ATHOL MEMORIAL HOSPITAL INCORPORATED: Form 990, tax year 2015

View the entire original 990 at ProPublica ↗

Organization: ATHOL MEMORIAL HOSPITAL INCORPORATED (EIN 04-2126583)
Tax period: 2015-10-01 to 2016-09-30
Filed: 2017-05-08
IRS object ID: 201701319349304525
Schema version: 2015v3.0
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 I
Schedule J
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2017-05-08T13:30:02-07:00	ReturnTs
Tax Period End	2016-09-30	TaxPeriodEndDt
Return Type	990	ReturnTypeCd
Tax Period Begin	2015-10-01	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	2017-04-25	SignatureDt

Field	Value	IRS element (for citing)
Tax	2015	TaxYr
Build TS	2021-01-29 14:40:06Z	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	Heywood Hospital	AddressLine1Txt
Address Line2	242 Green St	AddressLine2Txt
City	Gardner	CityNm
State Abbreviation	MA	StateAbbreviationCd
ZIP	01440	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$26,904,663	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	257	TotalEmployeeCnt
Total Volunteers	22	TotalVolunteersCnt
Total Gross UBI	$0	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$0	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$824,733	PYContributionsGrantsAmt
CY Contributions Grants	$1,690,173	CYContributionsGrantsAmt
PY Program Service Revenue	$22,536,620	PYProgramServiceRevenueAmt
CY Program Service Revenue	$25,046,682	CYProgramServiceRevenueAmt
PY Investment Income	-$11,057	PYInvestmentIncomeAmt
CY Investment Income	$1,250	CYInvestmentIncomeAmt
PY Other Revenue	$554,748	PYOtherRevenueAmt
CY Other Revenue	$147,250	CYOtherRevenueAmt
PY Total Revenue	$23,905,044	PYTotalRevenueAmt
CY Total Revenue	$26,885,355	CYTotalRevenueAmt
PY Grants And Similar Paid	$0	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$14,867	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$9,560,732	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$8,862,206	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$62,818	CYTotalFundraisingExpenseAmt
PY Other Expenses	$14,695,160	PYOtherExpensesAmt
CY Other Expenses	$16,163,708	CYOtherExpensesAmt
PY Total Expenses	$24,255,892	PYTotalExpensesAmt
CY Total Expenses	$25,040,781	CYTotalExpensesAmt
PY Revenues Less Expenses	-$350,848	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$1,844,574	CYRevenuesLessExpensesAmt
Total Assets BOY	$10,349,937	TotalAssetsBOYAmt
Total Assets EOY	$13,071,779	TotalAssetsEOYAmt
Total Liabilities BOY	$7,774,238	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$7,154,509	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$2,575,699	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$5,917,270	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	$23,156,101	ExpenseAmt
Grant	$0	GrantAmt
Revenue	$25,048,682	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	$23,156,101	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	0	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	Yes (1)	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	60	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (1)	BackupWthldComplianceInd
Employee	257	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	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	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 (30 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
Kenneth Pierce
Chairman	0.2	Yes (X)	$0	$0	$0
Glenn Hunt
Vice Chairman	0.2	Yes (X)	$0	$0	$0
Roy Lake
Treasurer	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
Robert Chauvin
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
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	$782,320	$73,748	40	Yes (X)
Elizabeth Nottleson
Trustee/Family Physician	0.2	Yes (X)	$0	$327,410	$20,721	28
Kami Phillips
Trustee/Family Physician	0.2	Yes (X)	$0	$28,430	$1,422	24
Robert Crosby
VP of Finance	0.2		$0	$312,908	$56,616	40	Yes (X)
Michael Grimmer
VP of Support Services	0		$0	$256,070	$52,195	40	Yes (X)
Rebecca Bialecki
VP of Community Health Relations	0		$0	$132,623	$26,430	40	Yes (X)
Tina Griffin
VP/CNO	0		$0	$198,861	$30,503	40	Yes (X)
Dawn Casavant
VP of External Affairs	0		$0	$167,495	$48,415	40	Yes (X)
Carol Roosa
CIO	0		$0	$178,925	$49,077	40	Yes (X)
Rose Kavalchuck
VP of Professional Services	0		$0	$199,198	$45,924	40	Yes (X)
Bruce Bertrand
Chief Medical Officer	0		$0	$263,226	$36,548	40	Yes (X)
Mark Wu
Surgeon	40		$280,687	$0	$19,422	0		Yes (X)
Jordan Bergeron
Director of Nursing	40		$108,197	$0	$26,147	0		Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$388,884	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$2,847,466	TotReportableCompRltdOrgAmt
Total Other Compensation	$487,168	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	2	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	0	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
PO Box 423	Gardner	MA	01440	PT & OT Services	$891,746
New England Inpatient Specialists
120 Water Street	North Andover	MA	01845	Hospitalists Physicians	$606,654
Quest Diagnostics
12436 Collections Center Dr	Chicago	IL	60693	Clinical Laboratory Services	$173,569
St Vincent Physician Services
123 Summer Street	Worcester	MA	01608	ER & Hospitalist Physicians	$150,000
Littler Mendelson PC
PO Box 45547	San Francisco	CA	94145	Legal Services	$123,108

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	5	CntrctRcvdGreaterThan100KCnt
Federated Campaigns	$0	FederatedCampaignsAmt
Membership Dues	$0	MembershipDuesAmt
Fundraising	$32,826	FundraisingAmt
Related Organizations	$0	RelatedOrganizationsAmt
Government Grants	$419,262	GovernmentGrantsAmt
All Other Contributions	$1,238,085	AllOtherContributionsAmt
Noncash Contributions	$0	NoncashContributionsAmt
Total Contributions	$1,690,173	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt	Unrelated Business RevenueUnrelatedBusinessRevenueAmt	ExclusionExclusionAmt
Ancillary OP Services	622110	$17,799,055	$17,799,055	$0	$0
Ancillary IP & Routine Services	622110	$7,010,054	$7,010,054	$0	$0
Anesthesia Patient Revenue	622110	$109,468	$109,468	$0	$0
MRI Scan Income	622110	$82,346	$82,346	$0	$0
Occupational Health/CPR Classes	622110	$30,526	$30,526	$0	$0

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$15,233	TotalRevenueColumnAmt
Related Or Exempt Func Income	$15,233	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$0	ExclusionAmt

Field	Value	IRS element (for citing)
Total Program Service Revenue	$25,046,682	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$2,573	TotalRevenueColumnAmt
Related Or Exempt Func Income	$0	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$2,573	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	$650	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	$650	RealAmt
Personal	$0	PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$650	TotalRevenueColumnAmt
Related Or Exempt Func Income	$0	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$650	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Securities	$0	SecuritiesAmt
Other	$3,711	OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Securities	$0	SecuritiesAmt
Other	$5,034	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$0	SecuritiesAmt
Other	-$1,323	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	-$1,323	TotalRevenueColumnAmt
Related Or Exempt Func Income	$0	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	-$1,323	ExclusionAmt

Field	Value	IRS element (for citing)
Fundraising Gross Income	$8,552	FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event	$32,826	ContriRptFundraisingEventAmt
Fundraising Direct Expenses	$14,274	FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

Field	Value	IRS element (for citing)
Total Revenue Column	-$5,722	TotalRevenueColumnAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	-$5,722	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	722212	$100,244	$0	$0	$100,244
Refunds/Settlements	900099	$13,781	$0	$0	$13,781
Gift Shop/Auxilliary	453220	$34,538	$0	$0	$34,538

Miscellaneous Revenue MiscellaneousRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$3,759	TotalRevenueColumnAmt
Related Or Exempt Func Income	$0	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$3,759	ExclusionAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$152,322	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$26,885,355	TotalRevenueColumnAmt
Related Or Exempt Func Income	$25,046,682	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$148,500	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	$14,367	TotalAmt
Program Services	$14,367	ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

Field	Value	IRS element (for citing)
Total	$500	TotalAmt
Program Services	$500	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	$7,239,838	TotalAmt
Program Services	$7,145,745	ProgramServicesAmt
Management And General	$94,093	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$57,752	TotalAmt
Program Services	$56,566	ProgramServicesAmt
Management And General	$1,186	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$988,370	TotalAmt
Program Services	$969,657	ProgramServicesAmt
Management And General	$18,713	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$576,246	TotalAmt
Program Services	$570,706	ProgramServicesAmt
Management And General	$5,540	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	$107,176	TotalAmt
Program Services	$1,219	ProgramServicesAmt
Management And General	$105,957	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$11,177	TotalAmt
Program Services	$0	ProgramServicesAmt
Management And General	$11,177	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	$0	TotalAmt
Fundraising	$0	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	$4,604,047	TotalAmt
Program Services	$4,604,047	ProgramServicesAmt
Management And General	$0	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$25,264	TotalAmt
Program Services	$25,264	ProgramServicesAmt
Management And General	$0	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$2,634,901	TotalAmt
Program Services	$2,578,420	ProgramServicesAmt
Management And General	$56,481	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt
Program Services	$0	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	$367,968	TotalAmt
Program Services	$367,968	ProgramServicesAmt
Management And General	$0	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$14,965	TotalAmt
Program Services	$12,320	ProgramServicesAmt
Management And General	$2,645	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	$25,851	TotalAmt
Program Services	$24,797	ProgramServicesAmt
Management And General	$1,054	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$34,303	TotalAmt
Program Services	$34,303	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	$946,606	TotalAmt
Program Services	$943,787	ProgramServicesAmt
Management And General	$2,819	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$148,809	TotalAmt
Program Services	$40,905	ProgramServicesAmt
Management And General	$107,904	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt	FundraisingFundraisingAmt
Professional Fees	$4,721,516	$3,316,250	$1,342,448	$62,818
Bad Debt	$1,397,114	$1,397,114	$0	$0
Free Care	$636,688	$636,688	$0	$0
Outside Repairs	$104,380	$104,380	$0	$0

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$382,943	TotalAmt
Program Services	$311,098	ProgramServicesAmt
Management And General	$71,845	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$25,040,781	TotalAmt
Program Services	$23,156,101	ProgramServicesAmt
Management And General	$1,821,862	ManagementAndGeneralAmt
Fundraising	$62,818	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$881,817	BOYAmt
EOY	$1,570,114	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	$0	BOYAmt
EOY	$1,049,267	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$2,529,286	BOYAmt
EOY	$2,935,877	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	$348,237	BOYAmt
EOY	$342,920	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$175,940	BOYAmt
EOY	$157,277	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$15,394,541	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$9,754,028	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$4,790,013	BOYAmt
EOY	$5,640,513	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

Field	Value	IRS element (for citing)
BOY	$1,604,644	BOYAmt
EOY	$1,370,811	EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Intangible Assets IntangibleAssetsGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$20,000	BOYAmt
EOY	$5,000	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$10,349,937	BOYAmt
EOY	$13,071,779	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$5,158,156	BOYAmt
EOY	$4,878,060	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	$8,126	BOYAmt
EOY	$45,171	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	$636,159	BOYAmt
EOY	$77,920	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	$1,971,797	BOYAmt
EOY	$2,153,358	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$7,774,238	BOYAmt
EOY	$7,154,509	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows SFAS117	Yes (X)	OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$1,184,246	BOYAmt
EOY	$3,497,193	EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$69,734	BOYAmt
EOY	$1,081,080	EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$1,321,719	BOYAmt
EOY	$1,338,997	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$2,575,699	BOYAmt
EOY	$5,917,270	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$10,349,937	BOYAmt
EOY	$13,071,779	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	$1,844,574	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	$17,349	NetUnrlzdGainsLossesInvstAmt
Donated Services And Use Fclts	$0	DonatedServicesAndUseFcltsAmt
Investment Expense	$0	InvestmentExpenseAmt
Prior Period Adjustments	$0	PriorPeriodAdjustmentsAmt
Other Changes In Net Assets	$1,479,648	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	$1,391,453	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 Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

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 Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

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 Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

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

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$968,215	BeginningYearBalanceAmt
Contributions	$359,388	ContributionsAmt
Investment Earnings Or Losses	$137,402	InvestmentEarningsOrLossesAmt
Grants Or Scholarships	$0	GrantsOrScholarshipsAmt
Other Expenditures	$36,269	OtherExpendituresAmt
Administrative Expenses	$0	AdministrativeExpensesAmt
End Year Balance	$1,428,736	EndYearBalanceAmt

Field	Value	IRS element (for citing)
Board Designated Balance EOY	0	BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY	0.977	PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY	0.023	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	$6,260,321	OtherCostOrOtherBasisAmt
Depreciation	$4,364,429	DepreciationAmt
Book Value	$1,895,892	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	$7,402,304	OtherCostOrOtherBasisAmt
Depreciation	$5,389,599	DepreciationAmt
Book Value	$2,012,705	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	$0	InvestmentCostOrOtherBasisAmt
Other Cost Or Other Basis	$1,627,426	OtherCostOrOtherBasisAmt
Depreciation	$0	DepreciationAmt
Book Value	$1,627,426	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$5,640,513	TotalBookValueLandBuildingsAmt

Financial Derivatives FinancialDerivativesGrp

Field	Value	IRS element (for citing)
Book Value	$0	BookValueAmt

Closely Held Equity Interests CloselyHeldEquityInterestsGrp

Field	Value	IRS element (for citing)
Book Value	$0	BookValueAmt

Other Securities OtherSecuritiesGrp

Field	Value	IRS element (for citing)
Desc	Donor Restricted Investments	Desc
Book Value	$1,370,811	BookValueAmt
Method Valuation	F	MethodValuationCd

Field	Value	IRS element (for citing)
Total Book Value Securities	$1,370,811	TotalBookValueSecuritiesAmt
Federal Income Tax Liability	$0	FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDesc	AmtAmt
Estimated Third Party Settlements	$2,148,358
Estimated Malpractice Liability	$5,000

Field	Value	IRS element (for citing)
Total Liability	$2,153,358	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 on investments, price-level trends, and general economic conditions.

Schedule D, Part X, Line 2

Heywood Healthcare, Heywood Hospital, Athol, HMGI,Charitable Foundation, and Quabbin Healthcare have been determined to be not-for-profit corporations as described in Section 501(c)(3) of 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. Tax years from 2012 through the current year remain open for examination by federal and state taxing authorities. Additionally, the Organization has filed all applicable returns, as required, in jurisdictions where so required. For the years ended September 30, 2015, there were no interest or penalties recorded or included in the statement of operations.

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

Field	Value	IRS element (for citing)
Event1	Golf Tournament	Event1Nm
Gross Receipts Event1	$41,378	GrossReceiptsEvent1Amt
Charitable Contri Event1	$32,826	CharitableContriEvent1Amt
Gross Revenue Event1	$8,552	GrossRevenueEvent1Amt
Cash Prizes Event1	$0	CashPrizesEvent1Amt
Non Cash Prizes Event1	$1,622	NonCashPrizesEvent1Amt
Rent Facility Costs Event1	$5,210	RentFacilityCostsEvent1Amt
Food And Beverage Event1	$3,844	FoodAndBeverageEvent1Amt
Entertainment Event1	$0	EntertainmentEvent1Amt
Other Direct Expenses Event1	$3,598	OtherDirectExpensesEvent1Amt
Food And Beverage Other Events	$0	FoodAndBeverageOtherEventsAmt
Entertainment Other Events	$0	EntertainmentOtherEventsAmt
Gross Receipts Total	$41,378	GrossReceiptsTotalAmt
Charitable Contributions Tot	$32,826	CharitableContributionsTotAmt
Gross Revenue Total Events	$8,552	GrossRevenueTotalEventsAmt
Cash Prizes Total Events	$0	CashPrizesTotalEventsAmt
Non Cash Prizes Total Events	$1,622	NonCashPrizesTotalEventsAmt
Rent Fclty Costs Total Events	$5,210	RentFcltyCostsTotalEventsAmt
Food And Beverage Total Events	$3,844	FoodAndBeverageTotalEventsAmt
Entertainment Total Events	$0	EntertainmentTotalEventsAmt
Oth Direct Expnss Total Events	$3,598	OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events	$14,274	DirectExpenseSummaryEventsAmt
Net Income Summary	-$5,722	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	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	$348,662	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$221,456	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$127,206	NetCommunityBenefitExpnsAmt
Total Expense	0.0051	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$6,076,660	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$5,822,504	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$254,156	NetCommunityBenefitExpnsAmt
Total Expense	0.0101	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	$6,425,322	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$6,043,960	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$381,362	NetCommunityBenefitExpnsAmt
Total Expense	0.0152	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$390,535	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$390,535	NetCommunityBenefitExpnsAmt
Total Expense	0.0155	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$2,860	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$2,860	NetCommunityBenefitExpnsAmt
Total Expense	0.0001	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

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

Research ResearchGrp

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

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$13,517	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$13,517	NetCommunityBenefitExpnsAmt
Total Expense	0.0005	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	0	ActivitiesOrProgramsCnt
Persons Served	0	PersonsServedCnt
Total Community Benefit Expns	$406,912	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$406,912	NetCommunityBenefitExpnsAmt
Total Expense	0.0161	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	0	ActivitiesOrProgramsCnt
Persons Served	0	PersonsServedCnt
Total Community Benefit Expns	$6,832,234	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$6,043,960	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$788,274	NetCommunityBenefitExpnsAmt
Total Expense	0.0313	TotalExpensePct

Physical Imprv And Housing PhysicalImprvAndHousingGrp

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

Economic Development EconomicDevelopmentGrp

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

Community Support CommunitySupportGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$225	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$225	NetCommunityBenefitExpnsAmt
Total Expense	0	TotalExpensePct

Environmental Improvements EnvironmentalImprovementsGrp

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

Leadership Development LeadershipDevelopmentGrp

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

Coalition Building CoalitionBuildingGrp

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

Health Improvement Advocacy HealthImprovementAdvocacyGrp

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

Workforce Development WorkforceDevelopmentGrp

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

Other Communtity Building Acty OtherCommuntityBuildingActyGrp

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 Communtity Building Acty TotalCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Activities Or Programs	0	ActivitiesOrProgramsCnt
Persons Served	0	PersonsServedCnt
Total Community Benefit Expns	$225	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$225	NetCommunityBenefitExpnsAmt
Total Expense	0	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (1)	BadDebtExpenseReportedInd
Bad Debt Expense	$466,766	BadDebtExpenseAmt
Bad Debt Expense Attributable	$0	BadDebtExpenseAttributableAmt
Reimbursed By Medicare	$6,187,651	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$6,139,983	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	$47,668	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
Information Gaps	Yes (X)	InformationGapsInd
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
Paper Copy Public Inspection	Yes (X)	PaperCopyPublicInspectionInd
Implementation Strategy Adopt	Yes (1)	ImplementationStrategyAdoptInd
Implementation Strategy Adpt	15	ImplementationStrategyAdptYr
Strategy Posted Website	Yes (1)	StrategyPostedWebsiteInd
Strategy Website URL	www.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	www.atholhospital.org	FAPAvailableOnWebsiteURLTxt
FAP Summary On Website	Yes (X)	FAPSummaryOnWebsiteInd
FAP Summary On Website URL	www.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
FAP Notice Displayed	Yes (X)	FAPNoticeDisplayedInd
Communtity Notified FAP	Yes (X)	CommuntityNotifiedFAPInd
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
FAP Notified Upon Admission	Yes (X)	FAPNotifiedUponAdmissionInd
FAP Notified Before Discharge	Yes (X)	FAPNotifiedBeforeDischargeInd
FAP Notified All Patients	Yes (X)	FAPNotifiedAllPatientsInd
Documented Elig Determination	Yes (X)	DocumentedEligDeterminationInd
Nondis Emergency Care Policy	Yes (1)	NondisEmergencyCarePolicyInd
Lowest Negotiated Rates	Yes (X)	LowestNegotiatedRatesInd
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. * Promoted healthy summer habits for youth by educating over 225 youth and their families on Lyme disease, benefits of exercise and healthy eating, sun safety and skin cancer detection. * Provided health information about heart disease and offered free blood pressure screenings to over 50 individuals. * Promoted wellness by providing flu prevention education in community settings and free flu vaccinations to 75 individuals. * Promoted mental health awareness and substance use prevention by educating 135 community members and business leaders on recognizing signs and symptoms of substance abuse; sponsoring free disposal of sharps and needles; and supporting men to gain self-care techniques to better manage their behavioral health and/or addiction issues. * Provided 2,421 individuals with counseling on health insurance coverage and financial assistance. Completed 620 health insurance applications and made 367 referrals to reduce barriers to accessing health care and social supports. * Assisted 149 patients with transportation and as a result were able to follow up with their healthcare and prevented missed appointments. * Actively participated 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 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". 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. 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 B, Line 6	The allowable costs on line 6 were obtained from our FY 2016 Medicare Cost Report, Worksheet D schedules.
Schedule H, Part III, Section B, Line 8	There is no shortfall.
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 participation with the following coalitions and organizations: Minority Coalition; North Quabbin Community Coalition; Multicultural task force; Greater Gardner Religious Council and Gardner Rotary.
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 I IRS990ScheduleI

Field	Value	IRS element (for citing)
Grant Records Maintained	Yes (1)	GrantRecordsMaintainedInd

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Athol Royalston Middle School	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1062 Pleasant St	AddressLine1Txt
City	Athol	CityNm
State Abbreviation	MA	StateAbbreviationCd
ZIP	01331	ZIPCd

Field	Value	IRS element (for citing)
Recipient EIN	046006370	RecipientEIN
Non Cash Assistance	$11,567	NonCashAssistanceAmt
Non Cash Assistance	Camera Equipment	NonCashAssistanceDesc
Purpose Of Grant	Capital equipment donation	PurposeOfGrantTxt

Field	Value	IRS element (for citing)
Total501c3 Org	1	Total501c3OrgCnt
Total Other Org	0	TotalOtherOrgCnt

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Schedule I, Part I, Line 2	FormAndLineReferenceDesc
Explanation	Athol Hospital purchased the donated equipment.	ExplanationTxt

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 (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
Mark Wu
Surgeon	$258,980	$0	$18,849	$0	$2,858	$0	$2,914	$0	$16,508	$0	$300,109	$0	$0	$0
Winfield Brown
President/ CEO	$0	$459,347	$0	$52,728	$0	$270,244	$0	$23,200	$0	$50,549	$0	$856,068	$0
Elizabeth Nottleson
Trustee/Family Physician	$0	$311,718	$0	$15,326	$0	$366	$0	$6,000	$0	$14,721	$0	$348,131	$0	$0
Robert Crosby
VP of Finance	$0	$271,280	$0	$39,000	$0	$2,628	$0	$23,300	$0	$33,316	$0	$369,524	$0	$0
Michael Grimmer
VP of Support Services	$0	$217,471	$0	$18,818	$0	$19,781	$0	$21,281	$0	$30,914	$0	$308,265	$0	$0
Tina Griffin
VP/CNO	$0	$197,106	$0	$0	$0	$1,754	$0	$5,963	$0	$24,540	$0	$229,363	$0	$0
Carol Roosa
CIO	$0	$154,834	$0	$23,515	$0	$575	$0	$21,288	$0	$27,789	$0	$228,001	$0	$0
Dawn Casavant
VP of External Affairs	$0	$147,098	$0	$20,161	$0	$236	$0	$21,107	$0	$27,308	$0	$215,910	$0	$0
Bruce Bertrand
Chief Medical Officer	$0	$257,653	$0	$751	$0	$4,822	$0	$22,996	$0	$13,551	$0	$299,773	$0	$0
Rose Kavalchuck
VP of Professional Services	$0	$196,386	$0	$0	$0	$2,812	$0	$21,110	$0	$24,814	$0	$245,122	$0	$0
Rebecca Bialecki
VP of Community Health Relations	$0	$119,571	$0	$12,500	$0	$552	$0	$4,896	$0	$21,534	$0	$159,053	$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 7

Dr. Mark Wu has an employment contract with Athol Hospital for a Physician Bonus Award. This contract states "In each year, your bonus will be calculated based upon Employer receiving net receipts in excess of the Physician Base Salary. In addition, the Employer will be entitled to recoup up to $30,000 in Personal Insurance Benefits prior to the processing of the Bonus Award. After the Base Salary and the above mentioned Personal Insurance Benefits, the incentive will be split 40% for the Hospital and 60% for the Physician". For the period of January 1, 2015 through December 31,2015, Dr. Wu earned $18,849 for a bonus incentive. The entire amount was paid in Fiscal year 2015.

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 Hospital prepares the form 990 and provides it to the Senior Accountant and Controller for review. The form is then sent to the CFO for final review. Once approved and signed, form 990 is placed on the Hospital Cyber Board for the Board of Trustees' review. Form 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	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 of $3,365,436, Outside Clinical fees of $903,300. Temporary Employees of $324,911, Medical Staff of $9,000 and Other Contracted Services of $1,400.
Form 990, Part XI, Line 9	The other changes in net assets relates to discounts on pledges receivable of $(23,976) and $1,503,624 from a related organization to support operations.

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)			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	0	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	0	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