ATHOL MEMORIAL HOSPITAL INCORPORATED: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- ATHOL MEMORIAL HOSPITAL INCORPORATED (EIN 04-2126583)
- Tax period
- 2019-10-01 to 2020-09-30
- Filed
- 2021-08-13
- IRS object ID
- 202122259349301102
- Schema version
- 2019v5.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-08-13T07:07:15-05:00 | ReturnTs |
| Tax Period End | 2020-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 010523282 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Berry Dunn McNeil & Parker LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 1100 | AddressLine1Txt |
| City | Portland | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 041041100 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2019-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 042126583 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Athol Memorial Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | ATHO | BusinessNameControlTxt |
| Phone | 9782493511 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2033 Main Street | AddressLine1Txt |
| City | Athol | CityNm |
| State Abbreviation | MA | StateAbbreviationCd |
| ZIP | 01331 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Michael Abbatiello | PersonNm |
| Person Title | VP of Finance/CFO | PersonTitleTxt |
| Phone | 9782493511 | PhoneNum |
| Signature | 2021-08-12 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Barbara J McGuan CPA | PreparerPersonNm |
| PTIN | P00219457 | PTIN |
| Phone | 2077752387 | PhoneNum |
| Preparation | 2021-08-12 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Winfield Brown | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2033 Main Street | AddressLine1Txt |
| City | Athol | CityNm |
| State Abbreviation | MA | StateAbbreviationCd |
| ZIP | 01331 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $35,479,066 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.atholhospital.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1918 | FormationYr |
| Legal Domicile State | MA | LegalDomicileStateCd |
| Activity Or Mission | 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. | ActivityOrMissionDesc |
| Voting Members Governing Body | 21 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 19 | VotingMembersIndependentCnt |
| Total Employee | 282 | TotalEmployeeCnt |
| Total Volunteers | 51 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,133,873 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,431,247 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $31,584,757 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $34,037,774 | CYProgramServiceRevenueAmt |
| PY Investment Income | $23,341 | PYInvestmentIncomeAmt |
| CY Investment Income | $3,994 | CYInvestmentIncomeAmt |
| PY Other Revenue | $319,073 | PYOtherRevenueAmt |
| CY Other Revenue | $6,051 | CYOtherRevenueAmt |
| PY Total Revenue | $33,061,044 | PYTotalRevenueAmt |
| CY Total Revenue | $35,479,066 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $1,245 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $12,029 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $10,609,404 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $10,947,242 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $42,000 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $47,645 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $287,719 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $21,593,890 | PYOtherExpensesAmt |
| CY Other Expenses | $22,533,091 | CYOtherExpensesAmt |
| PY Total Expenses | $32,246,539 | PYTotalExpensesAmt |
| CY Total Expenses | $33,540,007 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $814,505 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,939,059 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $25,329,768 | TotalAssetsBOYAmt |
| Total Assets EOY | $36,363,474 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $16,066,599 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $14,346,796 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $9,263,169 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $22,016,678 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Our mission is to be our communities' trusted choice for exceptional patient-centered care. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $29,859,231 | ExpenseAmt |
| Grant | $12,029 | GrantAmt |
| Revenue | $34,037,774 | RevenueAmt |
| Desc | 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. For FY 2020, there were 60,829 outpatient visits to the Hospital. 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. For FY 2020 the hospital provided 3,377 days of Inpatient Care.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. In FY2020, there were 28,288 visits to these practices. | Desc |
| Total Program Service Expenses | $29,859,231 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (1) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | Yes (1) | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 32 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 282 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (1) | QuidProQuoContriDisclInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 21 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 19 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | MA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Michael Abbatiello | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9786306157 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2033 Main Street | AddressLine1Txt |
| City | Athol | CityNm |
| State Abbreviation | MA | StateAbbreviationCd |
| ZIP | 01331 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (28 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| Bob Chauvin | |||||||||
| Chairman | 0.20 | 1.40 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Roy Lake | |||||||||
| Vice Chairman | 0.20 | 1.40 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Cheney Castine | |||||||||
| Treasurer | 0.20 | 1.40 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| JoAnne Parks | |||||||||
| Clerk | 0.20 | 1.40 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Craig Twohey | |||||||||
| Trustee | 0.20 | 1.40 | Yes (X) | $0 | $0 | $0 | |||
| Thomas Kane | |||||||||
| Trustee | 0.20 | 1.40 | Yes (X) | $0 | $0 | $0 | |||
| Nicole Moorshead | |||||||||
| Trustee | 0.20 | 1.40 | Yes (X) | $0 | $0 | $0 | |||
| Elizabeth Nottleson | |||||||||
| Trustee | 0.20 | 29.40 | Yes (X) | $0 | $278,691 | $7,206 | |||
| Glenn Hunt | |||||||||
| Trustee | 0.20 | 1.40 | Yes (X) | $0 | $0 | $0 | |||
| David Spackman | |||||||||
| Trustee | 0.20 | 1.40 | Yes (X) | $0 | $0 | $0 | |||
| Jim Meehan | |||||||||
| Trustee | 0.20 | 1.40 | Yes (X) | $0 | $0 | $0 | |||
| Joel Shaughnessy | |||||||||
| Trustee | 0.20 | 1.40 | Yes (X) | $0 | $0 | $0 | |||
| John Flick | |||||||||
| Trustee | 0.20 | 1.40 | Yes (X) | $0 | $0 | $0 | |||
| John Skrzypczak | |||||||||
| Trustee | 0.20 | 1.40 | Yes (X) | $0 | $0 | $0 | |||
| Joyce Fletcher | |||||||||
| Trustee | 0.20 | 1.40 | Yes (X) | $0 | $0 | $0 | |||
| Debra Vescovi | |||||||||
| Trustee | 0.20 | 1.40 | Yes (X) | $0 | $0 | $0 | |||
| Kenneth Pierce | |||||||||
| Trustee | 0.20 | 1.40 | Yes (X) | $0 | $0 | $0 | |||
| Michelle Parker | |||||||||
| Trustee | 0.20 | 1.40 | Yes (X) | $0 | $0 | $0 | |||
| Tina Sbrega | |||||||||
| Trustee | 0.20 | 1.40 | Yes (X) | $0 | $0 | $0 | |||
| Albert Rose | |||||||||
| Trustee | 0.20 | 1.40 | Yes (X) | $0 | $0 | $0 | |||
| Winfield Brown | |||||||||
| President/CEO | 0.00 | 40.00 | Yes (X) | Yes (X) | $0 | $911,200 | $64,820 | ||
| Michael Abbatiello | |||||||||
| Chief Financial Officer | 0.00 | 40.00 | Yes (X) | $0 | $20,000 | $42 | |||
| Nancy Mallory | |||||||||
| Director of Nursing | 40.00 | 0.00 | $133,169 | $0 | $3,210 | Yes (X) | |||
| Roxanne Dunn | |||||||||
| Director of ER | 40.00 | 0.00 | $119,645 | $0 | $2,817 | Yes (X) | |||
| Patricia Whitfield | |||||||||
| Case Manager RN | 40.00 | 0.00 | $118,233 | $0 | $3,237 | Yes (X) | |||
| Marie King | |||||||||
| Clinical Coordinator | 40.00 | 0.00 | $116,745 | $0 | $3,117 | Yes (X) | |||
| Carole Vaidulas | |||||||||
| ER RN | 36.00 | 0.00 | $112,052 | $0 | $2,771 | Yes (X) | |||
| Robert Crosby | |||||||||
| Former Chief Financial Officer | 0.00 | 40.00 | $0 | $346,993 | $31,330 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $599,844 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,556,884 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $118,550 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 10 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Quartulli & Associates Inc | |||||
| PO Box 423 | Gardner | MA | 01440 | PT & OT Services | $997,735 |
| Medefis Inc | |||||
| 2121 North 117th Ave | Omaha | NE | 68164 | Medical Staffing Services | $427,950 |
| Tele-Physicians PC MA | |||||
| 1768 Business Center Drive | Reston | VA | 20190 | Telemedicine Services | $281,803 |
| Pinnacle Medical Group | |||||
| 451 Andover Street Suite 110 | North Andover | MA | 01845 | Medical Staffing Services | $219,291 |
| Labcorp of America | |||||
| PO Box 12140 | Burlington | NC | 27216 | Clinical Laboratory Services | $174,484 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $994,993 | GovernmentGrantsAmt |
| All Other Contributions | $436,254 | AllOtherContributionsAmt |
| Total Contributions | $1,431,247 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| Patient Service Revenue | 622100 | $82,855,753 | $82,855,753 | |
| Miscellaneous Revenue | 622100 | $198,347 | $187,200 | $11,147 |
| Cafeteria Revenue | 622100 | $98,165 | $98,165 | |
| Provision for Bad Debts | 622100 | -$1,836,844 | -$1,836,844 | |
| Contractual Allowances/Charity Ca | 622100 | -$47,277,647 | -$47,277,647 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $34,037,774 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,994 | TotalRevenueColumnAmt |
| Exclusion | $3,994 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $6,051 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $6,051 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $6,051 | TotalRevenueColumnAmt |
| Exclusion | $6,051 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $35,479,066 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $33,928,462 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $119,357 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,279 | TotalAmt |
| Program Services | $9,279 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,750 | TotalAmt |
| Program Services | $2,750 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,851,478 | TotalAmt |
| Program Services | $8,746,905 | ProgramServicesAmt |
| Management And General | $104,573 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $68,793 | TotalAmt |
| Program Services | $67,980 | ProgramServicesAmt |
| Management And General | $813 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,275,452 | TotalAmt |
| Program Services | $1,260,384 | ProgramServicesAmt |
| Management And General | $15,068 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $751,519 | TotalAmt |
| Program Services | $742,640 | ProgramServicesAmt |
| Management And General | $8,879 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,667 | TotalAmt |
| Management And General | $6,667 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $66,601 | TotalAmt |
| Program Services | $2,974 | ProgramServicesAmt |
| Management And General | $63,627 | ManagementAndGeneralAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $47,645 | TotalAmt |
| Fundraising | $47,645 | FundraisingAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $193 | TotalAmt |
| Management And General | $193 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,684,696 | TotalAmt |
| Program Services | $10,407,896 | ProgramServicesAmt |
| Management And General | $241,454 | ManagementAndGeneralAmt |
| Fundraising | $35,346 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,452 | TotalAmt |
| Fundraising | $3,452 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $407,904 | TotalAmt |
| Program Services | $313,797 | ProgramServicesAmt |
| Management And General | $94,107 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,392 | TotalAmt |
| Program Services | $4,013 | ProgramServicesAmt |
| Management And General | $379 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,530,253 | TotalAmt |
| Program Services | $1,316,318 | ProgramServicesAmt |
| Management And General | $213,935 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,649 | TotalAmt |
| Program Services | $9,649 | ProgramServicesAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,885 | TotalAmt |
| Program Services | $20,342 | ProgramServicesAmt |
| Management And General | $2,543 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,292 | TotalAmt |
| Program Services | $24,292 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $701,598 | TotalAmt |
| Program Services | $701,598 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $167,305 | TotalAmt |
| Program Services | $17,117 | ProgramServicesAmt |
| Management And General | $150,188 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| Allocations | $3,920,556 | $2,421,168 | $1,298,172 | $201,216 |
| Medical Supplies | $3,161,733 | $3,161,733 | ||
| Miscellaneous | $1,558,772 | $379,709 | $1,179,063 | |
| Food | $262,143 | $248,687 | $13,396 | $60 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $33,540,007 | TotalAmt |
| Program Services | $29,859,231 | ProgramServicesAmt |
| Management And General | $3,393,057 | ManagementAndGeneralAmt |
| Fundraising | $287,719 | FundraisingAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part X | Yes (X) | InfoInScheduleOPartXInd |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,765,689 | BOYAmt |
| EOY | $11,305 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $8,995,308 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $437,469 | BOYAmt |
| EOY | $208,495 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,623,459 | BOYAmt |
| EOY | $4,655,529 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,439,300 | BOYAmt |
| EOY | $11,439,300 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $333,292 | BOYAmt |
| EOY | $330,386 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $281,633 | BOYAmt |
| EOY | $180,724 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $18,154,074 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $12,163,825 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,635,091 | BOYAmt |
| EOY | $5,990,249 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $3,038,000 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,613,835 | BOYAmt |
| EOY | $1,509,178 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $195,000 | BOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,000 | BOYAmt |
| EOY | $5,000 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,329,768 | BOYAmt |
| EOY | $36,363,474 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,008,228 | BOYAmt |
| EOY | $3,386,473 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $170,183 | BOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,542,796 | BOYAmt |
| EOY | $638,993 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,345,392 | BOYAmt |
| EOY | $10,321,330 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,066,599 | BOYAmt |
| EOY | $14,346,796 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,211,865 | BOYAmt |
| EOY | $20,299,006 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,051,304 | BOYAmt |
| EOY | $1,717,672 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,263,169 | BOYAmt |
| EOY | $22,016,678 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,329,768 | BOYAmt |
| EOY | $36,363,474 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $1,939,059 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $3,847 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $10,810,603 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,613,835 | BeginningYearBalanceAmt |
| Contributions | $357,693 | ContributionsAmt |
| Investment Earnings Or Losses | $3,847 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $466,004 | OtherExpendituresAmt |
| Administrative Expenses | $193 | AdministrativeExpensesAmt |
| End Year Balance | $1,509,178 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,518,883 | BeginningYearBalanceAmt |
| Contributions | $750,616 | ContributionsAmt |
| Investment Earnings Or Losses | -$23,962 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $630,565 | OtherExpendituresAmt |
| Administrative Expenses | $1,137 | AdministrativeExpensesAmt |
| End Year Balance | $1,613,835 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,503,083 | BeginningYearBalanceAmt |
| Contributions | $705,622 | ContributionsAmt |
| Investment Earnings Or Losses | $25,302 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $713,855 | OtherExpendituresAmt |
| Administrative Expenses | $1,269 | AdministrativeExpensesAmt |
| End Year Balance | $1,518,883 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,370,811 | BeginningYearBalanceAmt |
| Contributions | $706,454 | ContributionsAmt |
| Investment Earnings Or Losses | $63,874 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $636,832 | OtherExpendituresAmt |
| Administrative Expenses | $1,224 | AdministrativeExpensesAmt |
| End Year Balance | $1,503,083 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,391,453 | BeginningYearBalanceAmt |
| Contributions | $94,080 | ContributionsAmt |
| Investment Earnings Or Losses | $18,408 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $133,124 | OtherExpendituresAmt |
| Administrative Expenses | $6 | AdministrativeExpensesAmt |
| End Year Balance | $1,370,811 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.93210 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.06790 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $104,490 | OtherCostOrOtherBasisAmt |
| Book Value | $104,490 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,046,088 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,047,002 | DepreciationAmt |
| Book Value | $2,999,086 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $9,439,663 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,919,309 | DepreciationAmt |
| Book Value | $2,520,354 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $563,833 | OtherCostOrOtherBasisAmt |
| Depreciation | $197,514 | DepreciationAmt |
| Book Value | $366,319 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $5,990,249 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| CARES Act Funding | $9,125,830 |
| Estimated Settlements with Third Parties | $1,190,500 |
| Estimated Malpractice Liability | $5,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $10,321,330 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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, 2020 and 2019, there were no interest or penalties recorded or included in the consolidated statements of operations. |
Schedule G IRS990ScheduleG
| Field | Value | IRS element (for citing) |
|---|---|---|
| Mail Solicitations | Yes (X) | MailSolicitationsInd |
| Email Solicitations | Yes (X) | EmailSolicitationsInd |
| Phone Solicitations | Yes (X) | PhoneSolicitationsInd |
| In Person Solicitations | Yes (X) | InPersonSolicitationsInd |
| Solicitation Of Non Govt Grants | Yes (X) | SolicitationOfNonGovtGrantsInd |
| Solicitation Of Govt Grants | Yes (X) | SolicitationOfGovtGrantsInd |
| Special Fundraising Events | Yes (X) | SpecialFundraisingEventsInd |
| Agrmt Prof Fundraising Acty | Yes (1) | AgrmtProfFundraisingActyInd |
Fundraiser Activity Info FundraiserActivityInfoGrp
Organization Business Name OrganizationBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JNB & Associates | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 21 Water Street | AddressLine1Txt |
| City | Amesbury | CityNm |
| State Abbreviation | MA | StateAbbreviationCd |
| ZIP | 01913 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activity | Consultant | ActivityTxt |
| Fundraiser Control Of Funds | 0 | FundraiserControlOfFundsInd |
| Gross Receipts | $0 | GrossReceiptsAmt |
| Retained By Contractor | $47,645 | RetainedByContractorAmt |
| Net To Organization | -$47,645 | NetToOrganizationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Retained By Contractors | $47,645 | TotalRetainedByContractorsAmt |
| Total Net To Organization | -$47,645 | TotalNetToOrganizationAmt |
| Licensed States | MA | LicensedStatesCd |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent150 | Yes (X) | Percent150Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $483,195 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $257,957 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $225,238 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00670 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,064,858 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,637,667 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,427,191 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04260 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,548,053 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,895,624 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,652,429 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04930 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $378,618 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $378,618 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01130 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $149,074 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $149,074 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00440 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,884 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,759 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $125 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $534,576 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,759 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $527,817 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01570 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $10,082,629 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,902,383 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,180,246 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06500 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $411 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $411 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $411 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $411 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $890,369 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $7,697,387 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $7,960,245 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$262,858 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Athol Memorial Hospital | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2033 Main Street | AddressLine1Txt |
| City | Athol | CityNm |
| State Abbreviation | MA | StateAbbreviationCd |
| ZIP | 01331 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.atholhospital.org | WebsiteAddressTxt |
| State License | 2226 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Athol Memorial Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 18 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | https://www.atholhospital.org/about-us/community-benefit | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 18 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | https://www.atholhospital.org/about-us/community-benefit | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 150.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | www.heywood.org/about-us/community-benefit/patient-financial-services | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | www.heywood.org/about-us/community-benefit/patient-financial-services | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | www.heywood.org/about-us/community-benefit/patient-financial-services | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit Report To Credit Agency | Yes (X) | PermitReportToCreditAgencyInd |
| Permit Legal Judicial Process | Yes (X) | PermitLegalJudicialProcessInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Athol Memorial Hospital | Part V, Section B, Line 5: In 2018, 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 596 Surveys, 17 Focus Groups, and 12 Healthcare Professional Interviews 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: Conducting the CHNA was a collaboration between the Montachusett Regional Planning Commission (MRPC), UMASS Memorial Health Alliance Clinton Hospital, The Community Health Network of North Central MA (CHNA 9) Group, North Quabbin Community Coalition, and John Snow, Inc. Quantitative data sources came from Massachusetts Community Health Information Profile (MassCHIP) 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. Staff at MRPC was responsible for conducting research and analysis efforts. The Community Benefits Leadership Team made up of department heads from Athol and Heywood Hospitals, the North Quabbin Community Coalition, the CHNA-9 Group, and other relevant community partners, provided input into the process. Leadership Team members assisted with analyzing and reviewing the report. Other organizations and individuals also contributed to the assessment, including the North Quabbin Recovery Planning Group; Jail to Community Task Force; Children's Health and Wellness; Multicultural Task Force; Gardner Area Interagency Team; Substance Abuse Task Force; Greater Gardner Religious Council; Schwartz Center Rounds; Greater Gardner Chamber of Commerce; Heywood Senior Team; Regional Behavioral Health Collaborative; Gardner MENders Support Group; Montachusett Suicide Prevention Task Force; North Quabbin Community Coalition; Community Health Connections Board; Montachusett Public Health Network; and CHNA-9 CHIP Breakfast. |
| Athol Memorial Hospital | Part V, Section B, Line 7d: Hospital staff presented the CHNA findings with community members, stakeholders, and partners and solicited input in response to the CHNA to help inform the development of a Community Health Improvement Plan (CHIP). Numerous community groups provided feedback on the assessment findings and helped to identify priority health focus areas and strategies. These groups included the Multicultural Task Force; Gardner Area Interagency Team; Substance Abuse Task Force; Greater Gardner Religious Council; Schwartz Center Rounds; Heywood Leadership Team; Regional Behavioral Health Collaborative; Athol and Heywood Hospital Medical Ethics; Athol and Heywood PFAC; Montachusett Suicide Prevention Task Force; North Quabbin Community Coalition; Heywood Charitable Foundation Community Investment Committee and CHNA-9. |
| 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. |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 2020 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: | The primary service area served by Athol Hospital includes Athol, Erving, New Salem, Orange, Petersham, Phillipston, Royalston, Warwick, Wendell. The Service Area population of 28,102 has remained essentially the same over the past 10 years. The Racial Makeup of the service area is 95% white, non-Hispanic, but the most significant population growth between 2010-2019 is the Hispanic/Latino population. 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 lack of public transportation make 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 when it comes to 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: | 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, Athol and Orange Boards of Health, Athol and Orange School District, Athol, Orange, Petersham Police Department, LUK, Inc, LifePath, Transitions Home Health, Sterling Villages, Gardner Rehabilitation and Nursing Center, Option Care Health, Genesis Homecare, Broad View Assisted Living, Sunrise Senior Living, Open Sky, CareCentral VNA, Clinical & Support Options, Athol Orange Rotary, Seeds of Solidarity, Quabbin Food Harvest, GAAMHA, Mount Wachusett Community College. Multicultural Task Force, Valuing our Children. |
| 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. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (3 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Elizabeth Nottleson | ||||||||||||||
| Trustee | $0 | $278,691 | $0 | $0 | $0 | $0 | $0 | $5,394 | $0 | $1,812 | $0 | $285,897 | $0 | $0 |
| Winfield Brown | ||||||||||||||
| President/CEO | $0 | $550,259 | $0 | $74,782 | $0 | $286,159 | $0 | $24,600 | $0 | $40,220 | $0 | $976,020 | $0 | $0 |
| Robert Crosby | ||||||||||||||
| Former Chief Financial Officer | $0 | $207,493 | $0 | $12,000 | $0 | $127,500 | $0 | $16,683 | $0 | $14,647 | $0 | $378,323 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 Controller 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 4,025,391. Management and general expenses 0. Fundraising expenses 0. Total expenses 4,025,391. Contracted Services: Program service expenses 509,824. Management and general expenses 90. Fundraising expenses 0. Total expenses 509,914. Temporary Employees: Program service expenses 815,943. Management and general expenses 0. Fundraising expenses 0. Total expenses 815,943. Outside Fees: Program service expenses 3,872,101. Management and general expenses 42,157. Fundraising expenses 35,346. Total expenses 3,949,604. Other Professional Fees: Program service expenses 1,184,637. Management and general expenses 199,207. Fundraising expenses 0. Total expenses 1,383,844. |
| 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 from Affiliate 10,810,603. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (8 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 | 0 | Heywood Healthcare Inc | |
| Heywood Medical Group | |||||||||||
| 242 Green Street | Gardner | MA | 01440 | 043163589 | Multi-Spec. Physicians | MA | 501(c)(3) | Line 10 | 0 | Heywood Healthcare Inc | |
| Quabbin Healthcare Inc | |||||||||||
| 242 Green Street | Gardner | MA | 01440 | 812053488 | Behavioral Health | MA | 501(c)(3) | Line 12b, II | 0 | Heywood Healthcare Inc | |
| Heywood Realty Corp | |||||||||||
| 242 Green Street | Gardner | MA | 01440 | 043327447 | Prop. Holding Corp | MA | 501(c)(2) | 0 | Heywood Healthcare Inc | ||
| Heywood Healthcare Charitable Foundation Inc | |||||||||||
| 242 Green Street | Gardner | MA | 01440 | 222720562 | Charitable Foundation | MA | 501(c)(3) | Line 7 | 0 | Heywood Healthcare Inc | |
| Athol Memorial Hospital NMTC Holdings Inc | |||||||||||
| 242 Green Street | Gardner | MA | 01440 | 822171549 | Supporting Organization | MA | 501(c)(3) | Line 12a, I | 0 | Heywood Healthcare Inc | |
| Winchendon Health Foundation Inc | |||||||||||
| 55 Hospital Drive | Winchendon | MA | 01475 | 042113276 | Community Health Care | MA | 501(c)(3) | Line 12d, III-O | 0 | N/A | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (1) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | Yes (1) | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Heywood Realty Corporation | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | K | TransactionTypeTxt |
| Involved | $367,952 | InvolvedAmt |
| Method Of Amount Determination | FMV | MethodOfAmountDeterminationTxt |