2013-08-06T13:50:27-05:00 2012-09-30 042684828 FEELEY & DRISCOLL PC 200 PORTLAND STREET BOSTON MA 02114 990 2011-10-01 042103577 HARRINGTON MEMORIAL HOSPITAL INC HARR 5087653010 100 SOUTH STREET SOUTHBRIDGE MA 015508002 EDWARD MOORE 5087653010 2013-07-24 1 ALAN GAROFALO P00744592 6177427788 2011 2016-02-24 21:20:13Z EDWARD MOORE 100 SOUTH STREET SOUTHBRIDGE MA 015508002 123864798 0 X WWW.HARRINGTONHOSPITAL.ORG X 1928 MA CHARITABLE - TO PROVIDE HIGH QUALITY MEDICAL SERVICES IN A COST EFFICIENT AND COST EFFECTIVE MANNER TO THE RESIDENTS OF SOUTH CENTRAL MASSACHUSETTS. 13 12 1353 470 1233038 117797 38460 658689 113851059 112922703 3730366 1995263 463218 2100253 118083103 117676908 0 0 0 0 59340191 64385443 0 0 595537 50212886 53820815 109553077 118206258 8530026 -529350 119393195 123033530 47572036 54271294 71821159 68762236 THE PRIMARY MISSION OF THE HOSPITAL IS TO PROVIDE HIGH QUALITY MEDICAL SERVICES IN A COST EFFICIENT MANNER TO THE RESIDENTS OF SOUTH CENTRAL MASSACHUSETTS. 0 0 45680199 62250931 THE OPERATION OF AN ACUTE CARE HOSPITAL, WHICH HAD OVER 250,000 OUTPATIENT VISITS DURING THE YEAR ENDED SEPTEMBER 30, 2012. 32161283 23920007 THE OPERATION OF AN ACUTE CARE HOSPITAL, WHICH PROVIDED 16,672 DAYS OF INPATIENT CARE DURING THE YEAR ENDED SEPTEMBER 30, 2012. IN FY 2012, THE HOSPITAL HAD 113 BEDS AND 12 NURSERIES. 20727591 27608144 THE OPERATION OF AN ACUTE CARE HOSPITAL, WHICH PROVIDED TREATMENT FOR 37,396 EMERGENCY ROOM VISITS DURING THE YEAR ENDED SEPTEMBER 30, 2012. 98569073 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 0 0 0 0 1 36 0 1 1353 1 1 1 0 0 0 0 0 0 0 0 0 X 13 12 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 MA X X TOM SULLIVAN 5087658130 100 SOUTH STREET SOUTHBRIDGE MA 015508002 ALAN PEPPEL 1.00 X 0 0 0 RONALD CARLSON 1.00 X 0 0 0 THERESA COLOGNESI 1.00 X 0 0 0 DAVID TURNER 1.00 X 0 0 0 ANTHONY M DETARANDO 1.00 X 0 0 0 PIOTR GRABIAS MD 1.00 X 0 0 0 ANTHONY JAY DETARANDO 1.00 X 0 0 0 JOHN G STAGIAS MD 1.00 X 0 0 0 ENDRE TAMAS MD 1.00 X 0 0 0 JAMES WADDICK 1.00 X 0 0 0 LAURANCE MORRISON 1.00 X 0 0 0 RONALD VAIRO 1.00 X 0 0 0 MARK PALMERINO 1.00 X 0 0 0 EDWARD MOORE 40.00 X 486322 0 218859 THOMAS SULLIVAN 40.00 X 289114 0 18469 DOUGLAS CRAPSER 40.00 X 167072 0 23402 ARTHUR RUSSO MD 40.00 X 233448 0 9847 THOMAS HIJECK 40.00 X 164760 0 8370 JAMES STEPHENS MD 34.00 X 280871 0 16284 GIL ROHALD MD 30.00 X 483972 0 35851 WILLIAM PETRONE MD 34.00 X 282230 0 25904 BRIAN P D'ANGONA MD 30.00 X 308450 0 26397 MICHAEL GAUDET MD 30.00 X 255837 0 32932 2952076 0 416315 54 0 1 0 ABM HEALTH INC PO BOX 8500 PHILADELPHIA PA 19178 PROFESSIONAL SERVICES 889008 QUEST DIAGNOSTICS 12436 COLLECTION CENTER DR CHICAGO IL 60693 LAB SERVICES 803197 SODEXHO OPERATIONS LLC PO BOX 81049 WOBURN MA 01813 CAFETERIA MANAGEMENT 555347 WEBSTER EMS 19 NORFOLK AVENUE SOUTH EASTON MA 02375 AMBULANCE SERVICES 451154 NAVIN HAFFY & ASSOCIATES 200 CORDWAINER DR SUITE 100 NORWELL MA 02061 IT CONSULTING 446230 5 658689 658689 NET PATIENT SERVICE RE 900099 110533500 109300462 1233038 CONTRACT REVENUE 900099 1917984 1917984 OTHER CLINICAL REVENUE 900099 471219 471219 112922703 2041842 2041842 354988 344152 10836 10836 10836 5797159 5843738 -46579 -46579 -46579 SETTLEMENT PAYMENTS 900099 983073 983073 CAFETERIA REVENUE 900099 699532 699532 INSURANCE RECOVERIES 900099 218000 218000 188812 188812 2089417 117676908 113779082 1233038 2006099 1447588 443186 1004402 50689051 43085311 7503620 100120 1629246 1358948 266898 3400 6969746 5813439 1141764 14543 3649812 3044294 597902 7616 111410 111410 120325 120325 66839 66839 5877648 3829664 1737597 310387 58516 1648 56868 1419161 598480 820679 2 1210931 284180 926751 4929057 3828913 1068296 31848 221918 192086 27081 2751 96387 48309 48078 545787 11527 534260 8736785 7124602 1559987 52196 1173823 995495 178328 MEDICAL/SURGICAL SUPPLI 9358780 9331317 27463 PROVISION FOR UNCOLLECT 7199235 7199235 PHARMACEUTICALS 3419313 3419313 PHYSICIAN FEES 3376073 3369426 6647 5898827 4589700 1293321 15806 118206258 98569073 19041648 595537 1813753 1327722 12212339 12498211 1725667 349203 1981880 2224525 1217873 1428759 110453249 67125577 47967316 43327672 50791617 59957594 1682750 1919844 119393195 123033530 11422651 16101029 19600000 19190000 223876 81509 1700000 16325509 17198756 47572036 54271294 X 64569371 61671275 2031956 1001551 5219832 6089410 71821159 68762236 119393195 123033530 X -529350 -2529573 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 64795 64795 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: THE HOSPITAL PAYS DUES TO THE MASSACHUSETTS HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION. THE PORTION OF THE HOSPITAL'S ANNUAL DUES ALLOCATED TO LOBBYING BY THE ASSOCIATIONS WAS $22,795 FOR THE YEAR ENDED SEPTEMBER 30, 2012. THE HOSPITAL ALSO UTILIZES THE SERVICES OF A CONSULTANT, GOVERNMENT RELATIONS GROUP, FOR GENERAL LOBBYING ON ITS BEHALF AS AN ACUTE CARE COMMUNITY HOSPITAL. TOTAL FEES PAID TO THE GROUP WERE $42,000 FOR THE YEAR ENDED SEPTEMBER 30, 2012. 44179103 8561095 88313 52651885 48013237 -620226 3213908 44179103 48284148 -270911 48013237 48772738 -488590 48284148 0.88000 0.11000 0.01000 1 0 913536 913536 46691955 23151055 23540900 4290294 844657 3445637 53911142 40920562 12990580 4646322 2209303 2437019 43327672 INVESTMENTS 59957594 F 59957594 ESTIMATED SETTLEMENTS WITH THIRD-PARTY PAYORS 1710312 PENSION LIABILITY 11561121 INTEREST RATE SWAPS 1948190 CAPITAL LEASE OBLIGATION 1979133 17198756 117676908 118206258 -529350 7431387 -9960960 -2529573 -3058923 117113803 88313 88313 117025490 651418 651418 117676908 118206258 0 118206258 0 118206258 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: TO SUPPORT THE OPERATIONS AND FUNCTIONS OF THE ORGANIZATION. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AND HAS BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE"), AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. ACCORDINGLY, NO PROVISION FOR FEDERAL INCOME TAXES HAS BEEN RECORDED IN THE ACCOMPANYING FINANCIAL STATEMENTS. IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, 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: ADJUSTMENT TO MINIMUM PENSION LIABILITY -1,289,049. EQUITY TRANSFERS TO AFFILIATE -8,530,928. UNREALIZED LOSS ON INTEREST RATE SWAP AGREEMENT -140,983. TOTAL TO SCHEDULE D, PART XI, LINE 8: -9,960,960. PART XII, LINE 2D - OTHER ADJUSTMENTS: NET ASSETS RELEASED FROM RESTRICTIONS USED IN OPERATIONS 88,313. PART XII, LINE 4B - OTHER ADJUSTMENTS: TEMPORARILY RESTRICTED CONTRIBUTIONS 591,109. TEMPORARILY RESTRICTED INVESTMENT INCOME 60,309. 1 1 X 1 X 1 X 1 1 1 0 1 1 4003980 2045215 1958765 0.01760 21784455 19097721 2686734 0.02420 3136931 3067949 68982 0.00060 28925366 24210885 4714481 0.04240 2061217 1542248 518969 0.00470 959576 625532 334044 0.00300 3020793 2167780 853013 0.00770 31946159 26378665 5567494 0.05010 5400 5400 0.00000 5400 5400 1 3815595 178964 22317531 28964675 -6647144 X 1 1 1 10 N MAIN STREET MEDICAL OFFICE SPACE 0.50000 0.00000 0.00000 2 CENTRAL MASS COMPREHENSIVE CANCER CENTER MEDICAL FACILITY 0.22000 0.00000 0.00000 3 CHARLTON MRI MRI FACILITY 0.50000 0.00000 0.00000 1 1 HARRINGTON MEMORIAL HOSPITAL

100 SOUTH STREET SOUTHBRIDGE MA 015508002

X X X SEE SCHED. O NOTE HARRINGTON MEMORIAL HOSPITAL 1 1 X X X X X X X X 10 1 0 1 X X X X X 1 1 1 200.000000000000 1 400.000000000000 1 X X X X X 1 1 X X X X 1 X X 1 X X X X X X 1 X 0 1 PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 7199235. PART III, LINE 4: THE ORGANIZATION PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS EQUAL TO ESTIMATED BAD DEBT LOSSES. THE ESTIMATED LOSSES ARE BASED ON HISTORICAL COLLECTION EXPERIENCE TOGETHER WITH A REVIEW OF THE CURRENT STATUS OF EXISTING RECEIVABLES.THE ORGANIZATION USED A RATIO OF ITS TOTAL COSTS TO CHARGES TO CALCULATE THE AMOUNT OF BAD DEBT EXPENSE AT COST. PART III, LINE 8: THE SHORTFALL EXPERIENCED BY THE ORGANIZATION FROM PROVIDING CARE TO MEDICARE BENEFICIARIES SHOULD BE TREATED AS A COMMUNITY BENEFIT AS IT REPRESENTS THE ORGANIZATION'S CONTRIBUTION TO PROVIDING CARE TO THE FRAIL AND ELDER CITIZENS OF THE COMMUNITY IT SERVES BEYOND THE AMOUNT IT RECEIVES FROM THE MEDICARE PROGRAM. THIS CONTRIBUTION LEVEL IS CONSISTENT WITH THE ORGANIZATION'S OVERALL CHARITABLE MISSION TO PROVIDE CARE TO ALL INDIVIDUALS, REGARDLESS OF THE LEVEL OF PAYMENT RECEIVED FOR PROVIDING THAT CARE.THE ORGANIZATION USED A RATIO OF ITS TOTAL COSTS TO CHARGES TO CALCULATE THE ALLOWABLE COSTS RELATED TO MEDICARE REVENUE RECEIVED. HARRINGTON MEMORIAL HOSPITAL PART V, SECTION B, LINE 15E: REFERRAL TO COLLECTION AGENCY. HARRINGTON MEMORIAL HOSPITAL PART V, SECTION B, LINE 16E: COLLECTION AGENCY ACTIVITIES. HARRINGTON MEMORIAL HOSPITAL PART V, SECTION B, LINE 19D: PATIENT RESPONSIBLE AMOUNTS ARE BASED ON FAMILY SIZE AND RELATIONSHIP OF THE FAMILY'S INCOME TO THE FEDERAL POVERTY GUIDELINES, PER THE HOSPITAL'S UNINSURED RELIEF POLICY. RELIEF IS AVAILABLE FOR INDIVIDUALS WHOSE FAMILY INCOME IS 400% OR LESS OF THE FEDERAL POVERTY GUIDELINES. RELIEF PROVIDED TO THE PATIENT RANGES FROM 100% RELIEF TO 20% RELIEF OF OUTSTANDING AMOUNTS DEPENDING ON FAMILY SIZE AND INCOME LEVEL. HARRINGTON MEMORIAL HOSPITAL PART V, SECTION B, LINE 21: ALL HOSPITAL PATIENTS ARE CHARGED ACCORDING TO THE HOSPITAL'S ESTABLISHED CHARGES FOR SERVICES. IT IS INCUMBENT UPON THE PATIENT TO AVAIL HIMSELF/HERSELF OF RELIEF THROUGH THE HOSPITAL'S UNINSURED RELIEF PROGRAM. PART VI, LINE 2: IN NEEDING TO CREATE A NEW HEALTH ASSESSMENT FOR 2011-2013, AN EXTERIOR COMMITTEE WAS FORMED IN 2009 - CONSISTING OF SEVEN MEMBERS, RANGING FROM THOSE IN THE MEDICAL FIELD TO COMMUNITY LIAISONS AND TOWN/LEAGUE REPRESENTATIVES, INCLUDING A CURRENT HARRINGTON HOSPITAL BOARD MEMBER. MEETINGS WERE HELD APPROXIMATELY ONCE PER MONTH FROM JANUARY-DECEMBER 2010, NOT INCLUDING ADDITIONAL EMAIL COMMUNICATION.SURVEY DESIGNED AND IMPLEMENTED IN 2010. COMMITTEE UTILIZED THIRD-PARTY RESOURCES TO ORIGINATE INITIAL DATA ON REGION. 20 QUESTION SURVEY DESIGNED AND DISTRIBUTED TO SEVEN OF THE MAJOR TOWNS HARRINGTON SERVICES. THE SURVEY INCLUDED DEMOGRAPHIC INDICATORS (AGE, INCOME, HOUSEHOLD MEMBERS, ETHNICITY, ZIP CODE OF RESIDENCE, GENDER, EDUCATION LEVEL) AND COMMUNITY HEALTH INDICATORS. MOST QUESTIONS RANKED HEALTH CONDITIONS ON A 1-5 SCALE AND INCLUDED RATING CONDITIONS/ISSUES IN ORDER OF PRIORITY FOR FUNDING, AND A SEPARATE HEALTH CONDITION ANALYSIS FOR YOUTH AND SENIORS. X X 0 1 0 0 0 0 0 0 0 EDWARD MOORE 387179 0 83781 0 15362 0 203349 0 15510 0 705181 0 0 0 THOMAS SULLIVAN 248356 0 40758 0 0 0 9800 0 8669 0 307583 0 0 0 DOUGLAS CRAPSER 150315 0 16757 0 0 0 5390 0 18012 0 190474 0 0 0 ARTHUR RUSSO MD 208780 0 24668 0 0 0 8350 0 1497 0 243295 0 0 0 THOMAS HIJECK 148344 0 16416 0 0 0 5728 0 2642 0 173130 0 0 0 JAMES STEPHENS MD 240871 0 40000 0 0 0 7266 0 9018 0 297155 0 0 0 GIL ROHALD MD 463972 0 20000 0 0 0 9800 0 26051 0 519823 0 0 0 WILLIAM PETRONE MD 262230 0 20000 0 0 0 9800 0 16104 0 308134 0 0 0 BRIAN P D'ANGONA MD 288450 0 20000 0 0 0 9800 0 16597 0 334847 0 0 0 MICHAEL GAUDET MD 235837 0 20000 0 0 0 7006 0 25926 0 288769 0 0 0 MASSACHUSETTS HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 042456011 57586C7U3 2008-06-26 20000000 CONSTRUCTION AND RENOVATIONS 0 0 0 20940526 2037221 306250 0 0 0 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 1 1 PIPER JAFFRAY FINANCIAL PRODUCTS 15.000000000000 0 0 0 1 0 MICHAEL COLOGNESI HUSBAND OF CHAIRWOMAN OF THE BOARD OF DIRECTORS, THERESA COLOGNESI 11620 THE HOSPITAL USED THE LEGAL SERVICES OF MICHAEL COLOGNESI FOR REAL ESTATE COUNSEL. 0 JRD REALTY TRUST TRUSTEES OF THE TRUST ARE INDIVIDUAL BOARD MEMBERS OF THE HOSPITAL. 38445 THE HOSPITAL LEASED SPACE OWNED BY THE JRD REALTY TRUST, THE TRUSTEES OF WHICH ARE ANTHONY M. DETARANDO AND ANTHONY J. DETARANDO, BOTH OF WHOM ARE INDIVIDUAL BOARD MEMBERS OF THE HOSPITAL. 0 FORM 990, PART VI, SECTION A, LINE 2 BOARD MEMBERS ANTHONY M. DETARANDO AND ANTHONY JAY DETARANDO ARE RELATED AS FATHER AND SON. FORM 990, PART VI, SECTION A, LINE 6 THE HOSPITAL'S SOLE CORPORATE MEMBER IS HARRINGTON HEALTHCARE SYSTEM, INC. FORM 990, PART VI, SECTION A, LINE 7A THE HOSPITAL'S SOLE CORPORATE MEMBER IS HARRINGTON HEALTHCARE SYSTEM, INC. FORM 990, PART VI, SECTION A, LINE 7B THE HOSPITAL'S SOLE CORPORATE MEMBER IS HARRINGTON HEALTHCARE SYSTEM, INC. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PREPARED BY THE HOSPITAL'S OUTSIDE INDEPENDENT ACCOUNTANT WITH INFORMATION GIVEN TO THEM BY THE HOSPITAL STAFF. AFTER COMPLETION, IT IS REVIEWED BY THE HOSPITAL'S CONTROLLER AND VP OF FINANCE BEFORE BEING PRESENTED TO THE BOARD OF DIRECTORS. 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 ANNUALLY) ALL BUSINESS AND OTHER RELATIONSHIPS WHICH MIGHT POTENTIALLY CREATE A CONFLICT OF INTEREST AND ALL CONFLICTS OF INTEREST AS DEFINED BY THE POLICY. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS REVIEW AND APPROVE THE COMPENSATION OF THE CEO AND TOP MANAGEMENT. THE CEO REVIEWS AND APPROVES TOP MANAGEMENT SALARIES. TOP MANAGEMENT WILL THEN REVIEW AND APPROVE KEY EMPLOYEE SALARIES. FORM 990, PART VI, SECTION C, LINE 18 THE HOSPITAL MAKES ITS FORM 990 AND 990-T AVAILABLE TO THE PUBLIC UPON REQUEST. ADDITIONALLY, THE HOSPITAL'S FORM 990 AND 990-T ARE AVAILABLE ON THE PUBLIC CHARITIES WEBSITE MAINTAINED BY THE COMMONWEALTH OF MASSACHUSETTS ATTORNEY GENERAL. FORM 990, PART VI, SECTION C, LINE 19 THE HOSPITAL MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. ADDITIONALLY, THE HOSPITAL'S FINANCIAL STATEMENTS ARE 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: NET UNREALIZED GAINS ON INVESTMENTS: 7,431,387. ADJUSTMENT TO MINIMUM PENSION LIABILITY -1,289,049. EQUITY TRANSFERS TO AFFILIATE -8,530,928. UNREALIZED LOSS ON INTEREST RATE SWAP AGREEMENT -140,983. TOTAL TO FORM 990, PART XI, LINE 5: -2,529,573. HARRINGTON PHYSICIAN SERVICES INC 100 SOUTH STREET SOUTHBRIDGE MA 015508002 134366504 HEALTHCARE SERVICES MA 501(C)(3) 9 HARRINGTON HEALTHCARE SYSTEM INC 0 HARRINGTON HEALTHCARE SYSTEM INC 100 SOUTH STREET SOUTHBRIDGE MA 015508002 001014624 HEALTHCARE SUPPORT MA 501(C)(3) 9 0 CHARLTON MRI SERVICES LLC 10 NORTH MAIN STREET CHARLTON MA 01507 000993849 HEALTHCARE SERVICES MA BIH RADIOLOGIC FOUNDATION INC RELATED -91471 208727 0 0 CENTRAL MASSACHUSETTS COMPREHENSIVE CANCER CENTER LLC 55 SAYLES STREET SOUTHBRIDGE MA 01550 261795998 HEALTHCARE SERVICES MA NEW ENGLAND RADIATION THERAPY MANAGEMENT SERVICES INC RELATED 162284 812217 0 0 10 NORTH MAIN STREET LLC 10 NORTH MAIN STREET CHARLTON MA 01507 000000001 HEALTHCARE SERVICES MA COMPASS DEVELOPMENT LLC RELATED 242126 3177155 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 HARRINGTON PHYSICIAN SERVICES INC Q 8530928