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        <Explanation>FIN 48 Footnote from Caritas Christi's audited financial statements - On October 1, 2007, Caritas Christi adopted ASC 740-10, Accounting for Uncertainty in Income Taxes - an Interpretation of FASB Statement No. 109. ASC 740-10 prescribes a recognition threshold and measurement attribute for the financial statement recognition and measurement of a tax position taken, or expected to be taken, in a tax return. This interpretation also provides guidance on derecognition, classification, interest and penalties, accounting in interim periods, and disclosure requirements for uncertain tax positions. The adoption of ASC 740-10 did not have a material impact on Caritas Christis consolidated financial statements.</Explanation>
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          <BusinessNameLine1>caritas st elizabeth's medical center</BusinessNameLine1>
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        <Address>
          <AddressLine1>736 cambridge st</AddressLine1>
          <City>brighton</City>
          <State>MA</State>
          <ZIPCode>02135</ZIPCode>
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        <LicensedHospital>X</LicensedHospital>
        <GeneralMedicalAndSurgical>X</GeneralMedicalAndSurgical>
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      <Form990ScheduleHPartVI>
        <CostingMethodUsed>Part I, Line 7: The cost to charge ratio as derived from worksheet 2 was used as the costing methodology used to calculate the amount used to calculate the amounts in the table of line 7.</CostingMethodUsed>
        <SubsidizedHealthServicesExpln>Part I, Line 7g: N/A</SubsidizedHealthServicesExpln>
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        <BadDebtFootnote>Part III, Line 4: The Hospital provides a wide variety of health care services to patients within the community in order to ensure access to appropriate care for populations in need. The Hospital, grant credit without collateral to their patients, many of whom are local residents and are insured under third-party payor agreements. The Hospital provides care without charge or at amounts less than established rates to patients who meet certain criteria under the Hospital's charity care policies. Because the Hospital does not pursue collection of amounts determined to qualify as charity care, they are not reported as revenue.</BadDebtFootnote>
        <ShortfallAsCommunityBenefit>Part III, Line 8: Cost reporting principles are used to determine allowable and non-allowable costs based on rule and regulations. The Medicare shortfall is the subsidized amount of care provided to patients and should be considered a community benefit.</ShortfallAsCommunityBenefit>
        <DebtCollectionPolicy>Part III, Line 9b: The Hospital provides care without charge or at amounts less than established rates to patients who meet certain criteria under the Hospital's charity care policies. The Hospital's collection policy exempts these individuals and patients from any collection or billing procedures pursuant to the Commonwealth of Massachusetts regulations and policies.The Commonwealth of Massachusetts operates a 'health safety net' to reimburse hospitals for the cost of uncompensated care, defined as charity care, and bad debts associated with emergency services. Amounts are paid to the health safety net based on a percentage of private sector charges. Reimbursement from the health safety net is a flat amount per visit or discharge, determined prospectively from a Medicare-based reimbursement model.</DebtCollectionPolicy>
        <NeedsAssessment>Part VI, Line 2: In accordance with the Massachusetts Attorney General's Community Benefits Guidelines for Non-Profit Hospitals, The Hospital conducted a Needs Assessment. Massachusetts law also requires that all non-profit hospitals and health plans submit an annual Community Benefits Report that details the extent to which these institutions provide charity care and support community health activities in their service areas. The Hospital conducts a periodic community health needs assessments that clarify the leading health concerns, service gaps, and barriers to access for their patients. The primary aim of these needs assessments are to help ensure that hospital and health plan community benefit activities are targeted appropriately.In the Spring of 2009, The Hospital engaged an outside consulting firm to assist with the community health needs assessment. The needs assessment compiled and analyzed secondary data drawn from existing federal, state, and local sources as well as analyzed primary data that the Hospital collected through surveys administered to patients in clinic waiting rooms. The needs assessment process explored issues related to: health care access and preventive services; maternal and child health status; the prevalence of chronic disease, mental illness, and substance abuse, and the extent to which patients are involved in risky behaviors. Then the information collected was analyzed and reported. The goal of the needs assessment was to address both quantitative and qualitative health care needs of the community.</NeedsAssessment>
        <PatientEducationAssistance>Part VI, Line 3: The Hospital's policy is that no individual will ever be refused care. Care is provided regardless of age, race, sex, religion, nationality, or ability to pay. The policy is posted on signs throughout the Hospital along with signs informing patients of the availability Public Assistance &amp; MassHealth programs are posted at all Registration points, the Emergency Department, Cashier's Window, and Financial Counselor offices. All signs are large enough that they are clearly visible and legible by patients visiting these areas. Signs are in both English and any other language spoken by more then 10% of the population in the Hospital's service area. The Hospital also provides care to the elderly and the indigent under the Medicare and Medicaid programs, granted at a discount, which is generally less than cost. The proportion of services provided to Medicaid patients approximates the proportion of Medicaid beneficiaries living in the medical center's service areas. In addition, the Hospital pays into the Health Safety Net for hospitals within the Commonwealth of Massachusetts. Throughout 2010, the Hospital continued to enroll and provide referral and health care services for the indigent, underinsured and uninsured in our community. The Hospital recognizes the delivery of care to those in need as an integral part of our mission and we will continue to focus on meeting the health care needs of this population going forward.</PatientEducationAssistance>
        <CommunityInformation>Part VI, Line 4: St. Elizabeth's Medical Center (SEMC) is located in the Allston-Brighton community, Boston's second largest neighborhood, with a diverse population of almost 70,000 residents. During the past two decades, the Latino and Asian populations have grown significantly. Allston-Brighton has a strong neighborhood flavor and community feeling that is attractive to long-term multigenerational residents, immigrants, students, and young professionals.SEMC is the largest employer in the area with more than 14 percent (or 340 employees) from the Allston-Brighton community. Other health care facilities in the area include Brighton Marine Health Center, Joseph M. Smith Community Health Center, Franciscan Hospital for Children (a small pediatric rehabilitation hospital), community health centers, nursing homes and physician offices. The community also abuts three major universities and is home to WGBH Educational Foundation. The multiplier effect of the major employers has resulted in the creation of many small and medium-sized businesses such as restaurants, bars, ethnic grocery stores, convenience stores, auto body shops, banks, hair salons, laundries, locksmiths, moving companies, and real estate offices. The high cost of housing and living, in general, is a major social issue for Allston-Brighton; 80 percent of its housing is rental property. The lack of buildable land and the large number of college student residents exacerbate the housing crisis.</CommunityInformation>
        <OtherInformation>Part VI, Line 6: In furtherance of its charitable purpose, the Hospital provides a wide variety of services to the community in order to ensure access to appropriate care for populations in need. The Hospital, Caritas Christi and its members support services which target not only the general population in each member's respective service area, but also particular populations with special health care needs, including the poor, the elderly, children, and minority populations. Supported services include various clinics, health screening programs, health education programs, and support area groups operated in the local area. The Organization and its members work actively with other service providers to ensure the development of an effective community health network. The Organization and its members also participate in activities designed to foster a vital local economic and civic environment.Several of the member organizations provide care without charge or at amounts less than established rates to patients who meet certain criteria under the organizations charity care policies. Because the member organizations do not pursue collection of amounts determined to qualify as charity care, they are not reported as revenue. Mission Statement:Being part of a Catholic Health Care System means that ours is a ministry with roots in the teachings of the Church and the Gospel message of Jesus. At Caritas Christi we are not just another provider of health care. We are a continuation of the healing ministry of Jesus. Our Mission and Values are the forces that drive us toward achieving Exceptional Care.Our Mission is our reason for being:Caritas Christi Health Care, rooted in the healing ministry of Jesus, is committed to serving the physical and spiritual needs of our community by delivering the highest quality care with compassion and respect.Our Vision describes a set of ideals and picture for the future:We envision an exceptional Catholic healthcare ministry which will lead to the transformation of healthcare.Our Values are the principles or beliefs that guide our work:CompassionAccountabilityRespectExcellenceAs women and men working in healthcare, everyday we come to work we have an opportunity to effect change. It is our way of offering service that makes us different. Our identity as a Catholic health care system is reflected in who we are and how we act. It is reflected in who we serve and how we care for those we serve. It is reflected in how we treat one another, and it is reflected in how we contribute to the common good. Our identity and our integrity are a result of using our time, our talents, our compassion and making concrete efforts to work for the dignity of every person.</OtherInformation>
        <AffiliatedHealthCareSystem>Part VI, Line 7: Caritas Christi is a Catholic health care system organized by the Roman Catholic Archdiocese of Boston (RCAB). Member hospital organizations of Caritas Christi include St. Anne's Health Care System, Inc. and affiliates, including St. Anne's Hospital Corporation; Caritas St. Elizabeth's Medical Center of Boston, Inc.; Caritas Valley Regional Health System, Inc. and affiliates, including Caritas Holy Family Hospital, Inc.; Caritas Carney Hospital, Inc.; Caritas Norwood Hospital, Inc. and Caritas Good Samaritan Medical Center, Inc. Caritas Christi serves as the sole corporate member of each of these organizations.Caritas Christi and its members support services which target not only the general population in each member's respective service area, but also particular populations with special health care needs, including the poor, the elderly, children, and minority populations. Supported services include various clinics, health screening programs, health education programs, and support area groups operated in the local area. Caritas Christi and its members work actively with other service providers to ensure the development of an effective community health network. Caritas Christi and its members also participate in activities designed to foster a vital local economic and civic environment.Caritas Christi is an affiliated health care system, New England's largest community hospital network. Effective November 6, 2010, Caritas Christi transferred substantially all of its assets to Steward Health Care System, LLC. Steward is a comprehensive, integrated health care delivery network, providing community-based medicine and tertiary care in eastern Massachusetts, southern New Hampshire, and Rhode Island.</AffiliatedHealthCareSystem>
        <ReportsFiledWithStates>MA</ReportsFiledWithStates>
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        <ReturnReference>Part I, Line 4a:</ReturnReference>
        <Explanation>Severence payments made to: Deborah Gratto- $151,043; Barbara Goldsmith- $116,969; Nancy Gaden- $115,762; Eleanor Silva- $11,886; Martha Butler- $8,617; Frank Krasin- $2,483; Janet Pizzi- $1,538.</Explanation>
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        <AmountOfTransaction>201670</AmountOfTransaction>
        <DescriptionOfTransaction>Lester Sheehan owns Sheehan &amp; Zahner Orthopedic Associates. SEMC paid Sheehan &amp; Zahner for administrative support for Dr. Sheehan and for seeing patients in the Hanscom and Brighton Marine clinics.</DescriptionOfTransaction>
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      <GeneralExplanation>
        <Identifier>Form 990, Part III, line 2</Identifier>
        <ReturnReference>New Program Services</ReturnReference>
        <Explanation>Caritas St. Elizabeth's Medical Center opened a Geriatric Psychology unit in October of 2009. The new unit is a 16-bed inpatient unit providing comprehensive treatment in a specially designed setting to respond to psychological needs as well as address the medical conditions of older adult patients. The team of specially trained health care professionals experienced in addressing the complex mental health and physical needs of older adults includes Board-certified psychiatrists, Clinical social workers, medical specialists, Nursing staff, nutritionists, occupational therapists and physical therapists. Services include discharge and after care planning, individual and group therapy, medical evaluation and management, specialist consultations, medication adjustments, nutritional consultation, occupational therapy, patient and family education, psychiatric evaluations, and Sensory room to promote stress management.</Explanation>
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      <GeneralExplanation>
        <Identifier>Form 990, Part VI, Section A, line 6</Identifier>
        <Explanation>Caritas Christi is the sole member of the Organization and elects the board of directors. There are no classes of directors. Caritas Christi has the power to remove directors, to fill vacancies, and to increase or decrease the size of the board.</Explanation>
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      <GeneralExplanation>
        <Identifier>Form 990, Part VI, Section A, line 7a</Identifier>
        <Explanation>Caritas Christi is the sole member of the Organization and elects the board of directors. There are no classes of directors. Caritas Christi has the power to remove directors, to fill vacancies, and to increase or decrease the size of the board.</Explanation>
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      <GeneralExplanation>
        <Identifier>Form 990, Part VI, Section A, line 7b</Identifier>
        <Explanation>Caritas Christi is the sole member of the Organization and elects the board of directors. There are no classes of directors. Caritas Christi has the power to remove directors, to fill vacancies, and to increase or decrease the size of the board.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>Form 990, Part VI, Section B, line 11</Identifier>
        <Explanation>The organization prepares the Form 990 and the related disclosures with assistance and guidance from its individual tax advisors (CPA firm).The Form 990 is reviewed by the individual entities' and the parent organizations' management teams prior to submission to the board of directors and the IRS.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>Form 990, Part VI, Section B, line 12c</Identifier>
        <Explanation>The organization requires that key employees, members and officers of the board of directors and any member of any committee disclose in writing (and update annually) all business and other relationships which might potentially create a conflict of interest as defined by the policy. The written disclosure shall include an itemization of any substantive conflict of interest for such individual by virtue of his or her activities. The conflict of interest policy is reviewed and communicated to ensure individuals with outside relationships do not inappropriately participate in business decisions of the Organization in which they are not independent. The conflict of interest policy and procedures are currently under review and revision.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>Form 990, Part VI, Section B, line 15</Identifier>
        <Explanation>All compensation for the CEO and senior executives throughout the system are governed and overseen by the Board of Director's of Caritas Christi, their sole member. The Board established a Compensation Committee, made up of disinterested trustees, who are given the authority to establish compensation for all senior executives. The Compensation Committee performs annual reviews and approves executive compensation. In order to assist the Committee in its responsibilities, the Compensation Committee hires independent, outside compensation consultants to advise the committee on the reasonableness of the overall executive compensation. The Committee works with these consultants to ensure that all compensation is reasonable, meets all regulatory requirements, and is competitive within the relevant market.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>Form 990, Part VI, Section C, line 19</Identifier>
        <Explanation>The organization makes its governing documents, conflict of interest policy and financial statements available to the public upon request. Additionally, the organization's financial statements are available on the public charities website maintained by the Commonwealth of Massachusetts Attorney General.</Explanation>
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          <City>Brighton</City>
          <State>MA</State>
          <ZIPCode>021352997</ZIPCode>
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          <State>MA</State>
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          <State>MA</State>
          <ZIPCode>018444597</ZIPCode>
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          <City>Methuen</City>
          <State>MA</State>
          <ZIPCode>018444597</ZIPCode>
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          <State>MA</State>
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          <City>Dorchester</City>
          <State>MA</State>
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        <NameOfOtherOrganization>
          <BusinessNameLine1>excell laboratories inc</BusinessNameLine1>
        </NameOfOtherOrganization>
        <TransactionType>I</TransactionType>
        <AmountInvolved>343800</AmountInvolved>
      </TransactionsRelatedOrgsTable>
      <TransactionsRelatedOrgsTable>
        <NameOfOtherOrganization>
          <BusinessNameLine1>st elizabeth's realty inc</BusinessNameLine1>
        </NameOfOtherOrganization>
        <TransactionType>O</TransactionType>
        <AmountInvolved>616533</AmountInvolved>
      </TransactionsRelatedOrgsTable>
      <TransactionsRelatedOrgsTable>
        <NameOfOtherOrganization>
          <BusinessNameLine1>excell laboratories inc</BusinessNameLine1>
        </NameOfOtherOrganization>
        <TransactionType>K</TransactionType>
        <AmountInvolved>70000</AmountInvolved>
      </TransactionsRelatedOrgsTable>
      <TransactionsRelatedOrgsTable>
        <NameOfOtherOrganization>
          <BusinessNameLine1>excell laboratories inc</BusinessNameLine1>
        </NameOfOtherOrganization>
        <TransactionType>L</TransactionType>
        <AmountInvolved>8434464</AmountInvolved>
      </TransactionsRelatedOrgsTable>
      <TransactionsRelatedOrgsTable>
        <NameOfOtherOrganization>
          <BusinessNameLine1>excell laboratories inc</BusinessNameLine1>
        </NameOfOtherOrganization>
        <TransactionType>R</TransactionType>
        <AmountInvolved>7640175</AmountInvolved>
      </TransactionsRelatedOrgsTable>
      <TransactionsRelatedOrgsTable>
        <NameOfOtherOrganization>
          <BusinessNameLine1>st elizabeth's foundation inc</BusinessNameLine1>
        </NameOfOtherOrganization>
        <TransactionType>R</TransactionType>
        <AmountInvolved>3623577</AmountInvolved>
      </TransactionsRelatedOrgsTable>
      <TransactionsRelatedOrgsTable>
        <NameOfOtherOrganization>
          <BusinessNameLine1>st elizabeth's realty inc</BusinessNameLine1>
        </NameOfOtherOrganization>
        <TransactionType>I</TransactionType>
        <AmountInvolved>55193</AmountInvolved>
      </TransactionsRelatedOrgsTable>
      <TransactionsRelatedOrgsTable>
        <NameOfOtherOrganization>
          <BusinessNameLine1>st john of god</BusinessNameLine1>
        </NameOfOtherOrganization>
        <TransactionType>R</TransactionType>
        <AmountInvolved>31348</AmountInvolved>
      </TransactionsRelatedOrgsTable>
    </IRS990ScheduleR>
  </ReturnData>
</Return>