2022-08-18T12:01:56-05:00 2021-09-30 010523282 Berry Dunn McNeil & Parker LLC 2211 Congress St Portland ME 04102 990 2020-10-01 042126583 Athol Memorial Hospital ATHO 9782493511 2033 Main Street Athol MA 01331 Winfield Brown CEO 9782493511 2022-08-17 1 Winfield Brown 999009999 Barbara J McGuan CPA P00219457 2077752387 2022-08-17 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z Winfield Brown 2033 Main Street Athol MA 01331 40239523 0 X www.atholhospital.org X 1918 MA Our vision is to be one of the best independent community hospitals in America. Our mission is to be our communities' trusted choice for exceptional patient-centered care. 21 19 309 24 0 0 1431247 1180795 34037774 39041483 3994 12707 6051 4538 35479066 40239523 12029 1095737 0 0 10947242 12329032 47645 0 137063 22533091 22798636 33540007 36223405 1939059 4016118 36363474 33079219 14346796 14893677 22016678 18185542 X Our mission is to be our communities' trusted choice for exceptional patient-centered care. 0 0 33269527 1095737 39041483 Athol Hospital provides various outpatient services such as an Emergency Room, on-site Cardiac specialists, high tech laboratory, cardio pulmonary testing, a short stay unit, advanced imaging, rehabilitation services, and many others on an outpatient basis. Athol Hospital provides inpatient acute care services, as well as a Swing Bed program, which transitions beds from acute care to sub-acute care to accommodate the rehabilitation needs of recovering patients. Athol Hospital has three provider based practices: one was an established Rural Health Clinic, and the otherwas converted to a Rural Health Clinic in 2020, and the last one is a specialty care practice that focuses onmany areas including Cardiology, Gastroenterology, Orthopedics, Pulmonology, and General Surgery. 33269527 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 36 0 1 309 1 0 0 0 0 0 0 0 0 0 0 0 0 X 21 19 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X Tom Sullivan 9786306157 2033 Main Street Athol MA 01331 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 Andrew Cocchiarella Trustee 0.20 1.40 X 0 884650 27654 Joyce Fletcher Trustee 0.20 1.40 X 0 0 0 Thomas Kane Trustee 0.20 1.40 X 0 0 0 Jim Meehan 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 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 David Spackman Trustee 0.20 1.40 X 0 0 0 John Skrzypczak Trustee 0.20 1.40 X 0 0 0 Craig Twohey Trustee 0.20 1.40 X 0 0 0 Debra Vescovi Trustee 0.20 1.40 X 0 0 0 Winfield Brown President/CEO 0.20 41.40 X X 0 911680 66625 Elizabeth Nottleson Past Trustee 0.20 1.40 X 9000 276879 7342 John Flick Past Trustee 0.20 1.40 X 0 0 0 Michael Abbatiello Chief Financial Officer 0.00 40.00 X 0 430232 45413 Anne Nolan Infection Control Nurse 40.00 0.00 X 136893 0 16189 Bethany Maselli ER RN 40.00 0.00 X 134252 0 22331 Roxanne Dunn Director of ER 40.00 0.00 X 129809 0 3687 Karen Landry OR RN 40.00 0.00 X 127908 0 17051 Kathy Ledford ER RN 36.00 0.00 X 116720 0 17221 654582 2503441 223513 12 0 1 0 Quartulli & Associates Inc PO Box 423 Gardner MA 01440 PT & OT Services 1011935 Medefis Inc 2121 North 117th Ave Omaha NE 68164 Medical Staffing Services 768725 Labcorp of America PO Box 12140 Burlington NC 27216 Clinical Laboratory Services 508914 Hospital Medicine Solutions PO Box 660 Exeter NH 03833 Medical Staffing Services 385553 Tele-Physicians PC MA 1768 Business Center Drive Reston VA 20190 Telemedicine Services 308425 6 994686 186109 1180795 Patient Service Revenue 622100 93439661 93439661 Miscellaneous Revenue 622100 487508 487508 Cafeteria Revenue 622100 115590 115590 Provision for Bad Debts 622100 -1877995 -1877995 Contractual Allowances/Charity Ca 622100 -53123281 -53123281 39041483 7707 7707 4538 0 4538 4538 4538 5000 0 5000 5000 5000 40239523 38925893 0 132835 X 1093237 1093237 2500 2500 9000 9000 9776294 9652404 123890 111260 109851 1409 1695449 1673983 21466 737029 727698 9331 53417 53417 249 249 181 181 12375557 11675961 645238 54358 4940 150 4790 378689 280287 98382 20 2137 2137 2008950 1594849 414101 3347 3347 17956 17956 -4738 -4738 723193 723193 187162 17247 169915 Medical Supplies 3488540 3488540 Allocations 2742569 1432457 1232292 77820 Miscellaneous 597600 572952 24648 Food 218887 196516 22296 75 36223405 33269527 2816815 137063 X 11305 11406 8995308 1375950 208495 115811 4655529 8067925 11439300 11439300 330386 358781 180724 148639 18797999 12897946 5990249 5900053 3038000 1847205 1509178 5000 3814149 36363474 33079219 3386473 7403907 248986 638993 634492 10321330 6606292 14346796 14893677 X 20299006 16214427 1717672 1971115 22016678 18185542 36363474 33079219 X 4016118 171187 -8018441 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 4130 4130 0 Part II-B, Line 1: The Organization pays dues to various associations, a portion of which is attributable to lobbying expenses. 1509178 108437 257589 28000 1847204 1613835 357693 3847 466004 193 1509178 1518883 750616 -23962 630565 1137 1613835 1503083 705622 25302 713855 1269 1518883 1370811 706454 63874 636832 1224 1503083 0.00000 0.85422 0.14578 0 0 104490 104490 8046088 5302852 2743236 9832950 7376883 2456067 814471 218211 596260 5900053 Estimated Malpractice Receivable 5000 Due from Affiliate 3809149 3814149 Advances from Third Party Payors 4925568 Estimated Settlements with Third Party Payors 730390 Estimated Malpractice Liability 5000 Due to Affiliate 945334 6606292 X Part V, Line 4: The Organization's endowment includes both donor restricted endowment funds and funds designated by the Board of Trustees to function as endowments. As required by GAAP, net assets associated with endowment funds, including funds designated by the Board of Trustees to function as endowments, are classified and reported based on the existence or absence of donor-imposed restrictions. The Organization has interpreted state law as requiring realized and unrealized gains of permanently restricted net assets to be retained in a temporarily restricted net asset classification until appropriated by the Organization's Board of Trustees and expended. State law allows the Board to appropriate as much of the net appreciation of permanently restricted net assets as is prudent considering the Organization's long and short-term needs, present and anticipated financial requirements, expected total return on investments, price-level trends, and general economic conditions. 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, 2021 and 2020, 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 46667 -46667 46667 -46667 MA 1 1 X 1 X 1 X 1 1 1 0 1 1 546067 362351 183716 0.00510 8175284 8138596 36688 0.00100 8721351 8500947 220404 0.00610 489709 489709 0.01350 98565 98565 0.00270 1095737 1095737 0.03020 1684011 1684011 0.04640 10405362 8500947 1904415 0.05250 30086 30086 0.00080 30086 30086 0.00080 1 708896 7469022 7995370 -526348 X 1 1 1 1 Athol Memorial Hospital 2033 Main Street Athol MA 01331 www.atholhospital.org 2226 X X X X Athol Memorial Hospital 1 0 0 1 X X X X X X X X 20 1 1 1 1 X https://www.atholhospital.org/about-us/community-benefit X X 1 20 1 https://www.atholhospital.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 X 1 X X 0 X X X 1 X 0 0 Athol Memorial Hospital Part V, Section B, Line 5: In 2021, Athol Hospital conducted a comprehensive Community Health Needs Assessment (CHNA). A priority of the health assessment is to understand the needs of under-resourced populations and 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. Athol Memorial Hospital Part V, Section B, Line 6a: The CHNA was a collaborative effort conducted by Athol Hospital and Heywood Hospital. The assessment focuses on the 15 primary communities served by the two hospitals. The data was analyzed and presented in three ways the Heywood Healthcare total service area of 15 communities, the Athol Hospital service area of 9 communities, and the Heywood Hospital service area of 6 towns. Athol 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. Organizations include 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. Athol 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. Athol Memorial Hospital Part V, Section B, Line 11: Athol Memorial Hospital - The Community Health Improvement Plan (CHIP) prioritizes health focus areas (Social Determinants, Interpersonal Violence and Injuries, Mental Health and Substance Use, and Wellness and Chronic Disease). It identifies at risk populations (racial and ethnic minorities, older adults, veterans, low socioeconomic, and youth/adolescents). The CHIP outlines the strategies and community partners the hospital will partner with to respond to the health needs. Heywood's approach to addressing the critical health needs is to collaborate with cross sector coalitions, healthcare and behavioral health providers, community, and faith-based organizations and businesses to develop and implement our plan, goals, and strategies. We engage community-based organizations, our P.F.A.C, and the Community Benefits Advisory Committee in the development of the CHIP to ensure that the CHIP has input from persons who represent the broad interests and special knowledge of the significant health needs of our community. 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: Athol Memorial Hospital's Community Benefits Mission Statement is "Athol 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 Athol 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 2021 Medicare Cost Report, Worksheet D schedules. Part III, Line 9b: Athol Hospital provides patients with information about financial assistance programs that are available through the Commonwealth of MA or through Athol Hospital's own financial assistance program, which may cover all or some of their unpaid hospital bills. For those patients that request such assistance, Athol 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 Athol 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, Athol 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. Athol Hospital specifically assists the patient in completing the application and secure the necessary documentation required by the applicable financial assistance program. Athol 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: 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. Athol 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 Athol Hospital includes Athol, Erving, New Salem, Orange, Petersham, Phillipston, Royalston, Warwick, and Wendell. The Service Area population of 28,102 has remained essentially the same over the past ten years. The Racial Makeup of the service area is 95% white and non-Hispanic; the most significant population growth between 2010-2019 is the Hispanic/Latino. The Service Area has a median age is ten years higher than the State and Nation and a higher percentage population with veteran status (9.3%), State (5.0%), and Nation (6.9%). The rural nature of Athol Hospital's communities, the social isolation, and the lack of public transportation makes it more challenging for older adults, individuals with disabilities, or those that lack transportation to access basic daily needs. Overall, the services area has a lower median household income ($63,745) than the State ($81,215). The poverty rate for the service area (8.9%) is lower than the State (10.3); however, higher rates exist in the towns of Athol, Erving, and Wendell. Veterans in the Service Area are better off than the State and Nation regarding health outcomes and financial stability, but disparities in unemployment and disability compared to non-veterans are prevalent throughout the Service Area. Part VI, Line 5: Promotion of Community Health: Athol 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 North Quabbin Community Coalition, Athol YMCA, Town Boards of Health, Police Departments and School Districts, LUK, Inc, LifePath, Seeds of Solidarity, Quabbin Food Harvest, Athol and Orange Senior Centers, GAAMHA, Woods Ambulance and Medi-van Services, Mount Wachusett Community College, Fitchburg State University, North Central Mass Minority Coalition, Gardner Area Interagency Team, Montachusett Suicide Prevention Task Force,. Part VI, Line 6: Athol Hospital, a 25-bed not-for-profit Critical Access Hospital in Athol, MA, is part of Heywood Healthcare, an independent, community-owned healthcare system serving north-central Massachusetts and southern New Hampshire. In addition to Athol Hospital, the health system includes Heywood Hospital; Heywood Medical Group; the Quabbin Retreat; Heywood Rehabilitation Group; Murdock and ACES School-based Health Centers; and the Winchendon Health Center. Part VI, Line 7 Community Benefit Report is filed with the Attorney General's Office, State of Massachusetts. 1 Ralph C Mahar Regional School 507 South Main Street Orange MA 01364 Public School 10004 Operations Support Athol-Royalston Regional School 1062 Pleasant Street Athol MA 01331 Public School 10005 Operations Support Pioneer Valley Regional School District 97 F Summer Turner Road Northfield MA 01360 Public School 12005 Operations Support Athol Memorial Hospital NMTC Holdings 242 Green Street Gardner MA 01440 822171549 501(c)(3) 131723 Operations Support Heywood Realty Corporation 242 Green Street Gardner MA 01440 043327447 501(c)(2) 929500 Operations Support 4 1 Part I, Line 2: Athol Memorial 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. Athol Memorial 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. 0 0 0 0 0 0 0 1 0 Winfield Brown President/CEO 0 588587 0 72782 0 250311 0 25100 0 41525 0 978305 0 0 Andrew Cocchiarella Trustee 0 848900 0 35750 0 0 0 4449 0 23205 0 912304 0 0 Michael Abbatiello Chief Financial Officer 0 368247 0 61985 0 0 0 19500 0 25913 0 475645 0 0 Elizabeth Nottleson Past Trustee 9000 276879 0 0 0 0 0 5537 0 1805 9000 284221 0 0 Bethany Maselli ER RN 134252 0 0 0 0 0 2014 0 20317 0 156583 0 0 0 Anne Nolan Infection Control Nurse 130579 0 6314 0 0 0 1306 0 14883 0 153082 0 0 0 Part I, Line 3 The related organization, Henry Heywood Memorial Hospital, uses the following methods to establish the compensation of the organization's CEO: - Compensation committee - Independent compensation consultant - Form 990 of other ogranizations - Written employment contract - Compensation survey or study - Approval by the board or compensation committee 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. 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 All Officers and the CEO's salaries are paid by related corporations. The salaries are determined by the Board of Trustees, considering comparable salary information for Officers of other entities of similar size and level of activity. 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 4,871,638. Management and general expenses 0. Fundraising expenses 0. Total expenses 4,871,638. Contracted Services: Program service expenses 511,780. Management and general expenses 0. Fundraising expenses 0. Total expenses 511,780. Temporary Employees: Program service expenses 716,997. Management and general expenses 0. Fundraising expenses 0. Total expenses 716,997. Outside Fees: Program service expenses 4,428,947. Management and general expenses 473,088. Fundraising expenses 54,358. Total expenses 4,956,393. Other Professional Fees: Program service expenses 1,146,599. Management and general expenses 172,150. Fundraising expenses 0. Total expenses 1,318,749. Form 990, Part X, Line 10: Land, Buildings, and Equipment: Section 1.263(a)-3(n) Election: Athol Memorial Hospital 2033 Main Street Athol, MA 01331 EIN: 04-2126583 Athol 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 Affiliate -8,018,441. Heywood Healthcare Inc 242 Green Street Gardner MA 01440 222720658 Parent Corp MA 501(c)(3) Line 12b, II 0 Henry Heywood Memorial Hospital 242 Green Street Gardner MA 01440 042103581 Acute Care 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 1 1 1 0 0 0 1 0 1 1 0 1 1 1 1 1 0 0 Heywood Realty Corporation B 929500 FMV Heywood Realty Corporation K 122651 FMV