ATHOL MEMORIAL HOSPITAL INCORPORATED: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- ATHOL MEMORIAL HOSPITAL INCORPORATED (EIN 04-2126583)
- Tax period
- 2016-10-01 to 2017-09-30
- Filed
- 2018-05-11
- IRS object ID
- 201821359349301112
- Schema version
- 2016v3.0
- 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 | 2018-05-11T13:38:23-07:00 | ReturnTs |
| Tax Period End | 2017-09-30 | TaxPeriodEndDt |
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-10-01 | 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 INCORPORATED | 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 | Robert Crosby | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 9786305008 | PhoneNum |
| Signature | 2018-04-30 | SignatureDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Robert Crosby | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 242 Green Street | AddressLine1Txt |
| City | Gardner | CityNm |
| State Abbreviation | MA | StateAbbreviationCd |
| ZIP | 01440 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $29,235,035 | 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 | 20 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 17 | VotingMembersIndependentCnt |
| Total Employee | 249 | TotalEmployeeCnt |
| Total Volunteers | 30 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,690,173 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,167,664 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $25,046,682 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $27,791,416 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,250 | PYInvestmentIncomeAmt |
| CY Investment Income | -$57,958 | CYInvestmentIncomeAmt |
| PY Other Revenue | $147,250 | PYOtherRevenueAmt |
| CY Other Revenue | $256,988 | CYOtherRevenueAmt |
| PY Total Revenue | $26,885,355 | PYTotalRevenueAmt |
| CY Total Revenue | $29,158,110 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $14,867 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $5,105 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $8,862,206 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $9,930,551 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $56,000 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $175,896 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $16,163,708 | PYOtherExpensesAmt |
| CY Other Expenses | $16,759,394 | CYOtherExpensesAmt |
| PY Total Expenses | $25,040,781 | PYTotalExpensesAmt |
| CY Total Expenses | $26,751,050 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,844,574 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $2,407,060 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $13,071,779 | TotalAssetsBOYAmt |
| Total Assets EOY | $13,520,928 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $7,154,509 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $5,124,396 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $5,917,270 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $8,396,532 | NetAssetsOrFundBalancesEOYAmt |
| 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 | $24,686,269 | ExpenseAmt |
| Grant | $5,105 | GrantAmt |
| Revenue | $27,791,416 | RevenueAmt |
| Desc | Athol Memorial Hospital is a critical access hospital (CAH) serving the nine towns of North Quabbin Region. The areas relatively small population is dispersed over a large geographic area. Inherent in the Hospital mission of providing healthcare services are efforts to help improve the health and lives of our community. This intent is the framework for our community benefits activities. | Desc |
| Total Other Prog Srvc Expense | $0 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Grant | $0 | TotalOtherProgSrvcGrantAmt |
| Total Other Prog Srvc Revenue | $0 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $24,686,269 | 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 |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (1) | 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 | Yes (1) | 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 With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| 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 | 56 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 249 | 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 | 0 | QuidProQuoContributionsInd |
| 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 |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 20 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 17 | 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 | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | 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 | Heywood Hospital | BusinessNameLine1Txt |
| Business Name Line2 | Robert Crosby | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9786306157 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 242 Green Street | AddressLine1Txt |
| City | Gardner | CityNm |
| State Abbreviation | MA | StateAbbreviationCd |
| ZIP | 01440 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (33 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| Glenn Hunt | |||||||||
| Chairman | 0.2 | Yes (X) | $0 | $0 | $0 | ||||
| Robert Chauvin | |||||||||
| Vice Chairman | 0.2 | Yes (X) | $0 | $0 | $0 | ||||
| Roy Lake | |||||||||
| 2nd Vice Chairman | 0.2 | Yes (X) | $0 | $0 | $0 | ||||
| Cheney Castine Esq | |||||||||
| Treasurer | 0.2 | Yes (X) | $0 | $0 | $0 | ||||
| JoAnne Parks | |||||||||
| Clerk | 0.2 | Yes (X) | $0 | $0 | $0 | ||||
| Daniel Asquino | |||||||||
| Trustee | 0.2 | Yes (X) | $0 | $0 | $0 | ||||
| Joyce Fletcher | |||||||||
| Trustee | 0.2 | Yes (X) | $0 | $0 | $0 | ||||
| John Flick Esq | |||||||||
| Trustee | 0.2 | Yes (X) | $0 | $0 | $0 | ||||
| James Garrison | |||||||||
| Trustee | 0.2 | Yes (X) | $0 | $0 | $0 | ||||
| James Meehan | |||||||||
| Trustee | 0.2 | Yes (X) | $0 | $0 | $0 | ||||
| Donald Mruk MD | |||||||||
| Trustee | 0.2 | Yes (X) | $0 | $0 | $0 | ||||
| Michele Parker MD | |||||||||
| Trustee | 0.2 | Yes (X) | $0 | $0 | $0 | ||||
| Kenneth Pierce | |||||||||
| Trustee | 0.2 | Yes (X) | $0 | $0 | $0 | ||||
| Tina Sbrega | |||||||||
| Trustee | 0.2 | Yes (X) | $0 | $0 | $0 | ||||
| Joel Shaughnessy | |||||||||
| Trustee | 0.2 | Yes (X) | $0 | $0 | $0 | ||||
| John Skrzypczak MD | |||||||||
| Trustee | 0.2 | Yes (X) | $0 | $0 | $0 | ||||
| Craig Twohey | |||||||||
| Trustee | 0.2 | Yes (X) | $0 | $0 | $0 | ||||
| Winfield Brown | |||||||||
| President/ CEO | 0.2 | Yes (X) | $0 | $851,290 | $70,930 | 40 | Yes (X) | ||
| Elizabeth Nottleson | |||||||||
| Trustee/Family Physician | 0.2 | Yes (X) | $0 | $275,692 | $19,205 | 28 | |||
| Benjamin Prentiss | |||||||||
| Trustee/Family Physician | 0.2 | Yes (X) | $0 | $415,610 | $40,424 | 38 | |||
| Robert Crosby | |||||||||
| VP of Finance | 0.2 | $0 | $324,813 | $57,218 | 40 | Yes (X) | |||
| Rebecca Bialecki | |||||||||
| VP of Community Health Relations | 0 | $0 | $171,493 | $44,693 | 40 | Yes (X) | |||
| Tina Griffin | |||||||||
| VP/CNO | 40 | $0 | $230,256 | $47,332 | 0 | Yes (X) | |||
| Dawn Casavant | |||||||||
| VP of External Affairs | 0 | $0 | $157,505 | $49,690 | 40 | Yes (X) | |||
| Bruce Bertrand | |||||||||
| Chief Medical Officer | 0 | $0 | $293,679 | $37,538 | 40 | Yes (X) | |||
| Rose Kavalchuck | |||||||||
| VP of Professional Services | 0 | $0 | $257,104 | $46,995 | 40 | Yes (X) | |||
| Carol Roosa | |||||||||
| CIO | 0 | $0 | $186,573 | $50,621 | 40 | Yes (X) | |||
| Jordan Bergeron | |||||||||
| Director of Nursing | 40 | $107,635 | $0 | $28,304 | 0 | Yes (X) | |||
| Kathy Ledford | |||||||||
| RN | 40 | $103,656 | $0 | $23,600 | 0 | Yes (X) | |||
| Michele Munger | |||||||||
| Xray Coordinator | 40 | $103,696 | $0 | $18,665 | 0 | Yes (X) | |||
| Patricia Whitefield | |||||||||
| Clinical Coordinator | 40 | $105,076 | $0 | $12,315 | 0 | Yes (X) | |||
| Leticia Hebert | |||||||||
| RN | 32 | $101,918 | $0 | $11,920 | 0 | Yes (X) | |||
| Michael Grimmer | |||||||||
| VP of Support Services | 0.2 | $0 | $261,351 | $53,040 | 40 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $521,981 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $3,425,366 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $612,490 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 5 | 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 | Address Line2ContractorAddress/USAddress/AddressLine2Txt |
|---|---|---|---|---|---|---|
| Quartulli & Associates | ||||||
| PO Box 423 | Gardner | MA | 01440 | PT & OT Services | $908,290 | |
| New England Inpatient Specialists | ||||||
| 120 Water Street | North Andover | MA | 01845 | Hospitalists Physicians | $803,429 | |
| SMRT Inc | ||||||
| PO Box 618 | Portland | ME | 04104 | Architect Services | $802,987 | |
| Hutter Construction Corp | ||||||
| 810 Turnpike Rd | New Ipswich | NH | 03071 | Construction Services | $256,520 | Rte 124 |
| Quest Diagnostics | ||||||
| 12436 Collections Center Dr | Chicago | IL | 60693 | Clinical Laboratory Services | $236,046 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 10 | CntrctRcvdGreaterThan100KCnt |
| Federated Campaigns | $0 | FederatedCampaignsAmt |
| Membership Dues | $0 | MembershipDuesAmt |
| Fundraising | $28,879 | FundraisingAmt |
| Related Organizations | $2,953 | RelatedOrganizationsAmt |
| Government Grants | $541,907 | GovernmentGrantsAmt |
| All Other Contributions | $593,925 | AllOtherContributionsAmt |
| Noncash Contributions | $0 | NoncashContributionsAmt |
| Total Contributions | $1,167,664 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt | ExclusionExclusionAmt |
|---|---|---|---|---|---|
| Ancillary OP Services | 622110 | $18,779,675 | $18,779,675 | $0 | $0 |
| Ancilliary IP & Routine Services | 622110 | $8,850,726 | $8,850,726 | $0 | $0 |
| Anesthesia Patient Revenu | 622110 | $161,015 | $161,015 | $0 | $0 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $27,791,416 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$526 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | -$526 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $99,330 | RealAmt |
| Personal | $0 | PersonalAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
| Personal | $0 | PersonalAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $99,330 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $99,330 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $99,330 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | $0 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | $57,432 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | -$57,432 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$57,432 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | -$57,432 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $11,716 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $28,879 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $19,493 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$7,777 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | -$7,777 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gaming Gross Income | $0 | GamingGrossIncomeAmt |
| Gaming Direct Expenses | $0 | GamingDirectExpensesAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $0 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $0 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt | ExclusionExclusionAmt |
|---|---|---|---|---|---|
| Meal Revenue | 722310 | $109,812 | $0 | $0 | $109,812 |
| Gift Shop | 453220 | $14,768 | $0 | $0 | $14,768 |
| Occupational Health | 900099 | $14,751 | $0 | $0 | $14,751 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $26,104 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $26,104 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $165,435 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $29,158,110 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $27,791,416 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $199,030 | 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 | $3,055 | TotalAmt |
| Program Services | $3,055 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,050 | TotalAmt |
| Program Services | $2,050 | ProgramServicesAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,971,806 | TotalAmt |
| Program Services | $7,868,833 | ProgramServicesAmt |
| Management And General | $102,973 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $61,798 | TotalAmt |
| Program Services | $60,655 | ProgramServicesAmt |
| Management And General | $1,143 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,248,590 | TotalAmt |
| Program Services | $1,223,407 | ProgramServicesAmt |
| Management And General | $25,183 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $648,357 | TotalAmt |
| Program Services | $643,015 | ProgramServicesAmt |
| Management And General | $5,342 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,754 | TotalAmt |
| Program Services | $1,301 | ProgramServicesAmt |
| Management And General | $8,453 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,700 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $11,700 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $56,000 | TotalAmt |
| Fundraising | $56,000 | FundraisingAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,734,676 | TotalAmt |
| Program Services | $4,704,747 | ProgramServicesAmt |
| Management And General | $29,929 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,409 | TotalAmt |
| Program Services | $26,161 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $248 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,910,404 | TotalAmt |
| Program Services | $2,854,416 | ProgramServicesAmt |
| Management And General | $55,196 | ManagementAndGeneralAmt |
| Fundraising | $792 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $220,137 | TotalAmt |
| Program Services | $220,137 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $395,114 | TotalAmt |
| Program Services | $361,851 | ProgramServicesAmt |
| Management And General | $33,263 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,774 | TotalAmt |
| Program Services | $11,197 | ProgramServicesAmt |
| Management And General | $7,577 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $40,812 | TotalAmt |
| Program Services | $16,183 | ProgramServicesAmt |
| Management And General | $24,629 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,139 | TotalAmt |
| Program Services | $13,139 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $980,327 | TotalAmt |
| Program Services | $975,862 | ProgramServicesAmt |
| Management And General | $4,465 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $96,931 | TotalAmt |
| Program Services | $78,042 | ProgramServicesAmt |
| Management And General | $18,889 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| Professional Fees | $5,141,971 | $3,530,839 | $1,492,276 | $118,856 |
| Bad Debt | $1,479,916 | $1,479,916 | $0 | $0 |
| Free Care | $550,848 | $550,848 | $0 | $0 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $128,482 | TotalAmt |
| Program Services | $60,615 | ProgramServicesAmt |
| Management And General | $67,867 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,751,050 | TotalAmt |
| Program Services | $24,686,269 | ProgramServicesAmt |
| Management And General | $1,888,885 | ManagementAndGeneralAmt |
| Fundraising | $175,896 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,570,114 | BOYAmt |
| EOY | $1,967,773 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,049,267 | BOYAmt |
| EOY | $943,244 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,935,877 | BOYAmt |
| EOY | $2,854,570 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $342,920 | BOYAmt |
| EOY | $396,384 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $157,277 | BOYAmt |
| EOY | $200,601 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $16,381,914 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $10,731,641 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,640,513 | BOYAmt |
| EOY | $5,650,273 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,370,811 | BOYAmt |
| EOY | $1,503,083 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | 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 | $13,071,779 | BOYAmt |
| EOY | $13,520,928 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,878,060 | BOYAmt |
| EOY | $2,542,740 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $45,171 | BOYAmt |
| EOY | $72,332 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $77,920 | BOYAmt |
| EOY | $40,868 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,153,358 | BOYAmt |
| EOY | $2,468,456 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,154,509 | BOYAmt |
| EOY | $5,124,396 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,497,193 | BOYAmt |
| EOY | $5,950,205 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,081,080 | BOYAmt |
| EOY | $1,042,764 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,338,997 | BOYAmt |
| EOY | $1,403,563 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,917,270 | BOYAmt |
| EOY | $8,396,532 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,071,779 | BOYAmt |
| EOY | $13,520,928 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $2,407,060 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $64,557 | NetUnrlzdGainsLossesInvstAmt |
| Donated Services And Use Fclts | $0 | DonatedServicesAndUseFcltsAmt |
| Investment Expense | $0 | InvestmentExpenseAmt |
| Prior Period Adjustments | $0 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | $7,645 | 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 | $1,370,811 | BeginningYearBalanceAmt |
| Contributions | $706,454 | ContributionsAmt |
| Investment Earnings Or Losses | $63,874 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $0 | GrantsOrScholarshipsAmt |
| Other Expenditures | $636,832 | OtherExpendituresAmt |
| Administrative Expenses | $1,224 | AdministrativeExpensesAmt |
| End Year Balance | $1,503,083 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,391,453 | BeginningYearBalanceAmt |
| Contributions | $94,080 | ContributionsAmt |
| Investment Earnings Or Losses | $18,408 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $0 | GrantsOrScholarshipsAmt |
| Other Expenditures | $133,124 | OtherExpendituresAmt |
| Administrative Expenses | $6 | AdministrativeExpensesAmt |
| End Year Balance | $1,370,811 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,546,049 | BeginningYearBalanceAmt |
| Contributions | $63,274 | ContributionsAmt |
| Investment Earnings Or Losses | -$139,376 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $0 | GrantsOrScholarshipsAmt |
| Other Expenditures | $78,492 | OtherExpendituresAmt |
| Administrative Expenses | $2 | AdministrativeExpensesAmt |
| End Year Balance | $1,391,453 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,559,197 | BeginningYearBalanceAmt |
| Contributions | $54,696 | ContributionsAmt |
| Investment Earnings Or Losses | -$2,219 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $0 | GrantsOrScholarshipsAmt |
| Other Expenditures | $65,622 | OtherExpendituresAmt |
| Administrative Expenses | $3 | AdministrativeExpensesAmt |
| End Year Balance | $1,546,049 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,428,736 | BeginningYearBalanceAmt |
| Contributions | $15,816 | ContributionsAmt |
| Investment Earnings Or Losses | $1,091 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $0 | GrantsOrScholarshipsAmt |
| Other Expenditures | -$113,554 | OtherExpendituresAmt |
| Administrative Expenses | $0 | AdministrativeExpensesAmt |
| End Year Balance | $1,559,197 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.934 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.066 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $104,490 | OtherCostOrOtherBasisAmt |
| Book Value | $104,490 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $6,669,540 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,372,622 | DepreciationAmt |
| Book Value | $2,296,918 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $0 | OtherCostOrOtherBasisAmt |
| Depreciation | $0 | DepreciationAmt |
| Book Value | $0 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $7,706,471 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,208,062 | DepreciationAmt |
| Book Value | $1,498,409 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $1,901,413 | OtherCostOrOtherBasisAmt |
| Depreciation | $150,957 | DepreciationAmt |
| Book Value | $1,750,456 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $5,650,273 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Donor Restricted Investments | Desc |
| Book Value | $1,503,083 | BookValueAmt |
| Method Valuation | F | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $1,503,083 | TotalBookValueSecuritiesAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| Estimated Third-Party Settlements | $2,463,456 |
| Estimated Malpractice Liability | $5,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $2,468,456 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule D, 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 of investments, price-level trends, and general economic conditions. |
| Schedule D, Part X, Line 2 | Heywood Healthcare, Heywood Hospital, Athol, HMGI and Charitable Foundation 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. Quabbin Healthcare has filed for its exempt status under Section 501(c)(3) of the Code. The Organization annually evaluates its tax status and tax positions taken with respect to its operations and financial position. Tax years from 2013 through the current year remain open for examination by federal and state taxing authorities. |
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 St | 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 | $56,000 | RetainedByContractorAmt |
| Net To Organization | -$56,000 | NetToOrganizationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Gross Receipts | $0 | TotalGrossReceiptsAmt |
| Total Retained By Contractors | $56,000 | TotalRetainedByContractorsAmt |
| Total Net To Organization | -$56,000 | TotalNetToOrganizationAmt |
| Licensed States | MA | LicensedStatesCd |
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | Golf Tournament | Event1Nm |
| Gross Receipts Event1 | $40,595 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $28,879 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $11,716 | GrossRevenueEvent1Amt |
| Cash Prizes Event1 | $0 | CashPrizesEvent1Amt |
| Non Cash Prizes Event1 | $351 | NonCashPrizesEvent1Amt |
| Rent Facility Costs Event1 | $6,770 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $4,886 | FoodAndBeverageEvent1Amt |
| Entertainment Event1 | $0 | EntertainmentEvent1Amt |
| Other Direct Expenses Event1 | $7,486 | OtherDirectExpensesEvent1Amt |
| Food And Beverage Other Events | $0 | FoodAndBeverageOtherEventsAmt |
| Entertainment Other Events | $0 | EntertainmentOtherEventsAmt |
| Gross Receipts Total | $40,595 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $28,879 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $11,716 | GrossRevenueTotalEventsAmt |
| Cash Prizes Total Events | $0 | CashPrizesTotalEventsAmt |
| Non Cash Prizes Total Events | $351 | NonCashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $6,770 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $4,886 | FoodAndBeverageTotalEventsAmt |
| Entertainment Total Events | $0 | EntertainmentTotalEventsAmt |
| Oth Direct Expnss Total Events | $7,486 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $19,493 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$7,777 | NetIncomeSummaryAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| 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 | $508,708 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $228,935 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $279,773 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.011 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,700,212 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,644,632 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $55,580 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0022 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $7,208,920 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,873,567 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $335,353 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0132 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $500,491 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $500,491 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0198 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $33,996 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $600 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $33,396 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0013 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $10,429 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $10,429 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0004 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $544,916 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $600 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $544,316 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0215 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $7,753,836 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,874,167 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $879,669 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0347 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,948 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,944 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,004 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0001 | TotalExpensePct |
Environmental Improvements EnvironmentalImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,079 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,079 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $6,027 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,944 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,083 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0001 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $430,675 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $6,748,517 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $7,083,487 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$334,970 | 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 |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
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 |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| CHNA Conducted | 15 | 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 | www.atholhospital.org | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | www.jointcoalitiononhealth.org | OtherWebsiteURLTxt |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | atholhospital.org | StrategyWebsiteURLTxt |
| Strategy Attached | 0 | StrategyAttachedInd |
| 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 | 100 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400 | 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 | atholhospital.org | FAPAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | atholhospital.org | 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 | Yes (X) | LookBackMedicareInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule H, Part V, Section B, Line 3-Athol Memorial Hospital | The 2015 Community Health Needs Assessment of North Central Massachusetts was a joint effort between Heywood Healthcare's Heywood Hospital and Athol Hospital, Health Alliance Hospital, Community Health Connections FQHC, the Montachusett Public Health Network (MPHN), MA Department of Public Health's Community Health Network Area of North Central Massachusetts (CHNA 9) and the Joint Coalition on Health. The assessment is designed to provide information and analyses relative to the health status, issues, concerns and assets of the North Central Region of Massachusetts. The assessment includes 30 cities and towns which are primary service areas of the three hospitals Heywood Hospital, Athol Hospital and Health Alliance Hospital. The data was presented and analyzed in four ways including, the entire region, Heywood Healthcare Service Areas, Health Alliance Service Areas, and the MPHN Service Areas. Comparisons were made between the different service areas and to Massachusetts as a whole. All data was gathered systematically utilizing standards which guided the methodologies. The quantitative data collected came from the Massachusetts Community Health Information Profile, the Massachusetts Department of Public Health, the US Census Bureau, the MA Department of Workforce Development, the MA Department of Elementary and Secondary Education, the Youth Risk Behavior Survey (YRBS) Data, and the CD Behavioral Risk Factor Surveillance System (BRFSS). Qualitative data was gathered through 16 focus groups and 26 key informant interviews representing diverse communities and populations in the region, such as illness, Black African Americans, Latinos, Brazilian's, Hmong, LGBTQ, elders, young adults, homeless individuals, veterans and adults with major mental illness. They were conducted in cooperation with Westwinds Clubhouse; North Quabbin Community Coalition; Veterans Homestead Inc; 15 West Teen Coffeehouse; Clinton Hospital; Montachusett Opportunity Council; New Hope Baptist Church; Hope Center; Fitchburg Senior Center; Goodrich Academy Alternative High School; and Regional Behavioral Health Collaborative. Priority Health Issues identified from the CHNA are Mental Health and Substance Abuse; Suicide Prevention; Chronic Disease and related risk factors; Nutrition Issues including Obesity and food insecurity. As well as addressing health disparities that exist in our region and improving access to care for populations adversely affected by social determinants of health. |
| Schedule H, Part V, Section B, Line 5-Athol Memorial Hospital | Athol Hospital's 2015 Community Health Needs Assessment took into account input from person's who represent the community. This input was gathered through 16 focus groups and 26 key informant interviews representing diverse communities and populations in the region, such as Black African Americans, Latinos, Brazilians, Hmong, LGBTQ, elders, young adults, homeless individuals, veterans, and adults with major mental illness. |
| Schedule H, Part V, Section B, Line 6a-Athol Memorial Hospital | Hospitals included in the development of the 2015 Community Health Needs Assessment are Athol Hospital, Athol, MA; Heywood Hospital, Gardner, MA; HealthAlliance Hospital, Leominster, MA. |
| Schedule H, Part V, Section B, Line 6b-Athol Memorial Hospital | Other organizations involved in the development of the 2015 Community Health Needs Assessment was Community Health Connections FQHC, the Montachusett Public Health Network (MPHN), MA Department of Public Health's Community Health Network Area of North Central Massachusetts (CHNA 9) and the Joint Coalition on Health. The focus groups were conducted in collaboration with the Westwinds Clubhouse; North Quabbin Community Coalition; Veterans Homestead Inc; 15 West Teen Coffeehouse; Clinton Hospital; Montachusett Opportunity Council; New Hope Baptist Church; Hope Center; Fitchburg Senior Center; Goodrich Academy Alternative High School; and Regional Behavioral Health Collaborative. |
| Schedule H, Part V, Section B, Line 11-Athol Memorial Hospital | Athol Hospital's approach to addressing the critical health needs identified by the CHNA is through outreach, education, and support to the communities we serve. Hospital members actively participate on and 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. Partners include: North Quabbin Community Coalition; Valuing our Children; Franklin Hampshire North Quabbin Opiate Prevention Task Force; The Regional Behavioral Health Collaborative; Athol and Royalston Boards of Health; Suicide Prevention Task Force; Athol YMCA; Athol Public School District; Athol, Erving, and Winchendon Senior Center; Phillipston Congregational Church; Salvation Army. Key Accomplishments of Reporting Year: * Partnered with the Athol Schools to address food insecurity by providing food assistance to 50 low- income and at-risk youth through a weekend backpack food program. * Provided health information about heart disease and offered free blood pressure screenings to over 80 individuals. * Promoted wellness by providing flu prevention education in community settings and free flu vaccinations to 16 individuals. * Supported 103 individuals with mental health and substance use disease with self-care techniques to better manage their disease. * Distributed 135 biohazard containers and offered free disposal of sharps and needles reducing risk to families and waste management and landfill staff. * Offered wellness instruction and self-care techniques to 58 individuals to cope and manage symptoms associated with Cancer and chronic conditions and end of life care. * Provided 2592 individuals with health insurance counseling and financial assistance. Completed 488 health insurance applications. Made 2409 referrals to reduce barriers to accessing health care and social supports. * Assisted 19 patients with transportation and as a result was able to follow up with their healthcare and prevented missed appointments. * Offered free psychosocial support to 47 community members looking for information and referrals on issues related to housing, food, transportation, behavioral and substance abuse. * Provided 1,026 hours of mentorship to 5 students pursuing careers in healthcare. * Actively participate on community boards and committees including, the North Quabbin Community Coalition, Athol YMCA Diabetes Prevention Advisory Board, Valuing our Children, Franklin Hampshire North Quabbin Opiate Prevention Task Force, and the Regional Behavioral Health Collaborative, to collaboratively address community health needs and gaps in services. |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule H, Part I, Line 6a | Community Benefit Report is filed with Attorney General's Office, State of Massachusetts. |
| Schedule H, Part I, Line 7 | The costing methodology used to calculate the amounts reported in the table in Part I, for lines 7a through 7c was based on the cost to charge ratio derived from the supplied Worksheet 2, in the IRS schedule H instructions. |
| Schedule H, Part II | The Athol 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." |
| Schedule H, Part III, Section A, Line 2 | The costing methodology used for line 2 was based on the cost charge ratio derived from the supplied worksheet 2 in the IRS Schedule H instructions. |
| Schedule H, Part III, Section A, Line 3 | The methodology used for line 3 was to take the percentage of financial assistance applications that were due to inadequate documentation divided by the total applications received for FY 2016. This amounted to approximately 0% which was applied against the number on line 2. As a tax exempt hospital, we must provide necessary services regardless of the patient's ability to pay for the service provided. As a not for profit, patient care is provided to all, regardless of ability to pay for that care, making quality patient care available to all in our community, regardless of their economic means, qualifies bad debts as community benefit. |
| Schedule H, Part III, Section A, Line 4 | The footnote can be found on Page 8 of the financial statements - footnote #2 under "Allowance of Doubtful Accounts". |
| Schedule H, Part III, Section B, Line 8 | The allowable costs on line 6 were obtained from our FY 2016 Medicare Cost Report, Worksheet D schedules. |
| Schedule H, Part III, Section C, 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 Heywood Hospital with accurate and timely information to determine of 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 Heywood obtains will be maintained in accordance with applicable federal and state privacy and security laws. The screening and application process for public health insurance program 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 after completing the application. All Virtual Gateway applications are reviewed and processed 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. Hospitals have 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 request for documentation, then our standard collection procedures apply. |
| Schedule H, Part VI, Line 2 | Athol Hospital collaborates with many local and state agencies and organizations to assess community health needs in the North Central region of MA. We continue to assess the health care needs of the community and collaboratively develop strategies to address these issues through our active |
| Schedule H, Part VI, Line 3 | Role of Hospital Certified Financial Counselors and other Finance Staff: The hospital will try to identify available coverage options for patients who may be uninsured or underinsured with their current insurance program when the patient is scheduling their services, while the patient is in the hospital, upon discharge, and for a reasonable time following discharge from the hospital. The hospital will direct all patients seeking available coverage options, or those that the hospital determines may be eligible, to the hospital's patient financial counseling to screen for eligibility in an appropriate coverage option. The hospital will then assist the patient in applying for the appropriate coverage options that are available or notify them of availability of financial assistance through the hospital's own internal financial assistance program, if available. Notification Practices: Individual printed notices are available by contacting a Financial Counselor or through the Patient Accounts Office. Notices indicate the criteria used to determine eligibility for MassHealth and the Health Safety Net Trust Fund and where or how patients may apply. The goal of these notices is to assist patients in applying for coverage within a financial assistance program such as MassHealth, Commonwealth Care, Children's Medical Security Plan, Healthy Start, and Health Safety Net. When applicable, the hospital may also assist patients in applying for coverage of services as a Medical Hardship based on the patient's documented income and allowable medical expenses. When a patient contacts the hospital, Patient Accounting, Financial Counseling or Social Service Staff will attempt to identify if a patient qualifies for a public financial assistance program or payment plan. Patients who are already enrolled in a public financial assistance program, such as MassHealth or Health Safety Net, may qualify for certain federal, state and private assistance agencies. Patients may also qualify for additional assistance based on the hospital's own internal criteria for financial assistance, or qualify for coverage of services as a Medical Hardship based on the patient's documented income and allowable medical expenses. The following items outline more specifically the notification process, criteria, and availability of information beyond the signs that are posted in the hospital. 1. The hospital will provide an individual notice of the availability of financial assistance programs and other programs of public assistance to a patient expected to incur charges for which he/she will be personally responsible, exclusive of personal convenience items or services that may not be paid in full by third party coverage. 2. The hospital or its agents will include a notice or statement about Eligible Services to Low Income Patients and other programs of public assistance in its initial bill and subsequent correspondence with the patient. All correspondence will direct the patient where and how they can receive more information or additional assistance and will inform the patient that they may apply or reapply for financial and public assistance before, during or after care, or after collection agency assignment if their situation changes. 3. The hospital will include a notice regarding the availability of financial assistance and other programs of public assistance to Low Income Patients in all written collection actions. The hospital will notify the patient that it offers a payment plan if the patient is determined to be eligible for MassHealth or free care/uncompensated care through the Health Safety Net Trust Fund as a low income patient or due to Medical Hardship. These payment plans are consistent with 1016 CMR 6613.08 (1)(f)(4). The hospital will also offer payment plan options for those individuals who do not qualify for Low Income Patient status. 4. Heywood Hospital will include language on its written notices that reads: "You may be eligible for assistance through our Financial Assistance Program. For eligibility information, please contact our Customer Services Department at 1-800-305-6757." Verbiage may change to accommodate changes of department information. 5. There is no primary language other than English that is spoken by 5% or more of the hospital's service area. Signage and other documentation will be provided in English. The hospital provides translator services for several other languages and this service may be accessed for those individuals whose primary language is not English or Spanish. 6. For cases where the hospital continues to determine eligibility for free care/uncompensated care through the Health Safety Net Trust Fund application, then MassHealth will provide written notice of determination that the patient is or is not eligible within 30 days of receiving a completed application and the required supporting documentation. The vast majority of patients will however be screened via the common intake process and processed through the Virtual Gateway and MA-21 system. 7. Whether the hospital is using the MassHealth application process through the Virtual Gateway or submitting a MassHealth application directly, the hospital will assist the patient in completing the application or intake process for enrollment and eligibility screening. |
| Schedule H, Part VI, Line 4 | The Athol Hospital Service Area is comprised of the city of Athol and the surrounding towns of the North Quabbin region, Orange, Petersham, Phillipston, Royalston, New Salem, Wendell, Erving and Warwick. The designated rural area has a population of approx. 28,000, with a median income below the state average and an unemployment rate above the state average. The area has identified social determinants of health related to its rural nature, such as isolation, high unemployment, low wages, lack of transportation and access to healthcare. |
| Schedule H, Part VI, Line 5 | Athol Hospital is dedicated to the community benefit goals of improving the health status of our community, addressing the special health needs of the underserved and collaboration with others to enhance quality and contain the growth of community healthcare costs. Examples of activities the hospital participates in to promote the health of the community include: Partner with The Athol Royalston Regional School District to offer food assistance to low-income and at-risk youth through a weekend backpack food program; Provide health information by participating at community health fairs and events at venues reaching vulnerable populations; offer support groups for cancer survivors; Offer CPR and first aid training to community members unable to afford the classes; Educate the community and implement a program of safe disposal of sharps and provide insurance information and enrollment assistance to individuals reducing financial barriers to accessing healthcare; Offered free psychosocial support to community members looking for information on issues related to housing, food, transportation, behavioral and substance abuse. |
| Schedule H, Part VI, Line 7 | Community Benefit Report is filed with Attorney General's Office, State of Massachusetts. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | Yes (1) | 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 | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (11 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Winfield Brown | ||||||||||||||
| President/ CEO | $0 | $480,315 | $0 | $93,000 | $0 | $277,975 | $0 | $23,300 | $0 | $47,631 | $0 | $922,221 | $0 | |
| Elizabeth Nottleson | ||||||||||||||
| Trustee/Family Physician | $0 | $260,326 | $0 | $0 | $0 | $15,365 | $0 | $5,370 | $0 | $13,835 | $0 | $294,896 | $0 | $0 |
| Robert Crosby | ||||||||||||||
| VP of Finance | $0 | $280,484 | $0 | $41,602 | $0 | $2,727 | $0 | $23,300 | $0 | $33,918 | $0 | $382,031 | $0 | $0 |
| Michael Grimmer | ||||||||||||||
| VP of Support Services | $0 | $222,642 | $0 | $31,562 | $0 | $7,147 | $0 | $21,458 | $0 | $31,582 | $0 | $314,391 | $0 | $0 |
| Rebecca Bialecki | ||||||||||||||
| VP of Community Health Relations | $0 | $147,933 | $0 | $22,221 | $0 | $1,338 | $0 | $21,097 | $0 | $23,596 | $0 | $216,185 | $0 | |
| Tina Griffin | ||||||||||||||
| VP/CNO | $0 | $198,927 | $0 | $29,500 | $0 | $1,829 | $0 | $21,313 | $0 | $26,019 | $0 | $277,588 | $0 | $0 |
| Bruce Bertrand | ||||||||||||||
| Chief Medical Officer | $0 | $265,122 | $0 | $24,700 | $0 | $3,857 | $0 | $23,300 | $0 | $14,238 | $0 | $331,217 | $0 | $0 |
| Rose Kavalchuck | ||||||||||||||
| VP of Professional Services | $0 | $202,888 | $0 | $51,298 | $0 | $2,918 | $0 | $20,708 | $0 | $26,288 | $0 | $304,100 | $0 | $0 |
| Carol Roosa | ||||||||||||||
| CIO | $0 | $166,900 | $0 | $18,839 | $0 | $834 | $0 | $21,523 | $0 | $29,098 | $0 | $237,194 | $0 | $0 |
| Dawn Casavant | ||||||||||||||
| VP of External Affairs | $0 | $156,998 | $0 | $0 | $0 | $508 | $0 | $21,313 | $0 | $28,377 | $0 | $207,196 | $0 | $0 |
| Benjamin Prentiss | ||||||||||||||
| Trustee/Family Physician | $0 | $374,797 | $0 | $40,215 | $0 | $598 | $0 | $7,653 | $0 | $32,771 | $0 | $456,034 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule J, Part I, Line 3 | The CEO's compensation is paid by Heywood Hospital, a related organization and is determined by market data and analysis provided to the Hospital's Compensation Committee and Board of Trustees by an independent compensation consultant engaged by the Board of Trustees annually. |
| Schedule J, Part I, Line 4 | Michael Grimmer, COO received a severance package when he terminated employment in April 2017 for 1 year severance. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section B, Line 11b | The Accountant for Athol prepares the form 990 and provides it to the Sr. Accountant and Controller for review. The form is then sent to the CFO for final review. Once approved and signed, the 990 is placed on the Hospital Cyber Board for the Board of Trustees' review. The 990 is then approved by the Board and submitted by the Accounting Department. |
| 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, Officers and Employees are regularly and consistently monitoring and enforcing it. |
| Form 990, Part VI, Section B, Line 15 | All Officers and the CEO's salary are paid by Heywood Memorial Hospital. The salaries are determined by the Board of Directors 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 the 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 | The expenses that make up this line are as follows: Physician Fees - $3,475,883, Outside Clinical Fees - $934,712, Temporary Employees - $281,127, Medical Staff - $9000 and Other Contracted Services - $33,954. |
| Form 990, Part XI, Line 9 | The other changes in net assets relates to discounts on pledges receivable of $(3,017) and $4,628 for a related organization to support services. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Heywood Healthcare Inc | |||||||||||
| 242 Green Street | Gardner | MA | 01440 | 222720658 | Parent Corp | MA | 501(c)(3) | 11b | N/A | 0 | |
| Heywood Healthcare Charitable Foundation Inc | |||||||||||
| 242 Green Street | Gardner | MA | 01440 | 222720562 | Charitable Foundation | MA | 501(c)(3) | 7 | 0 | Heywood Healthcare Inc | |
| Henry Heywood Memorial Hospital | |||||||||||
| 242 Green Street | Gardner | MA | 01440 | 042103581 | Hospital | MA | 501(c)(3) | 3 | 0 | Heywood Healthcare Inc | |
| Heywood Affiliated Medical Group | |||||||||||
| 242 Green Street | Gardner | MA | 01440 | 043163589 | Multi-Specialty Physicians | MA | 501(c)(3) | 9 | 0 | Heywood Healthcare Inc | |
| Heywood Realty Corp | |||||||||||
| 242 Green Street | Gardner | MA | 01440 | 043327447 | Property Holding Corp | MA | 501(c)(2) | n/a | 0 | Heywood Healthcare Inc | |
| Quabbin Healthcare Inc | |||||||||||
| 242 Green St | Gardner | MA | 01440 | 812053488 | Behavioral Health | MA | Pending | Pending | 0 | Heywood Healthcare Inc | |
| 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 | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | 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 | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | Yes (1) | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | 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 | Yes (1) | TransferFromOtherOrgInd |