2013-08-08T14:08:38-05:00 2012-09-30 042684828 FEELEY & DRISCOLL PC 200 PORTLAND STREET BOSTON MA 02114 990 2011-10-01 134366504 HARRINGTON PHYSICIAN SERVICES INC HARR 5087653010 100 SOUTH STREET SOUTHBRIDGE MA 015508002 EDWARD MOORE 5087653010 2013-08-08 1 ALAN GAROFALO P00744592 6177427788 2013-07-18 2011 2016-02-24 21:20:13Z EDWARD MOORE 100 SOUTH STREET SOUTHBRIDGE MA 01550 14844920 0 X WWW.HARRINGTONHOSPITAL.ORG X 2008 MA CHARITABLE-THE PROVISION OF HEALTHCARE SERVICES 3 2 225 0 0 0 0 0 13844536 14518110 522 394 138784 326416 13983842 14844920 0 0 0 0 17544959 18973014 0 0 0 4243764 4612809 21788723 23585823 -7804881 -8740903 2090520 2348317 1144348 1612120 946172 736197 X TO PROVIDE OPTIMAL HEALTHCARE TO THE PATIENTS OF SOUTH CENTRAL MASSACHUSETTS AND NORTHEASTERN CONNECTICUT. HARRINGTON PHYSICIAN SERVICES IS COMMITTED TO TOTAL LOCAL CARE WHICH IT PROVIDES THROUGH PHYSICIAN OFFICES LOCATED IN COMMUNITIES THROUGHOUT THE HARRINGTON HOSPITAL SERVICE AREA. 0 0 22399526 14844526 HPS SERVES THE CHARITABLE PURPOSES OF HARRINGTON MEMORIAL HOSPITAL BY PROVIDING PHYSICIANS WHO ARE NEEDED TO SERVICE THE HOSPITAL'S COMMUNITY. 22399526 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 9 0 1 225 1 0 0 0 0 0 0 0 0 0 0 X 3 2 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X X KRISTIN WOLFF-MORALES 5087652433 100 SOUTH STREET SOUTHBRIDGE MA 015508002 ARTHUR RUSSO MD 1.00 X 0 233448 9847 ALAN PEPPEL 1.00 X 0 0 0 ANTHONY M DETARANDO 1.00 X 0 0 0 EDWARD MOORE 40.00 X 0 486322 218859 THOMAS SULLIVAN 40.00 X 0 289114 18469 KRISTIN WOLFF-MORALES 40.00 X 144821 0 20206 CHARLES SOMMER MD 40.00 X 450734 0 20042 RICHARD IRWIN MD 40.00 X 368506 0 28822 JOHN REHEIS 40.00 X 344934 0 25840 ELIAS BELEZOS MD 40.00 X 413161 0 26038 YOUNG-HO OH 40.00 X 449455 0 12392 2171611 1008884 380515 45 0 1 0 BARTON ASSOCIATES 10 DEARBORN ROAD PEABODY MA 01960 PHYSICIAN SERVICES 259105 CHARLTON 10 NORTH MAIN ST LLC 354 TURNPIKE STREET COMPASS STE 30 CANTON MA 02021 ADMINISTRATIVE SERVICES 170029 CRIMSON INITIATIVE PO BOX 79461 BALTIMORE MD 21279 SOFTWARE MANAGEMENT 156000 OAK TRANSCRIPTION INC 202 PRINCE ROAD SOUTHBRIDGE MA 01550 TRANSCRIPTION SERVICES 107338 4 NET PATIENT SERVICE RE 621110 14518110 14518110 14518110 394 394 INCENTIVE PAYMENTS 621110 239012 239012 OTHER CLINICAL SERVICE 621110 79675 79675 MEDICAL RECORDS INCOME 621110 7729 7729 326416 14844920 14844526 0 394 164148 164148 15223537 14900250 323287 719958 697152 22806 1752093 1696592 55501 1113278 1078013 35265 8578 8578 12552 12552 473671 353018 120653 30892 3245 27647 270836 229439 41397 256579 256579 799647 799647 22608 7708 14900 168660 168346 314 956824 956824 MED/SURG SUPPLIES 515302 515302 PHARMACEUTICALS 392550 392550 BAD DEBT EXPENSE 364839 364839 339271 236601 102670 23585823 22399526 1186297 0 270573 134005 1081156 1279926 19401 19175 316125 243396 1140572 468757 403265 671815 2090520 2348317 1144348 1612120 1144348 1612120 X 946172 736197 946172 736197 2090520 2348317 X -8740903 8530928 X 0 1 1 X 0 X 6224206 11256734 13844536 14518110 45843586 6224206 11256734 13844536 14518110 45843586 0 0 0 45843586 68 716 522 394 1700 68 716 522 394 1700 36399 139240 318687 494326 6224274 11293849 13984298 14837191 46339612 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: OTHER CLINICAL INCOME SCHEDULE A, PART IV, SUPPLEMENTAL INFORMATION: OTHER CLINICAL INCOME CONSISTS OF VARIOUS INCENTIVE PAYMENTS FROM MEDICARE AND MEDICAID FOR PHYSICIANS MEETING ELECTRONIC HEALTH RECORD BENCHMARKS AND INCENTIVE PAYMENTS FROM INSURANCE COMPANIES FOR MEETING AND EXCEEDING CERTAIN BENCHMARKS. 62578 6877 55701 1077994 461880 616114 671815 14844920 23585823 -8740903 8530928 8530928 -209975 14844920 0 14844920 0 14844920 23585823 0 23585823 0 23585823 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE ORGANIZATION ANNUALLY EVALUATES ITS TAX STATUS AND TAX POSITIONS TAKEN WITH RESPECT TO ITS OPERATIONS AND FINANCIAL POSITION. PART XI, LINE 8 - OTHER ADJUSTMENTS: EQUITY TRANSFERS FROM SOLE MEMBER; HARRINGTON MEMORIAL HOSPITAL 8,530,928. X X 0 1 0 0 0 0 0 0 0 ARTHUR RUSSO MD 0 208780 0 24668 0 0 0 8350 0 1497 0 243295 0 0 EDWARD MOORE 0 387179 0 83781 0 15362 0 203349 0 15510 0 705181 0 0 THOMAS SULLIVAN 0 248356 0 40758 0 0 0 9800 0 8669 0 307583 0 0 KRISTIN WOLFF-MORALES 129836 0 14985 0 0 0 3046 0 17160 0 165027 0 0 0 CHARLES SOMMER MD 450734 0 0 0 0 0 4900 0 15142 0 470776 0 0 0 RICHARD IRWIN MD 359852 0 0 0 8654 0 4900 0 23922 0 397328 0 0 0 JOHN REHEIS 339934 0 5000 0 0 0 337 0 25503 0 370774 0 0 0 ELIAS BELEZOS MD 394994 0 18167 0 0 0 337 0 25701 0 439199 0 0 0 YOUNG-HO OH 445993 0 0 0 3462 0 4900 0 7492 0 461847 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION'S SOLE CORPORATE MEMBER IS HARRINGTON HEALTHCARE SYSTEM, INC. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION'S SOLE CORPORATE MEMBER IS HARRINGTON HEALTHCARE SYSTEM, INC. FORM 990, PART VI, SECTION A, LINE 7B THE ORGANIZATION'S SOLE CORPORATE MEMBER IS HARRINGTON HEALTHCARE SYSTEM, INC. FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION WORKS WITH ITS INDEPENDENT CERTIFIED PUBLIC ACCOUNTANT TO COMPILE THE FORM 990 AND ITS RELATED DISCLOSURES. THE FORM 990 IS REVIEWED IN DETAIL WITH THE CERTIFIED PUBLIC ACCOUNTANT BY MANAGEMENT AND THEN PROVIDED TO THE ORGANIZATION'S BOARD OF DIRECTORS PRIOR TO SUBMISSION. FORM 990, PART VI, SECTION B, LINE 12C THE CORPORATION REQUIRES THAT ALL EMPLOYEES, AND MEMBERS AND OFFICERS OF THE BOARD OF DIRECTORS OF THE CORPORATION AND ANY MEMBER OF ANY COMMITTEE DISCLOSE IN WRITING (AND UPDATE AT LEAST ANNUALLY) ALL BUSINESS AND OTHER RELATIONSHIPS WHICH MIGHT POTENTIALLY CREATE A CONFLICT OF INTEREST AND ALL CONFLICTS OF INTEREST AS DEFINED BY THE POLICY. THE WRITTEN DISCLOSURE SHALL INCLUDE AN ITEMIZATION OF ANY SUBSTANTIVE CONFLICT OF INTEREST FOR SUCH EMPLOYEE, OR OFFICER OR MEMBER OF THE BOARD OF DIRECTORS AND ANY MEMBER OF A COMMITTEE BY VIRTUE OF HIS OR HER ACTIVITIES OR THAT OF RELATED PARTIES. IF AN EMPLOYEE, A MEMBER OR AN OFFICER OF THE BOARD OF DIRECTORS OR A MEMBER OF ANY COMMITTEE BELIEVES THAT HE/SHE, OR A RELATED PARTY, HAS A CONFLICT OF INTEREST, HE/SHE MUST IMMEDIATELY DISCLOSE THIS IN WRITING TO THE EXECUTIVE DIRECTOR. DISCLOSURES BY MEMBERS AND OFFICERS OF THE BOARD OF DIRECTORS AND A MEMBER OF ANY COMMITTEE MUST ALSO BE MADE TO THE PRESIDENT (AND IF IT IS THE PRESIDENT WHO HAS THE CONFLICT OF INTEREST, HE OR SHE MUST MAKE DISCLOSURE TO THE VICE-PRESIDENT). IF, AFTER PROVIDING THE WRITTEN DISCLOSURE, AN ACTUAL OR POTENTIAL CONFLICT ARISES, THE EMPLOYEE OR MEMBER OR OFFICER OF THE BOARD OF DIRECTORS AND ANY MEMBER OF ANY COMMITTEE WITH THE CONFLICT SHALL IMMEDIATELY NOTIFY THE CORPORATION IN WRITING. THE NOTIFICATION SHALL BE DIRECTED TO THE EXECUTIVE DIRECTOR AND TO THE PRESIDENT FOR CONFLICTS OF INTEREST INVOLVING MEMBERS AND OFFICERS OF THE BOARD OF DIRECTORS AND ANY MEMBER OF ANY COMMITTEE. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS ANNUALLY, IN CONJUCTION WITH THE CEO, REVIEWS THE EXECUTIVE DIRECTOR'S PERFORMANCE AND DETERMINES COMPENSATION BASED ON MEASURES THAT INCLUDE THE ORGANIZATION'S FINANCIAL, CLINICAL AND COMMUNITY ACTIVITIES. THE BOARD USES INFORMATION FROM COMPARABLE PHYSICIAN ASSOCIATIONS IN MEASURING THE PROPRIETY OF THE EXECUTIVE DIRECTOR'S COMPENSATION. FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. ADDITIONALLY, THE ORGANIZATION'S FINANCIAL STATEMENTS ARE AVAILABLE ON THE PUBLIC CHARITIES WEBSITE MAINTAINED BY THE COMMONWEALTH OF MASSACHUSETTS ATTORNEY GENERAL. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS FORM 990 AVAILABLE TO THE PUBLIC UPON REQUEST. ADDITIONALLY, THE ORGANIZATION'S FORM 990 IS AVAILABLE ON THE PUBLIC CHARITIES WEBSITE MAINTAINED BY THE COMMONWEALTH OF MASSACHUSETTS ATTORNEY GENERAL. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: EQUITY TRANSFERS FROM SOLE MEMBER; HARRINGTON MEMORIAL HOSPITAL 8,530,928. TOTAL TO FORM 990, PART XI, LINE 5: 8,530,928. HARRINGTON MEMORIAL HOSPITAL 100 SOUTH STREET SOUTHBRIDGE MA 01550 042103577 ACUTE CARE HOSPITAL MA 501(C)(3) PUBLIC CHARITY 0 HARRINGTON HEALTHCARE SYSTEM INC 100 SOUTH STREET SOUTHBRIDGE MA 01550 001014624 HEALTHCARE SUPPORT MA 501(C)(3) PUBLIC CHARITY 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1