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FAIRVIEW HOSPITAL: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
FAIRVIEW HOSPITAL (EIN 04-2133860)
Tax period
2010-10-01 to 2011-09-30
Filed
2012-08-15
IRS object ID
201222289349301987
Schema version
2010v3.4
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-08-15T16:24:08-05:00Timestamp
Tax Period End Date2011-09-30TaxPeriodEndDate
Return Type990ReturnType
Tax Period Begin Date2010-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN042133860EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1FAIRVIEW HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlFAIRNameControl
Phone4134472508Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1725 NORTH STREETAddressLine1
CityPITTSFIELDCity
StateMAState
ZIP Code012014109ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDARLENE RODOWICZName
TitleCFOTitle
Phone4134472809Phone
Date Signed2012-08-15DateSigned
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonDARLENE RODOWICZNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1725 NORTH STAddressLine1
CityPITTSFIELDCity
StateMAState
ZIP Code012014109ZIPCode
FieldValueIRS element (for citing)
Gross Receipts47586006GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.BHS1.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1912YearFormation
State Legal DomicileMAStateLegalDomicile
Activity Or Mission DescriptionTHE MISSION OF FAIRVIEW HOSPITAL IS TO IMPROVE THE HEALTH OF ALL PEOPLE IN THE BERKSHIRES AND (CONTINUED FROM FORM 990)...SURROUNDING COMMUNITIES, REGARDLESS OF THEIR ABILITY TO PAY.ActivityOrMissionDescription
Nbr Voting Members Governing Body24NbrVotingMembersGoverningBody
Nbr Independent Voting Members20NbrIndependentVotingMembers
Total Nbr Employees329TotalNbrEmployees
Total Nbr Volunteers50TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year576768ContributionsGrantsPriorYear
Contributions Grants Current Year511811ContributionsGrantsCurrentYear
Program Service Revenue Prior Year39162376ProgramServiceRevenuePriorYear
Program Service Revenue CY41845111ProgramServiceRevenueCY
Investment Income Prior Year600743InvestmentIncomePriorYear
Investment Income Current Year924885InvestmentIncomeCurrentYear
Other Revenue Prior Year519146OtherRevenuePriorYear
Other Revenue Current Year658321OtherRevenueCurrentYear
Total Revenue Prior Year40859033TotalRevenuePriorYear
Total Revenue Current Year43940128TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year20750843SalariesEtcPriorYear
Salaries Etc Current Year22365294SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year79573TotalFundrsngExpCurrentYear
Other Expense Prior Year19409642OtherExpensePriorYear
Other Expenses Current Year19708790OtherExpensesCurrentYear
Total Expenses Prior Year40160485TotalExpensesPriorYear
Total Expenses Current Year42074084TotalExpensesCurrentYear
Revenues Less Expenses Prior Year698548RevenuesLessExpensesPriorYear
Revenues Less Expenses CY1866044RevenuesLessExpensesCY
Total Assets BOY28199684TotalAssetsBOY
Total Assets EOY28000233TotalAssetsEOY
Total Liabilities BOY18992731TotalLiabilitiesBOY
Total Liabilities EOY17923149TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY9206953NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY10077084NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTHE MISSION OF FAIRVIEW HOSPITAL IS TO IMPROVE THE HEALTH OF ALL PEOPLE IN THE BERKSHIRES AND SURROUNDING COMMUNITIES, REGARDLESS OF THEIR ABILITY TO PAY.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense38091780Expense
Revenue42295271Revenue
DescriptionFAIRVIEW HOSPITAL, A 24 BED CRITICAL ACCESS COMMUNITY HOSPITAL, IS THE PRIMARY PROVIDER OF HEALTH CARE & ACCESS TO HEALTH CARE SERVICES IN SOUTHERN BERKSHIRE COUNTY, MA. THE HOSPITAL SERVES A RURAL AREA WHICH INCLUDES TOWNS IN MA, NORTHWEST CT, & COLUMBIA COUNTY, NY WITH A FULL RANGE OF PRIMARY CARE SERVICES, INCLUDING PREVENTATIVE, DIAGNOSTIC & THERAPEUTIC CARE, ON BOTH AN IN- & OUT-PATIENT BASIS. THE PRIMARY SERVICE AREA HAS A RESIDENT POPULATION OF APPROXIMATELY 30,000. THE HOSPITAL PLAYS AN ACTIVE ROLE IN MEETING THE HEALTH NEEDS OF THE COMMUNITY OUTSIDE THE HOSPITAL WALLS IN ITS PROACTIVE COMMUNITY OUTREACH, EDUCATION, & SCREENING INITIATIVES, WHICH ARE DESIGNED TO IMPROVE THE HEALTH STATUS OF THE COMMUNITY. THROUGH COLLABORATION WITH NUMEROUS HEALTH & SOCIAL SERVICE AGENCIES, (CONTINUED ON SCHEDULE O) (CONTINUED FROM FORM 990)...FAIRVIEW HOSPITAL PROMOTES ACCESS TO INFORMATION & SERVICES, & DRAWS EXTENSIVE MEDICAL, TECHNOLOGICAL, & FINANCIAL RESOURCES TO THE AREA THROUGH ITS AFFILIATION WITH BERKSHIRE MEDICAL CENTER & BERKSHIRE HEALTH SYSTEMS. AS A RESULT, THE SOUTHERN BERKSHIRE COMMUNITY ENJOYS A COMPLETE CONTINUUM OF CARE SERVICES INCLUDING EDUCATION, PREVENTION, SCREENING, DIAGNOSTIC, THERAPEUTIC, REHABILITATIVE, & LONG-TERM CARE SERVICES, AN UNUSUALLY HIGH LEVEL OF HEALTH SERVICES WHEN COMPARED WITH SIMILAR RURAL COMMUNITIES. PLEASE SEE THE FY2011 "COMMUNITY BENEFITS REPORT" AT WWW.CBSYS.AGO.STATE.MA.US/CBPUBLIC/PUBLIC/ANNUAL_REPORTS_START.ASPX FOR MORE DETAILS.Description
Total Program Service Expense38091780TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities1FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity1TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109670NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees329NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions1QuidProQuoContributions
Quid Pro Quo Disclosure1QuidProQuoDisclosure
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members24NbrVotingGoverningBodyMembers
Number Independent Voting Members20NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledMAStatesWhereCopyOfReturnIsFiled
States Where Copy Of Return Is FiledNYStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1DARLENE RODOWICZ CFOBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number4134472809TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1725 NORTH STREETAddressLine1
CityPITTSFIELDCity
StateMAState
ZIP Code012014109ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (37 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
JEROME J ANDERSON
TRUSTEE2.00X000
THOMAS O ANDREWS
TRUSTEE2.00X000
ALFRED A BARBALUNGA
TRUSTEE2.00X000
BRONLY S BOYD
TRUSTEE/VICE CHAIRMAN2.00X000X
BRIAN T BURKE MD
TRUSTEE/PHYSICIAN50.00X200213037926
KIT DOBELLE
TRUSTEE2.00X000
TIMOTHY C DOHERTY
TRUSTEE/CHAIRMAN2.00X000X
RICHARD M DOHONEY
TRUSTEE2.00X000
BRIAN H FAIRBANK
TRUSTEE2.00X000
A KING FRANCIS
TRUSTEE2.00X000
DENNIS J HOGAN
TRUSTEE2.00X000
EDMUND H HORNSTEIN DO
TRUSTEE/CONTRACT PHYSICIAN2.00X0875690
JOHN R KEARNS MD
TRUSTEE2.00X000
SUSAN M KORMANIK
TRUSTEE2.00X000
LORINDA ACKLEY MAZUR
TRUSTEE2.00X000
JOAN M MCFALLS
TRUSTEE2.00X000
LAURIE NORTON MOFFATT
TRUSTEE2.00X000
DAVID E PHELPS
PRESIDENT/TRUSTEE58.00X052252039741X
PAUL E RAVERTA
TRUSTEE2.00X000
CAROLE G SIEGEL
TRUSTEE2.00X000
GEORGE T SMITH
TRUSTEE2.00X000
MARILYN L SPERLING
TRUSTEE2.00X000
ANN H TRABULSI
TRUSTEE2.00X000
ROBERT P WESPISER MD
TRUSTEE/CONTRACT PHYSICIAN2.00X01320350
THADDEUS S TUCKER WELCH
TRUSTEE/NOT SERVING AT YEAR-END2.00X000
DARLENE RODOWICZ
TREASURER51.00032947735958X
EUGENE DELLEA
PRESIDENT, FAIRVIEW HOSPTL50.00020742819464X
PHELPS D1-TIME RETIRMNT BENEFT ADJ
PRESIDENT1.00010855530X
CHERYL M BOUDREAU
CLERK41.0007997413078X
ALEC R BELMAN MD
DIRECTOR, EMERGENCY DEPT.50.00234365039209X
DOREEN HUTCHINSON
VICE PRESIDENT, OPERATIONS50.00159852033422X
RAYMOND SABATELLI MD
DIRECTOR, EMERGENCY DEPT.50.00308680039555X
STEPHEN TRACY MD
PHYSICIAN50.00225612034978X
GLEN R LOVEJOY MD
PHYSICIAN50.00224064035939X
BRUCE E NAYOWITH MD
PHYSICIAN50.00210291043668X
TOMASZ T PAJAK MD
PHYSICIAN50.00177038037668X
KERSTIN L VOSS MD
PHYSICIAN50.00176894021101X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1917009TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs2444556TotalReportableCompFrmRltdOrgs
Total Other Compensation431707TotalOtherCompensation
Number Individuals GT100 K24NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
BARR & BARR INC
260 COCHITUATE RD FL 2FRAMINGHAMMA017014608CONSTRUCTION SVCS568268
BERKSHIRE SURGICAL ASSOCIATES PC
777 NORTH ST STE 407PITTSFIELDMA012014141HEALTHCARE SERVICES189510
WE WILLIAMS PAVING INC
PO BOX 78W STOCKBRIDGEMA012660078CONSTRUCTION SVCS185801
COMPHEALTH MEDICAL STAFFING INC
PO BOX 972651DALLASTX753972651HEALTHCARE STAFFING116325
WEATHERBY LOCUMS INC
PO BOX 972633DALLASTX753972633HEALTHCARE STAFFING113683
FieldValueIRS element (for citing)
Number Of Contractors GT100 K7NumberOfContractorsGT100K
Fundraising Events130306FundraisingEvents
Government Grants91251GovernmentGrants
All Other Contributions290254AllOtherContributions
Noncash Contributions2804NoncashContributions
Total Contributions511811TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionNET PATIENT SVC REVENUDescription
Business Code622110BusinessCode
Total Revenue Column41845111TotalRevenueColumn
Related Or Exempt Function Income41845111RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue41845111TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column292157TotalRevenueColumn
Exclusion$292,157ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column42280TotalRevenueColumn
Exclusion$42,280ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real50912Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real8038Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real42874Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column42874TotalRevenueColumn
Exclusion$42,874ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities4133097Securities
Other5641Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities3544910Securities
Other3380Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities588187Securities
Other2261Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column590448TotalRevenueColumn
Exclusion$590,448ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events89550GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events130306CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses89550FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeExclusionExclusionAmount
PHARMACY SALES446110290672290672
CAFETERIA SALES722212165287$165,287
REIMBURSED EXPENSES9000996152161521

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column97967TotalRevenueColumn
Related Or Exempt Function Income97967RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue615447TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column43940128TotalRevenueColumn
Related Or Exempt Function Income42295271RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$1,133,046ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1022123Total
Program Services1018372ProgramServices
Management And General3332ManagementAndGeneral
Fundraising419Fundraising

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total16471841Total
Program Services16138409ProgramServices
Management And General296199ManagementAndGeneral
Fundraising37233Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total643923Total
Program Services630865ProgramServices
Management And General11601ManagementAndGeneral
Fundraising1457Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total3023293Total
Program Services2971550ProgramServices
Management And General46188ManagementAndGeneral
Fundraising5555Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1204114Total
Program Services1180785ProgramServices
Management And General20724ManagementAndGeneral
Fundraising2605Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total3325172Total
Management And General3325172ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total13840Total
Management And General13840ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total260Total
Management And General260ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total12546Total
Program Services12546ProgramServices

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total25727Total
Management And General25727ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total5558897Total
Program Services5540064ProgramServices
Management And General13828ManagementAndGeneral
Fundraising5005Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total35370Total
Program Services23327ProgramServices
Management And General461ManagementAndGeneral
Fundraising11582Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total3332671Total
Program Services3299924ProgramServices
Management And General24488ManagementAndGeneral
Fundraising8259Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total343432Total
Program Services343294ProgramServices
Management And General138ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total764155Total
Program Services749350ProgramServices
Management And General13497ManagementAndGeneral
Fundraising1308Fundraising

Travel Travel

FieldValueIRS element (for citing)
Total183106Total
Program Services177249ProgramServices
Management And General3469ManagementAndGeneral
Fundraising2388Fundraising

Interest Interest

FieldValueIRS element (for citing)
Total358687Total
Program Services358687ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1647557Total
Program Services1615637ProgramServices
Management And General31920ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total494686Total
Program Services485102ProgramServices
Management And General8514ManagementAndGeneral
Fundraising1070Fundraising

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
RECIPROCAL/TEACHNG FEES11922481192248
BAD DEBT706503706503
MAINTENANCE & REPAIRS55514454438810756
MINOR HOSPITAL EQUIP2102392088601379
HLTH SFTY NET ASSESSMNT185952185952

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total762598Total
Program Services708668ProgramServices
Management And General51238ManagementAndGeneral
Fundraising2692Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total42074084Total
Program Services38091780ProgramServices
Management And General3902731ManagementAndGeneral
Fundraising79573Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY5413BOY
EOY11574EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1280167BOY
EOY1256157EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY80BOY
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY4155306BOY
EOY4338011EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY143020BOY
EOY30125EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY301106BOY
EOY278996EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY161844BOY
EOY150987EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis24429441LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec15724045LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY8824499BOY
EOY8705396EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY9705191BOY
EOY11469349EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY3225731BOY
EOY1341202EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY13330BOY
EOY11811EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY383997BOY
EOY406625EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY28199684BOY
EOY28000233EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY2835539BOY
EOY2899111EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY49788BOY
EOY29524EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY7172075BOY
EOY6884364EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY8935329BOY
EOY8110150EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY18992731BOY
EOY17923149EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY7507775BOY
EOY8079580EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1440936BOY
EOY1739262EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY258242BOY
EOY258242EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY9206953BOY
EOY10077084EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY28199684BOY
EOY28000233EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses1866044ReconcilationRevenueExpenses
Reconcilation Other Changes-995913ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required1FederalGrantAuditRequired
Federal Grant Audit Performed1FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$12,546OtherActivitiesAmount
Total Lobbying Expenditures IIB12546TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF OTHER LOBBYING ACTIVITIES:Identifier
Return ReferencePART II-B, LINE 1I:ReturnReference
ExplanationLOBBYING ACTIVITIES EXPENDITURES FAIRVIEW HOSPITAL PAYS ANNUAL MEMBERSHIP DUES TO THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE MASSACHUSETTS HOSPITAL ASSOCIATION (MHA). A PORTION OF THESE DUES ARE USED BY THE AHA AND THE MHA TO CONDUCT LOBBYING ACTIVITIES. FOR THE FYE 09/30/2011, THE PORTION OF THE DUES PAID TO THE AHA FOR LOBBYING ACTIVITIES WAS $2,900, AND THE PORTION OF THE DUES PAID TO THE MHA FOR LOBBYING ACTIVITIES WAS $9,646, FOR A TOTAL OF $12,546.Explanation

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance1046753BeginningOfYearBalance
Investment Earnings Or Losses11564InvestmentEarningsOrLosses
End Of Year Balance1058317EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance989912BeginningOfYearBalance
Investment Earnings Or Losses56841InvestmentEarningsOrLosses
End Of Year Balance1046753EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance1028277BeginningOfYearBalance
Investment Earnings Or Losses-22233InvestmentEarningsOrLosses
Other Expenditures16132OtherExpenditures
End Of Year Balance989912EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.75600BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.24400PermanentEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis16887OtherCostOrOtherBasis
Book Value16887BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis2137042OtherCostOrOtherBasis
Depreciation1994509Depreciation
Book Value142533BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis12392332OtherCostOrOtherBasis
Depreciation8778084Depreciation
Book Value3614248BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis9883180OtherCostOrOtherBasis
Depreciation4951452Depreciation
Book Value4931728BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings8705396TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (7 entries)

DescriptionDescriptionAmountAmount
DUE TO AFFILIATES$5,937,525
DUE TO THIRD PARTY PAYORS$1,318,971
ACCRUED FIN 47 ACCRETION$565,995
INTEREST RATE SWAP LIABILITY$197,473
DEFERRED COMPENSATION$69,530
DEFERRED PENSION FORFEITURE$18,356
REBATE FUND LIABILITY$2,300
FieldValueIRS element (for citing)
Total Of Amounts8110150TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS:PART V, LINE 4:INTENDED USES OF THE ORGANIZATION'S ENDOWMENT FUNDS FAIRVIEW HOSPITAL HAS FIVE PERMANENT ENDOWMENT FUNDS. THE BALDWIN FUND'S INCOME IS TO BE USED FOR THE CARE OF PEOPLE WITHOUT OR OF LIMITED MEANS. THE BEECHER FUND'S INCOME IS TO BE USED TO OFFSET THE HEALTHCARE COSTS OF AGING WOMEN OR UNWED MOTHERS. THE BRANDI FUND'S INCOME HAS THREE PURPOSES: (1) TO PROVIDE SCHOLARSHIPS FOR THE CONTINUING EDUCATION OF NURSES OR PROSPECTIVE NURSES ASSOCIATED WITH THE HOSPITAL; (2) TO SERVE AS A SOURCE OF EMERGENCY LOANS TO RETIRED NURSES OR CERTAIN NURSES WHO ARE CURRENTLY WORKING FOR THE HOSPITAL; AND (3) FOR THE PURCHASE OF EQUIPMENT, FURNISHINGS, OR OTHER ITEMS FOR THE BENEFIT OF THE NURSES OR THE MATERNITY SECTION OF THE HOSPITAL. THE MOSKOWITZ FUND'S INCOME IS TO BE USED TO PROVIDE FOR SCHOLARSHIPS TO EMPLOYEES AND CHILDREN OF EMPLOYEES OF THE HOSPITAL WHO ARE ADVANCING THEIR EDUCATION OR TECHNICAL SKILLS AT A RECOGNIZED LEARNING INSTITUTION. THE STANLEY FUND'S INCOME IS TO BE USED FOR THE REPAIR, UPKEEP, AND ADDITIONS TO THE HOSPITAL'S X-RAY EQUIPMENT.
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:PART X:THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS AND OTHER FINANCIAL INFORMATION OF BERKSHIRE HEALTH SYSTEMS, INC. AND AFFILIATES (INCLUDING FAIRVIEW HOSPITAL) FOR THE YEARS ENDED SEPTEMBER 30, 2011 AND 2010 DOES NOT CONTAIN A FOOTNOTE ADDRESSING ANY LIABILITY FOR UNCERTAIN TAX PROVISIONS UNDER FIN 48.

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1GALANameOfEvent1
Gross Receipts Event1187226GrossReceiptsEvent1
Charitable Contributions Event1113438CharitableContributionsEvent1
Gross Revenue Event173788GrossRevenueEvent1
Non Cash Prizes Event11847NonCashPrizesEvent1
Rent Facility Costs Event115098RentFacilityCostsEvent1
Food And Beverage Event117356FoodAndBeverageEvent1
Entertainment Event112495EntertainmentEvent1
Other Direct Expenses Event126992OtherDirectExpensesEvent1
Name Of Event2GOLF TOURNAMENTNameOfEvent2
Gross Receipts Event232630GrossReceiptsEvent2
Charitable Contributions Event216868CharitableContributionsEvent2
Gross Revenue Event215762GrossRevenueEvent2
Non Cash Prizes Event25538NonCashPrizesEvent2
Rent Facility Costs Event24347RentFacilityCostsEvent2
Food And Beverage Event23169FoodAndBeverageEvent2
Other Direct Expenses Event22708OtherDirectExpensesEvent2
Gross Receipts Total219856GrossReceiptsTotal
Charitable Contributions Total130306CharitableContributionsTotal
Gross Revenue Total Events89550GrossRevenueTotalEvents
Non Cash Prizes Total Events7385NonCashPrizesTotalEvents
Rent Facility Costs Total Events19445RentFacilityCostsTotalEvents
Food And Beverage Total Events20525FoodAndBeverageTotalEvents
Entertainment Total Events12495EntertainmentTotalEvents
Other Direct Expenses Total Events29700OtherDirectExpensesTotalEvents
Direct Expense Summary Events89550DirectExpenseSummaryEvents
Net Income Summary0NetIncomeSummary

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent400XPcent400
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense632056TotalCommunityBenefitExpense
Net Community Benefit Expense632056NetCommunityBenefitExpense
Percent Of Total Expense0.01530PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense5235456TotalCommunityBenefitExpense
Direct Offsetting Revenue3661780DirectOffsettingRevenue
Net Community Benefit Expense1573676NetCommunityBenefitExpense
Percent Of Total Expense0.03800PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Total Community Benefit Expense2738560TotalCommunityBenefitExpense
Direct Offsetting Revenue2132481DirectOffsettingRevenue
Net Community Benefit Expense606079NetCommunityBenefitExpense
Percent Of Total Expense0.01470PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense8606072TotalCommunityBenefitExpense
Direct Offsetting Revenue5794261DirectOffsettingRevenue
Net Community Benefit Expense2811811NetCommunityBenefitExpense
Percent Of Total Expense0.06800PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense221230TotalCommunityBenefitExpense
Net Community Benefit Expense221230NetCommunityBenefitExpense
Percent Of Total Expense0.00530PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense2297887TotalCommunityBenefitExpense
Direct Offsetting Revenue1040934DirectOffsettingRevenue
Net Community Benefit Expense1256953NetCommunityBenefitExpense
Percent Of Total Expense0.03040PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense2519117TotalCommunityBenefitExpense
Direct Offsetting Revenue1040934DirectOffsettingRevenue
Net Community Benefit Expense1478183NetCommunityBenefitExpense
Percent Of Total Expense0.03570PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense11125189TotalCommunityBenefitExpense
Direct Offsetting Revenue6835195DirectOffsettingRevenue
Net Community Benefit Expense4289994NetCommunityBenefitExpense
Percent Of Total Expense0.10370PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Total Community Building Expense77158TotalCommunityBuildingExpense
Direct Offsetting Revenue72955DirectOffsettingRevenue
Net Community Building Expense4203NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Leadership Development LeadershipDevelopment

FieldValueIRS element (for citing)
Total Community Building Expense7325TotalCommunityBuildingExpense
Direct Offsetting Revenue7325DirectOffsettingRevenue
Percent Of Total Expense0.00000PercentOfTotalExpense

Workforce Development WorkforceDevelopment

FieldValueIRS element (for citing)
Total Community Building Expense20033TotalCommunityBuildingExpense
Net Community Building Expense20033NetCommunityBuildingExpense
Percent Of Total Expense0.00050PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense104516TotalCommunityBuildingExpense
Direct Offsetting Revenue80280DirectOffsettingRevenue
Net Community Building Expense24236NetCommunityBuildingExpense
Percent Of Total Expense0.00060PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$433,276BadDebtExpenseAmount
Amount Attributable To0AmountAttributableTo
Amount Reimbursed By Medicare16151346AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare16012534CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall138812MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare
Number Of Hospital Facilities5NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA (5 entries)

Facility NumberFacilityNumberAddress Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeLicensed HospitalLicensedHospitalGeneral Medical And SurgicalGeneralMedicalAndSurgicalCritical Access HospitalCriticalAccessHospitalEr24 HoursEr24HoursOtherOther
FAIRVIEW HOSPITAL
129 LEWIS AVEGREAT BARRINGTONMA012301796XXXX
FAIRVIEW PHYSICAL & SPORTS THERAPY CTR
2710 STOCKBRIDGE RD STE 1LEEMA01238OUTPATIENT SERVICES
FAIRVIEW HOSPITAL AQUATIC THERAPY PROG
315 CHRISSEY RDGREAT BARRINGTONMA01230OUTPATIENT SERVICES
FAIRVIEW HSP OUTPATNT PHYSICAL THERAPY
410 MAPLE AVEGREAT BARRINGTONMA01230OUTPATIENT SERVICES
FAIRVIEW HOSPITAL DIALYSIS CENTER
510 MAPLE AVEGREAT BARRINGTONMA01230OUTPATIENT SERVICES

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1FAIRVIEW HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber

Form990 Schedule H Part VI Form990ScheduleHPartVI (14 entries)

ExplanationExplanationIdentifierIdentifierReturn ReferenceReturnReference
PART I, LINE 7: THE TOTAL COMMUNITY BENEFIT EXPENSE REPORTED ON PART I, LINES 7A, 7B, & 7C HAS BEEN CALCULATED USING THE RATIO OF PATIENT CARE COST TO CHARGES AS COMPUTED USING WORKSHEET 2 IN THE SCHEDULE H INSTRUCTIONS. THE TOTAL COMMUNITY BENEFIT EXPENSE REPORTED ON PART I, LINE 7G HAS BEEN CALCULATED USING A COST ACCOUNTING METHOD. BAD DEBT EXPENSE HAS BEEN EXCLUDED FROM THE COMPUTATION OF ALL COMMUNITY BENEFIT EXPENSE SHOWN IN PART I, LINE 7.
PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES: FAIRVIEW HOSPITAL RENAL DIALYSIS SERVICES
PART I, L7 COL(F): BAD DEBT EXPENSE OF $715,803 ATTRIBUTABLE TO PATIENT ACCOUNTS HAS BEEN EXCLUDED FROM THE COMPUTATION OF ALL COMMUNITY BENEFIT EXPENSE SHOWN IN PART I, LINE 7, COLUMN F.
PART II: COMMUNITY BUILDING ACTIVITIES - AS SUMMARIZED IN PART II, EXPENDITURES BY FAIRVIEW HOSPITAL TO PROTECT OR IMPROVE THE COMMUNITY'S HEALTH OR SAFETY INCLUDE THE FOLLOWING:LINE 3 COMMUNITY SUPPORT: EMERGENCY PREPAREDNESS - GROSS EXPENSE $40,503 LESS OFFSETTING REVENUE $36,300 = NET COMMUNITY BENEFIT EXPENSE $4,203LINE 3 COMMUNITY SUPPORT: MEDICAL RESERVE CORPS - GROSS EXPENSE $36,655 LESS OFFSETTING REVENUE $36,655 = NET COMMUNITY BENEFIT EXPENSE $0LINE 5 DEVELOPMENT & TRAINING: MEDICAL INTERPRETER/CONVERSATIONAL SPANISH TRAINING - GROSS EXPENSE $7,325 LESS OFFSETTING REVENUE $7,325 = NET COMMUNITY BENEFIT EXPENSE $0LINE 8 WORKFORCE DEVELOPMENT: PHYSICIAN RECRUITMENT - GROSS EXPENSE $20,033 LESS OFFSETTING REVENUE $0 = NET COMMUNITY BENEFIT EXPENSE $20,033. THIS IS IN RESPONSE TO CRITICAL PHYSICIAN SHORTAGES IN THE HOSPITAL'S SERVICE AREA AND THE EXPENDITURES REPORTED ARE AN INVESTMENT IN REPLENISHING THE SUPPLY OF INDEPENDENT PRIMARY CARE AND SPECIALTY PHYSICIANS AVAILABLE TO THE COMMUNITY BY ASSISTING IN ESTABLISHING NEW PHYSICIANS IN THE SERVICE AREA.
PART III, LINE 4: FOOTNOTE 11 ("CHARITY CARE") TO THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS AND OTHER FINANCIAL INFORMATION OF BERKSHIRE HEALTH SYSTEMS, INC. AND AFFILIATES (INCLUDING FAIRVIEW HOSPITAL) FOR THE YEARS ENDED SEPTEMBER 30, 2011 AND 2010 CONTAINS THE FOLLOWING REGARDING BAD DEBT EXPENSE: "THE HEALTH SYSTEM PROVIDES CARE TO PATIENTS WHO MEET CHARITY CARE POLICY CRITERIA WITHOUT CHARGE OR AT AMOUNTS LESS THAN ESTABLISHED RATES." "IF A PATIENT IS INELIGIBLE FOR CHARITY CARE OR CARE AT REDUCED RATES BECAUSE THE PATIENT'S INCOME EXCEEDS THE ELIGIBILITY GUIDELINES, SERVICES RENDERED ARE RECORDED AT ESTABLISHED RATES AND ANY UNPAID ACCOUNT RECEIVABLE BALANCE IS WRITTEN OFF TO BAD DEBTS AFTER A REASONABLE COLLECTION EFFORT HAS BEEN MADE."THE ESTIMATED COST OF BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS REPORTED ON LINE 2, PART III WAS CALCULATED USING THE RATIO OF PATIENT CARE COST TO CHARGES AS COMPUTED USING WORKSHEET 2 IN THE SCHEDULE H INSTRUCTIONS. NO BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER FAIRVIEW HOSPITAL'S CHARITY CARE POLICY HAS BEEN REPORTED ON LINE 3, PART III BECAUSE ALL GROSS PATIENT CHARGES ATTRIBUTABLE TO THESE PATIENTS THAT WERE NOT PAID FROM UNCOMPENSATED CARE POOLS OR PROGRAMS WERE WRITTEN OFF AS "FREE CARE" EXPENSE.
PART III, LINE 8: THE AMOUNT REPORTED ON LINE 6, PART III WAS DETERMINED USING THE COST ALLOCATION METHODOLOGY USED FOR THE MEDICARE COST REPORTS.
PART III, LINE 9B: THE FOLLOWING INDIVIDUALS AND PATIENT POPULATIONS ARE EXEMPT FROM ANY COLLECTION OR BILLING PROCEDURES PURSUANT TO STATE REGULATIONS: A. PATIENTS ENROLLED IN A STATE HEALTH INSURANCE PROGRAM, INCLUDING BUT NOT LIMITED TO, MASSHEALTH, EMERGENCY AID TO THE ELDERLY, DISABLED AND CHILDREN, HEALTHY START, CHILDREN'S MEDICAL SECURITY PLAN, "LOW INCOME PATIENTS" AS DETERMINED BY THE OFFICE OF MEDICAID. PLEASE NOTE THAT FAIRVIEW HOSPITAL (FVH) MAY SEEK COLLECTION ACTION AGAINST ANY PATIENT ENROLLED IN THE ABOVE MENTIONED PROGRAMS FOR THEIR REQUIRED CO-PAYMENTS AND DEDUCTIBLES THAT ARE SET FORTH BY EACH SPECIFIC PROGRAM. FVH MAY ALSO INITIATE BILLING OR COLLECTION FOR A PATIENT WHO ALLEGES THAT HE OR SHE IS A PARTICIPANT IN A FINANCIAL ASSISTANCE PROGRAM THAT COVERS THE COSTS OF THE HOSPITAL SERVICES, BUT FAILS TO PROVIDE PROOF OF SUCH PARTICIPATION. UPON RECEIPT OF SATISFACTORY PROOF THAT A PATIENT IS A PARTICIPANT IN A FINANCIAL ASSISTANCE PROGRAM (INCLUDING RECEIPT OR VERIFICATION OF SIGNED APPLICATION), FVH SHALL CEASE ITS BILLING OR COLLECTION ACTIVITIES. FVH MAY CONTINUE COLLECTION ACTION ON ANY LOW INCOME PATIENT FOR SERVICES RENDERED PRIOR TO THE LOW INCOME PATIENT DETERMINATION, PROVIDED THAT THE CURRENT LOW INCOME PATIENT STATUS HAS BEEN TERMINATED OR EXPIRED. HOWEVER, ONCE A PATIENT IS DETERMINED ELIGIBLE AND ENROLLED IN THE HEALTH SAFETY NET, MASSHEALTH, OR CERTAIN COMMONWEALTH CARE PROGRAMS, FVH WILL CEASE COLLECTION ACTIVITY FOR SERVICES, PREVIOUSLY BILLED, THAT NOW FALL INTO THE ELIGIBILITY PERIOD. FVH MAY SEEK COLLECTION ACTION AGAINST ANY OF THE PATIENTS PARTICIPATING IN THE PROGRAMS LISTED ABOVE FOR NON-COVERED SERVICES THAT THE PATIENT HAS AGREED TO BE RESPONSIBLE FOR, PROVIDED THAT THE HOSPITAL OBTAINED THE PATIENT'S PRIOR WRITTEN CONSENT TO BE BILLED FOR THE SERVICE. FVH WILL NOT UNDERTAKE COLLECTION ACTION AGAINST AN INDIVIDUAL THAT HAS BEEN APPROVED FOR MEDICAL HARDSHIP UNDER THE MASSACHUSETTS HEALTH SAFETY NET PROGRAM WITH RESPECT TO THE AMOUNT OF THE BILL THAT EXCEEDS THE MEDICAL HARDSHIP CONTRIBUTION. B. FVH WILL NOT GARNISH A LOW INCOME PATIENT'S (AS DETERMINED BY THE OFFICE OF MEDICAID) OR THE PATIENT'S GUARANTOR'S WAGES OR EXECUTE A LIEN ON THE LOW INCOME PATIENT'S OR THE PATIENT'S GUARANTOR'S PERSONAL RESIDENCE OR MOTOR VEHICLE UNLESS: (1) THE HOSPITAL CAN SHOW THAT THE PATIENT OR THE PATIENT'S GUARANTOR HAS THE ABILITY TO PAY, (2) THE PATIENT DID NOT RESPOND TO HOSPITAL REQUESTS FOR INFORMATION OR THE PATIENT REFUSED TO COOPERATE WITH THE HOSPITAL TO SEEK AN AVAILABLE FINANCIAL ASSISTANCE PROGRAM, OR (3) FOR PURPOSES OF THE LIEN, IT WAS APPROVED BY THE HOSPITAL'S BOARD OF TRUSTEES ON AN INDIVIDUAL CASE BY CASE BASIS. C. FVH AND ITS AGENTS SHALL NOT CONTINUE COLLECTION OR BILLING ON A PATIENT WHO IS A MEMBER OF A BANKRUPTCY PROCEEDING EXCEPT TO SECURE ITS RIGHTS AS A CREDITOR IN THE APPROPRIATE ORDER.
PART I, LINE 6A: FAIRVIEW HOSPITAL AND BERKSHIRE MEDICAL CENTER EACH FILE A SEPARATE COMMUNITY BENEFITS REPORT WITH THE STATE OF MASSACHUSETTS. FAIRVIEW'S FISCAL YEAR 2011 COMMUNITY BENEFITS REPORT CAN BE ACCESSED AT WWW.CBSYS.AGO.STATE.MA.US/CBPUBLIC/PUBLIC/ANNUAL_REPORTS_START.ASPX.
PART VI, LINE 2: FAIRVIEW HOSPITAL PLACES A PRIORITY ON MAINTAINING CLOSE ALLIANCES WITH ALL SOCIAL, HEALTH, SAFETY, LAW ENFORCEMENT AND WELFARE AGENCIES IN THE SOUTHERN BERKSHIRE COMMUNITY. OUR PARTNERSHIPS WITH SCHOOLS, BUSINESSES, AS WELL AS CIVIC AND OTHER COMMUNITY ORGANIZATIONS KEEP FAIRVIEW HOSPITAL ABREAST OF THE HEALTH STATUS OF THE SOUTHERN BERKSHIRES. FAIRVIEW ENGAGES A BROAD RANGE OF OUR CONSTITUENTS (INCLUDING PHYSICIANS, TOWN LEADERS, HEALTH OFFICIALS, SPECIAL INTEREST GROUPS, AND IMMIGRANT COMMUNITIES) TO RECEIVE DIRECT FEEDBACK AND INFORMATION. IN ADDITION, COMMUNITY MEMBERS SERVE ON MANY HOSPITAL COMMITTEES, INCLUDING OUR PATIENT FAMILY ADVISORY COUNCIL WHICH PROVIDES FEEDBACK ON HOW FAIRVIEW HOSPITAL CAN BETTER SERVE OUR COMMUNITY.STATISTICAL EVIDENCE SUPPORTS OUR COMMUNITY NEEDS ASSESSMENT. FAIRVIEW UTILIZES IN-PATIENT, EMERGENCY AND MAJOR DIAGNOSTIC CATEGORIES DATA AND ONGOING POST-STAY SURVEYS. FEDERAL, STATE AND LOCAL REPORTING ALERTS FAIRVIEW TO IMPORTANT TRENDS AND IDENTIFICATION OF AREAS THAT ARE ABOVE THE STATE NORM.FAIRVIEW PARTICIPATES WITH THE WORK OF OUR PARTNER ORGANIZATIONS AND UTILIZES MANY ASSESSMENTS THAT ARE MADE AVAILABLE ON BEHALF OF SPECIFIC COMMUNITIES. AMONG THE ORGANIZATIONS THAT HAVE PROVIDED SURVEY DATA ARE THE BERKSHIRE HEALTH SYSTEMS COMMUNITY HEALTH ASSESSMENT 2011 SURVEY, SOUTHERN BERKSHIRE YOUTH COALITION YOUTH SURVEY, UNITED WAY COMMUNITY IMPACT (FY2010) BASELINE REPORT, 2011 MASSACHUSETTS PREVENTION NEEDS ASSESSMENT SURVEY, CROSS-CULTURAL ACTION NETWORK, SOUTHERN BERKSHIRE EDUCATIONAL COLLABORATIVE, 2010 MASSACHUSETTS COUNTY HEALTH RANKINGS (UNIVERSITY OF WISCONSIN POPULATION HEALTH INSTITUTE), MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH DEMOGRAPHIC DATA AND HEALTH REGIONALIZATION STATUS REPORTS, BERKSHIRE HILLS REGIONAL SCHOOL DISTRICT BMI REPORTS 2008/2009, AND BERKSHIRE COUNTY BOARDS OF HEALTH ASSOCIATION 2010 BERKSHIRE COMMUNITY HEALTH ASSESSMENT.
PART VI, LINE 3: FAIRVIEW HOSPITAL HELPS PATIENTS ACCESS COVERAGE AND CONSISTENTLY PROMOTES ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE AND LOCAL GOVERNMENT PROGRAMS INSIDE AND OUTSIDE THE HOSPITAL. THE ADVOCACY FOR ACCESS OFFICE, EASILY ACCESSIBLE AT THE MAIN ENTRANCE OF FAIRVIEW HOSPITAL, FACILITATES ASSISTANCE TO THOSE WHO NEED IMMEDIATE CARE AS WELL AS THOSE WHO ARE UNINSURED OR UNDERINSURED. THE ADVOCACY TEAM HAS TRAINED STAFF AT ENTRY POINTS AS WELL AS CAREGIVERS THROUGHOUT THE HOSPITAL KNOWLEDGEABLE ABOUT THE IMPORTANT ROLE THEY CAN PROVIDE TO PATIENTS. THE ADVOCACY TEAM REGULARLY VISITS PATIENTS IN THE HOSPITAL TO ANSWER QUESTIONS THE PATIENTS MAY HAVE AS WELL AS FACILITATING ENROLLMENT IN THE APPROPRIATE PLAN. IN ADDITION, A FINANCIAL ADVISOR IS AVAILABLE DURING BUSINESS HOURS TO ASSIST PATIENTS IN EXPLAINING BILLING ISSUES AND CREATING FLEXIBLE BILLING ARRANGEMENTS TO MEET THE PATIENTS' NEEDS.
PART VI, LINE 4: FAIRVIEW HOSPITAL SERVES A RURAL, GEOGRAPHICALLY ISOLATED AREA OF THE TWELVE TOWNS IN THE SOUTHWESTERN CORNER OF MASSACHUSETTS AND NEARBY COMMUNITIES IN NEW YORK STATE AND CONNECTICUT. PRIMARY RESIDENTS OF THE SOUTHERN BERKSHIRES FACE THE SOCIAL AND ECONOMIC CHALLENGES OF RURAL COMMUNITIES ACROSS THE NATION. THESE ARE SOME OF THE STATE'S REMOTEST COMMUNITIES. THE SOUTHERN BERKSHIRE COMMUNITY IS PREDOMINATELY CAUCASIAN WITH A GROWING MULTI-CULTURAL COMMUNITY. TWENTY-FIVE PERCENT OF FAMILIES ARE LIVING BELOW 200% OF THE POVERTY LEVEL (MORE THAN 3% OVER STATE AVERAGES) AND THE AVERAGE PER CAPITA INCOME IS $3,297 LOWER THAN THE STATE AVERAGE. OVER 25% OF THE STUDENTS IN THE LOCAL DISTRICT ARE ON FREE OR REDUCED PRICED LUNCHES.THE ELDER POPULATION IN THE SOUTHERN BERKSHIRES IS SIGNIFICANTLY ABOVE THE STATE POPULATION, REACHING OVER 20% IN SOME COMMUNITIES (MASSACHUSETTS RATES ARE 13%) WITH MANY ELDERS LIVING ALONE. THERE ARE TWO SENIOR HOUSING UNITS AND THREE NURSING HOMES IN THE AREA, AND SENIOR CENTERS IN MOST AREA TOWNS. BECAUSE THE SOUTHERN BERKSHIRES IS A MAJOR TOURIST DESTINATION FOR THE NEW YORK METROPOLITAN AREA, IN MANY COMMUNITIES MORE THAN HALF THE HOMES ARE OWNED BY PART-TIME RESIDENTS. PART-TIME SERVICE JOBS ARE A MAJOR SOURCE OF INCOME FOR PRIMARY RESIDENTS. HOWEVER, THE HOUSING MARKET REFLECTS THE SECONDARY MARKET WITH HIGHER VALUES THAT ARE NOT WITHIN REACH OF THE INCOME OF MOST LOCAL FAMILIES. RURAL HOMELESSNESS IS A HIDDEN, BUT PERVASIVE SOCIAL AND ECONOMIC ISSUE. PUBLIC TRANSPORTATION IS LIMITED AND NOT EASILY ACCESSIBLE. AS A RESULT, TRANSPORTATION IS AN OBSTACLE FOR CARE FOR MANY, PARTICULARLY AMONG THE ELDERLY. A PUBLIC TRANSPORTATION AGENCY RUNS A LIMITED BUS ROUTE WITH LIMITED HOURS. ADDITIONAL ELDERLY TRANSPORTATION IS AVAILABLE BUT LIMITED. PEOPLE WHO NEED TO ACCESS HEALTHCARE MUST RELY ON FAMILY OR FRIENDS TO GET TO MEDICAL CARE. SPECIALTY CARE IS A PARTICULAR CHALLENGE TO OBTAIN. FAIRVIEW HOSPITAL COLLABORATES WITH AREA ORGANIZATIONS TO HELP MAKE TRANSPORTATION OPTIONS AVAILABLE. HEALTHCARE AND EDUCATION ARE THE PRIMARY EMPLOYMENT SECTORS. THE SOUTHERN BERKSHIRE ECONOMY'S PRIMARY ECONOMIC ENGINE IS TOURISM, WITH A HIGH NUMBER OF HOTELS, BED AND BREAKFASTS, RESTAURANTS, AND RETAIL SHOPS AND SERVICES CATERING TO THE TOURIST COMMUNITY. THE LOCAL CONSTRUCTION INDUSTRY WAS SEVERELY IMPACTED BY THE ECONOMIC DOWNTURN. ALTHOUGH THESE ARE OFTEN SEASONAL AND SERVICE BASED JOBS, THEY ARE A SIGNIFICANT PART OF THE ECONOMY.
PART VI, LINE 6: FAIRVIEW HOSPITAL VALUES THE COMMUNITY'S VITAL ROLE AS STEWARDS OF THEIR COMMUNITY HOSPITAL. MEMBERS OF THE COMMUNITY, REPRESENTING VARIOUS DEMOGRAPHIC AND CONSTITUENCY GROUPS, SERVE ON OUR GOVERNING BOARDS AS WELL AS VARIOUS COMMITTEES WHICH ASSURE THE INPUT AND INTERESTS OF THE COMMUNITY ARE REPRESENTED AT THE HIGHEST LEVELS. HOSPITAL STAFF ALSO PLAY AN ACTIVE ROLE IN MANY LOCAL AND REGIONAL ORGANIZATIONS, SUPPORTING THEIR EFFORTS AND, BY ENGAGING WITH THEIR MISSION AND INTERESTS, CREATING NEW AVENUES OF COLLABORATION AND OPPORTUNITY TO BETTER MEET OUR COMMUNITY'S HEALTH NEEDS.THE GOVERNING BODY OF FAIRVIEW HOSPITAL CONSISTS OF 20 COMMUNITY VOLUNTEERS, THREE PHYSICIAN REPRESENTATIVES, AND AS AN EX-OFFICIO MEMBER, THE CHIEF EXECUTIVE OFFICER. THE COMMUNITY VOLUNTEERS ARE ELECTED FOR TERMS OF UP TO THREE YEARS, ARE SUBJECT TO TERM LIMITS AND REPRESENT A WIDE SPECTRUM OF COMMUNITY INTERESTS - INCLUDING SOCIAL SERVICE PROVIDERS, LOCAL BUSINESS LEADERS, FINANCIAL PROFESSIONALS, CONSUMER ADVOCATES AND EDUCATIONAL LEADERS. MOST COMMITTEES OF THE BOARD OF TRUSTEES INCLUDE ADDITIONAL COMMUNITY REPRESENTATIVES. FAIRVIEW MAINTAINS A PATIENT AND FAMILY COUNCIL TO PROVIDE INPUT AND ADVICE ON A WIDE RANGE OF SERVICE TOPICS.THE MEDICAL STAFF OF FAIRVIEW HOSPITAL IS OPEN TO ALL PHYSICIANS WHO MEET CLINICAL AND PATIENT SERVICE CRITERIA, ALTHOUGH CERTAIN HOSPITAL BASED SERVICES - RADIOLOGY, ANESTHESIA, EMERGENCY DEPARTMENT AND PATHOLOGY - ARE FUNCTIONALLY CLOSED BECAUSE OF THE MANNER IN WHICH THOSE DEPARTMENTS ARE STRUCTURED.FAIRVIEW REGULARLY EXPENDS PERSONNEL AND FINANCIAL RESOURCES IN SUPPORT OF COMMUNITY INITIATIVES THAT PROMOTE IMPROVEMENTS IN COMMUNITY HEALTH AND WELL-BEING AND FOR WHICH IT DOES NOT EXPECT REIMBURSEMENT. FAIRVIEW HOSPITAL'S SERVICE AREA IS A DESIGNATED MEDICALLY UNDERSERVED COMMUNITY AND IT HAS PLACED HIGH PRIORITY ON RECRUITING PHYSICIANS TO OUR RURAL COMMUNITY TO ASSURE THAT THE PRIMARY HEALTH NEEDS ARE MET. THE BERKSHIRE COUNTY COMMUNITY HAS LONG LABORED UNDER A CRITICAL PHYSICIAN SHORTAGE IN VARIOUS SPECIALTIES AND BERKSHIRE MEDICAL CENTER AND FAIRVIEW HOSPITAL HAVE IN RECENT YEARS EXPENDED SIGNIFICANT PERSONNEL TIME AND FINANCIAL RESOURCES IN RECRUITING PHYSICIANS TO THE AREA AS DIRECT EMPLOYEES OF BMC, FAIRVIEW, OR THEIR AFFILIATES. MOREOVER, BMC AND FAIRVIEW HAVE, IN APPROPRIATE WAYS, PROVIDED SUBSTANTIAL ASSISTANCE TO COMMUNITY MEDICAL PRACTICES TO RECRUIT AND SUPPORT THE PRACTICE START-UP OF NEW PHYSICIANS IN NEEDED SPECIALTIES. FAIRVIEW HAS EXTENSIVE COMMUNITY OUTREACH PROGRAMS AND SUPPORT WHICH ARE COMPREHENSIVE AND COMMUNITY-BASED TO ADDRESS SUCH DIVERSE HEALTHCARE CHALLENGES AS DIABETES, HEART FAILURE, CHRONIC PAIN MANAGEMENT, AND NARCOTICS MISUSE AND DIVERSION.AS STEWARD OF THE COMMUNITY'S PRIMARY HEALTH ORGANIZATION, AND A NOT-FOR-PROFIT ORGANIZATION, FAIRVIEW HOSPITAL UTILIZES ANY SURPLUS FUNDS TO MEET THE HIGHEST PRIORITY NEEDS INCLUDING PATIENT CARE, SERVICE AND PROGRAM DEVELOPMENT, MEDICAL EDUCATION OF ALL STAFF, COMMUNITY SUPPORT AND EDUCATION AND RESEARCH.BECAUSE FAIRVIEW HOSPITAL'S SERVICE AREA IS THE MORE RURAL SOUTHERN CORNER OF THE REGION, FAIRVIEW HOSPITAL HAS ALSO ESTABLISHED A FAIRVIEW COMMUNITY BENEFITS ADVISORY COMMITTEE (FCBAC), WHICH ENGAGES HEALTHCARE PROFESSIONALS ON THE SPECIFIC NEEDS OF OUR GEOGRAPHIC DISTRICT. THE FCBAC MEETS THREE TIMES A YEAR INCLUDING THE PRESIDENT, TWO VICE PRESIDENTS, AND LEADERS OF THE HOSPITAL DEPARTMENTS AND STAFF WHO ARE DIRECTLY INVOLVED WITH PATIENTS, ALLOWING A GREATER FOCUS ON THE SPECIFIC NEEDS OF THIS GEOGRAPHIC DISTRICT THROUGH A MULTIDISCIPLINARY APPROACH TO IDENTIFY EMERGING HEALTH ISSUES IN THE COMMUNITY.AS THE CENTER OF THE HEALTH CARE COMMUNITY IN THE SOUTHERN BERKSHIRES, FAIRVIEW HOSPITAL IS AN ACTIVE LEADER IN THE PROMOTION OF BETTER HEALTH IN OUR COMMUNITY. FAIRVIEW OFFERS:PRIMARY SERVICES TO ALL WHO SEEK CARE, REGARDLESS OF ABILITY TO PAY;FREE OR LOW-COST EDUCATIONAL PROGRAMS, SUPPORT GROUPS AND SCREENINGS TO PROVIDE VALUABLE INFORMATION TO OUR COMMUNITY, WITH PARTICULAR FOCUS ON VULNERABLE POPULATIONS;ONGOING MEDIA COMMUNICATION FOR IMPORTANT HEALTH ACCESS INFORMATION INCLUDING FLU PREVENTION, VACCINATIONS, COMMONWEALTH CARE DEADLINES;HEALTHIER MENUS, MORE SUSTAINABLE OR ENVIRONMENTALLY FRIENDLY POLICIES, DISCONTINUATION OF SUGAR DRINKS IN THE HOSPITAL TO SERVE AS A ROLE MODEL FOR A HEALTHIER COMMUNITY; ANDLEADERSHIP AND COLLABORATION IN PUBLIC HEALTH INITIATIVES INCLUDING EMERGENCY PLANNING, BOARDS OF HEALTH AND OTHER COMMUNITY-WIDE INITIATIVES.
PART VI, LINE 7: FAIRVIEW HOSPITAL IS A PART OF AN INTEGRATED, NON-PROFIT HEALTHCARE SYSTEM THAT INCLUDES (A) A TEACHING HOSPITAL, (B) A CRITICAL ACCESS COMMUNITY HOSPITAL [FAIRVIEW], (C) A LARGE, MULTISPECIALTY FACULTY PRACTICE ORGANIZATION, (D) A HOME HEALTH AGENCY, AND (E) BY CONTRACT AND CLOSE COORDINATION, A NON-PROFIT SENIOR CARE ORGANIZATION THAT INCLUDES SUB-ACUTE SERVICES IN REHABILITATION AND LONG-TERM CARE FACILITIES, ASSISTED LIVING FACILITIES, HOSPICE CARE SERVICES, SENIOR DAY CARE AND OTHER ELDERCARE SERVICES. FAIRVIEW ENGAGES IN HEALTHCARE NEEDS ASSESSMENT AND PLANNING ON A SYSTEM-WIDE BASIS, WITH A GOAL OF A SEAMLESS TRANSITION OF PATIENT-CENTERED CARE ACROSS THE SPECTRUM OF SERVICES OFFERED BY EACH OF THE SYSTEM'S COMPONENT ENTITIES. FAIRVIEW, ALONG WITH ITS AFFILIATES, CONTINUES TO DEVELOP INTEGRATED CLINICAL AND INFORMATION SYSTEMS ACROSS THE ENTIRE ORGANIZATION SO AS TO RENDER CARE EFFICIENTLY, EFFECTIVELY AND CONSISTENTLY AT EVERY CARE SITE.
MAREPORTS FILED WITH STATESPART VI, LINE 7

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (13 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
BRIAN T BURKE MD
18238800017825093960285300238139000
DAVID E PHELPS
046625500056265011025028716056226100
DARLENE RODOWICZ
027514700054330011025024933036543500
EUGENE DELLEA
01631580004427008467010997022689200
PHELPS D1-TIME RETIRMNT BENEFT ADJ
00000108555300000108555300
ALEC R BELMAN MD
2089420109200145030109140282950273574000
DOREEN HUTCHINSON
14046900019383075290258930193274000
RAYMOND SABATELLI MD
2579760140400366640110250285300348235000
STEPHEN TRACY MD
175461010764039387093400256380260590000
GLEN R LOVEJOY MD
194834010764018466085440273950260003000
BRUCE E NAYOWITH MD
178883098280215800101380335300253959000
TOMASZ T PAJAK MD
16021400016824074660302020214706000
KERSTIN L VOSS MD
16003400016860080220130790197995000

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierSUPPLEMENTAL INFORMATIONIdentifier
Return ReferencePART IIIReturnReference
ExplanationSUPPLEMENTAL COMPENSATION INFORMATION IN REFERENCE TO SCHEDULE J PART II, NO COMPENSATION IS PAID BY THE FILING ENTITY TO ANY OFFICER OR TRUSTEE, WITH THE EXCEPTION OF BRIAN T. BURKE, MD, WHOSE COMPENSATION RELATES SOLELY TO SERVICES RENDERED FOR TAX EXEMPT PURPOSES AND NOT TO HIS ROLE AS TRUSTEE. A PROPORTIONAL SHARE OF THE COMPENSATION AMOUNT PAID TO OFFICERS IS ALLOCATED INTERNALLY TO THE FILING ENTITY FOR ACCOUNTING AND MANAGEMENT PURPOSES (SEE BELOW). COMPENSATION IS PAID TO OFFICERS OF THE FILING ENTITY BY BHS MANAGEMENT SERVICES, INC., A SUPPORTING ORGANIZATION THAT PROVIDES MANAGEMENT SERVICES TO THE FILING ENTITY AND 26 OTHER NOT-FOR-PROFIT, TAX-EXEMPT HEALTHCARE SERVICE ENTITIES. COMPENSATION FOR THESE INDIVIDUALS IS REVIEWED AND ESTABLISHED AT LEAST BIANNUALLY BY AN INDEPENDENT VOLUNTEER GOVERNING BODY, BASED ON PERFORMANCE REVIEW AND COMPARISON TO INDEPENDENT, REGIONALLY APPROPRIATE BENCHMARKS FOR SIMILAR POSITIONS IN SIMILARLY SIZED ORGANIZATIONS, AS VERIFIED BY INDEPENDENT, NATIONALLY RECOGNIZED COMPENSATION CONSULTANTS. THE GOVERNING BODY TARGETS TOTAL COMPENSATION FOR MANAGEMENT EMPLOYEES AT THE 50TH PERCENTILE OF APPROPRIATE BENCHMARKS. FOR MOST OF MR. PHELPS' 20 YEAR TENURE AS CHIEF EXECUTIVE, A WRITTEN AGREEMENT BETWEEN BERKSHIRE HEALTH SYSTEMS AND MR. PHELPS HAS CALLED FOR BERKSHIRE HEALTH SYSTEMS TO FUND A RETIREMENT PROGRAM THAT, WHEN ADDED TO HIS BASE COMPENSATION AND OTHER BENEFITS, WAS INTENDED TO BRING HIS TOTAL COMPENSATION CLOSE TO THE 50TH PERCENTILE RANGE OF TOTAL COMPENSATION FOR COMPARABLE HEALTHCARE EXECUTIVES IN COMPARABLE HEALTHCARE ORGANIZATIONS, AS DETERMINED BY INDEPENDENT, NATIONALLY RECOGNIZED THIRD PARTY REVIEWERS. FOR MANY YEARS, A KEY ELEMENT OF THAT RETIREMENT PROGRAM WAS A CERTAIN LIFE INSURANCE POLICY IN WHICH BOTH BERKSHIRE HEALTH SYSTEMS AND MR. PHELPS HAD OWNERSHIP INTERESTS. IN 2010, BERKSHIRE HEALTH SYSTEMS AND MR. PHELPS AGREED TO REORGANIZE HIS RETIREMENT PROGRAM, SURRENDER HIS LIFE INSURANCE POLICY WHICH WAS, BY THEN, NO LONGER MEETING ITS GOALS AND OTHERWISE SIMPLIFY MR. PHELPS' RETIREMENT BENEFIT. AS PART OF THAT REORGANIZATION AND COMPROMISE, MR. PHELPS RECEIVED THE CASH VALUE OF THE SURRENDERED THE LIFE INSURANCE POLICY THAT HAD ACCUMULATED THROUGH HIS TENURE IN HIS CURRENT ROLE. BERKSHIRE HEALTH SYSTEMS' RETIREMENT FUNDING OBLIGATION WAS CORRESPONDINGLY REDUCED BY THAT AMOUNT. THE CASH VALUE OF THE SURRENDERED LIFE INSURANCE POLICY, REPORTED ON FORM 990, PART VII, SECTION A, COLUMN E AND ON SCHEDULE J, PART II, LINE 5(II), COLUMN B(III), IS REFLECTED BELOW, AS IS THE PORTION OF COMPENSATION ALLOCABLE TO EACH OF THE SUPPORTED ORGANIZATIONS. THE FOLLOWING LIST SHOWS THE ORGANIZATIONS TO WHICH THE IDENTIFIED OFFICER PROVIDED SERVICES, THE AVERAGE WEEKLY HOURS WORKED FOR EACH ENTITY, AND THE RESPECTIVE ALLOCABLE SHARE OF HIS OR HER ANNUAL COMPENSATION (REPORTABLE COMPENSATION AND OTHER COMPENSATION) FOR CALENDAR 2010: DAVID E. PHELPS, PRESIDENT BERKSHIRE MEDICAL CENTER, INC: 30 WEEKLY HOURS/58 WEEKLY HOURS $291,029 FAIRVIEW HOSPITAL: 4 HOURS/58 HOURS $38,796 BERKSHIRE FACULTY SERVICES, INC: 10 HOURS/58 HOURS $96,934 BERKSHIRE INDEMNITY CO, SPC, LTD: 2 HOURS/58 HOURS $19,398 BHS MANAGEMENT SERVICES, INC (12 HOURS/58 HOURS) FOR BENEFIT OF: BERKSHIRE HEALTHCARE SYSTEMS, INC: $29,069 BOURNE MANAGEMENT SYSTEMS, INC: $2,305 GREENFIELD MANAGEMENT SYSTEMS, INC: $2,305 NEW BEDFORD MANAGEMENT SYSTEMS, INC: $2,305 NORTHAMPTON MANAGEMENT SYSTEMS, INC: $2,305 EAST LONGMEADOW MANAGEMENT SYSTEMS, INC: $2,305 DANVERS MANAGEMENT SYSTEMS, INC: $2,305 PEABODY MANAGEMENT SYSTEMS, INC: $2,305 SOUTH YARMOUTH MANAGEMENT SYSTEMS, INC: $2,305 BERKSHIRE PENNSYLVANIA, INC: $2,305 XENIA EAST MANAGEMENT SYSTEMS, INC: $2,305 WILLOWOOD OF GREAT BARRINGTON, INC: $4,667 WILLOWOOD OF NORTH ADAMS, INC: $3,486 WILLOWOOD OF WILLIAMSTOWN, INC: $3,486 HILLCREST EXTENDED CARE SERVICES, INC: $8,153 BERKSHIRE RETIREMENT COMMUNITY, INC: $11,639 BERKSHIRE EXTENDED CARE SERVICES, INC: $8,153 INTEGRINURSE, INC: $3,486 INTEGRISCRIPT, INC: $3,486 HOSPICECARE IN THE BERKSHIRES, INC: $11,639 PITTSFIELD MANAGEMENT SYSTEMS, INC: $5,791 RETIREMENT BENEFIT ADJUSTMENT (ONE TIME): $1,085,553 DARLENE RODOWICZ, TREASURER BERKSHIRE MEDICAL CENTER, INC: 37 WEEKLY HOURS/51 WEEKLY HOURS $270,421 FAIRVIEW HOSPITAL: 3 HOURS/51 HOURS $21,926 BERKSHIRE FACULTY SERVICES, INC: 7 HOURS/51 HOURS $51,161 BERKSHIRE INDEMNITY CO, SPC, LTD: 3 HOURS/51 HOURS $18,272 BHS MANAGEMENT SERVICES, INC FOR BENEFIT OF BERKSHIRE HEALTHCARE SYSTEMS, INC: 1 HOUR/51 HOURS $3,654 CHERYL BOUDREAU, CLERK BERKSHIRE MEDICAL CENTER, INC: 20 WEEKLY HOURS/41 WEEKLY HOURS $45,375 FAIRVIEW HOSPITAL: 2 HOURS/41 HOURS $4,541 BERKSHIRE FACULTY SERVICES, INC: 8 HOURS/41 HOURS $18,155 BERKSHIRE INDEMNITY CO, SPC, LTD: 1 HOUR/41 HOURS $2,270 BHS MANAGEMENT SERVICES, INC (10 HOURS/41 HOURS) FOR BENEFIT OF: BERKSHIRE HEALTHCARE SYSTEMS, INC: $5,667 BOURNE MANAGEMENT SYSTEMS, INC: $456 GREENFIELD MANAGEMENT SYSTEMS, INC: $456 NEW BEDFORD MANAGEMENT SYSTEMS, INC: $456 NORTHAMPTON MANAGEMENT SYSTEMS, INC: $456 EAST LONGMEADOW MANAGEMENT SYSTEMS, INC: $456 DANVERS MANAGEMENT SYSTEMS, INC: $456 PEABODY MANAGEMENT SYSTEMS, INC: $456 SOUTH YARMOUTH MANAGEMENT SYSTEMS, INC: $456 BERKSHIRE PENNSYLVANIA, INC: $456 XENIA EAST MANAGEMENT SYSTEMS, INC: $456 WILLOWOOD OF GREAT BARRINGTON, INC: $912 WILLOWOOD OF NORTH ADAMS, INC: $679 WILLOWOOD OF WILLIAMSTOWN, INC: $679 HILLCREST EXTENDED CARE SERVICES, INC: $1,591 BERKSHIRE RETIREMENT COMMUNITY, INC: $2,270 BERKSHIRE EXTENDED CARE SERVICES, INC: $1,591 INTEGRINURSE, INC: $679 INTEGRISCRIPT, INC: $679 HOSPICECARE IN THE BERKSHIRES, INC: $2,270 PITTSFIELD MANAGEMENT SYSTEMS, INC: $1,135Explanation

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1MASS HEALTH & EDUCAT FACIL AUTHORITY SER FBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN042456011IssuerEIN
CUSIP Number57586CLN3CUSIPNumber
Date Issued2005-07-26DateIssued
Issue Price53089428IssuePrice
Description Of PurposeREFUND SER C & D BONDS; CAPITAL EXPDescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer0OnBehalfOfIssuer
Pool Financing0PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Amount Retired13270000AmountRetired
Total Proceeds54478799TotalProceeds
Amount In Reserve Fund5019000AmountInReserveFund
Issuance Costs From Proceeds1003800IssuanceCostsFromProceeds
Credit Enhancement898795CreditEnhancement
Working Capital Expenditures73681WorkingCapitalExpenditures
Capital Expenditures9003428CapitalExpenditures
Year Of Subst Completion2008YearOfSubstCompletion
Current Refunding1CurrentRefunding
Advance Refunding0AdvanceRefunding
Final Allocation Made1FinalAllocationMade
Adequate Books And Recds Maintaind1AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements0AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty0MngmentCntrctBondFinancdPrprty
Any Research Agreements0AnyResearchAgreements
Prcntge Prvt Business Use By Others0.00000PrcntgePrvtBusinessUseByOthers
Percentage Of Prvt Business Re UBI0.00000PercentageOfPrvtBusinessReUBI
Total Private Business Use0.00000TotalPrivateBusinessUse
Post Issuance Compliance Procdrs1PostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Form8038 T Filed1Form8038TFiled
Variable Rate Issue0VariableRateIssue
Hedge Identified In Books And Recds0HedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGIC
Gross Proceeds Invested1GrossProceedsInvested
Exception To Rebate0ExceptionToRebate

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (11 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION A, LINE 3FAIRVIEW HOSPITAL RELIES ON BHS MANAGEMENT SERVICES, INC. TO PROVIDE MANAGEMENT AND SUPPORT SERVICES FOR THE CHIEF EXECUTIVE OFFICER, CHIEF FINANCIAL OFFICER, VP GENERAL COUNSEL, AND VP OF HUMAN RESOURCES.
FORM 990, PART VI, SECTION A, LINE 6BERKSHIRE HEALTH SYSTEMS, INC. IS THE SOLE CORPORATE MEMBER.
FORM 990, PART VI, SECTION A, LINE 7ATHE BOARD OF TRUSTEES IS COMPOSED OF THE INCUMBENT MEMBERS OF THE BOARD OF TRUSTEES OF BERKSHIRE HEALTH SYSTEMS, INC.
FORM 990, PART VI, SECTION B, LINE 11BERKSHIRE HEALTH SYSTEMS, INC. WILL MAKE THE FORMS 990 FOR BHS AND AFFILIATES AVAILABLE TO THE MEMBERS OF THE RESPECTIVE GOVERNING BODIES FOR THEIR REVIEW BY (A) SENDING COPIES TO THEM PHYSICALLY OR ELECTRONICALLY, OR (B) NOTIFYING THE MEMBERS THAT THE FORMS 990 CAN BE ACCESSED BY A SECURE WEB-BASED FOLDER BEFORE THEY ARE FILED WITH THE IRS.
THE ORGANIZATION ENFORCES & MONITORS ITS CONFLICT OF INTEREST POLICY BY REQUIRING ALL MEMBERS OF THE GOVERNING BODY & SENIOR MANAGEMENT TO DISCLOSE POTENTIAL CONFLICTS OF INTEREST (A) ANNUALLY & (B) AS POTENTIAL CONFLICTS ARISE. SENIOR EMPLOYEES ARE NOT PERMITTED TO HAVE MATERIAL CONFLICTS OF INTEREST. MEMBERS OF THE GOVERNING BODY ARE TO ABSTAIN FROM ACTIONS THAT MAY BE INFLUENCED BY THEIR CONFLICT OR POTENTIAL CONFLICT BY: (A) NOT VOTING, OR (B) NOT VOTING & LEAVING THE ROOM, OR (C) LEAVING THE GOVERNING BODY, AS DETERMINED BY THE GOVERNING BODY.FORM 990, PART VI, SECTION B, LINE 12C
FAIRVIEW HOSPITAL RELIES ON BHS MANAGEMENT SERVICES, INC. TO SUPPLY ITS CHIEF EXECUTIVE OFFICER. THE PERFORMANCE & COMPENSATION PROVIDED TO CEO DAVID PHELPS IS REVIEWED ANNUALLY (AND OF OTHER SENIOR EXECUTIVES, PERIODICALLY) BY A SUBCOMMITTEE OF THE GOVERNING BODY, WHOSE MEMBERS ARE INDEPENDENT. THE FULL GOVERNING BODY REVIEWS & APPROVES THE COMPENSATION OF THE SENIOR EXECUTIVE. EVERY TWO OR THREE YEARS, THE ORGANIZATION ENGAGES A NATIONALLY RECOGNIZED HEALTHCARE COMPENSATION CONSULTING FIRM TO PROVIDE INFORMATION CONCERNING MARKET RATES OF COMPENSATION AND ASSESS THE ORGANIZATION'S COMPENSATION STRUCTURE AGAINST THOSE INDEPENDENT BENCHMARKS. THE ORGANIZATION FOLLOWED THIS PROCESS FOR THE YEAR ENDED 09/30/11.FORM 990, PART VI, SECTION B, LINE 15
THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC AT THE OFFICES OF (A) THE CHIEF FINANCIAL OFFICER & (B) THE VICE PRESIDENT, GENERAL COUNSEL AT 725 NORTH STREET, PITTSFIELD, MASSACHUSETTS 01201.FORM 990, PART VI, SECTION C, LINE 19
AVERAGE HOURS PER WEEKWITH THE EXCEPTION OF DAVID E. PHELPS AND BRIAN T. BURKE, MD, AVERAGE WEEKLY HOURS SHOWN ON FORM 990, PART VII, SECTION A, COLUMN (B) ARE FOR TRUSTEES' SERVICES AS TRUSTEES. DAVID PHELPS' HOURS ARE FURTHER DESCRIBED BELOW. DR. BURKE'S HOURS ARE NOT RELATED TO HIS SERVICE AS A TRUSTEE AND ARE SOLELY RELATED TO SERVICES PROVIDED TO THE ORGANIZATION FOR ITS TAX EXEMPT PURPOSES. EDMUND H. HORNSTEIN, DO'S HOURS SHOWN ARE FOR SERVICES AS A TRUSTEE, FOR WHICH HE RECEIVES NO COMPENSATION. DR. HORNSTEIN RECEIVES PAYMENT FROM BERKSHIRE MEDICAL CENTER FOR PHYSICIAN SERVICES. ROBERT P. WESPISER, MD'S HOURS SHOWN ARE FOR SERVICES AS A TRUSTEE, FOR WHICH HE RECEIVES NO COMPENSATION. DR. WESPISER RECEIVES PAYMENT FROM BERKSHIRE MEDICAL CENTER FOR PHYSICIAN SERVICES. ALL TRUSTEES (BOARD MEMBERS) RECEIVE NO COMPENSATION FOR SERVICES AS TRUSTEES. WITH RESPECT TO OFFICERS DAVID E. PHELPS, DARLENE RODOWICZ, AND CHERYL M. BOUDREAU, A PROPORTIONAL SHARE OF THE HOURS WORKED AND COMPENSATION AMOUNTS PAID BY RELATED ORGANIZATIONS IS ALLOCATED INTERNALLY TO THE FILING ENTITY AND 26 OTHER TAX EXEMPT HEALTHCARE ENTITIES FOR ACCOUNTING AND MANAGEMENT PURPOSES. THE FOLLOWING LIST SHOWS THE ORGANIZATIONS TO WHICH THE IDENTIFIED OFFICER PROVIDED SERVICES, THE AVERAGE WEEKLY HOURS WORKED FOR EACH ENTITY, AND THE RESPECTIVE ALLOCABLE SHARE OF HIS OR HER ANNUAL COMPENSATION (REPORTABLE COMPENSATION AND OTHER COMPENSATION) FOR CALENDAR 2010: DAVID E. PHELPS, PRESIDENT BERKSHIRE MEDICAL CENTER, INC: 30 WEEKLY HOURS/58 WEEKLY HOURS $291,029 FAIRVIEW HOSPITAL: 4 HOURS/58 HOURS $38,796 BERKSHIRE FACULTY SERVICES, INC: 10 HOURS/58 HOURS $96,934 BERKSHIRE INDEMNITY CO, SPC, LTD: 2 HOURS/58 HOURS $19,398 BHS MANAGEMENT SERVICES, INC (12 HOURS/58 HOURS) FOR BENEFIT OF: BERKSHIRE HEALTHCARE SYSTEMS, INC: $29,069 BOURNE MANAGEMENT SYSTEMS, INC: $2,305 GREENFIELD MANAGEMENT SYSTEMS, INC: $2,305 NEW BEDFORD MANAGEMENT SYSTEMS, INC: $2,305 NORTHAMPTON MANAGEMENT SYSTEMS, INC: $2,305 EAST LONGMEADOW MANAGEMENT SYSTEMS, INC: $2,305 DANVERS MANAGEMENT SYSTEMS, INC: $2,305 PEABODY MANAGEMENT SYSTEMS, INC: $2,305 SOUTH YARMOUTH MANAGEMENT SYSTEMS, INC: $2,305 BERKSHIRE PENNSYLVANIA, INC: $2,305 XENIA EAST MANAGEMENT SYSTEMS, INC: $2,305 WILLOWOOD OF GREAT BARRINGTON, INC: $4,667 WILLOWOOD OF NORTH ADAMS, INC: $3,486 WILLOWOOD OF WILLIAMSTOWN, INC: $3,486 HILLCREST EXTENDED CARE SERVICES, INC: $8,153 BERKSHIRE RETIREMENT COMMUNITY, INC: $11,639 BERKSHIRE EXTENDED CARE SERVICES, INC: $8,153 INTEGRINURSE, INC: $3,486 INTEGRISCRIPT, INC: $3,486 HOSPICECARE IN THE BERKSHIRES, INC: $11,639 PITTSFIELD MANAGEMENT SYSTEMS, INC: $5,791 DARLENE RODOWICZ, CFO BERKSHIRE MEDICAL CENTER, INC: 37 WEEKLY HOURS/51 WEEKLY HOURS $270,421 FAIRVIEW HOSPITAL: 3 HOURS/51 HOURS $21,926 BERKSHIRE FACULTY SERVICES, INC: 7 HOURS/51 HOURS $51,161 BERKSHIRE INDEMNITY CO, SPC, LTD: 3 HOURS/51 HOURS $18,272 BHS MANAGEMENT SERVICES, INC FOR BENEFIT OF BERKSHIRE HEALTHCARE SYSTEMS, INC: 1 HOUR/51 HOURS $3,654 CHERYL M. BOUDREAU, CLERK BERKSHIRE MEDICAL CENTER, INC: 20 WEEKLY HOURS/41 WEEKLY HOURS $45,375 FAIRVIEW HOSPITAL: 2 HOURS/41 HOURS $4,541 BERKSHIRE FACULTY SERVICES, INC: 8 HOURS/41 HOURS $18,155 BERKSHIRE INDEMNITY CO, SPC, LTD: 1 HOUR/41 HOURS $2,270 BHS MANAGEMENT SERVICES, INC (10 HOURS/41 HOURS) FOR BENEFIT OF: BERKSHIRE HEALTHCARE SYSTEMS, INC: $5,667 BOURNE MANAGEMENT SYSTEMS, INC: $456 GREENFIELD MANAGEMENT SYSTEMS, INC: $456 NEW BEDFORD MANAGEMENT SYSTEMS, INC: $456 NORTHAMPTON MANAGEMENT SYSTEMS, INC: $456 EAST LONGMEADOW MANAGEMENT SYSTEMS, INC: $456 DANVERS MANAGEMENT SYSTEMS, INC: $456 PEABODY MANAGEMENT SYSTEMS, INC: $456 SOUTH YARMOUTH MANAGEMENT SYSTEMS, INC: $456 BERKSHIRE PENNSYLVANIA, INC: $456 XENIA EAST MANAGEMENT SYSTEMS, INC: $456 WILLOWOOD OF GREAT BARRINGTON, INC: $912 WILLOWOOD OF NORTH ADAMS, INC: $679 WILLOWOOD OF WILLIAMSTOWN, INC: $679 HILLCREST EXTENDED CARE SERVICES, INC: $1,591 BERKSHIRE RETIREMENT COMMUNITY, INC: $2,270 BERKSHIRE EXTENDED CARE SERVICES, INC: $1,591 INTEGRINURSE, INC: $679 INTEGRISCRIPT, INC: $679 HOSPICECARE IN THE BERKSHIRES, INC: $2,270 PITTSFIELD MANAGEMENT SYSTEMS, INC: $1,135FORM 990, PART VII, SECTION A, COLUMN (B)
CHANGES IN NET ASSETS OR FUND BALANCES:NET UNREALIZED LOSSES ON INVESTMENTS: -995,913.FORM 990, PART XI, LINE 5:
TRUSTEES RECEIVE NO COMPENSATION FOR SERVICES AS TRUSTEESEDMUND H. HORNSTEIN, DO: HOURS SHOWN IN FORM 990, PART VII, SECTION A ARE FOR SERVICES AS A TRUSTEE, FOR WHICH HE RECEIVES NO COMPENSATION. DR. HORNSTEIN RECEIVES PAYMENT FROM BERKSHIRE MEDICAL CENTER FOR PHYSICIAN SERVICES. ROBERT P. WESPISER, MD: HOURS SHOWN IN FORM 990, PART VII, SECTION A ARE FOR SERVICES AS A TRUSTEE, FOR WHICH HE RECEIVES NO COMPENSATION. DR. WESPISER RECEIVES PAYMENT FROM BERKSHIRE MEDICAL CENTER FOR PHYSICIAN SERVICES.FORM 990, PART VII, SECTION A
FORM 5471DISCLOSURE STATEMENT RELATED TO FORM 5471, INFORMATION RETURN OF U.S. PERSONS WITH RESPECT TO CERTAIN FOREIGN CORPORATIONS, FILED ON BEHALF OF THE TAXPAYER UNDER THE CONSTRUCTIVE OWNERSHIP RULES OF IRC SECTIONS 958(A) AND (B), THE TAXPAYER MAY BE REQUIRED TO FILE FORM 5471, INFORMATION RETURN OF U.S. PERSONS WITH RESPECT TO CERTAIN FOREIGN CORPORATIONS, AS A CATEGORY 5 FILER WITH RESPECT TO A CERTAIN CONTROLLED FOREIGN CORPORATION (CFCS). THESE FILING REQUIREMENTS ARE OR WILL BE SATISFIED THROUGH THE FILING OF FORM 5471 FOR THIS CFCS BY ANOTHER U.S. TAXPAYER IDENTIFIED BELOW WHO HAS THE SAME FILING REQUIREMENT. TAXPAYER NAME: BERKSHIRE HEALTH SYSTEMS, INC. ADDRESS: 725 NORTH STREET, PITTSFIELD, MA 01201-4109 IDENTIFYING NUMBER OF U.S. TAX RETURN WITH WHICH THE FORM 5471 WAS OR WILL BE FILED: 04-2442944 IRS SERVICE CENTER WHERE U.S. TAX RETURN WAS OR WILL BE FILED: E-FILE

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrg
BERKSHIRE HEALTH SYSTEMS INC
725 NORTH STPITTSFIELDMA01201042442944PARENT CORPMA501(C)(3)11BN/A0
BERKSHIRE MEDICAL CENTER INC
725 NORTH STPITTSFIELDMA01201042791396ACUTE CARE HOSPITALMA501(C)(3)3N/A0
BERKSHIRE FACULTY SERVICES INC
725 NORTH STPITTSFIELDMA01201042995053PHYSICIAN SERVICESMA501(C)(3)11BN/A0
BHS MANAGEMENT SERVICES INC
725 NORTH STPITTSFIELDMA01201222755258MANAGEMENT SERVICESMA501(C)(3)11BN/A0

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1TRI-STATE MEDICAL MANAGEMENT CORPBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1725 NORTH STREETAddressLine1
CityPITTSFIELDCity
StateMAState
ZIP Code01201ZIPCode
FieldValueIRS element (for citing)
EIN042913352EIN
Primary ActivityREAL ESTATE MGMTPrimaryActivity
Legal Domicile StateMALegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1FAIRVIEW HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Type Of EntityCTypeOfEntity
Share Of Total Income-19949ShareOfTotalIncome
Share Of EOY Assets333418ShareOfEOYAssets
Percentage Ownership1.00000PercentageOwnership
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org1OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
TRI-STATE MEDICAL MANAGEMENT CORP
D328441FAIR MARKET VALUE
TRI-STATE MEDICAL MANAGEMENT CORP
R36962FAIR MARKET VALUE