2021-08-16T13:43:47-05:00 2020-09-30 990 2019-10-01 042103565 EMERSON HOSPITAL EMER 9782878709 133 OLD ROAD TO NINE ACRE CORNER CONCORD MA 01742 MICHAEL HACHEY SR VP CHIEF FINANCIAL OFFICER 9782878709 2021-08-16 2019 2022-09-23 18:48:47Z MICHAEL HACHEY 133 OLD ROAD TO NINE ACRE CORNER CONCORD MA 01742 264274321 0 X WWW.EMERSONHOSPITAL.ORG X 1924 MA EMERSON HOSPITAL IS AN ACUTE CARE NON PROFIT COMMUNITY HOSPITAL THAT OFFERS A WIDE RANGE OF MEDICAL, SURGICAL AND SPECIALTY CARE TO APPROXIMATELY 300,000 INDIVIDUALS IN 25 TOWNS. 17 11 2516 425 3449473 585722 2024434 275996 258352359 237135604 65318 169087 11629602 25862009 272071713 263442696 0 0 0 0 144617291 155701560 0 0 0 123765756 130376620 268383047 286078180 3688666 -22635484 213357704 233345597 163484534 188100053 49873170 45245544 X THE MISSION OF EMERSON HOSPITAL IS TO DELIVER HIGH QUALITY, SAFE AND COST-EFFECTIVE CARE TO OUR PATIENTS AND TO MAINTAIN A PROFESSIONAL AND RESPECTFUL ENVIRONMENT FOR ALL MEMBERS OF THE EMERSON HOSPITAL COMMUNITY. WE DEFINE HIGH QUALITY AS MEETING OR EXCEEDING THE REQUIREMENTS OF OUR CUSTOMERS: PATIENTS, PHYSICIANS, EMPLOYEES, THE COMMUNITY AND PAYERS. 0 0 77949487 79571933 EMERSON HOSPITAL IS AN 199-BED ACUTE CARE NON-PROFIT COMMUNITY HOSPITAL THAT PROVIDES SERVICES TO INPATIENTS. THE FACILITY INCLUDES THE FOLLOWING UNITS: THREE MEDICAL/SURGICAL UNITS, A LOCKED BEHAVIORAL HEALTH UNIT, A LOCKED MATERNITY/OBSTETRICS UNIT, A CRITICAL CARE UNIT, A SHORT TERM REHABILITATION TRANSITIONAL CARE UNIT, A PEDIATRICS UNIT AND A SPECIAL CARE NURSERY. EMERSON HOSPITAL SERVED 7,096 INPATIENTS AND 1,493 OBSERVATION PATIENTS FOR A TOTAL OF 35,790 PATIENT DAYS. 149482043 152593372 EMERSON HOSPITAL IS AN ACUTE CARE NON-PROFIT COMMUNITY HOSPITAL THAT PROVIDES A VARIETY OF SERVICES ON AN OUTPATIENT BASIS. EMERSON PERFORMED 1,216,535 PROCEDURES ON OUTPATIENTS DURING THE FISCAL YEAR ENDING SEPTEMBER 30, 2020 IN ADDITION, THE HOSPITAL ALSO HAD 26,109 EMERGENCY DEPARTMENT VISITS AND 64,804 REHABILITATION SERVICE VISITS. 4868956 4970299 EMERSON HOSPITAL PROVIDES HOMECARE SERVICES. HOME CARE IS AVAILABLE 24 HOURS PER DAY AND 7 DAYS PER WEEK TO HOMEBOUND PATIENTS OF ALL AGES. PRIMARY HOMECARE SERVICES INCLUDE PROFESSIONAL NURSES WHO DELIVER MEDICAL CARE AS ORDERED BY PHYSICIANS, REHABILITATION PROFESSIONALS WHO WORK WITH PATIENTS TO RESTORE FUNCTION AND INDEPENDENCE AND HOME HEALTH AIDES WHO ASSIST WITH PERSONAL CARE TASKS. FOR THE FISCAL YEAR ENDING SEPTEMBER 30, 2020 EMERSON HOSPITAL SAW 1,680 NEW HOMECARE PATIENTS. 232300486 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 282 0 1 2516 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 X 17 11 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X MICHAEL HACHEY 9782878709 OLD ROAD TO NINE ACRE CORNER CONCORD MA 01742 GLORIA CLOUGH CHAIR 12.00 X X 0 0 0 PAUL BIRCH VICE CHAIR 6.00 X X 0 0 0 JAMES DIGIOVANNI SECRETARY 6.00 X X 0 0 0 RICHARD CHURCHILL TREASURER 6.00 X X 0 0 0 CHRISTINE SCHUSTER EX OFFICIO PRESIDENT & CEO 60.00 X X 1214571 0 233146 JEFF CAMPBELL DIRECTOR 6.00 X 0 0 0 CHRISTOPHER COLOIAN DIRECTOR 6.00 X 0 0 0 EILEEN DEIGNAN MD DIRECTOR 6.00 X 0 0 0 ROSE ANN GIORDANO DIRECTOR 6.00 X 0 0 0 JOHN HICKLING DIRECTOR 6.00 X 0 0 0 DAVID LAUTZ MD DIRECTOR 6.00 X 1419582 0 43020 JOHN LIBERTINO MD DIRECTOR 6.00 X 201287 0 0 DAVID ROSE MD DIRECTOR 6.00 X 7500 0 0 WILLIAM RYAN DIRECTOR 6.00 X 0 0 0 JILL STANSKY DIRECTOR 6.00 X 0 0 0 JAMES STREET MD DIRECTOR 6.00 X 0 0 0 MICHAEL ZAK DIRECTOR 6.00 X 0 0 0 THOMAS LAMATTINA MD EX OFFICIO MED STAFFPRESI 6.00 X X 60000 0 0 CHRISTINA TROTTA ASSISTANT SECRETARY 40.00 X 86574 0 10311 MICHAEL HACHEY SR VP CFO 40.00 X 543716 0 73122 ERIC STASTNY CHIEF OPERATING OFFICER 40.00 X 511249 0 82007 JOYCE WELSH VP PATIENT CARE SERVICES 40.00 X 365388 0 44428 BARRETT KITCH MD SR VP CLINICAL AFFAIRS 40.00 X 406634 0 4400 CHRISTINE GALLERY SR VP PLANNING & MARKETING 40.00 X 351905 0 67873 CRAIG NESTA VP EMERSON PRACTICE AS 40.00 X 295950 0 34127 RENEE FOSBERG CHIEF INFORMATION OFFICER 40.00 X 249260 0 0 LEANNE ESPINDLE DIRECTOR,PERIOPERATIVE 40.00 X 226130 0 10311 5939746 0 602745 240 0 1 0 SODEXO INC & AFFILIATES PO BOX 81049 WOBURN MA 01813 ENVIRONMENTAL/CAFETERIA SERVICES 4137821 MASSACHUSETTS GENERAL PHYSICIANS 151 MERRIMAC STREET 4TH FLOOR BOSTON MA 02114 MEDICAL SERVICES 2299583 STERLING CONSTRUCTION 134 HEYWOD RD STERLING MA 01564 CONSTRUCTION SERVICES 2272065 ADVANTEDGE HEALTHCARE SOLUTIONS PO BOX 674415 DETROIT MI 48267 ACCOUNTS RECEIVABLE SERVICE 2010861 PARTNERS COMMUNITY PHYSICIANS 39 REVOLUTION DR SUITE 1030 SOMERVILLE MA 01245 MEDICAL MANAGEMENT 2004323 82 275996 275996 NET PATIENT REVENUE 621990 237135604 237135604 237135604 64588 64588 706610 393124 313486 313486 126665 186821 543000 438501 104499 104499 104499 CAFETERIA AND OTHER 900099 23868802 23868802 LAB SERVICES 621500 3262652 3262652 GAIN ON SWAP 623990 -1582931 -1582931 25548523 263442696 261235570 3449473 -1518343 3354285 2851143 503142 129095009 109730757 19364252 2918549 2480767 437782 11898678 10100221 1798457 8435039 7169783 1265256 16467046 16467046 614863 614863 4072121 4072121 16767 16767 1897394 1897394 1442712 1442712 609685 609685 12715897 8824741 3891156 398607 398607 2307449 2307449 10252661 10252661 2110183 2110183 SUPPLIES 46368904 46312894 56010 REPAIRS & MAINTENANCE 12369636 11364068 1005568 MISCELLANEOUS 9759074 3604388 6154686 BILLING COLLECTION 3075534 3075534 5898087 3125250 2772837 286078180 232300486 53777694 0 46404540 64497457 34549184 27850647 2865306 2164177 3201490 4772353 7096705 7887512 356917350 247324475 109729708 109592875 4474061 5724360 10582519 5036710 273697 213357704 233345597 37442105 32034138 54605000 52149069 15054025 15837938 3000000 56383404 85078908 163484534 188100053 X 45563733 40748634 4309437 4496910 49873170 45245544 213357704 233345597 X -22635484 865963 17141894 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 8384 1 8383 0 16767 0 PART II-B, LINE 1: THE AMOUNTS INCLUDED IN LOBBYING EXPENSES REPRESENT A PORTION OF DUES PAID TO ORGANIZATIONS WHO LOBBY ON BEHALF OF THEIR MEMBERS AND THE HOSPITAL INDUSTRY AS A WHOLE. 2315726 121795 127798 112721 2452598 2197719 111039 109254 102286 2315726 2084029 99540 104363 90213 2197719 1868612 195907 100612 81102 2084029 1606221 255473 81251 74333 1868612 0 1 1 2722757 2722757 186576572 117627107 68949465 159744329 127754116 31990213 7873692 1943252 5930440 109592875 ACCRUED PENSION PAYABLE 45806892 ACCRUED PAYROLL 18954052 FIN47 REMEDIATION OBLIGATION 739700 DEFERRED REVENUE 204581 BOND INTEREST RATE SWAP LIABILITY 3090726 DUE TO THIRD PARTY PAYORS 16282957 85078908 X 267527610 1582931 3260552 4843483 262684127 758569 758569 263442696 286078180 0 286078180 0 286078180 PART V, LINE 4: THE PRINCIPAL BALANCE OF THE ENDOWMENT FUND IS PERMANENTLY RESTRICTED FROM USE. INCOME ON THE ENDOWMENT FUND THAT HAS BEEN DESIGNATED FOR A SPECIFIC PURPOSE BY THE DONOR IS USED AS SPECIFIED. OTHERWISE THE INCOME IS USED TO ADVANCE THE ORGANIZATION'S GENERAL CHARITABLE PURPOSE. PART X, LINE 2: IN FISCAL 2020 THERE WAS NO FOOTNOTE IN THE AUDITED FINANCIAL STATEMENT REFERENCING FIN48 BECAUSE THE ORGANIZATION DID NOT FILE UNCERTAIN TAX POSITIONS. PART XI, LINE 2D - OTHER ADJUSTMENTS: NET ASSETS RELEASED FROM RESTRICTIONS FOR FOUNDATION 3,260,552. PART XI, LINE 4B - OTHER ADJUSTMENTS: NON OPERATING GAINS FROM AUDIT REPORT 482,573. CONTRIBUTIONS 275,996. PART XII, LINE 2D - OTHER ADJUSTMENTS: ROUNDING 1 1 1 X 1 X 1 1 0 1 1 2837564 107030 2730534 0.00950 14669753 10873434 3796319 0.01330 5361250 4048758 1312492 0.00460 22868567 15029222 7839345 0.02740 201571 201571 0.00070 22000 22000 0.00010 223571 223571 0.00080 23092138 15029222 8062916 0.02820 1 2048161 49803355 63633526 -13830171 X 1 1 1 RADIATION ONCOLOGY CENTER MANAGEMENT COMPANY LLC OPERATE A RADIATION ONCOLOGY FACILITY 0.50000 0.00000 0.00000 2 SHIELDS IMAGING MANAGEMENT AT EMERSON HOSPITAL LLC IMAGING SERVICES 0.50000 0.00000 0.00000 1 1 EMERSON HOSPITAL 133 OLD ROAD TO NINE ACRE CORNER CONCORD MA 01742 X X X EMERSON HOSPITAL 1 0 0 1 X X X X X X X X 15 1 0 0 1 X WWW.EMERSONHOSPITAL.ORG X 1 15 1 WWW.EMERSONHOSPITAL.ORG 0 1 X 200.000000000000 400.000000000000 X X X 1 1 X X X X 1 X WWW.EMERSONHOSPITAL.ORG X WWW.EMERSONHOSPITAL.ORG X X X X X 1 X X 0 X X 1 X 0 1 EMERSON HOSPITAL PART V, SECTION B, LINE 5: IN CONDUCTING THE MOST RECENT CHNA, THE HOSPITAL TOOK INTO ACCOUNT INPUT FROM KEY INFORMANT INTERVIEWS WITH COMMUNITY RESIDENTS AND STAKEHOLDERS. INDIVIDUALS CONSULTED INCLUDED LOCAL AND STATE PUBLIC HEALTH DEPARTMENTS, REPRESENTATIVES FROM COUNCILS ON AGING, HOUSING AUTHORITIES, SCHOOL NURSES, GUIDANCE COUNSELORS, THE UNITED WAY, LOCAL VETERAN'S AGENTS, THE DOMESTIC VIOLENCE NETWORK, EMERSON HOSPITAL'S BEHAVIORAL HEALTH SERVICES, AND REPRESENTATIVES OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS. EMERSON HOSPITAL PART V, SECTION B, LINE 11: EMERSON HOSPITAL IS FOCUSING PROGRAMS AND PLANNING ON THE KEY AREAS IDENTIFIED IN THE CHNA INCLUDING CANCER PREVENTION, DETECTION, AND CARE; MENTAL HEALTH AND SUBSTANCE ABUSE CARE; CARE COORDINATION FOR ELDERLY PATIENTS; DOMESTIC VIOLENCE AWARENESS AND ADVOCACY; AND HEALTH CARE SERVICES IN MAYNARD, MASSACHUSETTS. THE COMMUNITY BENEFITS ADVISORY COMMITTEE MEETS QUARTERLY TO REVIEW PROGRESS AND PROVIDE FURTHER INPUT. ALL KEY AREAS ARE IN THE PROCESS OF BEING ADDRESSED. EMERSON HOSPITAL PART V, SECTION B, LINE 18E: REPORTING TO CREDIT AGENCIES IS NOT PERMITTED UNDER EMERSON'S CREDIT AND COLLECTION POLICY. ALTHOUGH LIENS AND LAWSUITS ARE PERMITTED, THE HOSPITAL DID NOT EXECUTE ANY LAWSUITS OR LIENS DURING THE 2019 TAX YEAR. THE HOSPITAL DOES ENGAGE COLLECTION AGENCIES TO PURSUE UNDPAID BALANCES, BUT DOES NOT ALLOW THE COLLECTION AGENCIES TO REPORT TO CREDIT AGENCIES, FILE LAWSUITS OR PLACE LIENS. EMERSON HOSPITAL PART V, SECTION B, LINE 24: ALL PATIENTS REGARDLESS OF INSURANCE OR FINANCIAL MEANS ARE CHARGED THE SAME STANDARD RATE AS DETERMINED BY EMERSON HOSPITAL ON A PERIODIC BASIS. IF THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE OR PARTIAL FREE CARE, DISCOUNTS ARE THEN APPLIED TO CHARGES. PART I, 7F EMERSON HOSPITAL IS A NON-PROFIT ACUTE CARE COMMUNITY HOSPITAL THAT SERVES APPROXIMATELY 300,000 RESIDENTS IN 25 TOWNS. EMERSON WAS INCORPORATED AS TAX-EXEMPT INSTITUTION IN 1911 AND, SINCE THAT TIME HAS BEEN COMMITTED TO PROVIDING BOTH EMERGENCY AND NON-EMERGENCY CARE TO ALL IN NEED, REGARDLESS OF THEIR ABILITY TO PAY. PART I, LINE 3C: EMERSON HOSPITAL USES FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE. PART I, LINE 6A: THE ANNUAL COMMUNITY BENEFIT'S REPORT IS DISTRIBUTED TO THE HOSPITAL BOARD OF DIRECTORS AND TO THE COMMUNITIES SERVED BY THE HOSPITAL. THE REPORT IS ALSO AVAILABLE WITHIN THE HOSPITAL, ON THE WEBSITE, AND AT LOCAL LIBRARIES. IN ADDITION, INFORMATION REGARDING COMMUNITY BENEFITS PLAN ACTIVITIES IS DISSEMINATED THROUGH THE HOSPITAL'S INFORMATIONAL MATERIALS, INCLUDING HEALTHWORKS MAGAZINE, WHICH IS MAILED TO AREA RESIDENTS. THE REPORT IS ALSO FILED WITH THE STATE OF MASSACHUSETTS AND IS AVAILABLE THROUGH THE STATE. PART I, LINE 7: FINANCIAL ASSISTANCE AT COST IS DETERMINED USING THE MASSACHUSETTS HEALTHCARE SAFETY NET ASSESSMENT INCLUDING ANY SHORTFALL FUNDING TO THE HEALTHCARE SAFETY NET POOL. PART III, LINE 4: IN ANALYZING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS OF COLLECTION TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. AFTER ALL COLLECTION EFFORTS HAVE BEEN EXHAUSTED, THE HOSPITAL WILL WRITE OFF THE DIFFERENCE BETWEEN STANDARD RATES AND THE AMOUNTS ACTUALLY COLLECTED.BELOW IS THE PORTION OF THE FOOTNOTE FROM THE AUDITED FINANCIAL STATEMENTS OF EMERSON HEALTH SYSTEM, INC (OF WHICH EMERSON HOSPITAL IS PART OF THE CONSOLIDATION) WHICH CONCERNS BAD DEBT EXPENSE:CONCENTRATION OF CREDIT RISKTHE HEALTH SYSTEM GRANTS CREDIT WITHOUT COLLATERAL TO ITS PATIENTS, MOST OF WHOM ARE LOCAL RESIDENTS AND ARE INSURED UNDER THIRD PARTY PAYOR AGREEMENTS. THE HEALTH SYSTEM RECEIVES A SIGNIFICANT PORTION OF ITS PAYMENTS FOR SERVICES RENDERED FROM A LIMITED NUMBER OF GOVERNMENT AND COMMERCIAL THIRD PARTY PAYORS, INCLUDING MEDICARE, MEDICAID, BLUE CROSS OF MASSACHUSETTS, HARVARD PILGRIM HEALTH CARE, AND TUFTS ASSOCIATED HEALTH PLAN. THE HEALTH SYSTEM HAS NOT HISTORICALLY INCURRED ANY SIGNIFICANT CREDIT LOSSES OUTSIDE THE NORMAL COURSE OF BUSINESS. LINE 2 BAD DEBT EXPENSE AT COST WAS CALCULATED USING THE RATIO OF PATIENT CARE COST TO CHARGES MULTIPLIED BY THE ACTUAL BAD DEBT EXPENSE. PART III, LINE 8: THE COSTING METHODOLOGY USED IN DETERMINING ALLOWABLE COSTS OF CARE FOR MEDICARE IS THE COST TO CHARGE RATIO. MEDICARE COSTS ARE OBTAINED FROM THE COST REPORT FOR ALL SERVICES PROVIDED. PART III, LINE 9B: EMERSON HOSPITAL MAINTAINS VERIFICATION OF A PATIENT'S INSURANCE DATA AND CHARITY CARE ELIGIBLITY PERMANENTLY WITHIN THE HOSPITAL'S MEDITECH DATABASE. AT EACH SERVICE DATE, VERIFICATION OF CHARITY CARE APPROVAL THROUGH THE STATE PROGRAM (HSNO) IS PERFORMED BY THE PATIENT ACCOUNTS DEPARTMENT. PATIENTS WHO ARE NOT ENROLLED ARE SCREENED FOR OTHER HEALTH INSURANCE ENROLLMENT BY REGISTRATION AND PATIENT ACCOUNTS DEPARTMENT.ONCE CHARITY CARE APPROVAL HAS BEEN VERIFIED, ALL BILLING AND COLLECTION ATTEMPTS ARE CEASED. COPAYMENTS AND SOME HOSPITAL SERVICES, I.E. HOME CARE, ARE EXCLUDED FROM THE STATE'S CHARITY CARE PROGRAM. PART VI, LINE 2: EVERY THREE YEARS EMERSON HOSPITAL CONDUCTS A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) TO BETTER UNDERSTAND AND ADDRESS THE HEALTH NEEDS OF THE EMERSON HOSPITAL COMMUNITY AND TO MEET ALL PROVISIONS OF SECTION 501(R) OF THE AFFORDABLE CARE ACT. THE MOST RECENT ASSESSMENT WAS CONDUCTED IN 2016-2018. THE CHNA REPORT CONTAINS SECONDARY DATA FROM EXISTING SOURCES SUCH AS THE U.S. CENSUS, THE MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH, THE CDC BEHAVIOR RISK FACTOR SURVEILLANCE SURVEY DATA, YOUTH RISK BEHAVIOUR SURVEY, AMONG OTHERS IN THE PUBLIC DOMAIN AS WELL AS INPUT FROM INTERVIEWS WITH COMMUNITY RESIDENTS AN STAKEHOLDERS. PART VI, LINE 3: ALL PATIENTS ARE PROVIDED FINANCIAL ASSISTANCE LITERATURE THROUGH THE STATE ON ALL BILLING STATEMENTS AND SIGNS ARE POSTED AT ALL PATIENT REGISTRATION LOCATIONS. WE PROVIDE THE CURRENT YEAR FEDERAL POVERTY GUIDLINES ON ALL BILLING STATEMENTS. IN ADDITION, THESE GUIDELINES ARE POSTED IN OUR INPATIENT AREA, OUTPATIENT AREA AND AT OFFSITE LOCATIONS. FINANCIAL ASSISTANCE CONTACT INFORMATION BROCHURES ARE PROVIDED IN OUR SURGICAL DAY SERVICE PACKETS AND ALL ADMISSION PACKETS. PART VI, LINE 4: EMERSON HOSPITAL IS A FULL SERVICE NON-PROFIT ACUTE CARE REGIONAL HOSPITAL THAT SERVES A 25 TOWN SUBURBAN COMMUNITY WITH A GROWING POPULATION OF APPROXIMATELY 300,000. EMERSON IS THE ONLY HOSPITAL LOCATED WITHIN THE PRIMARY TWELVE TOWNS THAT THE HOSPITAL SERVES. THE MEDIAN HOUSEHOLD INCOME FOR THE TOWNS SERVED BY EMERSON RANGE FROM APPROXIMATELY 75,000 TO 272,000 AND APPROXIMATELY 2% OF THE HOUSEHOLDS CURRENTLY HAVE INCOME LEVELS BELOW THE FEDERAL POVERTY GUIDELINE. THERE ARE NO FEDERALLY DESIGNATED MEDICALLY UNDERSERVED POPULATIONS IN THE COMMUNITIES SERVED BY EMERSON AND APPROXIMATELY 9% OF THE COMMUNITY'S PATIENTS ARE MEDICAID RECIPIENTS. PART VI, LINE 5: EMERSON PROVIDES MANY COMMUNITY SERVICES SOME OF WHICH ARE DESCRIBED BELOW:-EMERGENCY RESPONSE AND DISASTER PLANNING IN CONJUNCTION WITH LOCAL AGENCIES, THE HOSPITAL PLANS AND COORDINATES EMERGENCY PREPAREDNESS AND HAS PROVIDED AND AT TIMES SUBSIDIZED AN ADVANCED LIFE SUPPORT SERVICE.-PREVENTATIVE CARE PROGRAMS SUCH AS FLU VACCINES, CANCER AWARENESS DAY, FREE HEALTH SCREENINGS INCLUDING CHOLETEROL, THYROID, DIABETES, BLOOD PRESSURE, SKIN CANCER AND PULMONARY.-YOUTH PROGRAMS WHICH INCLUDE THE YOUTH RISK BEHAVIOUR SURVEY, JOB SHADOWING AND VOLUNTEER OPPORTUNITIES FOR YOUTH.-SENIOR SERVICES WHICH INCLUDE HOME CARE HEALTH SCREENINGS AND MONTHLY WELLNESS PROGRAMS.-HEALTH EDUCATION WHICH INVOLVES EMERSON STAFF PRESENTING FREE LECTURES TO THE COMMUNITY ON VARIOUS HEALTH CARE ISSUES SUCH AS BREAST CANCER, CARDIAC HEALTH, SPORTS MEDICINE, PRENATAL CARE AND OTHERS. PART VI, LINE 6: N/A PART VI, LINE 7, REPORTS FILED WITH STATES MA 1 X X X X X X 0 1 0 0 0 1 0 1 0 CHRISTINE SCHUSTER EX OFFICIO PRESIDENT & CEO 962706 0 239943 0 11922 0 233146 0 0 0 1447717 0 0 0 DAVID LAUTZ MD DIRECTOR 643078 0 774182 0 2322 0 4400 0 38620 0 1462602 0 0 0 JOHN LIBERTINO MD DIRECTOR 201287 0 0 0 0 0 0 0 0 0 201287 0 0 0 MICHAEL HACHEY SR VP CFO 445227 0 96167 0 2322 0 56758 0 16364 0 616838 0 0 0 ERIC STASTNY CHIEF OPERATING OFFICER 423317 0 87392 0 540 0 51980 0 30027 0 593256 0 0 0 JOYCE WELSH VP PATIENT CARE SERVICES 308418 0 53406 0 3564 0 34117 0 10311 0 409816 0 0 0 BARRETT KITCH MD SR VP CLINICAL AFFAIRS 384312 0 20000 0 2322 0 4400 0 0 0 411034 0 0 0 CHRISTINE GALLERY SR VP PLANNING & MARKETING 288955 0 61708 0 1242 0 37846 0 30027 0 419778 0 0 0 CRAIG NESTA VP EMERSON PRACTICE AS 243458 0 51250 0 1242 0 4100 0 30027 0 330077 0 0 0 RENEE FOSBERG CHIEF INFORMATION OFFICER 234140 0 15000 0 120 0 0 0 0 0 249260 0 0 0 LEANNE ESPINDLE DIRECTOR,PERIOPERATIVE 210614 0 15000 0 516 0 0 0 10311 0 236441 0 0 0 PART I, LINE 4B EMERSON HOSPITAL OFFERS A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN TO A SELECT CLASS OF MANAGEMENT. SUPPLEMENTAL RETIREMENT INCOME IS ASSESSED BY AN INDEPENDENT ACTUARY TO DETERMINE ANNUAL CONTRIBUTION AMOUNTS BY EMERSON HOSPITAL. PLAN CONTRIBUTIONS BECOME INCOME TO THE PARTICIPANT BASED ON A CLIFF VESTING SCHEDULE, WHICH IS EVERY FIVE YEARS FROM THE DATE OF PLAN ENROLLMENT. THE FOLLOWING PERSONS PARTICIPATED IN A 457(F) SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN. CHRISTINE SCHUSTER $247,695 MICHAEL HACHEY $35,140 ERIC STASTNY $32,071 PART I, LINE 6 EXECUTIVES ARE ELIGIBLE TO RECEIVE INCENTIVE COMPENSATION IN THE AMOUNT OF 5% OF BASE SALARY IF THE ORGANIZATION ACHIEVES THE BOARD APPROVED BUDGETED GAIN FROM OPERATIONS FOR THE FISCAL YEAR. PART I, LINE 7 EXECUTIVES ARE ELIGIBLE TO RECEIVE INCENTIVE COMPENSATION IN THE AMOUNT OF 15-25% OF BASE SALARY IF THEY ACHIEVE SPECIFIC INDIVIDUAL GOALS. A MASSACHUSETTS DEVELOPMENT FINANCE AGENCY-SERIES 2015 043431814 000000000 2015-09-28 62255000 FINANCE CAPITAL EXP, REPAY CERTAIN TAXABLE LOANS REFUND SERIES E BONDS 0 0 0 A 62255000 4516595 451277 1 0 1 1 A 0 0 0 0 1 0 0 A 1 1 1 0 0 0 0 1 A 0 SARAH POWERS DAUGHTER OF BOARD MEMBER 48035 DAUGHTER IS EMPLOYEE OF EMERSON HOSPITAL 0 SCH L PART IV BOARD MEMBER / TREASURER RICHARD CHURCHILL'S DAUGHTER IS AN EMPLOYEE OF EMERSON HOSPITAL FORM 990, PART VI, SECTION A, LINE 3 EMERSON HOSPITAL OUTSOURCED THE MANAGEMENT OF THE FOLLOWING OPERATIONS: 1. TRANSITIONAL CARE UNIT TO RADIUS 2. NUTRITION ENGINEERING AND ENVIRONMENTAL SERVICES TO SODEXO 3. WOUND CARE CLINIC TO RESTORIX 4. SLEEP LAB TO NEUROCARE 5. PROPERTY MANAGEMENT OF SELECTED SATELLITE LOCATIONS TO CHARLES JAMES ASSOCIATES 6. PROPERTY MANAGEMENT OF SELECT LOCATIONS TO AVISON YOUNG 7. SECURITY SERVICES TO APG RHODE ISLAND, LLC FORM 990, PART VI, SECTION A, LINE 6 EMERSON HEALTH SYSTEM, INC, ACTING THROUGH ITS BOARD OF DIRECTORS, IS THE MEMBER FOR EMERSON HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7A THE NUMBER AND COMPOSITION OF THE BOARD OF DIRECTORS IS FIXED ANNUALLY BY THE MEMBER, EMERSON HEALTH SYSTEM. FORM 990, PART VI, SECTION A, LINE 7B THE NUMBER AND COMPOSITION OF THE BOARD OF DIRECTORS IS FIXED ANNUALLY BY THE MEMBER, EMERSON HEALTH SYSTEM. FORM 990, PART VI, SECTION B, LINE 11B THE COMPLETED FORM 990 WAS PRESENTED TO THE EMERSON HOSPITAL BOARD OF DIRECTORS DURING A REGULARLY SCHEDULED BOARD MEETING AND WAS OPEN FOR REVIEW, DISCUSSION, QUESTIONS AND COMMENTS. FURTHER EDUCATIONAL SESSIONS WERE OFFERED FOR ANY BOARD MEMBER TO REVIEW THE FORM 990 IN MORE DETAIL WITH THE CHIEF FINANCIAL OFFICER. IN ADDITION, THE SCHEDULE J WAS REVIEWED IN DETAIL IN A SESSION WITH THE COMPENSATION COMMITTEE AND THE FORM 990 WAS REVIEWED IN ITS ENTIRETY IN DETAIL IN A SESSION WITH THE AUDIT COMMITTEE. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF DIRECTORS REQUIRES THAT ALL BOARD MEMBERS AND SENIOR MANAGERS COMPLETE AND SIGN THE CONFLICT OF INTEREST QUESTIONNAIRE ANNUALLY. THE CEO REVIEWS THESE QUESTIONNAIRES AND SUMMARIZES ANY ISSUES THAT COULD CREATE A CONFLICT OF INTEREST. THIS SUMMARY IS REVIEWED BY THE GOVERNANCE COMMITTEE OF THE BOARD OF DIRECTORS AND IS PRESENTED TO THE ENTIRE BOARD ANNUALLY SO THAT ALL BOARD MEMBERS ARE AWARE OF POTENTIAL CONFLICTS OF INTEREST AND HAVE INFORMATION THEY CAN RELY ON IF THEY FEEL AN INDIVIDUAL MAY HAVE DIVIDED LOYALTIES ON A DECISION COMING BEFORE THE BOARD OF DIRECTORS. THE BOARD CHAIR IS RESPONSIBLE FOR EVALUATING ANY CONFLICT OF INTEREST AND DETERMINING THE TREATMENT OF THE SITUATION ACCORDING TO BOARD POLICY. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS HOLDS THE SOLE RESPONSIBILITY FOR ESTABLISHING THE COMPENSATION OF EMERSON HOSPITAL'S CEO. THE COMPENSATION COMMITTEE, A SUBCOMMITTEE OF THE BOARD OF DIRECTORS COMPRISED OF AT LEAST THREE INDEPENDENT BOARD MEMBERS, IS RESPONSIBLE FOR THE REVIEW AND RECOMMENDATION OF THE CEO'S COMPENSATION. THIS ANALYSIS INCLUDES AN ANNUAL INDEPENDENT REVIEW OF COMPARABLE INSTITUTIONS. THE VICE PRESIDENT OF OPERATIONS AND CHIEF HUMAN RESOURCES OFFICER, ACTING AS STAFF SUPPORT FOR THE COMMITTEE, MAINTAINS WRITTEN RECORDS ON COMPENSATION AND THE COMMITTEE'S ACTIONS. MEETING MINUTES DOCUMENT THE COMMITTEE'S DECISION-MAKING PROCESS, THE TYPES OF COMPARABLE DATA THAT WERE USED TO DETERMINE THE FAIR MARKET VALUE FOR AN EXECUTIVE'S SERVICES AND THE NATURE OF ANY DECISIONS MADE SO AS TO ESTABLISH A REBUTTABLE PRESUMPTION OF REASONABLENESS FOR COMPENSATION FOR A DISQUALIFIED INDIVIDUAL. THE COMPENSATION COMMITTEE ALSO REVIEWS AND APPROVES THE CEO'S RECOMMEDATION OF COMPENSATION FOR KEY EMPLOYEES INCLUDING OFFICERS AND VICE PRESIDENTS OF THE HOSPITAL. THIS ANALYSIS INCLUDES ANNUAL INDEPENDENT REVIEW OF COMPARABLE INSTITUTIONS. THE VICE PRESIDENT OF OPERATIONS AND CHIEF HUMAN RESOURCES OFFICER, ACTING AS STAFF SUPPORT FOR THE COMMITTEE, MAINTAINS WRITTEN RECORDS ON COMPENSATION AND THE COMMITTEE'S ACTIONS. MEETING MINUTES DOCUMENT THE COMMITTEE'S DECISION-MAKING PROCESS, THE TYPES OF COMPARABLE DATA THAT WAS USED TO DETERMINE THE FAIR MARKET VALUE FOR AN EXECUTIVE'S SERVICES AND THE NATURE OF ANY DECISIONS MADE SO AS TO ESTABLISH A REBUTTABLE PRESUMPTION OF REASONABLENESS FOR COMPENSATION FOR A DISQUALIFIED INDIVIDUAL. FORM 990, PART VI, SECTION C, LINE 18 FORM 990 IS AVAILABLE ON THE MASSACHUSETTS ATTORNEY GENERAL'S WEBSITE. FORMS 1023, 990, AND 990T ARE AVAILABLE UPON REQUEST TO THE HOSPITAL. FORM 990, PART VI, SECTION C, LINE 19 HOSPITAL'S BY-LAWS ARE AVAIALABLE ON THE MASSACHUSETTS SECRETARY OF STATE'S WEBSITE. CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: NET ASSETS RELEASED FOR PLANT AND EQUIPMENT 0. BENEFIT PLAN RELATED CHANGES OTHER THAN NET PERIODIC BENEFIT COSTS 13,036,135. TEMPORARILY RESTRICTED CHANGE IN INTEREST IN FOUNDATION 180,852. PERMANENTLY RESTRICTED CHANGE IN INTEREST IN THE FOUNDATION 0. NET ASSETS RELEASED TO THE FOUNDATION 2,941,584. TRANSFER TO AFFILIATES 983,323. ROUNDING SCHEDULE K, PART I, COLUMN F DESCRIPTION OF TAX EXEMPT BOND PURPOSE SERIES E BOND PROCEEDS WERE USED TO: (I) PROVIDE FOR THE CURRENT REFUNDING OF PRIOR BONDS, THE PROCEEDS OF WHICH WERE USED TO CONSTRUCT, RENOVATE, AND EQUIP PORTIONS OF THE INSTITUTIONS CAMPUS INCLUDING CONSTRUCTING THE JOHN CUMMING BUILDING, AN ADDITION TO THE WHEELER BUILDING, CONSTRUCTION OF A BUILDING TO HOUSE PATIENT CARE SERVICES, LABORATORY AND REHABILITATION SERVICES, A 31-BED PSYCHIATRIC UNIT, A 32-BED MEDICAL SURGICAL UNIT, 24 OBSTETRICS BEDS, 8 BIRTHING ROOMS, 2 DELIVERY ROOMS, A NEWBORN NURSERY AND CONSTRUCTION OF A FIVE LEVEL PARKING GARAGE WITH APPROXIMATELY 465 PARKING SPACES AND RENOVATING THE WHEELER BUILDING; (II) PROVIDE FOR THE FINANCING AND REFINANCING OF (A) RENOVATIONS TO EXISTING PRE AND POST OPERATING SURGICAL DAY CARE SUITES, THE CONSTRUCTION OF A NEW CYSTOSCOPY ROOM, CONSTRUCTION OF TWO OPERATING ROOMS AND RENOVATION OF THE POST ANESTHESIA CARE UNIT, (B) EXPANSION OF EXISTING SPACE USED FOR RADIOLOGY SERVICES INCLUDING CONSTRUCTION OF SEPARATE ENTRANCES AND SEGREGATED PREPARATION ACCESS FOR INPATIENT VERSUS OUTPATIENT USE AND THE ADDITION OF NEW RADIOLOGY EQUIPMENT, (C) EXPANSION OF THE EXISTING OBSTETRICS UNIT IN ORDER TO CREATE PRIVATE ROOMS AND (D) THE ACQUISITION AND INSTALLATION OF CAPITAL EQUIPMENT; (III) FUND THE DEBT SERVICE REVENUE FUND; (IV) PAY THE PREMIUM FOR THE BOND INSURANCE POLICY; AND (V) PAY CERTAIN COSTS AND EXPENSES INCURRED IN CONNECTION WITH THE ISSUANCE OF THE SERIES E BONDS. EMERSON HEALTH SYSTEM OLD ROAD TO NINE ACRE CORNER CONCORD MA 01742 042770977 PROVIDES ITS HEALTHCARE SUBSIDIARIES WITH A MANAGEMENT TEAM MA 501(C)3 509(A)(3) TYPE I N/A 0 EMERSON HEALTH CARE FOUNDATION OLD ROAD TO NINE ACRE CORNER CONCORD MA 01742 042770980 COORDINATE AND DEVELOP THE FUNDRAISING EFFORT FOR EMERSON HOSPITAL MA 501(C)3 509(A)(3) TYPE I EMERSON HEALTH SYSTEM INC 0 EMERSON PRACTICE ASSOCIATES OLD ROAD TO NINE ACRE CORNER CONCORD MA 01742 043111240 PROVIDE HEALTH CARE SERVICES IN THE COMMUNITIES SERVED BY EMERSON HOSPITAL MA 501(C)3 170(B)(1)(A)(III) EMERSON HEALTH SYSTEM INC 0 EMERSON PRACTICE ASSOCIATES II OLD ROAD TO NINE ACRE CORNER CONCORD MA 01742 800482067 PROVIDE HEALTH CARE SERVICES IN THE COMMUNITIES SERVED BY EMERSON HOSPITAL MA 501(C)3 170(B)(1)(A)(III) EMERSON HEALTH SYSTEM INC 0 RADIATION ONCOLOGY CENTER MANAGEMENT COMPANY LLC OLD ROAD TO NINE ACRE CORNER CONCORD MA 01742 043410861 OPERATE A RADIATION ONCOLOGY FACILITY MA N/A RELATED 2319484 0 1 0.50000 SHIELDS IMAGING MANAGEMENT AT EMERSON 700 CONGRESS STREET SUITE 204 QUINCY MA 02169 851985836 IMAGING SERVICES MA N/A RELATED 391903 0 1 0.50000 EMERSON PHYSICIAN HOSPITAL ORGANIZATION OLD ROAD TO NINE ACRE CORNER CONCORD MA 01742 043205706 HEALTH SERVICES CONTRACTING MA N/A C 5426 1665868 0.50000 0 EMERSON PROPERTY DEVELOPMENT CORP OLD ROAD TO NINE ACRE CORNER CONCORD MA 01742 042793599 PROPERTY MANAGEMENT MA EMERSON HEALTH SYSTEM INC C 0 EMERSON OCCUPATIONAL HEALTH SERVICES OLD ROAD TO NINE ACRE CORNER CONCORD MA 01742 042800607 HEALTH SERVICES MA EMERSON HEALTH SYSTEM INC C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 EMERSON PRACTICE ASSOCIATES N 1412009 REPORTED AT FAIR VALUE EMERSON PRACTICE ASSOCIATES O 25893958 REPORTED AT FAIR VALUE EMERSON PRACTICE ASSOCIATES Q 5112229 REPORTED AT FAIR VALUE EMERSON PRACTICE ASSOCIATES II N 38571 REPORTED AT FAIR VALUE EMERSON PRACTICE ASSOCIATES II O 398022 REPORTED AT FAIR VALUE EMERSON PRACTICE ASSOCIATES II Q 78937 REPORTED AT FAIR VALUE