitals, Inc.'s Speakeasy event and the Central New England Health Alliance, Inc.'s Hospital Golf Tourney event. Form 990, Part VI, Section A, line 2 Disclosure Year, Disclosing Individual, Title/Role, Relationship with, Relationship UMMHC 2010, John Budd, Board Member, Paul D'Onfro, business Ventures 2010, None Member Entities Health Alliance 2010, D'Onofro, Paul, Board Member, John Budd, business 2010, Cirillo, Bettyann, Board Member, John Howard, business CHL 2010, None Marlborough 2010, Murphy, Michael, Board member, Daniel Carlucci, business Richard Bennett, business Cornelius Ferris, business John Polanowicz, business Philip Purcell, business 2010, Molloy, Ann, Board member, Alan Brown, MD, business Wing 2010, Phaneuf, James, Board Member, Charles Cavagnaro, business Edward J. Noonan, business Robert S. Haveles, business James St. Amand, business Paul Scully, business Katherine Coolidge, business 2010, Noonan, Edward, Board Member, Charles Cavagnaro, business James St. Amand, business James Phaneuf, business Katherine Coolidge, business Robert S. Haveles, business Patrick Turley, business Elaine Anderson, business 2010, Desrochers, Roland, Board member, Charles Cavagnaro, business 2010, Turley, Patrick, Board member, Linda Mitchell, business Edward Noonan, business Ron Christiansen, business Paul Scully, business 2010, Haveles, Robert, Board Member, Edward Noonan. business James Phaneuf, business Paul Scully, business Patrick Turley, business 2010, Christiansen, Ronald, Board member, Patrick Turley, business Linda Mitchell, business Paul Scully, business 2010, Scully, Paul, Board Member, Ron Christiansen, business Patrick Turley, business Robert Haveles, business James Phaneuf, business Charles Cavagnaro, business 2010, Cavagnaro, Charles, President, Ed Noonan, business James Phaneuf, business Paul Scully, business Roland Desrochers, business Elaine Anderson, personal 2010, Mitchell, Linda, Board member, Ron Christiansen, business Robert Haveles, business Patrick Turley, business Edward Noonan, business Paul Scully, business 2010, Coolidge, Katherine, Board member, Edward Noonan, business James Phaneuf, business 2010, Anderson, Elaine, Board member, Paul Scully, business Edward Noonan, business 2010, Lyons, Cynthia, Board member, Paul Scully, business Clinton NONE Form 990, Part VI, Section A, line 6 There are no classes of directors. The voting rights of the member's board are absolute. Form 990, Part VI, Section A, line 7a The majority of entities in the Consolidated Group have a sole member (which is also within the Consolidated Group) that elects the board of trustees. There are no classes of trustees. The majority of the entities reserve to the Member the power to remove trustees, to fill vacancies, and to increase or decrease the size of the board. Form 990, Part VI, Section A, line 7b The majority of the entities in the Consolidated Group have a sole member (which is also within the Consolidated Group) with the right to approve or ratify decisions of the entity, which is exercised by that Member's board of trustees. There are no classes of trustees or members. Thus, the voting rights of a Member board are absolute. Generally, the sole member of each entity reserves the power to approve major transactions; to merge, consolidate or liquidate the corporation's assets; to adopt annual operating and capital budgets and amendments; to enter into loan agreements and/or guaranties; to appoint and/or elect the President and/or CEO; to elect and/or appoint and remove trustees, fill vacancies, to increase or decrease the size of the board; and to approve unbudgeted expenditures. Form 990, Part VI, Section B, line 11 Sections of the Core Form 990 related to Executive Compensation and, Schedule J are reviewed in detail with the Organization's Compensation Committee of the Board. The Compliance Committee of the Board reviews all content associated with Schedule L. The Audit Committee of the Board reviews the Form 990, including the above schedules and recommends the Form 990 to the full Board for approval. The full board is given access to the Form 990. Form 990, Part VI, Section B, line 12c Page 6 Section B. Policies Line 12 c: The Conflict of Interest Policy requires Board members and management to complete annual Disclosure Statements and, to update these Disclosure Statements for significant changes in their outside governance and professional activities or, financial relationships as appropriate. Additionally, all transactions involving Board members or management and the Organization are required to be approved by the Compliance Committee of the Board and, there is active monitoring and communication to ensure individuals with outside relationships do not inappropriately participate in business decisions of the Organization, purchasing or research decisions. Form 990, Part VI, Section B, line 15 Page 6 Section B. Policies Line 15 b: At UMass Memorial, all compensation matters for the CEO and senior executives throughout the system (including all "disqualified persons") are governed and overseen by the Board of Trustees of the Parent. The Board approved a Compensation Philosophy that governs all such decisions. The philosophy includes the objectives of the program, components of executive compensation, the relevant market, positioning in the market, factors considered in setting executive compensation and the importance of tying such compensation to performance. The Board established a Compensation Committee, made up of disinterested trustees, who are given the authority to establish compensation for all senior executives, within the parameters of the philosophy, and with full and complete reporting to the full board. The Compensation Committee performs its work pursuant to its charter and a Compensation Policy that establishes the process the committee will follow in reviewing and approving executive compensation each year. The committee ensures that its process meets the rebutable presumption of reasonableness established by the IRS. In order to assist the Committee in its responsibilities, the Compensation Committee hires independent, outside compensation consultants to advice the committee and the board on the reasonableness of overall executive compensation program, including compensation of the specific executives. These consultants report directly to the Committee and not to Management. The Committee works with these consultants, and with legal counsel, to ensure that all compensation paid, as well as the process followed to determine such compensation, is reasonable, meets all regulatory requirements and is competitive with the relevant market. Form 990, Part VI, Section C, line 19 Page 6: UMass Memorial makes it governing documents, conflict of interest policy, and financial statements available to the public as required by applicable state and federal laws, and by request on a case-by-case basis. Schedule K, (Form 1 of 2) Part I Column (f) description of purpose: A - Completion of the expansion of the Emergency Dept and routine capital equipment and/or renovation projects B - Renovation, equipping and construction for clinical, support service and infrastructure projects C - Renovation, equipping and construction for clinical, support service and infrastructure projects D - Pay off HEFA pool O loan, ER renovations, EICU Equipment, CT Scan lease, Mammography Unit schedule k, (Form 2 of 2) D - 57586EUS8 - 57586EUT6 - 57586EUU3 - 57586EUV1 - 57586EUW9 - 57586EUX7 - 57586EVE8 - 57586EUY5 - 57586EVF5 - 57586EUZ2 - 57586EVG3 - 57586EVA6 - 57586EVH1 - 57586EVB4 - 57586EVJ7 - 57586EVC2 - 57586EVD0 Part I Column (f) description of purpose: D - Refunding of Central New England Health Alliance Series A Bond (1993) and Medical Center of Central Massachusetts, Series B (1992) Page 1, Line H(b) List of Affiliated Organizations The Clinton Hospital Association; 201 Highland Street, Clinton, MA 01510 EIN: 04-1185520 Fiscal Year end: 9/30/2010 Marlborough Hospital; 157 Union Street, Marlborough, MA 01752 EIN: 04-2104693 Fiscal Year end: 9/30/2010 UMass Memorial Behavioral Health System, Inc.; 328 Shrewsbury Street, Worcester, MA 01604 EIN: 04-3374724 Fiscal Year end: 9/30/2010 UMass Memorial Hospitals, Inc.; 328 Shrewsbury Street, Worcester, MA 01604 EIN: 04-3296271 Fiscal Year end: 9/30/2010 UMass Memorial Health Ventures, Inc.; 328 Shrewsbury Street, Worcester, MA 01604 EIN: 22-2605679 Fiscal Year end: 9/30/2010 UMass Memorial Laboratories, Inc.; 328 Shrewsbury Street, Worcester, MA 01604 EIN: 04-3321703 Fiscal Year end: 9/30/2010 UMass Memorial Medical Center, Inc.; 328 Shrewsbury Street, Worcester, MA 01604 EIN: 04-3358564 Fiscal Year end: 9/30/2010 UMass Memorial Medical Group, Inc.; 328 Shrewsbury Street, Worcester, MA 01604 EIN: 04-2911067 Fiscal Year end: 9/30/2010 UMass Memorial Realty, Inc.; 328 Shrewsbury Street, Worcester, MA 01604 EIN: 04-2805630 Fiscal Year end: 9/30/2010 Wing Memorial Hospital Corp.; 40 Wright Street, Palmer, MA 01069 EIN: 22-2519813 Fiscal Year end: 9/30/2010 UMass Memorial Health Care, Inc. (Parent); 328 Shrewsbury Street, Worcester, MA 01604 EIN: 04-3358566 Fiscal Year end: 9/30/2010 Community HealthLink, Inc.; 72 Jaques Avenue, Worcester, MA 01610 EIN: 04-2626179 Fiscal Year end: 9/30/2010 Central Massachusetts Magnetic Imaging Center, Inc.; 367 Plantation Street, Worcester, MA 01605 EIN: 04-2981362 Fiscal Year end: 9/30/2010 Central New England HealthAlliance, Inc.; 60 Hospital Road, Leominster, MA 01453 EIN: 04-3172496 Fiscal Year end: 9/30/2010 Coordinated Primary Care, Inc.; 60 Hospital Road, Leominster, MA 01453 EIN: 04-3210002 Fiscal Year end: 9/30/2010 HealthAlliance Home Health and Hospice, Inc.; 25 Tucker Road, Leominster, MA 01453 EIN: 04-2932308 Fiscal Year end: 9/30/2010 HealthAlliance Hospitals, Inc.; 60 Hospital Road, Leominster, MA 01453 EIN: 04-2103555 Fiscal Year end: 9/30/2010 Caitlin Raymond International Registry, Inc.; 328 Shrewsbury Street, Worcester, MA 01604 EIN: 06-1749208 Fiscal Year end: 9/30/2010 Clinton Hospital Foundation, Inc.; 328 Shrewsbury Street, Worcester, MA 01604 EIN: 04-3357881 Fiscal Year end: 9/30/2010 Page 8 Part VII Section B. Independent Contractors - Description of service Description of services Footnote A - General Contractor management fees. Subcontracts to a variety of services, including but not limited to: cost of materials, plumbing, HVAC, electrical, bricklayers, laborers. This vendor may also supply their own laborers as opposed to subcontracting the work out. Page 12 Part XI LINE 2c The organization's financial statements were audited by an independent accounting firm on a consolidated basis. The organization has an audit committee responsible for oversight of the audit of its financial statements as well as the selection of an independent accounting firm. Schedule G part i, line 2b, column III UMass Memorial Foundation, Inc. is identified as the administrator of the philanthropic activities of the reporting entities of UMass Memorial Health Care, Inc. This includes the coordination of all charitable work and the management of office operations to support fundraising including the following procedures: 1) Active Development Work 2) Donor Relations and Communications 3) Services to UMass Memorial Staff 4) Contribution Reports, Donor Record Files 5) Transfer of Contributions Received (Contributions received by the Foundation that are designated to a UMass Memorial reporting entity are deposited into a designated account of the respective reporting entity upon receipt.) 6) Expenditures of Contributions SCHEDULE G Part I, Line 2b; Column (v) UMass Memorial Health Care, Inc. pays UMass Memorial Foundation, Inc. its prorata share of operating expenses based on the split of UMass Memorial contribution receipts versus the overall total contribution receipts as collected by the Foundation. schedule g, part ii Part II, Column (a) Event #1: The Hospital Golf Tourney was held by Central New England HealthAlliance, Inc. Part II, Column (b) Event #2: The Winter Ball was held by the Parent. Part II, Column (c) Other events The 7 events reported in Column (c ) are: Golf Tournament held by Wing Memorial Hospital, Corp., Speakeasy held by HealthAlliance Hospitals, Inc., Dennehy Golf Tournament held by HealthAlliance Home Health and Hospice, Inc., Lovelight held by HealthAlliance Home Health and Hospice, Inc. Golf Tournament was held by Marlborough Hospital, Golf Tournament was held by the Parent, and Star Light Gala was held by the Parent. SCHEDULE L PART II LOANS FROM INTERESTED PERSONS The VARIOUS-CASH VALUE OF LIFE INSUR. POLICIES INCLUDES THE FOLLOWING: Amounts due from current and former officers pertain to split dollar life insurance policies of the respected individuals. These policies were originated at various times during the insured's employment with UMass Memorial Health Care, Inc. The corresponding policy premiums were funded by the employer as an employee benefit. In accordance with IRS Notice 2002-8, Treasury Regulation 1.61-22 and Treasury Regulation 1.7872-15, these payments require classification as loans due from the insured. These loan balances are reflected at the lower of the discounted cash surrender value or discounted cumulative premiums paid. (a) Name of interested person (c) Original principal amount (d) Balance due John O'Brien, Current President & CEO $ 2,141,413 $ 932,797 Walter Ettinger, Current Key Employee of Medical Center $ 606,000 $ 256,193 Thomas Cummings, Former CEO of Marlborough Hospital $ 377,630 $ 188,916 Richard H. Scheffer, Former CEO of Wing Memorial Corp. $ 26,660 $ 75,265 William J. Williams, Former Officer of HealthAlliance Hospitals, Inc. $ 1,981,627 $ 3,178,826 Floyd Connelly, Former Executive Director of CMMIC, Inc. $ 455,570 $ 255,454 UMass Memorial Foundation Inc 333 South Street Shrewsbury MA 01545 043108190 fundraising support MA 501( c)(3) 11c N/A Health Alliance Realty Corporation 326 Nichols Road Fitchburg MA 01420 042560754 real estate management MA 501( c)(2) N/A Wing Health Foundation Inc 40 Wright Street Palmer MA 01069 042105839 issuance of health related grants MA 501( c)(3) 11b N/A UMass Memorial Investment Partnership LLP One Biotech Park 365 Plantation St Worcester MA 01605 043530755 investment management MA N/A excluded 514 4952839 327743407 0 -7731 1 UMass Memorial Marlborough MRI 157 Union Street Marlborough MA 01752 202293995 magnetic resonance imaging MA marlborough hospital related 606235 327791 0 0 UMass Memorial Health Alliance MRI center llc 60 Hospital Road Leominster MA 01453 043561571 magnetic resonance imaging MA N/A related 1018617 807167 0 0 Commonwealth Professional Assurance Co LTD PO Box 1051 GT Grand Cayman CJ 980226143 insurance CJ N/A C 26780692 131240395 1.00000 Memorial Office Condominium Trust 328 Shrewsbury Street Worcester MA 01604 046616900 Condominium association MA Umass Memorial Medical Center Inc T 23315 94884 0.53690 bio-lab inc 215 west street milford MA 01757 042708828 clinical laboratory MA umass Memorial health ventures inc S 1.00000 0 1 0 0 0 0 0 0 0 1 0 1 0 1 1 1 0 0 Commonwealth Professional Assurance Company LTD L 23072004 UMass Memorial Medical Center Inc B 5082696 UMass Memorial Medical Center Inc N 736353 UMass Memorial Medical Center Inc L 6202000 UMass Memorial Medical Group Inc L 2985387 UMass Memorial Medical Group Inc N 575995 UMass Memorial Medical Group Inc B 67886 UMass Memorial Realty Inc J 2851790 UMass Memorial Foundation Inc O 2963697 UMass Memorial Health Ventures Inc P 256161 UMass Memorial Laboratories Inc P 2229087 UMass Memorial Realty Inc P 254016 Marlborough Hospital P 1861677 The Clinton Hospital Association P 1356714 Wing Memorial Hospital Corporation P 1788570 Wing Memorial Hospital Corporation N 101257 Central New England Health Alliance Inc P 3298569 UMass Memorial Medical Center Inc P 130316668 UMass Memorial Medical Group Inc P 28454628 Central Massachusetts Magnetic Imaging Center Inc P 189546 Community HealthLink Inc P 637326 Commonwealth Professional Assurance Company LTD P 15091995 Caitlin Raymond International Registry P 4368