HENRY HEYWOOD MEMORIAL HOSPITAL: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization: HENRY HEYWOOD MEMORIAL HOSPITAL (EIN 04-2103581)
Tax period: 2011-10-01 to 2012-09-30
Filed: 2013-05-09
IRS object ID: 201331349349300753
Schema version: 2011v1.2
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule B
Schedule D
Schedule G
Schedule H
Schedule I
Schedule J
Schedule K
Schedule M
Schedule O
Schedule R
Reasonable Cause Explanation

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2013-05-09T19:48:30-07:00	Timestamp
Tax Period End Date	2012-09-30	TaxPeriodEndDate
Return Type	990	ReturnType
Tax Period Begin Date	2011-10-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	042103581	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	HENRY HEYWOOD MEMORIAL HOSPITAL	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	HENR	NameControl
Phone	9786323420	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	242 Green Street	AddressLine1
City	Gardner	City
State	MA	State
ZIP Code	01440	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	Robert Crosby	Name
Title	Sr VP of Finance, Treasurer, CFO	Title
Phone	9786306157	Phone
Date Signed	2013-04-17	DateSigned

Field	Value	IRS element (for citing)
Tax Year	2011	TaxYear
Build TS	2016-02-24 21:20:13Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	Robert Crosby	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	242 Green Street	AddressLine1
City	Gardner	City
State	MA	State
ZIP Code	01440	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	112251996	GrossReceipts
Group Return For Affiliates	0	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	www.heywood.org	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1907	YearFormation
State Legal Domicile	MA	StateLegalDomicile
Activity Or Mission Description	Heywood Hospital is a community oriented and supported not-for-profit acute care hospital governed by a local Board of Trustees. Our mission is to be our communities' trusted choice for exceptional patient-centered care.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	20	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	19	NbrIndependentVotingMembers
Total Nbr Employees	988	TotalNbrEmployees
Total Nbr Volunteers	289	TotalNbrVolunteers
Total Gross UBI	0	TotalGrossUBI
Net Unrelated Business Txbl Income	0	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	995825	ContributionsGrantsPriorYear
Contributions Grants Current Year	3474560	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	98848732	ProgramServiceRevenuePriorYear
Program Service Revenue CY	100862323	ProgramServiceRevenueCY
Investment Income Prior Year	-135263	InvestmentIncomePriorYear
Investment Income Current Year	1034227	InvestmentIncomeCurrentYear
Other Revenue Prior Year	1044642	OtherRevenuePriorYear
Other Revenue Current Year	967815	OtherRevenueCurrentYear
Total Revenue Prior Year	100753936	TotalRevenuePriorYear
Total Revenue Current Year	106338925	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	231428	GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY	118567	GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year	0	BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	52620474	SalariesEtcPriorYear
Salaries Etc Current Year	52430754	SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year	21806	TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY	12925	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	102038	TotalFundrsngExpCurrentYear
Other Expense Prior Year	49068941	OtherExpensePriorYear
Other Expenses Current Year	49513662	OtherExpensesCurrentYear
Total Expenses Prior Year	101942649	TotalExpensesPriorYear
Total Expenses Current Year	102075908	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	-1188713	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	4263017	RevenuesLessExpensesCY
Total Assets BOY	86669292	TotalAssetsBOY
Total Assets EOY	91777100	TotalAssetsEOY
Total Liabilities BOY	44191517	TotalLiabilitiesBOY
Total Liabilities EOY	46158901	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	42477775	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	45618199	NetAssetsOrFundBalancesEOY
Mission Description	Heywood Hospital is a community oriented and supported not-for-profit acute care hospital governed by a local Board of Trustees. Our mission is to be our communities' trusted choice for exceptional patient-centered care and to be one of the best independent community hospitals in America.	MissionDescription
Significant New Program Services	0	SignificantNewProgramServices
Significant Change	0	SignificantChange
Expense	96309728	Expense
Grants	118567	Grants
Revenue	100862323	Revenue
Description	Heywood Hospital is dedicated to the community benefit goals of improving the health status of our community, addressing the specific health care needs of the under-served and collaborating with others to enhance quality and contain the growth of community health care costs. Details to this are published in "The Community Benefit Report of Heywood Hospital - Fiscal Year 2012" filed with the MA Attorney Generals Office.	Description
Total Of Other Program Service Exp	0	TotalOfOtherProgramServiceExp
Total Of Other Program Service Grnt	0	TotalOfOtherProgramServiceGrnt
Total Of Other Program Service Rev	0	TotalOfOtherProgramServiceRev
Total Program Service Expense	96309728	TotalProgramServiceExpense
Described In501 C3	1	DescribedIn501C3
Schedule B Required	1	ScheduleBRequired
Political Activities	0	PoliticalActivities
Lobbying Activities	0	LobbyingActivities
Subject To Proxy Tax	0	SubjectToProxyTax
Donor Advised Funds	0	DonorAdvisedFunds
Conservation Easements	0	ConservationEasements
Collections Of Art	0	CollectionsOfArt
Credit Counseling	0	CreditCounseling
Term Or Permanent Endowments	1	TermOrPermanentEndowments
Report Land Bldg Equip	1	ReportLandBldgEquip
Report Invest Oth Securities	0	ReportInvestOthSecurities
Report Prog Rel Invest	0	ReportProgRelInvest
Report Other Assets	0	ReportOtherAssets
Report Other Liabilities	1	ReportOtherLiabilities
Report Fin48 Footnote	1	ReportFin48Footnote
Independent Audit Financial Stmt	0	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	1	ConsolidatedAuditFinancialStmt
School	0	School
Foreign Office	0	ForeignOffice
Foreign Activities	0	ForeignActivities
More Than5000 K To Organizations	0	MoreThan5000KToOrganizations
More Than5000 K To Individuals	0	MoreThan5000KToIndividuals
Professional Fundraising	0	ProfessionalFundraising
Fundraising Activities	1	FundraisingActivities
Gaming	0	Gaming
Hospital	1	Hospital
Financial Stmt Attached	1	FinancialStmtAttached
Grants To Organizations	1	GrantsToOrganizations
Grants To Individuals	0	GrantsToIndividuals
Schedule J Required	1	ScheduleJRequired
Tax Exempt Bonds	1	TaxExemptBonds
Invest Tax Exempt Bonds	0	InvestTaxExemptBonds
Escrow Account	0	EscrowAccount
On Behalf Of Issuer	0	OnBehalfOfIssuer
Excess Benefit Transaction	0	ExcessBenefitTransaction
Prior Excess Benefit Transaction	0	PriorExcessBenefitTransaction
Loan To Officer Or DQP	0	LoanToOfficerOrDQP
Grant To Related Person	0	GrantToRelatedPerson
Bsnss Rltnshp With Organization	0	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	0	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	0	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	1	DeductibleNonCashContributions
Deductible Contributions Of Art	0	DeductibleContributionsOfArt
Terminated	0	Terminated
Partial Liquidation	0	PartialLiquidation
Disregarded Entity	0	DisregardedEntity
Related Entity	1	RelatedEntity
Related Org Controlled Entity	1	RelatedOrgControlledEntity
Transaction Related Entity	1	TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org	1	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	0	ActivitiesConductedPartnership
Schedule O Required	1	ScheduleORequired
Number Forms Transmitted With1096	121	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	1	ComplianceWithBackupWitholding
Number Of Employees	988	NumberOfEmployees
Employment Tax Returns Filed	1	EmploymentTaxReturnsFiled
Unrelated Business Income	0	UnrelatedBusinessIncome
Foreign Financial Account	0	ForeignFinancialAccount
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTrans
Taxable Party Notification	0	TaxablePartyNotification
Non Deductible Contributions	0	NonDeductibleContributions
Indoor Tanning Services	0	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	20	NbrVotingGoverningBodyMembers
Number Independent Voting Members	19	NumberIndependentVotingMembers
Family Or Business Relationship	0	FamilyOrBusinessRelationship
Delegation Of Management Duties	0	DelegationOfManagementDuties
Changes To Organizing Docs	0	ChangesToOrganizingDocs
Material Diversion Or Misuse	0	MaterialDiversionOrMisuse
Members Or Stockholders	0	MembersOrStockholders
Election Of Board Members	0	ElectionOfBoardMembers
Decisions Subject To Approval	0	DecisionsSubjectToApproval
Minutes Of Governing Body	1	MinutesOfGoverningBody
Minutes Of Committees	1	MinutesOfCommittees
Officer Mailing Address	0	OfficerMailingAddress
Local Chapters	0	LocalChapters
Form990 Provided To Governing Body	1	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	1	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	1	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	1	RegularMonitoringEnforcement
Whistleblower Policy	1	WhistleblowerPolicy
Document Retention Policy	1	DocumentRetentionPolicy
Compensation Process CEO	1	CompensationProcessCEO
Compensation Process Other	1	CompensationProcessOther
Investment In Joint Venture	0	InvestmentInJointVenture
States Where Copy Of Return Is Filed	MA	StatesWhereCopyOfReturnIsFiled
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Field	Value	IRS element (for citing)
Name Person	Robert Crosby	NamePerson
Telephone Number	9786306157	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	242 Green Street	AddressLine1
City	Gardner	City
State	MA	State
ZIP Code	01440	ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (34 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	OfficerOfficer	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	FormerFormer	Institutional TrusteeInstitutionalTrustee	Highest Compensated EmployeeHighestCompensatedEmployee
Winfield Brown
President /CEO (hired 8/1/11)	40	X	X	176640	0	16189
Gerald L Bankowski
Vice-Chairman, Trustee	0	X		0	0	0
Robert Chauvin
Trustee	0	X		0	0	0
Laura Chen
Trustee	0	X		0	0	0
Joyce Fletcher
Trustee	0	X		0	0	0
John Flick
Trustee	0	X		0	0	0
James Garrison
Treasurer	0	X		0	0	0
Stephen Hemman
Trustee	0	X		0	0	0
Glenn A Hunt
Trustee	0	X		0	0	0
John Kerney
Trustee	0	X		0	0	0
Anthony P Kraskouskas Jr
Trustee	0	X		0	0	0
Janet Latour
Trustee	0	X		0	0	0
Michele Parker
Trustee	0	X		0	0	0
JoAnne Parks
Clerk	0	X		0	0	0
Kenneth J Pierce
Chairman	0	X		0	0	0
Henri Sans
Trustee	0	X		0	0	0
Tina Sbrega
Trustee	0	X		0	0	0
John Skrzypczak MD
Trustee	0	X		0	0	0
Karl Sorenson MD
Trustee	0	X		0	0	0
Daniel P Moen
President / CEO (termed 1/24/11)	40	X	X	970645	0	22811	X
Daniel M Asquino
Trustee	0			0	0	0		X
Robert Crosby
Sr VP of Finance / CFO	40		X	248789	0	26834
Michael Grimmer
VP of Support Services (hired 9/19/11)	40		X	57021	0	8417
Tina Santos
VP of Patient Care Srvcs/CNO (hired 9/12/11)	40		X	66466	0	5476
Thomas Cady
VP of Human Resources	40		X	178896	0	28127
Rose Kavalchuck
VP of Quality Services	40		X	192100	0	25255
James Mullen
Sr VP of Patient Care / CNO (termed 5/27/11)	40		X	317386	0	28802	X
Lorie Martiska
VP of Community Relations (termed 8/25/11)	30		X	160059	0	11793	X
David Gill
Staff Phychologist	40			256112	0	27681			X
Sheila Ebert
Oncology Physician	24			190343	0	14449			X
Alice Vaine
OR Nurse Practitioner	30			139559	0	12682			X
Tina Griffin
Director of Oncology	40			132463	0	23587			X
Laura Duffy
ER Registered Nurse	32			128659	0	27120			X
Dianne Cormier
Endo Registered Nurse	32			126373	0	11791	X		X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	3341511	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	0	TotalReportableCompFrmRltdOrgs
Total Other Compensation	291014	TotalOtherCompensation
Number Individuals GT100 K	56	NumberIndividualsGT100K
Formers Listed	1	FormersListed
Total Comp GT150 K	1	TotalCompGT150K
Compensation From Other Sources	0	CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1	CityAddressOfContractor/AddressUS/City	StateAddressOfContractor/AddressUS/State	ZIP CodeAddressOfContractor/AddressUS/ZIPCode	Description Of ServicesDescriptionOfServices	CompensationCompensation
Quartulli and Associates Inc
PO Box 423	Gardner	MA	01440	Physical Therapy	2984257
Bay State Emergency Medical Inc
44 Crosby Road	Ashburnham	MA	01430	Emergency Room Physicians	2664370
William A Berry & Sons Inc
99 Conifer Hill Drive	Danvers	MA	01923	Construction Services	2315189
Alliance Healthcare Services
100 Bay View Circle	Newport Beach	CA	92660	MRI	1165811
Quest Diagnostics Inc
5763 Collection Center Drive	Chicago	IL	60693	Lab Contracted Services	938278

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	26	NumberOfContractorsGT100K
Federated Campaigns	0	FederatedCampaigns
Membership Dues	0	MembershipDues
Fundraising Events	53825	FundraisingEvents
Related Organizations	0	RelatedOrganizations
Government Grants	2140981	GovernmentGrants
All Other Contributions	1279754	AllOtherContributions
Noncash Contributions	704524	NoncashContributions
Total Contributions	3474560	TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome	ExclusionExclusionAmount
Ancillary O/P Service	622110	56606353	56606353	$0
Ancillary I/P & Routine	622110	43392280	43392280	$0
Contracted Services	900099	545101	545101	$0
HMG Patient Revenue (net)	621111	198519	198519	$0
Lifeline	624120	63052	63052	$0

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	57018	TotalRevenueColumn
Related Or Exempt Function Income	57018	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$0	ExclusionAmount

Field	Value	IRS element (for citing)
Total Program Service Revenue	100862323	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	234823	TotalRevenueColumn
Related Or Exempt Function Income	0	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$234,823	ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

Field	Value	IRS element (for citing)
Total Revenue Column	58	TotalRevenueColumn
Related Or Exempt Function Income	0	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$58	ExclusionAmount

Royalties Revenue RoyaltiesRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn
Related Or Exempt Function Income	0	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$0	ExclusionAmount

Gross Rents GrossRents

Field	Value	IRS element (for citing)
Real	37698	Real
Personal	0	Personal

Less Rental Expenses LessRentalExpenses

Field	Value	IRS element (for citing)
Real	0	Real
Personal	0	Personal

Rental Income Or Loss RentalIncomeOrLoss

Field	Value	IRS element (for citing)
Real	37698	Real
Personal	0	Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	37698	TotalRevenueColumn
Related Or Exempt Function Income	0	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$37,698	ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

Field	Value	IRS element (for citing)
Securities	6622412	Securities
Other	42905	Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

Field	Value	IRS element (for citing)
Securities	5847011	Securities
Other	18960	Other

Gain Or Loss GainOrLoss

Field	Value	IRS element (for citing)
Securities	775401	Securities
Other	23945	Other

Net Gain Or Loss Investments NetGainOrLossInvestments

Field	Value	IRS element (for citing)
Total Revenue Column	799346	TotalRevenueColumn
Related Or Exempt Function Income	0	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$799,346	ExclusionAmount

Field	Value	IRS element (for citing)
Gross Income Fundraising Events	29800	GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events	53825	CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses	47100	FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

Field	Value	IRS element (for citing)
Total Revenue Column	-17300	TotalRevenueColumn
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	-$17,300	ExclusionAmount

Field	Value	IRS element (for citing)
Gross Income Gaming	0	GrossIncomeGaming
Gaming Direct Expenses	0	GamingDirectExpenses

Net Income From Gaming NetIncomeFromGaming

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn
Related Or Exempt Function Income	0	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$0	ExclusionAmount

Field	Value	IRS element (for citing)
Gross Sales Of Inventory	0	GrossSalesOfInventory
Cost Of Goods Sold	0	CostOfGoodsSold

Net Income Or Loss NetIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn
Related Or Exempt Function Income	0	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$0	ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	ExclusionExclusionAmount
Meal Revenue	722212	688968	$688,968
Purchase Discounts	900099	149217	$149,217
Medical Record Copies	561499	23235	$23,235

Miscellaneous Revenue MiscellaneousRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	85997	TotalRevenueColumn
Related Or Exempt Function Income	0	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$85,997	ExclusionAmount

Field	Value	IRS element (for citing)
Total Other Revenue	947417	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	106338925	TotalRevenueColumn
Related Or Exempt Function Income	100862323	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$2,002,042	ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

Field	Value	IRS element (for citing)
Total	118567	Total
Program Services	118567	ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

Field	Value	IRS element (for citing)
Total	0	Total
Program Services	0	ProgramServices

Foreign Grants ForeignGrants

Field	Value	IRS element (for citing)
Total	0	Total
Program Services	0	ProgramServices

Benefits To Members BenefitsToMembers

Field	Value	IRS element (for citing)
Total	0	Total
Program Services	0	ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	1719868	Total
Program Services	645244	ProgramServices
Management And General	1074624	ManagementAndGeneral
Fundraising	0	Fundraising

Comp Disqual Persons CompDisqualPersons

Field	Value	IRS element (for citing)
Total	0	Total
Program Services	0	ProgramServices
Management And General	0	ManagementAndGeneral
Fundraising	0	Fundraising

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	41676026	Total
Program Services	40185854	ProgramServices
Management And General	1422189	ManagementAndGeneral
Fundraising	67983	Fundraising

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	717163	Total
Program Services	616079	ProgramServices
Management And General	100044	ManagementAndGeneral
Fundraising	1040	Fundraising

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	4978986	Total
Program Services	4695442	ProgramServices
Management And General	269816	ManagementAndGeneral
Fundraising	13728	Fundraising

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	3338711	Total
Program Services	3163695	ProgramServices
Management And General	170398	ManagementAndGeneral
Fundraising	4618	Fundraising

Fees For Services Management FeesForServicesManagement

Field	Value	IRS element (for citing)
Total	0	Total
Program Services	0	ProgramServices
Management And General	0	ManagementAndGeneral
Fundraising	0	Fundraising

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	295717	Total
Program Services	15394	ProgramServices
Management And General	280323	ManagementAndGeneral
Fundraising	0	Fundraising

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	97342	Total
Program Services	0	ProgramServices
Management And General	97342	ManagementAndGeneral
Fundraising	0	Fundraising

Fees For Services Lobbying FeesForServicesLobbying

Field	Value	IRS element (for citing)
Total	0	Total
Program Services	0	ProgramServices
Management And General	0	ManagementAndGeneral
Fundraising	0	Fundraising

Fees For Services Prof Fundraising FeesForServicesProfFundraising

Field	Value	IRS element (for citing)
Total	12925	Total
Fundraising	12925	Fundraising

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

Field	Value	IRS element (for citing)
Total	0	Total
Program Services	0	ProgramServices
Management And General	0	ManagementAndGeneral
Fundraising	0	Fundraising

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	11768420	Total
Program Services	11762885	ProgramServices
Management And General	5535	ManagementAndGeneral
Fundraising	0	Fundraising

Advertising Advertising

Field	Value	IRS element (for citing)
Total	70570	Total
Program Services	61964	ProgramServices
Management And General	8606	ManagementAndGeneral
Fundraising	0	Fundraising

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	13897473	Total
Program Services	13658197	ProgramServices
Management And General	237532	ManagementAndGeneral
Fundraising	1744	Fundraising

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	1245383	Total
Program Services	1201322	ProgramServices
Management And General	44061	ManagementAndGeneral
Fundraising	0	Fundraising

Royalties Royalties

Field	Value	IRS element (for citing)
Total	0	Total
Program Services	0	ProgramServices
Management And General	0	ManagementAndGeneral
Fundraising	0	Fundraising

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	1687518	Total
Program Services	1668009	ProgramServices
Management And General	19509	ManagementAndGeneral
Fundraising	0	Fundraising

Travel Travel

Field	Value	IRS element (for citing)
Total	78719	Total
Program Services	67184	ProgramServices
Management And General	11535	ManagementAndGeneral
Fundraising	0	Fundraising

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

Field	Value	IRS element (for citing)
Total	0	Total
Program Services	0	ProgramServices
Management And General	0	ManagementAndGeneral
Fundraising	0	Fundraising

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	61883	Total
Program Services	39642	ProgramServices
Management And General	22241	ManagementAndGeneral
Fundraising	0	Fundraising

Interest Interest

Field	Value	IRS element (for citing)
Total	894164	Total
Program Services	894164	ProgramServices
Management And General	0	ManagementAndGeneral
Fundraising	0	Fundraising

Payments To Affiliates PaymentsToAffiliates

Field	Value	IRS element (for citing)
Total	0	Total
Program Services	0	ProgramServices
Management And General	0	ManagementAndGeneral
Fundraising	0	Fundraising

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	4560863	Total
Program Services	4546910	ProgramServices
Management And General	13953	ManagementAndGeneral
Fundraising	0	Fundraising

Insurance Insurance

Field	Value	IRS element (for citing)
Total	732925	Total
Program Services	691200	ProgramServices
Management And General	41725	ManagementAndGeneral
Fundraising	0	Fundraising

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
Professional Fees	5015772	3650088	1365684
Bad Debt	4274050	4274050	0
Free Care	2555954	2555954	0
Subscriptions & Dues	623491	203849	419642

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	1653418	Total
Program Services	1594035	ProgramServices
Management And General	59383	ManagementAndGeneral
Fundraising	0	Fundraising

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	102075908	Total
Program Services	96309728	ProgramServices
Management And General	5664142	ManagementAndGeneral
Fundraising	102038	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	1853123	BOY
EOY	2438924	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

Field	Value	IRS element (for citing)
BOY	3023263	BOY
EOY	2398884	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	10745265	BOY
EOY	10258616	EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

Field	Value	IRS element (for citing)
BOY	59961	BOY
EOY	72338	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	1366412	BOY
EOY	1371294	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	1024514	BOY
EOY	1080396	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	101611889	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	46904976	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	56055833	BOY
EOY	54706913	EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

Field	Value	IRS element (for citing)
BOY	11923586	BOY
EOY	17190937	EOY

Investments Other Securities InvestmentsOtherSecurities

Field	Value	IRS element (for citing)
BOY	493046	BOY
EOY	489451	EOY

Investments Program Related InvestmentsProgramRelated

Field	Value	IRS element (for citing)
BOY	124289	BOY
EOY	129347	EOY

Intangible Assets IntangibleAssets

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	1640000	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	86669292	BOY
EOY	91777100	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	13381637	BOY
EOY	13297762	EOY

Grants Payable GrantsPayable

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Deferred Revenue DeferredRevenue

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

Field	Value	IRS element (for citing)
BOY	26230945	BOY
EOY	26312766	EOY

Escrow Account Liability EscrowAccountLiability

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Loans From Officers Directors LoansFromOfficersDirectors

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

Field	Value	IRS element (for citing)
BOY	812024	BOY
EOY	729023	EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	3766911	BOY
EOY	5819350	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	44191517	BOY
EOY	46158901	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	36836852	BOY
EOY	40274861	EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	4634890	BOY
EOY	4337245	EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	1006033	BOY
EOY	1006093	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	42477775	BOY
EOY	45618199	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	86669292	BOY
EOY	91777100	EOY

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	X	InfoInScheduleOPartXI
Reconcilation Revenue Expenses	4263017	ReconcilationRevenueExpenses
Reconcilation Other Changes	-1122593	ReconcilationOtherChanges
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	1	AccountantCompileOrReview
FS Audited	1	FSAudited
Audit Committee	1	AuditCommittee
Financial Statement Consolidated	X	FinancialStatementConsolidated
Federal Grant Audit Required	0	FederalGrantAuditRequired

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital170b1 Aiii	X	Hospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

Field	Value	IRS element (for citing)
Contributor Number	RESTRICTED	ContributorNumber

Contributor Name Business ContributorNameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor Address US ContributorAddressUS

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)
Aggregate Contributions	RESTRICTED	AggregateContributions

Schedule D IRS990ScheduleD

Current Year CurrentYear

Field	Value	IRS element (for citing)
Beginning Of Year Balance	11897431	BeginningOfYearBalance
Contributions	5683	Contributions
Investment Earnings Or Losses	1966503	InvestmentEarningsOrLosses
Grants Or Scholarships	0	GrantsOrScholarships
Other Expenditures	-3258767	OtherExpenditures
Administrative Expenses	0	AdministrativeExpenses
End Of Year Balance	17128384	EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

Field	Value	IRS element (for citing)
Beginning Of Year Balance	17367013	BeginningOfYearBalance
Contributions	5000	Contributions
Investment Earnings Or Losses	-128702	InvestmentEarningsOrLosses
Grants Or Scholarships	0	GrantsOrScholarships
Other Expenditures	5345880	OtherExpenditures
Administrative Expenses	0	AdministrativeExpenses
End Of Year Balance	11897431	EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

Field	Value	IRS element (for citing)
Beginning Of Year Balance	16786738	BeginningOfYearBalance
Contributions	4875	Contributions
Investment Earnings Or Losses	958017	InvestmentEarningsOrLosses
Grants Or Scholarships	0	GrantsOrScholarships
Other Expenditures	382617	OtherExpenditures
Administrative Expenses	0	AdministrativeExpenses
End Of Year Balance	17367013	EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

Field	Value	IRS element (for citing)
Beginning Of Year Balance	18164728	BeginningOfYearBalance
Contributions	5250	Contributions
Investment Earnings Or Losses	-686973	InvestmentEarningsOrLosses
Grants Or Scholarships	0	GrantsOrScholarships
Other Expenditures	696267	OtherExpenditures
Administrative Expenses	0	AdministrativeExpenses
End Of Year Balance	16786738	EndOfYearBalance

Field	Value	IRS element (for citing)
Board Designated EOY Balance	0.86	BoardDesignatedEOYBalance
Permanent Endowment EOY Balance	0.06	PermanentEndowmentEOYBalance
Term Endowment EOY Balance	0.08	TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs	0	EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs	0	EndowmentsHeldByRelatedOrgs

Land Land

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	0	InvestmentCostOrOtherBasis
Other Cost Or Other Basis	125271	OtherCostOrOtherBasis
Book Value	125271	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	0	InvestmentCostOrOtherBasis
Other Cost Or Other Basis	64667161	OtherCostOrOtherBasis
Depreciation	20961879	Depreciation
Book Value	43705282	BookValue

Leasehold Improvements LeaseholdImprovements

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	0	InvestmentCostOrOtherBasis
Other Cost Or Other Basis	0	OtherCostOrOtherBasis
Depreciation	0	Depreciation
Book Value	0	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	0	InvestmentCostOrOtherBasis
Other Cost Or Other Basis	35983796	OtherCostOrOtherBasis
Depreciation	25943097	Depreciation
Book Value	10040699	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	0	InvestmentCostOrOtherBasis
Other Cost Or Other Basis	835661	OtherCostOrOtherBasis
Depreciation	0	Depreciation
Book Value	835661	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	54706913	TotalOfBookValueLandBuildings
Federal Income Tax Liability	0	FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescription	AmountAmount
Est Settlement with 3rd Party	$4,336,350
Est Insurance Claims	$1,483,000

Field	Value	IRS element (for citing)
Total Of Amounts	5819350	TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
SchD_P05_S00_L04	Schedule D, Part V, Line 4	Perm Endow Funds are established by donor restricted gifts and maintained to provide a permanent source of income. The principal of which is kept in perpetuity. Board Designated Funds are established by the governing body to fund capital projects and/or improvements of the organization. Temp Restricted funds are established by donor restricted gifts that maintain a source of invomce for a specific period of time.
SchD_P09_S00_L00	Schedule D, Part IX	1. Investment in purchased coalition = $157,000 2. Insurance recovery receivable = $1,483,000
SchD_P10_S00_L02	Schedule D, Part X, Line 2	The Hospital and HMG (as of April 2006) have been determined to be not-for-profit corporations as described in Section 501(c)(3), and the Realty Corp has been determined to be a not-for-profit corporation as described in Section 501(c)(2) of the Internal Revenue Code (the "Code") and are exempt from federal income taxes on related income pursuant to Section 501(a) of the code. The IRS has also previously determined that the hospital is not a provate foundation because it is an organization described under the IRC section 170(i)(A)(iii). Any income not substantially related to these Organizations' exempt purposes may be considered unrelated business income under IRC Section 511 and, as such, subject to tax at normal corporate rates. 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 positions. Tax years from 2008 through the current year remain open for examination by federal and state taxing authorities.

Schedule G IRS990ScheduleG

Events Information EventsInformation

Field	Value	IRS element (for citing)
Name Of Event1	Golf Classic	NameOfEvent1
Gross Receipts Event1	83625	GrossReceiptsEvent1
Charitable Contributions Event1	53825	CharitableContributionsEvent1
Gross Revenue Event1	29800	GrossRevenueEvent1
Cash Prizes Event1	0	CashPrizesEvent1
Non Cash Prizes Event1	2172	NonCashPrizesEvent1
Rent Facility Costs Event1	15720	RentFacilityCostsEvent1
Food And Beverage Event1	19593	FoodAndBeverageEvent1
Entertainment Event1	400	EntertainmentEvent1
Other Direct Expenses Event1	9215	OtherDirectExpensesEvent1
Food And Beverage Other Events	0	FoodAndBeverageOtherEvents
Entertainment Other Events	0	EntertainmentOtherEvents
Gross Receipts Total	83625	GrossReceiptsTotal
Charitable Contributions Total	53825	CharitableContributionsTotal
Gross Revenue Total Events	29800	GrossRevenueTotalEvents
Cash Prizes Total Events	0	CashPrizesTotalEvents
Non Cash Prizes Total Events	2172	NonCashPrizesTotalEvents
Rent Facility Costs Total Events	15720	RentFacilityCostsTotalEvents
Food And Beverage Total Events	19593	FoodAndBeverageTotalEvents
Entertainment Total Events	400	EntertainmentTotalEvents
Other Direct Expenses Total Events	9215	OtherDirectExpensesTotalEvents
Direct Expense Summary Events	47100	DirectExpenseSummaryEvents
Net Income Summary	-17300	NetIncomeSummary

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Charity Care Policy	1	CharityCarePolicy
Written Policy	1	WrittenPolicy
Policy Applied To All Hospitals	X	PolicyAppliedToAllHospitals
FPG Reference Free Care	1	FPGReferenceFreeCare
Pcent100	X	Pcent100
FPG Reference Discounted Care	1	FPGReferenceDiscountedCare
Pcent400	X	Pcent400
Free Disc Care Medically Indigent	1	FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care	1	AmountsBudgetedForCharityCare
Expenses Exceeded Budget	1	ExpensesExceededBudget
Unable To Provide Care	0	UnableToProvideCare
Annual Community Benefit Report	1	AnnualCommunityBenefitReport
Report Publically Available	1	ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

Field	Value	IRS element (for citing)
Total Community Benefit Expense	2056615	TotalCommunityBenefitExpense
Direct Offsetting Revenue	1157204	DirectOffsettingRevenue
Net Community Benefit Expense	899411	NetCommunityBenefitExpense
Percent Of Total Expense	0.0092	PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

Field	Value	IRS element (for citing)
Total Community Benefit Expense	15867678	TotalCommunityBenefitExpense
Direct Offsetting Revenue	13653014	DirectOffsettingRevenue
Net Community Benefit Expense	2214664	NetCommunityBenefitExpense
Percent Of Total Expense	0.0225	PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

Field	Value	IRS element (for citing)
Total Community Benefit Expense	0	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	0	NetCommunityBenefitExpense
Percent Of Total Expense	0	PercentOfTotalExpense

Total Charity Care TotalCharityCare

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	0	NumberOfActivitiesOrPrograms
Persons Served	0	PersonsServed
Total Community Benefit Expense	17924293	TotalCommunityBenefitExpense
Direct Offsetting Revenue	14810218	DirectOffsettingRevenue
Net Community Benefit Expense	3114075	NetCommunityBenefitExpense
Percent Of Total Expense	0.0317	PercentOfTotalExpense

Community Health Services CommunityHealthServices

Field	Value	IRS element (for citing)
Total Community Benefit Expense	966837	TotalCommunityBenefitExpense
Direct Offsetting Revenue	89597	DirectOffsettingRevenue
Net Community Benefit Expense	877240	NetCommunityBenefitExpense
Percent Of Total Expense	0.009	PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

Field	Value	IRS element (for citing)
Total Community Benefit Expense	427465	TotalCommunityBenefitExpense
Direct Offsetting Revenue	6407	DirectOffsettingRevenue
Net Community Benefit Expense	421058	NetCommunityBenefitExpense
Percent Of Total Expense	0.0043	PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

Field	Value	IRS element (for citing)
Total Community Benefit Expense	0	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	0	NetCommunityBenefitExpense
Percent Of Total Expense	0	PercentOfTotalExpense

Research Research

Field	Value	IRS element (for citing)
Total Community Benefit Expense	0	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	0	NetCommunityBenefitExpense
Percent Of Total Expense	0	PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

Field	Value	IRS element (for citing)
Total Community Benefit Expense	24714	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	24714	NetCommunityBenefitExpense
Percent Of Total Expense	0.0003	PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	0	NumberOfActivitiesOrPrograms
Persons Served	0	PersonsServed
Total Community Benefit Expense	1419016	TotalCommunityBenefitExpense
Direct Offsetting Revenue	96004	DirectOffsettingRevenue
Net Community Benefit Expense	1323012	NetCommunityBenefitExpense
Percent Of Total Expense	0.0136	PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	0	NumberOfActivitiesOrPrograms
Persons Served	0	PersonsServed
Total Community Benefit Expense	19343309	TotalCommunityBenefitExpense
Direct Offsetting Revenue	14906222	DirectOffsettingRevenue
Net Community Benefit Expense	4437087	NetCommunityBenefitExpense
Percent Of Total Expense	0.0453	PercentOfTotalExpense

Physical Improvements And Housing PhysicalImprovementsAndHousing

Field	Value	IRS element (for citing)
Total Community Building Expense	386	TotalCommunityBuildingExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Building Expense	386	NetCommunityBuildingExpense
Percent Of Total Expense	0.00	PercentOfTotalExpense

Economic Development EconomicDevelopment

Field	Value	IRS element (for citing)
Total Community Building Expense	0	TotalCommunityBuildingExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Building Expense	0	NetCommunityBuildingExpense
Percent Of Total Expense	0	PercentOfTotalExpense

Community Support CommunitySupport

Field	Value	IRS element (for citing)
Total Community Building Expense	1957	TotalCommunityBuildingExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Building Expense	1957	NetCommunityBuildingExpense
Percent Of Total Expense	0	PercentOfTotalExpense

Environmental Improvements EnvironmentalImprovements

Field	Value	IRS element (for citing)
Total Community Building Expense	1100	TotalCommunityBuildingExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Building Expense	1100	NetCommunityBuildingExpense
Percent Of Total Expense	0	PercentOfTotalExpense

Leadership Development LeadershipDevelopment

Field	Value	IRS element (for citing)
Total Community Building Expense	0	TotalCommunityBuildingExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Building Expense	0	NetCommunityBuildingExpense
Percent Of Total Expense	0	PercentOfTotalExpense

Coalition Building CoalitionBuilding

Field	Value	IRS element (for citing)
Total Community Building Expense	125354	TotalCommunityBuildingExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Building Expense	125354	NetCommunityBuildingExpense
Percent Of Total Expense	0.0013	PercentOfTotalExpense

Health Improvement Advocacy HealthImprovementAdvocacy

Field	Value	IRS element (for citing)
Total Community Building Expense	58434	TotalCommunityBuildingExpense
Direct Offsetting Revenue	16998	DirectOffsettingRevenue
Net Community Building Expense	41436	NetCommunityBuildingExpense
Percent Of Total Expense	0.0004	PercentOfTotalExpense

Workforce Development WorkforceDevelopment

Field	Value	IRS element (for citing)
Total Community Building Expense	294802	TotalCommunityBuildingExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Building Expense	294802	NetCommunityBuildingExpense
Percent Of Total Expense	0.0031	PercentOfTotalExpense

Other Other

Field	Value	IRS element (for citing)
Total Community Building Expense	0	TotalCommunityBuildingExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Building Expense	0	NetCommunityBuildingExpense
Percent Of Total Expense	0	PercentOfTotalExpense

Total Total

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	0	NumberOfActivitiesOrPrograms
Persons Served	0	PersonsServed
Total Community Building Expense	482033	TotalCommunityBuildingExpense
Direct Offsetting Revenue	16998	DirectOffsettingRevenue
Net Community Building Expense	465035	NetCommunityBuildingExpense
Percent Of Total Expense	0.0048	PercentOfTotalExpense

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	1	BadDebtExpenseReported
Bad Debt Expense	$2,006,886	BadDebtExpenseAmount
Amount Attributable To	130435	AmountAttributableTo
Amount Reimbursed By Medicare	30181944	AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare	26705266	CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall	3476678	MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

Field	Value	IRS element (for citing)
Other	X	Other

Field	Value	IRS element (for citing)
Written Debt Collection Policy	1	WrittenDebtCollectionPolicy
Provision For Charity Care	1	ProvisionForCharityCare
Number Of Hospital Facilities	1	NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

Field	Value	IRS element (for citing)
Facility Number	1	FacilityNumber

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	Henry Heywood Memorial Hospital	BusinessNameLine1

Address Address

Field	Value	IRS element (for citing)
Address Line1	242 Green Street	AddressLine1
City	Gardner	City
State	MA	State
ZIP Code	01440	ZIPCode

Field	Value	IRS element (for citing)
Licensed Hospital	X	LicensedHospital
General Medical And Surgical	X	GeneralMedicalAndSurgical
Er24 Hours	X	Er24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	Henry Heywood Memorial Hospital	BusinessNameLine1

Field	Value	IRS element (for citing)
Hospital Facility Number	1	HospitalFacilityNumber
Eligibility Criteria Explained	1	EligibilityCriteriaExplained
Uses FPG Free	1	UsesFPGFree
FPG Free Percent	100	FPGFreePercent
Uses FPG Discounted	1	UsesFPGDiscounted
FPG Discount Percent	400	FPGDiscountPercent
Explains Basis	1	ExplainsBasis
Income Level	X	IncomeLevel
Insurance Status	X	InsuranceStatus
State Regulation	X	StateRegulation
Explains Application Method	1	ExplainsApplicationMethod
Includes Publicity Measures	1	IncludesPublicityMeasures
Posted On Website	X	PostedOnWebsite
Attached To Invoices	X	AttachedToInvoices
Posted In Emergency Room	X	PostedInEmergencyRoom
Posted In Admission Office	X	PostedInAdmissionOffice
Provided On Admission	X	ProvidedOnAdmission
Available On Request	X	AvailableOnRequest
Actions On Nonpayment	1	ActionsOnNonpayment
Permit Report To Credit Agency	X	PermitReportToCreditAgency
Collection Activities	1	CollectionActivities
Report To Credit Agency	X	ReportToCreditAgency
Notify Upon Admission	X	NotifyUponAdmission
Notify Before Discharge	X	NotifyBeforeDischarge
Notified All Patients	X	NotifiedAllPatients
Documented Determination	X	DocumentedDetermination
Other Actions Taken	X	OtherActionsTaken
Nondiscrim Emergency Care Policy	1	NondiscrimEmergencyCarePolicy
Lowest Negotiated Rates	X	LowestNegotiatedRates
Amounts Generally Billed	0	AmountsGenerallyBilled
Gross Charges	0	GrossCharges

Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
SchH_P01_S00_L06a	Schedule H, Part I, Line 6a	The Organization makes it's annual Community Benefit Report available to the public by transmitting the report electronically to the Attorney General's Community Benefit office which then makes it public on their website.
SchH_P01_S00_L07	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. The costs for lines 7e through 7i were actual costs incurred.
SchH_P02_S00_L00	Schedule H, Part II	The Heywood Hospital's Community Benefits Mission Statement is "Heywood Hospital is dedicated to the community benefit goals of improving the health status of our community, addressing the specific health needs of the underserved and collaborating with others to enhance quality and contain growth of community healthcare costs." Sch H, Part II, line 1: The Hospital took part in building a community vegetable garden. This garden was established to assist the Veteran's Outreach Ceter to provide individuals with food, increased sense of productivity and fulfillment, as many of these individuals are disabled and cannot work full-time jobs. Sch H, Part II, Line 3: The Hospital has a Domestic Violence Task Force which helps the community in violence prevention. Also, a Substance Abuse Support Group was established for the community to reach out and help families. Sch H, Part II, Line 4: New this year, the Hospital established the Heywood Hospital Green Team. This group held Earth Day events which included a mercury thermometer exchange for new, non-mercury thermometers. Also, they held an electronic recycling day at no charge. This recycling project removed about 1,000lbs of electronic recycling from the community. Sch H, Part II, Line 6: Heywood's approach to Community Benefits has been to collaborate with others through the Joint Coalition on Health and other coalitions to develop our plan, goals and strategies. Partners include the Joint Coalition on Health, Greater Gardner Interagency Team, the CHNA, the Minority Coalition, Montachusetts Opportunity Council, Mount Wachusetts Community College, the Community Health Connections Health Centers, North Central Human Services, Luk, Inc, Community Health Link, Gardner VNA, the Gardner Public Schools, the Winchendon Public Schools, the Health Foundation of Central MA, Kresge Foundation, the Dpt of Public Health, AHEC and others. At this time, we continue to focus our efforts on mental health and substance abuse, insuring those without jobs and/or insurance, addressing the needs of underserved populations, focusing on the needs of youth and children, and targeting adults and children with overweight and obesity issues which lead to chronic diseases and diabetes. Sch H, Part II, Ln 7: Heywood Hospital had representation at a Community Service Health Fair on Oct 25, 2011. Additionally, Heywood Hospital Emergency Department includes a community health promotion advocate under the SBIRT project. This advocate screens emergency room patients and community members for health risks and substance abuse, and makes appropriate referrals. Sch H, Part II, Line 8: Heywood Hospital serves a Medically Underserved Population Area. Because of this, the Hospital is constantly working to recruit and search out physicians to serve our community.
SchH_P03_S0A_L04	Schedule H, Part III, Section A, Line 4	Footnote: "Allowance for Doubtful Accounts - Accounts Receivable are reduced by an allowance for doubtful accounts. In evaluating the collectability of accounts receivable, the Organization analyzes its past history and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for bad debts. Management regularly reviews data baout these major payor sources of revenue in evaluating the sufficiency of the allowance for doubful accounts. For receivables associated with services provided to patients who have third-party coverage, the Organization records a provision for bad debts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the standard rates and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts." The costing methodology used for line 2 was based on the cost to charge ratio derived from the supplied worksheet 2 in the IRS sch H instructions. The methodology used for line 3 was to take the percentage of financial assistance applications that were denied due to inadequate documentation divided by the total applications received for FY12. This amounted to approximately 6.5% which was applied against the number on line 2. It is our belief that $130,435 amount of bad debt should be included as community benefits. 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 debt as a community benefit.
SchH_P03_S0B_L08	Schedule H, Part III, Section B, Line 8	The allowable costs on line 6 were obtained from our FY2012 Medicare Cost Report, worksheet D schedules.
SchH_P03_S0C_L09b	Schedule H, Part III, Section C, Line 9b	Heywood Hospital provides patients with information about financial assistance programs that are available through the Commonwealth of MA or through Heywood Hospital's own financial assistance program, which may cover all or some of their unpaid hospital bills. For those patients that request such assistance, Heywood 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 determin if the patient is eligible to apply for certain health insurance programs. If the patient or guarantor is unable to provide the necessary information, Heywood Hospital may make reasonable efforts to obtain any additional information from other sources. Information that heywood obtains will be maintained in accordance with applicable federal and state privacy and security laws. The screening and application process for a public health insurance program is done through the 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, homless and disabled individuals. Heywood specifically assists the patient in completing the application and securith the necessary documentation required by the applicable financial assistance program. Heywood 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 Viertual 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 the determination of program eligibility made by the Commonwealth, but at the patient's request may take a direct role in appealing or seeking information related to the coverage decisions. it is still the patient;s responsibility to inform Heywood Hospital of all coverage 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.
SchH_P05_S0B_L17	Schedule H, Part V, Section B, Line 17	The Hospital posts general notices throughout the hospital about the financial assistance policy.
SchH_P06_S00_L02	Schedule H, Part VI, Line 2	Heywood Hospital co chairs the Joint Coalition on Health which undertakes comprehensive assessments of community needs and assets every three to five years. The Steering Committees of the JCOH and the CHNA, with support from the Minority Coalition of North Central MA, collaborate to finalize a comprehensive health assessment of a 27 town region in north central MA. After the addition of pertinent sections to the report originally completed in January 2011, a final report was made available to the public in the fall of 2011. It was published in hard copy and as an electronic file on the web sites of participating organizations. More than 20 focus groups and interviews were conducted by vendors who were responsible for the qualitative portion of the assessment. This data was gathered and analyzed by Blue Cross Blue Shield of MA. The Central MA Area Health Education Center intergrated the results of the qualitative work with the quantitative date to produce a final report.
SchH_P06_S00_L03	Schedule H, Part VI, Line 3	General Principles: For those patients who are uninsured or underinsured, Heywood Hospital will work with them to assist with applying for available financial assistance programs that may cover some or all of their unpaid hospital bills. In order to help uninsured and unnderinsured patients find available and appropriate financial assistance programs, Heywood Hospital will provide all patients with a general notice of the availability of programs in both the bills that are sent to patients as well as in general notices that are posted throughout the hospital. 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, Heywood 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. Heywood Hospital will provide, upon request, specific information about the eligibility process to be a Low Income Patient under either the Massachusetts Health Safety Net Program or additional assistance for patients who are low income through Heywood Hospital's own internal financial assistance program. Heywood Hospital will also notify the patient about available payment plans that may be available to them based on their family size and income. Role of Hospital Patient Finacnial Counselors and Other Finance Staff: Heywood 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 Heywood Hospital, upon discharge, and for a reasonable time following discharge from the hospital. The hospital registration and admission staff will direct all patients seeking available coverage options or financial assistance to the hospital's patient financial counseling office to determine if they are eligible and then to screen for eligibility in an appropriate coverage option. Heywood Hospital will then assist the patient in applying for the appropriate coverage options that are available or notify them of the availability of financial assistance through the hospital's own internal financial assistance program. Heywood Hospital will also provide information on how to contact the appropriate staff within the hospital's finance office to verify the accuracy of the hospital bill or to dispute certain charges. Notification Practices: Heywood Hospital will post a notice of availability of financial assistance in the following locations i. Service Delivery Areas such as Inpatient, Clinic and Emergency Department admissions and registration areas. ii. Patient Financial Counselor areas. iii. Central Admission and Registration areas and iv. Business office areas that are open to patients. Posting signs will be clearly visible and legible to patients visiting these areas. Heywood Hospital will also include a notice about the availability of financial assistance in all initial bills. When the patient contacts Heywood Hospital, the hospital finance staff will attempt to identify if a patient qualifies for a public financial assistance program or a payment plan. A patient who is enrolled in a public financial assistance program may qualify for certain plans. Patients may also qualify for additional assistance based on Heywood 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. For cases where Heywood Hospital is using the Virtual Gateway application, the hospital will assist the patient in completing the application for MassHealth, Commonwealth Care, Children's Medical Security Plan, Healthy Start, Health Safety Net or other forms of financial assistance programs, as they become part of the Virtual Gateway program.
SchH_P06_S00_L04	Schedule H, Part VI, Line 4	The Greater Gardner area, comprised of the City of Gardner and five surrounding towns, has a population of 60,000 people, a median income below the state average, and an unemployment rate above the state average. The community has been affected by the loss of the furniture industry over the past few decades, and by the current economic downturn. Mental Health and Substance Abuse are significant challenges for many residents of the area. the Hospital is the largest employer in the area, with around 1,000 employees. The community is largely white, non hispanic, but has a growing hispanic population. Gardner is one of three cities in the region, the others are Fitchburg and Leominster, which frequently collaborate for the betterment of the region. Heywood Hospital collaborates with the competing hospital in the Fitchburg Leominster area, HealthAlliance, on community health improvement acitivites.
SchH_P06_S00_L05	Schedule H, Part VI, Line 5	The Heywood Hospital's Community Benefit Mission Statement states Heywood 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 collaborating with others to enhance quality and contain the growth of community healthcare costs. The Hospital dedicates our organization to the community benefit goals by improving the health status of our community; addressing the special health problems of minorities, the poor, uninsured annd other underserved populations; containing the growth of community health care costs. Such goals will be undertaken within the framework of a Community Benefit Plan which shall include such elements as commitment on the part of the Board of Trustees and CEO; specific goals and objectives; annual evaluation processes; commitment of hospital resources through normal budgeting process; consideration of community served in all operational and policy decisions; defined community; health status and needs assessment; opportunity for public input and comment; the promotion of cooperative and collaborative relationships with other providers and agencies in order to carry out a broad health agenda in our community. Such community benefit goals are elements and are herby adopted and endorsed by the Board of Trustees of Heywood Hospital.
SchH_P06_S00_L06	Schedule H, Part VI, Line 6	not applicable
SchH_P06_S00_L07	Schedule H, Part VI, Line 7	Heywood Hospital files an annual Community Benefit Report to the Attorney General's Community Benefit Office in Massachusetts.

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Records Maintained	1	RecordsMaintained

Recipient Table RecipientTable (2 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EIN Of RecipientEINOfRecipient	IRC SectionIRCSection	Amount Of Cash GrantAmountOfCashGrant	Amount Of Non Cash AssistanceAmountOfNonCashAssistance	Method Of ValuationMethodOfValuation	Description Of Non Cash AssistanceDescriptionOfNonCashAssistance	Purpose Of GrantPurposeOfGrant
Montachusett Home Care Corp
680 Mechanic Street	Leominster	MA	01453	042551175	501(c)(3)	51339	0	n/a	n/a	The funds will be used by the Community Health Network of North Central MA as support and collaborative community health assessment work.
Montachusett Opportunity Council
133 Pritchard Street	Fitchburg	MA	01420	042401111	501(c)(3)	67228	0	n/a	n/a	The funds will be used by Joint Coalition on Health as support of operations, to provide Community Health grants in conjunction with identified priorities of the JCOH service area, and to support the Gardner Area InterAgency Team.

Field	Value	IRS element (for citing)
Total Nbr Of501 C3 And Govt Grants	2	TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations	0	TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

Field	Value	IRS element (for citing)
Identifier	SchI_P01_S00_L02	Identifier
Return Reference	Schedule I, Part I, Line 2	ReturnReference
Explanation	Montachusett Home Care Corp and the Community Health Network of MA file an annual report with the Office of Healthy Communities that contains a summary of how the funds are allocated.	Explanation

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Compensation Committee	X	CompensationCommittee
Independent Consultant	X	IndependentConsultant
Written Employment Contract	X	WrittenEmploymentContract
Compensation Survey	X	CompensationSurvey
Board Or Committee Approval	X	BoardOrCommitteeApproval
Severance Payment	1	SeverancePayment
Supplemental Nonqual Retire Plan	0	SupplementalNonqualRetirePlan
Equity Based Comp Arrangement	0	EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org	0	CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs	0	CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org	1	CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs	0	CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments	0	AnyNonFixedPayments
Initial Contract Exception	0	InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (15 entries)

Base Compensation Filing OrgBaseCompensationFilingOrg	Comp Based On Related OrgsCompBasedOnRelatedOrgs	Bonus Filing OrgBonusFilingOrg	Bonus Related OrgsBonusRelatedOrgs	Other Compensation Filing OrgOtherCompensationFilingOrg	Other Compensation Related OrgsOtherCompensationRelatedOrgs	Deferred Comp Filing OrgDeferredCompFilingOrg	Deferred Comp Related OrgsDeferredCompRelatedOrgs	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg	Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs	Total Compensation Filing OrgTotalCompensationFilingOrg	Total Compensation Related OrgsTotalCompensationRelatedOrgs	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg	Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Robert Crosby
225227	0	22441	0	1122	0	0	0	26834	0	275624	0	0	0
Winfield Brown
157667	0	15000	0	3972	0	0	0	16189	0	192828	0	0	0
Michael Grimmer
47867	0	6000	0	3154	0	0	0	8417	0	65438	0	0	0
Tina Santos
57908	0	8500	0	58	0	0	0	5476	0	71942	0	0	0
Thomas Cady
155361	0	22723	0	812	0	2398	0	25729	0	207023	0	0	0
Rose Kavalchuck
167709	0	23774	0	617	0	3479	0	21777	0	217356	0	0	0
David Gill
254821	0	0	0	1291	0	4900	0	22781	0	283793	0	0	0
Sheila Ebert
189238	0	0	0	1105	0	3807	0	10643	0	204793	0	0	0
Alice Vaine
139348	0	0	0	212	0	2843	0	9839	0	152242	0	0	0
Tina Griffin
131871	0	350	0	243	0	2754	0	20833	0	156051	0	0	0
Laura Duffy
101551	0	1609	0	25499	0	2187	0	24934	0	155780	0	0	0
Dianne Cormier
121588	0	4785	0	0	0	2412	0	9558	0	138343	0	0	0
Daniel P Moen
28403	0	0	0	942242	0	622	0	22189	0	993456	0	0	0
James Mullen
90766	0	23999	0	202621	0	3155	0	25647	0	346188	0	0	0
Lorie Martiska
75611	0	10956	0	73492	0	2020	0	9773	0	171852	0	0	0

Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
SchJ_P01_S00_L04	Schedule J, Part I, Line 4	James Mullen, former CNO, and Lorie Martiska, former VP of Community Relations, both received severence payments in 2011. James Mullen's severence was a total of 148,456 and Lorie Martiska's severance was a total of 48,893. Laura Duffy, former Director of Emergency Services, received severance of 25,470. She was later rehired as an ER RN.
SchJ_P01_S00_L06	Schedule J, Part I, Line 6	Heywood Hospital accrues 6% of the CFO & VP's salaries for a bonus payment that is based off the financial conditions of the hospital once the fiscal year is completed.
SchJ_P02_S00_L00	Schedule J, Part II	There were changes to the Hospital's management team. The former president, Daniel Moen, terminated on January 24, 2011 and the new president, Winfield Brown, was hired on August 1, 2011. The former CNO, James Mullen, terminated on May 27, 2011 and the new CNO, Tina Santos, was hired on September 12, 2011. The VP of Community Relations terminated on August 25, 2011 and this position was not filled during the fiscal year. In addition, a VP of Support Services, Michael Grimmer, was hired on September 19, 2011.

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)

Issuer EINIssuerEIN	CUSIP NumberCUSIPNumber	Date IssuedDateIssued	Issue PriceIssuePrice	Description Of PurposeDescriptionOfPurpose	DefeasedDefeased	On Behalf Of IssuerOnBehalfOfIssuer	Pool FinancingPoolFinancing
MA Health and Educational Facilitiy Authority
042456011	57586EGT2	2009-03-31	17785000	Funds used for new Watkins Bldg project	0	0	0
MA Health and Educational Facility Authority
042456011	57586C7E9	2008-06-19	6715000	Refunding and new Watkins Bldg project	0	0	0

Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)

Amount RetiredAmountRetired	Amount Bond DefeasedAmountBondDefeased	Total ProceedsTotalProceeds	Amount In Reserve FundAmountInReserveFund	Capitalized InterestCapitalizedInterest	Refunding EscrowRefundingEscrow	Issuance Costs From ProceedsIssuanceCostsFromProceeds	Credit EnhancementCreditEnhancement	Working Capital ExpendituresWorkingCapitalExpenditures	Capital ExpendituresCapitalExpenditures	Other Spent ProceedsOtherSpentProceeds	Amount UnspentAmountUnspent	Year Of Subst CompletionYearOfSubstCompletion	Current RefundingCurrentRefunding	Advance RefundingAdvanceRefunding	Final Allocation MadeFinalAllocationMade	Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind
0	0	66235	0	0	0	281690	0	0	17569545	0	0	2010	0	0	1	1
0	0	19154	0	0	0	329467	0	3597891	2806796	0	0	2008	1	0	1	1

Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)

Owning Bond Financed PropertyOwningBondFinancedProperty	Any Lease ArrangementsAnyLeaseArrangements	Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty	Any Research AgreementsAnyResearchAgreements	Prcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthers	Percentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBI	Total Private Business UseTotalPrivateBusinessUse	Post Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
0	0	0	0	0	0	0	1
0	0	0	0	0	0	0	1

Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)

Form8038 T FiledForm8038TFiled	Variable Rate IssueVariableRateIssue	Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds	Term Of HedgeTermOfHedge	Superintegrated HedgeSuperintegratedHedge	Hedge TerminatedHedgeTerminated	Gross Proceeds Invested In GICGrossProceedsInvestedInGIC	Gross Proceeds InvestedGrossProceedsInvested	Exception To RebateExceptionToRebate
TD Bank
0	1	1	18.7	0	0	0	0	1
Piper Jaffrey
0	1	1	18.7	0	0	0	0	1

Schedule M IRS990ScheduleM

Real Estate Commercial RealEstateCommercial

Field	Value	IRS element (for citing)
Non Cash Checkbox	X	NonCashCheckbox
Number Of Contributions	1	NumberOfContributions
Noncash Contribs Rptd F990	704524	NoncashContribsRptdF990
Method Of Determining Revenues	cost	MethodOfDeterminingRevenues

Field	Value	IRS element (for citing)
Number Of8283 Received	0	NumberOf8283Received
Any Property That Must Be Held	0	AnyPropertyThatMustBeHeld
Review Process Unusual NC Gifts	1	ReviewProcessUnusualNCGifts
Third Parties Used	0	ThirdPartiesUsed

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
F990_P06_S0B_L11b	Form 990, Part VI, Section B, Line 11b	The Senior Accountant at Heywood Hospital prepares the form 990 and provides to the Controller for review. The form is then sent to the CFO for final review. Once approved and signed, copies are provided to the governing body at their monthly meeting. The 990 is then approved for finaly submission by the accounting department.
F990_P06_S0B_L12c	Form 990, Part VI, Section B, Line 12c	Annually, a Conflict of Interest form is sent out to the managers, trustees and employees with a broad discretionary authority. These forms are required to be signed and are monitored by the VP of Professional Services for completion.
F990_P06_S0B_L15	Form 990, Part VI, Section B, Line 15	The CEO and Officer's salary is determined by the market data provided to the search committee by our search firm, an independent third party named Phillips DiPisa. This data supplemented the first hand knowledge of other comparable facilities in New England and that search firm had based on prior searches. Sources as the Massachusetts Hospital Salary Survey and Intimate knowledge of the going salaries for senior executives in healthcare also play a major role in determing salaries.
F990_P06_S0C_L19	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 Assistance, who provides copies upon request.
F990_P11_S00_L05	Form 990, Part XI, Line 5	The amount that makes up the changes in net assets or fund balances is from gains and losses on investments, discounts on pledge receivables and transfers to Heywood Medical Group to help support the organization as they employ physicians that serve the Hospital.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (5 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivitiesPrimaryActivities	Legal Domicile StateLegalDomicileState	Exempt Code SectionExemptCodeSection	Public Charity StatusPublicCharityStatus	Direct Controlling Entity NADirectControllingEntityNA	Controlled OrgControlledOrg
Heywood Affiliated Medical Group
242 Green Street	Gardner	MA	01440	043163589	employ physicians	MA	501(c)(3)	9	N/A	1
Heywood Hospital Realty Corporation
242 Green Street	Gardner	MA	01440	043327447	property holding company	MA	501(c)(2)		N/A	1
HHMH Aid Association
242 Green Street	Gardner	MA	01440	042198019	raise funds for the Hospital	MA	501(c)(3)	9	N/A	0
Winchendon Health Foundation
87 Central Street	Winchendon	MA	01475	042113276	supporting organization	MA	501(c)(3)	9	N/A	0
Heywood Physician Hospital Organization
242 Green Street	Gardner	MA	01440	043153119	Managed care contracted physicians	MA	501(c)(3)	9	N/A	0

Field	Value	IRS element (for citing)
Receipt Of Int Ann Rents Royalties	0	ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org	0	GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org	0	GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org	0	LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org	0	LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org	0	SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org	0	PurchaseOfAssetsFromOtherOrg
Exchange Of Assets	0	ExchangeOfAssets
Rental Of Facilities To Other Orgs	1	RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs	1	RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs	1	PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs	1	PerformOfServicesByOtherOrgs
Sharing Of Facilities	0	SharingOfFacilities
Sharing Of Paid Employees	0	SharingOfPaidEmployees
Reimbursement Paid To Other Org	1	ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org	1	ReimbursementPaidByOtherOrg
Other Transfer To Other Org	1	OtherTransferToOtherOrg
Other Transfer From Other Org	0	OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (5 entries)

Transaction TypeTransactionType	Amount InvolvedAmountInvolved	Method Of Amt DeterminationMethodOfAmtDetermination
Heywood Affiliated Medical Group
q	1584000	cash
Heywood Affiliated Medical Group
o	374195	actual cost
Heywood Physician Hospital Organization
p	224037	actual cost
Heywood Hospital Realty Corporation
p	179789	actual cost
Heywood Affiliated Medical Group
p	535180	actual cost

Reasonable Cause Explanation ReasonableCauseExplanation

Field	Value	IRS element (for citing)
Explanation	Heywood Hospital submitted, and was granted, an extension on the 990 filing to 5/15/13.	Explanation