2023-08-14T07:39:05-05:00 2022-09-30 010523282 Berry Dunn McNeil & Parker LLC 2211 Congress St Portland ME 04102 990 2021-10-01 042103581 Henry Heywood Memorial Hospital HENR 9786306106 242 Green Street Gardner MA 01440 Thomas Sullivan Interim CFO 9786306106 2023-08-07 1 Thomas Sullivan 999009999 Barbara J McGuan CPA P00219457 2077752387 2023-08-07 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z Heywood Hospital Thomas Sullivan 242 Green Street Gardner MA 01440 156657629 0 X www.heywood.org X 1907 MA To be our community's trusted choice for exceptional patient care. 22 18 1368 24 0 0 5901749 4502864 143266622 151237392 2155865 849718 84434 -5968 151408670 156584006 204209 131061 0 0 77104111 81442406 51333 51333 888244 73557249 93001560 150916902 174626360 491768 -18042354 147988951 118045157 102017325 108638212 45971626 9406945 X To be our community's trusted choice for exceptional patient care. 0 0 163431930 131061 151237392 Heywood offers various outpatient services such as an Emergency Room, Outpatient oncology and hematology advanced imaging, special procedures, rehabilitation services and many others on an outpatient basis. For FY 2022, there were 103,208 outpatient visits to the Hospital.Heywood offers Inpatient services including telemetry, intensive care, maternity, pediatrics, geriatric and adult inpatient care and inpatient adult mental health. For FY 2022, the Hospital provided 26,108 days of inpatient care. Heywood has eleven specialty and one Primary Care, provider based practices. The primary care practice focuses on Pediatrics and Family Practice, and the specialty care practices focus on the areas of Cardiology, Endocrinology, Gastroenterology, Gynecology/Obstetrics, Orthopedics, Pulmonology, Urology and General Surgery. In FY 2022, there were 43,633 visits to these practices. 163431930 1 1 0 1 0 0 0 0 0 1 1 0 0 1 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 1 0 0 0 0 0 0 1 0 1 0 1 135 0 1 1368 1 0 0 0 0 0 1 1 0 0 0 0 1 0 X 22 18 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X Thomas Sullivan 9786306157 242 Green Street Gardner MA 01440 Glenn Hunt Chairman 0.20 1.40 X X 0 0 0 Roy Lake Vice Chairman 0.20 1.40 X X 0 0 0 Cheney Castine Treasurer 0.20 1.40 X X 0 0 0 JoAnne Parks Clerk 0.20 1.40 X X 0 0 0 Bob Chauvin Trustee/Past Chairman 0.20 1.40 X 0 0 0 Joyce Fletcher Trustee 0.20 1.40 X 0 0 0 Andrew Cocchiarella Past Trustee/Director of Anesth 50.20 1.40 X 894113 0 48261 Thomas Kane Trustee 0.20 1.40 X 0 0 0 Nicole Moorshead Trustee 0.20 1.40 X 0 0 0 Craig Napolitano Trustee 0.20 1.40 X 0 0 0 Erin O'Hara Trustee 0.20 33.40 X 0 357028 29361 Michelle Parker Trustee 0.20 1.40 X 0 0 0 Kenneth Pierce Trustee 0.20 1.40 X 0 0 0 Albert Rose Trustee 0.20 1.40 X 0 0 0 Tina Sbrega Trustee 0.20 1.40 X 0 0 0 Joel Shaughnessy Trustee 0.20 1.40 X 0 0 0 John Skrzypczak Trustee 0.20 1.40 X 0 0 0 David Spackman Trustee 0.20 1.40 X 0 0 0 Frank Sweeney Trustee 0.20 1.40 X 0 0 0 Craig Twohey Trustee 0.20 1.40 X 0 0 0 Elizabeth Nottleson Trustee 0.20 29.40 X 0 273458 16839 Winfield Brown President/CEO 40.20 1.40 X X 1064638 0 71344 Debra Vescovi Trustee 0.20 1.40 X 0 0 0 Jim Meehan Past Trustee 0.20 1.40 X 0 0 0 Michael Abbatiello Past Chief Financial Officer 34.00 7.00 X 455812 0 58473 Thomas Sullivan Interim CFO 34.00 7.00 X 0 0 0 Ellen Ray Chief of ER Medicine 40.00 0.00 X 602383 0 57681 Daniel Wilson ER Physician 30.00 0.00 X 533830 0 19433 Kelly Robinson ER Physician 36.00 0.00 X 484388 0 57109 Saleem Khanani Oncology Physician 36.00 0.00 X 534284 0 49113 Jessica Darnobid Anesthiology Physician 40.00 0.00 X 463683 0 24119 5033131 630486 431733 266 0 1 0 Quartulli & Associates Inc PO Box 423 Gardner MA 01440 Physical Therapy 3079021 Hospital Medicine Solutions PO Box 660 Exeter NH 03833 Medical Staffing Services 2737691 Lab Corp Inc PO Box 12140 Burlington NC 27216 Diagnostic Laboratory Testing 2300230 Alliance Healthcare Services 18201 Von Karman Ave Suite 600 Irvine CA 92612 Radiology/Oncology Services 1772669 Spine and Pain Care Center 242 Green Street Gardner MA 01440 Medical Services 1289261 44 164490 2236161 2102213 4502864 Patient Service Revenue 622100 334795625 334795625 Miscellaneous Revenue 622100 11659820 11177250 482570 Contracted Services Revenue 622100 3996963 3996963 Provision for Bad Debts 622100 -7998615 -7998615 Contractual Allowances/Charity Ca 622100 -191216401 -191216401 151237392 837481 837481 47315 0 47315 47315 47315 12237 0 12237 12237 12237 20340 164490 73623 -53283 -53283 156584006 150754822 0 1326320 X 131061 131061 2592642 942374 1650268 66364840 64400000 1622334 342506 1402903 1384382 11133 7388 6383165 6127933 222961 32271 4698856 4460749 214708 23399 877507 48649 828858 223594 223594 51333 51333 9102 8519 583 50389753 45466568 4689797 233388 153692 602 960 152130 3321857 2499152 785027 37678 21111 12694 8417 5664494 5525659 131396 7439 32873 19735 13138 139411 111450 27919 42 2008669 2008669 4637196 4637196 956707 240247 716460 Medical Supplies 21794269 21794269 HSN Assessment 1824148 1824148 Food 1130662 964707 165868 87 Miscellaenous Expense 731206 628453 102753 -914691 194714 -1109405 174626360 163431930 10306186 888244 X 172310 135552 8276874 5735646 115425 0 33093058 16261495 2312711 1930302 1283956 1547830 139409398 76286789 58876028 63122609 32388770 11832676 1756525 922343 448899 434029 9264395 16122675 147988951 118045157 25518378 34277240 235204 1324887 48565000 57210000 4437357 3630922 23261386 12195163 102017325 108638212 X 40745676 4791437 5225950 4615508 45971626 9406945 147988951 118045157 X -18042354 -1604343 -16585239 -332745 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 14196 14196 0 Part II-B, Line 1: Henry Heywood Memorial Hospital pays dues to various organizations where a portion of the dues are allocable to lobbying expenditures. 29049836 660924 19229207 10481553 26855843 5968 2267060 79035 29049836 24926811 5923 2091501 168392 26855843 24317164 5932 780373 176658 24926811 25599932 4030 1873273 3160071 24317164 0.73940 0.16450 0.09610 0 0 251571 251571 68684495 36896494 31788001 50790843 37666330 13124513 19682489 1723965 17958524 63122609 Estimated Malpractice Receivable 920000 Deferred Compensation 1404469 Due from Related Parties 13798206 16122675 Estimated Malpractice Liability 920000 Estimated Settlements with Third-Party Payors 1944977 Refundable Advances 1886413 Due to Related Parties 6039304 Deferred Compensation 1404469 12195163 X Part V, Line 4: Permanent Endowment 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 Endowment funds are established by the governing body to fund capital projects and/or improvements of the organization. Temporary restricted funds are established by donor restricted gifts that maintain a source of income for a specific period of time. Part X, Line 2: Heywood Healthcare, Heywood Hospital, Athol, HMGI, Charitable Foundation, Quabbin, and NMTC have been determined to be not-for-profit corporations as described in Section 501(c)(3) of the Internal Revenue Code (the "Code"), and the Realty Corp. has been determined to be a not-for-profit corporation as described in Section 501(c)(2) of the Code. All of the entities are exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. The Organization annually evaluates its tax status and tax positions taken with respect to its operations and financial position. Under Accounting Standards Codification ("ASC") 740, an organization must recognize the financial statement effects of a tax position taken for tax return purposes when it is more likely than not that the person will not be sustained upon examination by a taxing authority. The Organization does not believe it has taken any material uncertain tax positions, and accordingly, it has not recorded any liability for unrecognized tax benefits. Additionally, the Organization has filed IRS Form 990 information returns, as required, and all other applicable returns in jurisdiction where so required. For the years ended September 30, 2022 and 2021, there were no interest or penalties recorded or included in the consolidated statements of operations. X X X X X X X 1 JNB & Associates 21 Water Street Amesbury MA 01913 Consultant 0 0 51333 -51333 51333 -51333 MA Golf Tournament 173050 155050 18000 4259 66578 Heywood 5k 11780 9440 2340 2340 446 1 184830 164490 20340 2340 4259 67024 73623 -53283 1 1 X 1 X 1 X 1 1 1 0 1 1 2039931 2039931 0.01170 30417843 19325646 11092197 0.06350 32457774 19325646 13132128 0.07520 2488742 2488742 0.01430 45988 45988 0.00030 2534730 2534730 0.01460 34992504 19325646 15666858 0.08980 17867 17867 0.00010 236034 236034 0.00140 253901 253901 0.00150 1 3604428 27677855 37054539 -9376684 X 1 1 1 1 Henry Heywood Memorial Hospital 242 Green Street Gardner MA 01440 www.heywood.org 2036 X X X Henry Heywood Memorial Hospital 1 0 0 1 X X X X X X X X X 20 1 1 1 1 X www.heywood.org/about-us/community-benefit X http://www.chna9.com/ X X 1 20 1 www.heywood.org/about-us/community-benefit 0 1 X 150.000000000000 300.000000000000 X 1 1 X X X X 1 X www.heywood.org/about-us/community-benefit/patient-financial-services X www.heywood.org/about-us/community-benefit/patient-financial-services X www.heywood.org/about-us/community-benefit/patient-financial-services X X X X X 1 X X 0 X X X X 1 X 0 0 Henry Heywood Memorial Hospital Part V, Section B, Line 5: In 2021, Heywood Healthcare conducted a comprehensive Community Health Needs Assessment (CHNA). A priority of the health assessment is to understand the needs of under-resourced populations and to identify and prioritize health issues and related socioeconomic determinants of health. Health disparities, health equity, and "communities within communities" received special attention during the assessment. Supplemental qualitative data collected from 1,341 Surveys and 18 Focus Groups with 200+ participants provided information and perceptions from under-represented racial/ethnic, socioeconomic, and geographic groups. Henry Heywood Memorial Hospital Part V, Section B, Line 6a: The CHNA was a collaborative effort conducted by Heywood Hospital and Athol Hospital. The assessment focuses on the 15 primary communities served by Heywood and Athol Hospitals. The data was analyzed and presented in three ways the Heywood Healthcare total service area of 15 communities, the Heywood Hospital service area of 6 towns, and the Athol Hospital service area of 9 communities. Henry Heywood Memorial Hospital Part V, Section B, Line 6b: The Community Health Needs Assessment was a collaboration between the Montachusett Regional Planning Commission (MRPC), UMass Memorial Health - HealthAlliance-Clinton Hospital (HealthAlliance-Clinton Hospital or HA-C), North Quabbin Community Coalition (NQCC), and the Community Health Network of North Central Massachusetts CHNA 9 Group (CHNA-9). Quantitative data sources came from Massachusetts Public Health Information Tool (Mass PHIT) data from the Massachusetts Department of Public Health (MassDPH); the Youth Risk Behavior Survey (YRBS) data; US Census data (including data from the American Community Survey); and other Commonwealth and Federal Government organizations and agencies. All data were subject to rigorous review, fact-checking, and verification processes. Staff at MRPC was responsible for conducting research and analysis efforts. Heywood Healthcare leadership assembled a CHNA Advisory Group to advise leadership on the process and the plan's strategic objectives. The advisory members are well-versed in the region's health needs. They include hospital department heads, patients, residents, community-based organizations and health service partners, community coalitions, public health officials, and local schools. Leadership Team members assisted with analyzing and reviewing the report. Other organizations and individuals also contributed to the assessment: Groups included the Gardner Community Action Team, Patient & Family Advisory Council, Clinton Area Partnership, Gardner Chamber of Commerce, North Quabbin Food Alliance, Clinton Community Stewards, Schwartz Rounds, CHNA-9 Behavioral Health Mental Health Substance Use Working Group, Youth Change Leaders, Montachusett Joint Transportation Group, North Central Homelessness Task Force, Gardner Area Interagency Team, Heywood Healthcare Care Transitions Group, CHNA 9 Racial Justice WorkGroup, Providers focused on serving LGBTQ+individuals with disabilities, and Veterans. Henry Heywood Memorial Hospital Part V, Section B, Line 7d: The CHNA findings were reported to the hospital leadership, the Community Benefits Committee, and community members. Discussions with these groups informed the prioritization of health needs and strategy development. These priority categories continue from the previous CHNA-CHIP process, as they represent ongoing, critical needs, especially for key populations, and several initiatives are still in progress to address them. The CHIP strategies address the pandemic's broader social and economic impacts highlighted in the 2021 CHNA. Henry Heywood Memorial Hospital Part V, Section B, Line 11: See Part VI Ln 2, 4, 5, 6, 7. Part I, Line 7: The costing method used to calculate the amounts reported in the table in Part I, was based on the cost to charge ratio derived from the supplied Worksheet 2, in the IRS Schedule H instructions. Part II, Community Building Activities: Henry Heywood Memorial 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 specific health needs of the under-served and collaborating with others to enhance quality and contain the growth of community healthcare costs. Part III, Line 2: The Organization used the cost-to-charge ratio as its costing methodology to calculate bad debt expense at cost. Part III, Line 4: Patient accounts receivable are recorded at net realizable value based on certain assumptions determined by each payor. For third-party payors including Medicare and Medicaid, the net realizable value is based on the estimated contractual reimbursement percentage, which is based on current contract prices or historical paid claims data by payor. For self-pay accounts receivable, which include patients who are uninsured and the patient responsibility portion for patients with insurance, the net realizable value is determined using estimates of historical collection experience. These estimates are adjusted for estimated conversions of patient responsibility portions, expected recoveries, and any anticipated changes in trends.Patient accounts receivable can be impacted by the effectiveness of the Organization's collection efforts. Additionally, significant changes in payor mix, business office operations, economic conditions, or trends in federal and state governmental healthcare coverage could affect the net realizable value of accounts receivable by monitoring historical cash collections, as well as by analyzing current period net revenue and admissions by payor classification, aged accounts receivable by payor, days revenue outstanding, the composition of self-pay receivables between pure self-pay patients, and the patient responsibility portion of third-party insured receivables. Final Settlements for some payors and programs are subject to adjustment based on administrative review and audit by third parties. Part III, Line 8: As Henry Heywood Memorial Hospital operates at a loss from Medicare, the shortfall could be treated as community benefit as there are no other funds available to subsidize the loss. The allowable costs on line 6 were obtained from our FY 2022 Medicare Cost Report, Worksheet D schedules. Part III, 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 of guarantor is unable to provide the necessary information, Heywood Hospital may make reasonable efforts to obtain any additional information from other sources. Information the Hospital obtains will be maintained in accordance with applicable federal and state privacy and security laws. The screening and application process for public health insurance programs is done through 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 secure 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 required 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. The Hospital has no role in determination of program eligibility made by the Commonwealth, but at the patient's request may take a direct role in appealing decisions made by the Commonwealth to ensure accurate and timely adjudication of all hospital bills. If the patient does not comply with the requests for documentation, then our standard collection procedures apply. Part VI, Line 2: Needs Assessment: In addition to conducting the CHNA, the organization monitors hospital data and actively engages with the hospital leadership team and Community Benefits Advisory Committee to continuously monitor and assess any changing or emerging community and healthcare needs. Part VI, Line 3: Role of Hospital Certified Financial Counselors and other Finance Staff: The hospital will try to identify available coverage options for patients who may be uninsured or underinsured with their current insurance program when the patient is scheduling their services, while the patient is in the hospital, upon discharge, and for a reasonable time following discharge from the hospital. The hospital will direct all patients seeking available coverage options, or those that the hospital determines may be eligible, to the hospital's patient financial counseling to screen for eligibility in an appropriate coverage option. The hospital will then assist the patient in applying for the appropriate coverage options that are available or notify them of availability of financial assistance through the hospital's own internal financial assistance program, if available. Notification Practices: Individual printed notices are available by contacting a Financial Counselor or through the Patient Accounts Office. Notices indicate the criteria used to determine eligibility for MassHealth and the Health Safety Net Trust Fund and where or how patients may apply. The goal of these notices is to assist patients in applying for coverage within a financial assistance program such as MassHealth, Commonwealth Care, Children's Medical Security Plan, Healthy Start, and Health Safety Net. When applicable, the hospital may also assist patients in applying for coverage of services as a Medical Hardship based on the patient's documented income and allowable medical expenses. When a patient contacts the hospital, Patient Accounting, Financial Counseling or Social Service Staff will attempt to identify if a patient qualifies for a public financial assistance program or payment plan. Patients who are already enrolled in a public financial assistance program, such as MassHealth or Health Safety Net, may qualify for certain federal, state and private assistance agencies. Patients may also qualify for additional assistance based on the hospital's own internal criteria for financial assistance, or qualify for coverage of services as a Medical Hardship based on the patient's documented income and allowable medical expenses. The following items outline more specifically the notification process, criteria, and availability of information beyond the signs that are posted in the hospital. 1. The hospital will provide an individual notice of the availability of financial assistance programs and other programs of public assistance to a patient expected to incur charges for which he/she will be personally responsible, exclusive of personal convenience items or services that may not be paid in full by third party coverage. 2. The hospital or its agents will include a notice or statement about Eligible Services to Low Income Patients and other programs of public assistance in its initial bill and subsequent correspondence with the patient. All correspondence will direct the patient where and how they can receive more information or additional assistance and will inform the patient that they may apply or reapply for financial and public assistance before, during or after care, or after collection agency assignment if their situation changes. 3. The hospital will include a notice regarding the availability of financial assistance and other programs of public assistance to Low Income Patients in all written collection actions. The hospital will notify the patient that it offers a payment plan if the patient is determined to be eligible for MassHealth or free care/uncompensated care through the Health Safety Net Trust Fund as a low income patient or due to Medical Hardship. These payment plans are consistent with 1016 CMR 6613.08 (1)(f)(4). The hospital will also offer payment plan options for those individuals who do not qualify for Low Income Patient status. 4. Heywood Hospital will include language on its written notices that reads: "You may be eligible for assistance through our Financial Assistance Program. For eligibility information, please contact our Customer Services Department at 1-800-305-6757." Verbiage may change to accommodate changes of department information. 5. There is no primary language other than English that is spoken by 5% or more of the hospital's service area. Signage and other documentation will be provided in English. The hospital provides translator services for several other languages and this service may be accessed for those individuals whose primary language is not English or Spanish. 6. For cases where the hospital continues to determine eligibility for free care/uncompensated care through the Health Safety Net Trust Fund application, then MassHealth will provide written notice of determination that the patient is or is not eligible within 30 days of receiving a completed application and the required supporting documentation. The vast majority of patients will however be screened via the common intake process and processed through the Virtual Gateway and MA-21 system. 7. Whether the hospital is using the MassHealth application process through the Virtual Gateway or submitting a MassHealth application directly, the hospital will assist the patient in completing the application or intake process for enrollment and eligibility screening. Part VI, Line 4: Community Information: The primary service area served by Heywood Hospital includes Gardner, Templeton, Winchendon, Ashburnham, Westminster, and Hubbardston. The Service Area varies significantly in terms of the demographics, social, and economic factors. Due to these factors, the health disparities and inequities experienced by people in the region vary widely from community to community. The overall population of the Service Area 58,336 has grown a modest 3.7% since 2010. This rate is less than the US overall (5.9%) and the Commonwealth of MA (5.0%). The region's population is predominately white (94.5%), but it is essential to note the change in racial makeup over time and the Hispanic/Latino population's growth since 2000. The growing diversity is reflected in the public-school student population. The Hispanic student population in the Service Area has increased by 45.1% vs. the 29.9% Statewide. The Narragansett (Templeton, Royalston) School Districts and Gardner School District had the most significant increase (200% and 188.9%, respectively) vs. State 50%. The increasing population numbers of non-white racial groups and the diverse mix of languages spoken among patients are reflected in the multicultural and language interpreter services at Heywood Hospital. The Service Area has a notably higher percentage population with veteran status (9.2%) than the State (5.0%) and Nation (6.9%), with Templeton having the most significant veteran status at 11.9%.There are wide-ranging disparities in incomes and poverty rates across the Service Area. The average median household income in 2019 for the area is $77,253 is lower than the State's $81,215. Westminster has the highest MHI ($100,972 per yr), and Gardner has the lowest ($49,679). The poverty rates also vary significantly by town. Perhaps most disheartening is the incredibly higher rates of poverty of those less than five years of age in Hubbardston (19.8%) and Winchendon (40.1%) when compared to the State (14.4%). Part VI, Line 5: Promotion of Community Health: Heywood Hospital's approach to addressing the critical health needs identified by the CHNA is to participate in cross-sector coalitions actively and collaborate with healthcare and behavioral health providers, community and faith-based organizations, and businesses. These collaborations help to develop and implement our plan, goals, and strategies. Partners include Health Equity Partnership of North Central (CHNA9); Gardner Area Interagency Team (GAIT); Montachusett Suicide Prevention Task Force; North Central MA Minority Coalition; Community Health Connections FQHC; GVNA Healthcare; LUK, Inc.; GAAMHA; Gardner Community Action Team (GCAT); Growing Places; Templeton Food Pantry; Worcester County Food Bank; Three Pyramid's; Gardner, Ashburnham, Narragansett, Winchendon, and Westminster Public School Districts, Police Departments, Boards of Health, Senior Centers, and City/Town officials; Winchendon and Gardner Community Action Center; The Winchendon School; Mount Wachusett Community College; Fitchburg State University; North Central Correctional Institution; Worcester County District Attorney; MOC Early Childcare; Aids Project Worcester; Spanish American Center; Montachusett Recovery Club; Open Sky; YOU Inc; Hope of Peace and Education; Gardner Rotary Club; Greater Gardner and North Central MA Chamber of Commerce; United Way of North Central MA; Community Foundation North Central MA. Part VI, Line 6: Heywood Hospital is part of Heywood Healthcare, an independent, community-owned healthcare system serving north-central Massachusetts and southern New Hampshire. It is comprised of Heywood Hospital, Athol Hospital, a 25-bed not-for-profit Critical Access Hospital in Athol, MA; Heywood Medical Group, with primary care physicians and specialists located throughout the region; and the Quabbin Retreat, our premier destination for treatment of mental health and substance misuse. The organization includes six satellite facilities in MA; Heywood Rehabilitation Center, Heywood Family Medicine and Urgent Care in Gardner; Winchendon Health Center and Murdock School-based Health Center in Winchendon; Tully Family Medicine and Walk-in and ACES School-based Health Center in Athol. The organization also includes the Heywood Healthcare Charitable Foundation. Line 7: Community Benefit Report is filed with the Attorney General's Office, State of Massachusetts. 1 Growing Places Garden Project 325 Lindell Ave Leominster MA 01453 100004885 501(c)(3) 11849 0 Increase access to and knowledge about healthy food and disease Three Pyramids 49 Nursery Lane Fitchburg MA 01420 237154260 501(c)(3) 6424 0 Pilot financial empowerment/asset building program for residents in Gardner. Boys & Girls Club of Fitchburg 365 Lindell Avenue Leominster MA 01453 043576700 501(c)(3) 10650 0 To support general operations The Shine Initiative 44 Portland Street Worcester MA 01608 834467250 501(c)(3) 10000 0 Radiant Sponsor May 2022 4 0 Part I, Line 2: Heywood Hospital has reporting systems in place to monitor grantee expenditures within each budget period and within the overall project period. This includes the requirements that grantees submit mid-year and end of year grant reports, to include a detailed report on the project budget expenditures. Heywood Hospital's Community Investment Committee reviews mid and end of year reports for financial and operational compliance to assure that use of funds are consistent with the approved project and budget. Montachusett Home Care Corp files an annual report with the Office of Healthy Communities that contains a summary of how funds are allocated. X 0 1 X X X X X X 0 0 0 0 0 0 0 1 0 Winfield Brown President/CEO 611124 0 146625 0 306889 0 25875 0 45469 0 1135982 0 0 0 Andrew Cocchiarella Past Trustee/Director of Anesth 715000 0 71500 0 107613 0 24105 0 24156 0 942374 0 0 0 Ellen Ray Chief of ER Medicine 602383 0 0 0 0 0 31000 0 26681 0 660064 0 0 0 Saleem Khanani Oncology Physician 508584 0 0 0 25700 0 28203 0 20910 0 583397 0 0 0 Daniel Wilson ER Physician 533830 0 0 0 0 0 0 0 19433 0 553263 0 0 0 Kelly Robinson ER Physician 484388 0 0 0 0 0 31100 0 26009 0 541497 0 0 0 Michael Abbatiello Past Chief Financial Officer 396330 0 59482 0 0 0 30786 0 27687 0 514285 0 0 0 Jessica Darnobid Anesthiology Physician 400462 0 40046 0 23175 0 1232 0 22887 0 487802 0 0 0 Erin O'Hara Trustee 0 314925 0 27872 0 14231 0 7060 0 22301 0 386389 0 0 Elizabeth Nottleson Trustee 0 255458 0 0 0 18000 0 15092 0 1747 0 290297 0 0 Part I, Line 1a Social Club membership dues were paid for Winfield Brown, CEO, per his employment contract. Part I, Line 1b There is no written policy for payment of Social Club Membership dues, this is paid based off an employment contract with the CEO/President. Part I, Line 7 Heywood Healthcare has an incentive (bonus) program for senior administration, directors, and managers that is a predefined percentage of their annual salary. The incentive program is structured on the financial health of the organization as well other indicators based surrounding leadership level. A Massachusetts Development Finance Agency 043431814 2019-11-20 59880000 Refunding and asset acquisition 0 0 0 A 4070000 59880000 2869006 535600 12062698 44412696 2019 1 1 1 1 A 0 0 0 0 0 0 1 A 0 1 0 0 0 0 0 0 1 A 1 Eliot Nottleson Family relationship with Elizabeth Nottleson, Trustee 40643 Employment 0 Kaitlin Fletcher Family relationship with Joyce Fletcher, Trustee 72719 Employment 0 Rozanna Penney Family relationship with Andrew Cocchiarella, Past Trustee 303767 Employment 0 Form 990, Part VI, Section B, line 11b The Form 990 is prepared by a third-party accounting firm with the assistance of the Accounting Department. The Form 990 is reviewed by the Director of Finance and CFO. Then the return is uploaded to the Hospital cyber board for the Board of Trustees to review prior to filing. Form 990, Part VI, Section B, line 12c The Board of Trustees review the Organization's Conflict of Interest policy annually in order to ensure that the Organization's Board of Trustees and Officers are regularly and consistently monitoring and enforcing it. Form 990, Part VI, Section B, line 15 The Board of Trustees holds the sole responsibility of establishing the compensation of the CEO, with the Compensation Committee responsible for review and recommendation of the CEO's compensation. The compensation is determined by considering comparable salary information for officers of other entities of similar size and level of activity, so as to establish a rebuttable presumption for reasonableness. The Compensation Committee also reviews and approves the CEO's recommendation of compensation for the Senior Leadership Team. Form 990, Part VI, Section C, line 19 The Organization makes its 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. Form 990, Part IX, line 11g Physician Fees: Program service expenses 9,074,420. Management and general expenses 0. Fundraising expenses 0. Total expenses 9,074,420. Contracted Services: Program service expenses 1,927,128. Management and general expenses 118,930. Fundraising expenses 0. Total expenses 2,046,058. Temporary Employees: Program service expenses 1,941,471. Management and general expenses 54,120. Fundraising expenses 0. Total expenses 1,995,591. Outside Fees: Program service expenses 31,862,821. Management and general expenses 4,174,821. Fundraising expenses 233,388. Total expenses 36,271,030. Other Professional Fees: Program service expenses 660,728. Management and general expenses 341,926. Fundraising expenses 0. Total expenses 1,002,654. Form 990, Part X, Line 10: Land, Buildings, and Equipment: Section 1.263(a)-3(n) Election: Henry Heywood Memorial Hospital 242 Green Street Gardner, MA 01440 EIN: 04-2103581 Henry Heywood Memorial Hospital is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n). Form 990, Part XI, line 9: Transfer to Affiliates -332,745. Heywood Healthcare Inc 242 Green Street Gardner MA 01440 222720658 Parent Corp MA 501(c)(3) Line 12b, II 0 Athol Memorial Hospital 2033 Main Street Athol MA 01331 042126583 Critical Access Hospital MA 501(c)(3) Line 3 Heywood Healthcare Inc 0 Heywood Medical Group 242 Green Street Gardner MA 01440 043163589 Multi-Spec. Physicians MA 501(c)(3) Line 10 Heywood Healthcare Inc 0 Quabbin Healthcare Inc 242 Green Street Gardner MA 01440 812053488 Behavioral Health MA 501(c)(3) Line 12b, II Heywood Healthcare Inc 0 Heywood Realty Corp 242 Green Street Gardner MA 01440 043327447 Prop. Holding Corp MA 501(c)(2) Heywood Healthcare Inc 0 Heywood Healthcare Charitable Foundation Inc 242 Green Street Gardner MA 01440 222720562 Charitable Foundation MA 501(c)(3) Line 7 Heywood Healthcare Inc 0 Athol Memorial Hospital NMTC Holdings Inc 242 Green Street Gardner MA 01440 822171549 Supporting Organization MA 501(c)(3) Line 12a, I Heywood Healthcare Inc 0 Winchendon Health Foundation Inc 55 Hospital Drive Winchendon MA 01475 042113276 Community Health Care MA 501(c)(3) Line 12d, III-O N/A 0 0 0 0 1 1 0 1 0 0 1 1 1 1 1 1 1 1 1 1 Heywood Realty Corporation K 567089 FMV Heywood Realty Corporation M 552293 FMV Heywood Realty Corporation P 490913 FMV Heywood Realty Corporation D 61938 FMV Heywood Realty Corporation E 155476 FMV