2012-08-15T16:24:08-05:00 2011-09-30 990 2010-10-01 042133860 FAIRVIEW HOSPITAL FAIR 4134472508 725 NORTH STREET PITTSFIELD MA 012014109 DARLENE RODOWICZ 4134472809 2012-08-15 2010 2016-02-24 21:20:13Z DARLENE RODOWICZ 725 NORTH ST PITTSFIELD MA 012014109 47586006 0 X WWW.BHS1.ORG X 1912 MA THE 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. 24 20 329 50 0 0 576768 511811 39162376 41845111 600743 924885 519146 658321 40859033 43940128 0 0 0 0 20750843 22365294 0 0 79573 19409642 19708790 40160485 42074084 698548 1866044 28199684 28000233 18992731 17923149 9206953 10077084 X THE MISSION OF FAIRVIEW HOSPITAL IS TO IMPROVE THE HEALTH OF ALL PEOPLE IN THE BERKSHIRES AND SURROUNDING COMMUNITIES, REGARDLESS OF THEIR ABILITY TO PAY. 0 0 38091780 42295271 FAIRVIEW 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. 38091780 1 1 0 1 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 70 0 1 329 1 0 0 0 0 0 1 1 0 0 0 0 X 24 20 0 1 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MA NY X DARLENE RODOWICZ CFO 4134472809 725 NORTH STREET PITTSFIELD MA 012014109 X JEROME J ANDERSON 2.00 X 0 0 0 THOMAS O ANDREWS 2.00 X 0 0 0 ALFRED A BARBALUNGA 2.00 X 0 0 0 BRONLY S BOYD 2.00 X X 0 0 0 BRIAN T BURKE MD 50.00 X 200213 0 37926 KIT DOBELLE 2.00 X 0 0 0 TIMOTHY C DOHERTY 2.00 X X 0 0 0 RICHARD M DOHONEY 2.00 X 0 0 0 BRIAN H FAIRBANK 2.00 X 0 0 0 A KING FRANCIS 2.00 X 0 0 0 DENNIS J HOGAN 2.00 X 0 0 0 EDMUND H HORNSTEIN DO 2.00 X 0 87569 0 JOHN R KEARNS MD 2.00 X 0 0 0 SUSAN M KORMANIK 2.00 X 0 0 0 LORINDA ACKLEY MAZUR 2.00 X 0 0 0 JOAN M MCFALLS 2.00 X 0 0 0 LAURIE NORTON MOFFATT 2.00 X 0 0 0 DAVID E PHELPS 58.00 X X 0 522520 39741 PAUL E RAVERTA 2.00 X 0 0 0 CAROLE G SIEGEL 2.00 X 0 0 0 GEORGE T SMITH 2.00 X 0 0 0 MARILYN L SPERLING 2.00 X 0 0 0 ANN H TRABULSI 2.00 X 0 0 0 ROBERT P WESPISER MD 2.00 X 0 132035 0 THADDEUS S TUCKER WELCH 2.00 X 0 0 0 DARLENE RODOWICZ 51.00 X 0 329477 35958 EUGENE DELLEA 50.00 X 0 207428 19464 PHELPS D1-TIME RETIRMNT BENEFT ADJ 1.00 X 0 1085553 0 CHERYL M BOUDREAU 41.00 X 0 79974 13078 ALEC R BELMAN MD 50.00 X 234365 0 39209 DOREEN HUTCHINSON 50.00 X 159852 0 33422 RAYMOND SABATELLI MD 50.00 X 308680 0 39555 STEPHEN TRACY MD 50.00 X 225612 0 34978 GLEN R LOVEJOY MD 50.00 X 224064 0 35939 BRUCE E NAYOWITH MD 50.00 X 210291 0 43668 TOMASZ T PAJAK MD 50.00 X 177038 0 37668 KERSTIN L VOSS MD 50.00 X 176894 0 21101 1917009 2444556 431707 24 0 1 0 BARR & BARR INC 260 COCHITUATE RD FL 2 FRAMINGHAM MA 017014608 CONSTRUCTION SVCS 568268 BERKSHIRE SURGICAL ASSOCIATES PC 777 NORTH ST STE 407 PITTSFIELD MA 012014141 HEALTHCARE SERVICES 189510 WE WILLIAMS PAVING INC PO BOX 78 W STOCKBRIDGE MA 012660078 CONSTRUCTION SVCS 185801 COMPHEALTH MEDICAL STAFFING INC PO BOX 972651 DALLAS TX 753972651 HEALTHCARE STAFFING 116325 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 753972633 HEALTHCARE STAFFING 113683 7 130306 91251 290254 2804 511811 NET PATIENT SVC REVENU 622110 41845111 41845111 41845111 292157 292157 42280 42280 50912 8038 42874 42874 42874 4133097 5641 3544910 3380 588187 2261 590448 590448 89550 130306 89550 0 PHARMACY SALES 446110 290672 290672 CAFETERIA SALES 722212 165287 165287 REIMBURSED EXPENSES 900099 61521 61521 97967 97967 615447 43940128 42295271 0 1133046 1022123 1018372 3332 419 16471841 16138409 296199 37233 643923 630865 11601 1457 3023293 2971550 46188 5555 1204114 1180785 20724 2605 3325172 3325172 13840 13840 260 260 12546 12546 25727 25727 5558897 5540064 13828 5005 35370 23327 461 11582 3332671 3299924 24488 8259 343432 343294 138 764155 749350 13497 1308 183106 177249 3469 2388 358687 358687 1647557 1615637 31920 494686 485102 8514 1070 RECIPROCAL/TEACHNG FEES 1192248 1192248 BAD DEBT 706503 706503 MAINTENANCE & REPAIRS 555144 544388 10756 MINOR HOSPITAL EQUIP 210239 208860 1379 HLTH SFTY NET ASSESSMNT 185952 185952 762598 708668 51238 2692 42074084 38091780 3902731 79573 5413 11574 1280167 1256157 80 0 4155306 4338011 143020 30125 301106 278996 161844 150987 24429441 15724045 8824499 8705396 9705191 11469349 3225731 1341202 13330 11811 383997 406625 28199684 28000233 2835539 2899111 49788 29524 7172075 6884364 8935329 8110150 18992731 17923149 X 7507775 8079580 1440936 1739262 258242 258242 9206953 10077084 28199684 28000233 X 1866044 -995913 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 12546 12546 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: LOBBYING 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. 1046753 11564 1058317 989912 56841 1046753 1028277 -22233 16132 989912 0.75600 0.24400 0 0 16887 16887 2137042 1994509 142533 12392332 8778084 3614248 9883180 4951452 4931728 8705396 DUE TO AFFILIATES 5937525 DUE TO THIRD PARTY PAYORS 1318971 ACCRUED FIN 47 ACCRETION 565995 INTEREST RATE SWAP LIABILITY 197473 DEFERRED COMPENSATION 69530 DEFERRED PENSION FORFEITURE 18356 REBATE FUND LIABILITY 2300 8110150 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. GALA 187226 113438 73788 1847 15098 17356 12495 26992 GOLF TOURNAMENT 32630 16868 15762 5538 4347 3169 2708 219856 130306 89550 7385 19445 20525 12495 29700 89550 0 1 1 1 X 1 X 1 1 1 0 1 1 632056 632056 0.01530 5235456 3661780 1573676 0.03800 2738560 2132481 606079 0.01470 8606072 5794261 2811811 0.06800 221230 221230 0.00530 2297887 1040934 1256953 0.03040 2519117 1040934 1478183 0.03570 11125189 6835195 4289994 0.10370 77158 72955 4203 0.00010 7325 7325 0.00000 20033 20033 0.00050 104516 80280 24236 0.00060 1 433276 0 16151346 16012534 138812 X 1 1 5 1 FAIRVIEW HOSPITAL

29 LEWIS AVE GREAT BARRINGTON MA 012301796

X X X X 2 FAIRVIEW PHYSICAL & SPORTS THERAPY CTR

710 STOCKBRIDGE RD STE 1 LEE MA 01238

OUTPATIENT SERVICES 3 FAIRVIEW HOSPITAL AQUATIC THERAPY PROG

15 CHRISSEY RD GREAT BARRINGTON MA 01230

OUTPATIENT SERVICES 4 FAIRVIEW HSP OUTPATNT PHYSICAL THERAPY

10 MAPLE AVE GREAT BARRINGTON MA 01230

OUTPATIENT SERVICES 5 FAIRVIEW HOSPITAL DIALYSIS CENTER

10 MAPLE AVE GREAT BARRINGTON MA 01230

OUTPATIENT SERVICES FAIRVIEW HOSPITAL 1 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. REPORTS FILED WITH STATES PART VI, LINE 7 MA 0 0 0 0 0 0 0 0 0 BRIAN T BURKE MD 182388 0 0 0 17825 0 9396 0 28530 0 238139 0 0 0 DAVID E PHELPS 0 466255 0 0 0 56265 0 11025 0 28716 0 562261 0 0 DARLENE RODOWICZ 0 275147 0 0 0 54330 0 11025 0 24933 0 365435 0 0 EUGENE DELLEA 0 163158 0 0 0 44270 0 8467 0 10997 0 226892 0 0 PHELPS D1-TIME RETIRMNT BENEFT ADJ 0 0 0 0 0 1085553 0 0 0 0 0 1085553 0 0 ALEC R BELMAN MD 208942 0 10920 0 14503 0 10914 0 28295 0 273574 0 0 0 DOREEN HUTCHINSON 140469 0 0 0 19383 0 7529 0 25893 0 193274 0 0 0 RAYMOND SABATELLI MD 257976 0 14040 0 36664 0 11025 0 28530 0 348235 0 0 0 STEPHEN TRACY MD 175461 0 10764 0 39387 0 9340 0 25638 0 260590 0 0 0 GLEN R LOVEJOY MD 194834 0 10764 0 18466 0 8544 0 27395 0 260003 0 0 0 BRUCE E NAYOWITH MD 178883 0 9828 0 21580 0 10138 0 33530 0 253959 0 0 0 TOMASZ T PAJAK MD 160214 0 0 0 16824 0 7466 0 30202 0 214706 0 0 0 KERSTIN L VOSS MD 160034 0 0 0 16860 0 8022 0 13079 0 197995 0 0 0 SUPPLEMENTAL INFORMATION PART III SUPPLEMENTAL 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: $1,135 MASS HEALTH & EDUCAT FACIL AUTHORITY SER F 042456011 57586CLN3 2005-07-26 53089428 REFUND SER C & D BONDS; CAPITAL EXP 0 0 0 13270000 54478799 5019000 1003800 898795 73681 9003428 2008 1 0 1 1 0 0 0 0 0.00000 0.00000 0.00000 1 1 0 0 0 1 0 FORM 990, PART VI, SECTION A, LINE 3 FAIRVIEW 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 6 BERKSHIRE HEALTH SYSTEMS, INC. IS THE SOLE CORPORATE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A THE 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 11 BERKSHIRE 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. FORM 990, PART VI, SECTION B, LINE 12C 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 15 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 C, LINE 19 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. AVERAGE HOURS PER WEEK FORM 990, PART VII, SECTION A, COLUMN (B) WITH 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: $1,135 CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -995,913. TRUSTEES RECEIVE NO COMPENSATION FOR SERVICES AS TRUSTEES FORM 990, PART VII, SECTION A EDMUND 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 5471 DISCLOSURE 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 BERKSHIRE HEALTH SYSTEMS INC 725 NORTH ST PITTSFIELD MA 01201 042442944 PARENT CORP MA 501(C)(3) 11B N/A 0 BERKSHIRE MEDICAL CENTER INC 725 NORTH ST PITTSFIELD MA 01201 042791396 ACUTE CARE HOSPITAL MA 501(C)(3) 3 N/A 0 BERKSHIRE FACULTY SERVICES INC 725 NORTH ST PITTSFIELD MA 01201 042995053 PHYSICIAN SERVICES MA 501(C)(3) 11B N/A 0 BHS MANAGEMENT SERVICES INC 725 NORTH ST PITTSFIELD MA 01201 222755258 MANAGEMENT SERVICES MA 501(C)(3) 11B N/A 0 TRI-STATE MEDICAL MANAGEMENT CORP 725 NORTH STREET PITTSFIELD MA 01201 042913352 REAL ESTATE MGMT MA FAIRVIEW HOSPITAL C -19949 333418 1.00000 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 TRI-STATE MEDICAL MANAGEMENT CORP D 328441 FAIR MARKET VALUE TRI-STATE MEDICAL MANAGEMENT CORP R 36962 FAIR MARKET VALUE