FAIRVIEW HOSPITAL: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- FAIRVIEW HOSPITAL (EIN 04-2133860)
- Tax period
- 2009-10-01 to 2010-09-30
- Filed
- 2011-08-15
- IRS object ID
- 201122279349303037
- Schema version
- 2009v1.7
- Note
- A later return for the same period supersedes this one.
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule G
- Schedule H
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-08-15T17:03:32-05:00 | Timestamp |
| Tax Period End Date | 2010-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ERNST & YOUNG US LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 55 IVAN ALLEN JR BLVD NW STE 1000 | AddressLine1 |
| City | ATLANTA | City |
| State | GA | State |
| ZIP Code | 303083051 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2009-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 042133860 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FAIRVIEW HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | FAIR | NameControl |
| Phone | 4134472508 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 725 NORTH STREET | AddressLine1 |
| City | PITTSFIELD | City |
| State | MA | State |
| ZIP Code | 012014109 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DARLENE RODOWICZ | Name |
| Title | CFO | Title |
| Phone | 4134472809 | Phone |
| Date Signed | 2011-08-15 | DateSigned |
| Authorize Third Party | 0 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4048748300 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2009 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | DARLENE RODOWICZ | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 725 NORTH ST | AddressLine1 |
| City | PITTSFIELD | City |
| State | MA | State |
| ZIP Code | 012014109 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 42912428 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | WWW.BERKSHIREHEALTHSYSTEMS.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1912 | YearFormation |
| State Legal Domicile | MA | StateLegalDomicile |
| Activity Or Mission Description | 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. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 24 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 20 | NbrIndependentVotingMembers |
| Total Nbr Employees | 320 | TotalNbrEmployees |
| Total Nbr Volunteers | 50 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 532386 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 576768 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 38628673 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 39162376 | ProgramServiceRevenueCY |
| Investment Income Prior Year | -261191 | InvestmentIncomePriorYear |
| Investment Income Current Year | 600743 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 332941 | OtherRevenuePriorYear |
| Other Revenue Current Year | 519146 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 39232809 | TotalRevenuePriorYear |
| Total Revenue Current Year | 40859033 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 19385066 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 20750843 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 81652 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 18887434 | OtherExpensePriorYear |
| Other Expenses Current Year | 19409642 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 38272500 | TotalExpensesPriorYear |
| Total Expenses Current Year | 40160485 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 960309 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 698548 | RevenuesLessExpensesCY |
| Total Assets BOY | 26244976 | TotalAssetsBOY |
| Total Assets EOY | 28199684 | TotalAssetsEOY |
| Total Liabilities BOY | 18247521 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 18992731 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 7997455 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 9206953 | NetAssetsOrFundBalancesEOY |
| Mission Description | 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. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 36127779 | Expense |
| Revenue | 39450387 | Revenue |
| Description | 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 FY2010 "COMMUNITY BENEFITS REPORT" AT www.cbsys.ago.state.ma.us/cbpublic/public/annual_reports_start.aspx FOR MORE DETAILS. | Description |
| Total Program Service Expense | 36127779 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Balance Sheet Amounts Reported | 1 | BalanceSheetAmountsReported |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 1 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 78 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 320 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 1 | QuidProQuoContributions |
| Quid Pro Quo Disclosure | 1 | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Nbr Voting Governing Body Members | 24 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 20 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | MA | StatesWhereCopyOfReturnIsFiled |
| States Where Copy Of Return Is Filed | NY | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DARLENE RODOWICZ CFO | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 4134472809 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 725 NORTH STREET | AddressLine1 |
| City | PITTSFIELD | City |
| State | MA | State |
| ZIP Code | 012014109 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (37 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| JEROME J ANDERSON | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| THOMAS O ANDREWS | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| ALFRED A BARBALUNGA | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| GINA C BIRCHALL | ||||||||
| TRUSTEE/NOT SERVING AT YEAR-END | 2.00 | X | 0 | 0 | 0 | |||
| BRONLY S BOYD | ||||||||
| TRUSTEE/VICE CHAIRMAN | 2.00 | X | 0 | 0 | 0 | X | ||
| BRIAN T BURKE MD | ||||||||
| TRUSTEE/PHYSICIAN | 50.00 | X | 177939 | 0 | 34984 | |||
| KIT DOBELLE | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| TIMOTHY C DOHERTY | ||||||||
| TRUSTEE/CHAIRMAN | 2.00 | X | 0 | 0 | 0 | X | ||
| RICHARD M DOHONEY | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| BRIAN H FAIRBANK | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| A KING FRANCIS | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| DENNIS J HOGAN | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| EDMUND H HORNSTEIN DO | ||||||||
| TRUSTEE/CONTRACTED PHYSICIAN | 2.00 | X | 0 | 71865 | 0 | |||
| JOHN R KEARNS MD | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| SUSAN M KORMANIK | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| LORINDA ACKLEY MAZUR | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| JOAN M McFALLS | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| LAURIE NORTON MOFFAT | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| DAVID E PHELPS | ||||||||
| PRESIDENT/TRUSTEE | 4.00 | X | 0 | 529983 | 38266 | X | ||
| SHEPARD D RAINIE | ||||||||
| TRUSTEE/NOT SERVING AT YEAR-END | 2.00 | X | 0 | 0 | 0 | |||
| PAUL E RAVERTA | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| CAROLE G SIEGEL | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| GEORGE T SMITH | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| MARILYN L SPERLING | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| ANGELO C STRACUZZI | ||||||||
| TRUSTEE/NOT SERVING AT YEAR-END | 2.00 | X | 0 | 0 | 0 | |||
| ANN H TRABULSI | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| THADDEUS S TUCKER WELCH | ||||||||
| TRUSTEE/NOT SERVING AT YEAR-END | 2.00 | X | 0 | 0 | 0 | |||
| ROBERT P WESPISER MD | ||||||||
| TRUSTEE/CONTRACTED PHYSICIAN | 2.00 | X | 0 | 129890 | 0 | |||
| CHERYL M BOUDREAU | ||||||||
| CLERK | 4.00 | 0 | 81074 | 13956 | X | |||
| DARLENE RODOWICZ | ||||||||
| TREASURER | 1.00 | 0 | 323664 | 35300 | X | |||
| EUGENE DELLEA | ||||||||
| PRESIDENT | 50.00 | 0 | 254606 | 22975 | X | |||
| DOREEN HUTCHINSON | ||||||||
| VICE PRESIDENT, OPERATIONS | 50.00 | 162131 | 0 | 33716 | X | |||
| ALEC R BELMAN MD | ||||||||
| PHYSICIAN | 50.00 | 216448 | 0 | 34989 | X | |||
| GLEN R LOVEJOY MD | ||||||||
| PHYSICIAN | 50.00 | 216404 | 0 | 33329 | X | |||
| BRUCE E NAYOWITH MD | ||||||||
| PHYSICIAN | 50.00 | 195852 | 0 | 39641 | X | |||
| RAYMOND SABATELLI MD | ||||||||
| PHYSICIAN | 50.00 | 292834 | 0 | 37102 | X | |||
| STEPHEN TRACY MD | ||||||||
| PHYSICIAN | 50.00 | 201967 | 0 | 31884 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1463575 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1391082 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 356142 | TotalOtherCompensation |
| Number Individuals GT100 K | 21 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| BARR & BARR INC | |||||
| 260 COCHITUATE RD FL 2 | FRAMINGHAM | MA | 017014608 | CONSTRUCTION SVCS | 298170 |
| AMN HEALTHCARE | |||||
| 12400 HIGH BLUFF DR | SAN DIEGO | CA | 921303077 | HEALTHCARE STAFFING | 171203 |
| BERKSHIRE SURGICAL ASSOCIATES PC | |||||
| 777 NORTH ST STE 407 | PITTSFIELD | MA | 012014141 | HEALTHCARE SERVICES | 143650 |
| TIVA HEALTHCARE INC | |||||
| 1613 HARRISON PKWY STE 200 | SUNRISE | FL | 33323 | HEALTHCARE STAFFING | 137813 |
| O'NIEL & ASSOCIATES | |||||
| 114 ALLYNDALE RD | CANAAN | CT | 06018 | CONSTRUCTION SVCS | 105597 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 6 | NumberOfContractorsGT100K |
| Fundraising Events | 139636 | FundraisingEvents |
| Government Grants | 121284 | GovernmentGrants |
| All Other Contributions | 315848 | AllOtherContributions |
| Noncash Contributions | 1356 | NoncashContributions |
| Total Contributions | 576768 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | NET PATIENT SVC REVENU | Description |
| Business Code | 622110 | BusinessCode |
| Total Revenue Column | 39162376 | TotalRevenueColumn |
| Related Or Exempt Function Income | 39162376 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 39162376 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 300174 | TotalRevenueColumn |
| Exclusion | $300,174 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 32788 | TotalRevenueColumn |
| Exclusion | $32,788 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 83621 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 21242 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 62379 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 62379 | TotalRevenueColumn |
| Exclusion | $62,379 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 2227116 | Securities |
| Other | 1800 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 1960147 | Securities |
| Other | 988 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 266969 | Securities |
| Other | 812 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 267781 | TotalRevenueColumn |
| Exclusion | $267,781 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 71018 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 139636 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 71018 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|---|
| CAFETERIA SALES | 722212 | 168756 | $168,756 | |
| PHARMACY SALES | 446110 | 122710 | 122710 | |
| REIMBURSED EXPENSES | 900099 | 60564 | 60564 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 104737 | TotalRevenueColumn |
| Related Or Exempt Function Income | 104737 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 456767 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 40859033 | TotalRevenueColumn |
| Related Or Exempt Function Income | 39450387 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $831,878 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 432735 | Total |
| Program Services | 428611 | ProgramServices |
| Management And General | 3657 | ManagementAndGeneral |
| Fundraising | 467 | Fundraising |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15948361 | Total |
| Program Services | 15611852 | ProgramServices |
| Management And General | 298423 | ManagementAndGeneral |
| Fundraising | 38086 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 609072 | Total |
| Program Services | 596186 | ProgramServices |
| Management And General | 11428 | ManagementAndGeneral |
| Fundraising | 1458 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2633345 | Total |
| Program Services | 2584208 | ProgramServices |
| Management And General | 43934 | ManagementAndGeneral |
| Fundraising | 5203 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1127330 | Total |
| Program Services | 1103844 | ProgramServices |
| Management And General | 20828 | ManagementAndGeneral |
| Fundraising | 2658 | Fundraising |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3401710 | Total |
| Management And General | 3401710 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7764 | Total |
| Management And General | 7764 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12755 | Total |
| Program Services | 12755 | ProgramServices |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 24687 | Total |
| Management And General | 24687 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5557913 | Total |
| Program Services | 5536162 | ProgramServices |
| Management And General | 17462 | ManagementAndGeneral |
| Fundraising | 4289 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 43814 | Total |
| Program Services | 30031 | ProgramServices |
| Management And General | 639 | ManagementAndGeneral |
| Fundraising | 13144 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3024893 | Total |
| Program Services | 2994962 | ProgramServices |
| Management And General | 19441 | ManagementAndGeneral |
| Fundraising | 10490 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 336300 | Total |
| Program Services | 336300 | ProgramServices |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 658749 | Total |
| Program Services | 645025 | ProgramServices |
| Management And General | 12550 | ManagementAndGeneral |
| Fundraising | 1174 | Fundraising |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 184035 | Total |
| Program Services | 178868 | ProgramServices |
| Management And General | 3749 | ManagementAndGeneral |
| Fundraising | 1418 | Fundraising |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 372399 | Total |
| Program Services | 372399 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1557067 | Total |
| Program Services | 1524628 | ProgramServices |
| Management And General | 32439 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 220479 | Total |
| Program Services | 215886 | ProgramServices |
| Management And General | 4074 | ManagementAndGeneral |
| Fundraising | 519 | Fundraising |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBT | 1339953 | 1339953 | |
| RECIPROCAL/TEACHNG FEES | 980389 | 980389 | |
| MAINTENANCE & REPAIRS | 592309 | 579969 | 12340 |
| MINOR HOSPITAL EQUIP | 256877 | 253675 | 3202 |
| HLTH SFTY NET ASSESSMNT | 177991 | 177991 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 659558 | Total |
| Program Services | 624085 | ProgramServices |
| Management And General | 32727 | ManagementAndGeneral |
| Fundraising | 2746 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 40160485 | Total |
| Program Services | 36127779 | ProgramServices |
| Management And General | 3951054 | ManagementAndGeneral |
| Fundraising | 81652 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 225013 | BOY |
| EOY | 5413 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1527886 | BOY |
| EOY | 1280167 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 50 | BOY |
| EOY | 80 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4301584 | BOY |
| EOY | 4155306 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 89256 | BOY |
| EOY | 143020 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 246348 | BOY |
| EOY | 301106 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 168498 | BOY |
| EOY | 161844 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 23068331 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 14243832 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7550913 | BOY |
| EOY | 8824499 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7743373 | BOY |
| EOY | 9705191 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3944294 | BOY |
| EOY | 3225731 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14849 | BOY |
| EOY | 13330 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 432912 | BOY |
| EOY | 383997 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 26244976 | BOY |
| EOY | 28199684 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2930983 | BOY |
| EOY | 2835539 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 27361 | BOY |
| EOY | 49788 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7448534 | BOY |
| EOY | 7172075 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7840643 | BOY |
| EOY | 8935329 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18247521 | BOY |
| EOY | 18992731 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5702748 | BOY |
| EOY | 7507775 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2036465 | BOY |
| EOY | 1440936 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 258242 | BOY |
| EOY | 258242 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7997455 | BOY |
| EOY | 9206953 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 26244976 | BOY |
| EOY | 28199684 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 1 | FederalGrantAuditRequired |
| Federal Grant Audit Performed | 1 | FederalGrantAuditPerformed |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $12,755 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 12755 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Part II-B, Line 1i: | Identifier |
| Return Reference | Explanation of Other Lobbying Activities: | ReturnReference |
| Explanation | 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 09/30/2010, the portion of the dues paid to the AHA for lobbying activities was $1,747, and the portion of the dues paid to the MHA for lobbying activities was $11,008, for a total of $12,755. | Explanation |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 989912 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 56841 | InvestmentEarningsOrLosses |
| End Of Year Balance | 1046753 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1028277 | BeginningOfYearBalance |
| Investment Earnings Or Losses | -22233 | InvestmentEarningsOrLosses |
| Other Expenditures | 16132 | OtherExpenditures |
| End Of Year Balance | 989912 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0.75330 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 0.24670 | PermanentEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 16887 | OtherCostOrOtherBasis |
| Book Value | 16887 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2137042 | OtherCostOrOtherBasis |
| Depreciation | 1975723 | Depreciation |
| Book Value | 161319 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 11829987 | OtherCostOrOtherBasis |
| Depreciation | 7626770 | Depreciation |
| Book Value | 4203217 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 9084415 | OtherCostOrOtherBasis |
| Depreciation | 4641339 | Depreciation |
| Book Value | 4443076 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 8824499 | TotalOfBookValueLandBuildings |
Other Securities OtherSecurities (3 entries)
| DescriptionDescription | Book ValueBookValue | Method Of ValuationMethodOfValuation |
|---|---|---|
| BLACKROCK EQUITY INDEX FUND B | 2251366 | F |
| ALLIANCE BERNSTEIN ACM IF-US STYLE BLEND FUND | 384345 | F |
| AXA ROSENBERG SM MID CAP INSTL FUND | 590020 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 3225731 | TotalOfBookValueSecurities |
Other Liabilities OtherLiabilities (6 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| DUE TO AFFILIATES | $5,527,521 |
| DUE TO THIRD PARTY PAYORS | $2,594,598 |
| ACCRUED FIN 47 ACCRETION | $528,721 |
| INTEREST RATE SWAP LIABILITY | $213,511 |
| DEFERRED COMPENSATION | $47,897 |
| DEFERRED PENSION FORFEITURE | $23,081 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 8935329 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Part V, Line 4: | Description of Intended Use of Endowment Funds: | 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. |
| Part X: | Description of Uncertain Tax Positions Under FIN 48: | 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, 2010 AND 2009 DOES NOT CONTAIN A FOOTNOTE ADDRESSING ANY LIABILITY FOR UNCERTAIN TAX PROVISIONS UNDER FIN 48. |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | GALA | NameOfEvent1 |
| Gross Receipts Event1 | 162744 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 116477 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 46267 | GrossRevenueEvent1 |
| Rent Facility Costs Event1 | 3300 | RentFacilityCostsEvent1 |
| Food And Beverage Event1 | 19704 | FoodAndBeverageEvent1 |
| Entertainment Event1 | 3923 | EntertainmentEvent1 |
| Other Direct Expenses Event1 | 19340 | OtherDirectExpensesEvent1 |
| Name Of Event2 | GOLF TOURNAMENT | NameOfEvent2 |
| Gross Receipts Event2 | 47910 | GrossReceiptsEvent2 |
| Charitable Contributions Event2 | 23159 | CharitableContributionsEvent2 |
| Gross Revenue Event2 | 24751 | GrossRevenueEvent2 |
| Non Cash Prizes Event2 | 6563 | NonCashPrizesEvent2 |
| Rent Facility Costs Event2 | 16135 | RentFacilityCostsEvent2 |
| Other Direct Expenses Event2 | 2053 | OtherDirectExpensesEvent2 |
| Charitable Contrib Other Events | 0 | CharitableContribOtherEvents |
| Non Cash Prizes Other Events | 0 | NonCashPrizesOtherEvents |
| Gross Receipts Total | 210654 | GrossReceiptsTotal |
| Charitable Contributions Total | 139636 | CharitableContributionsTotal |
| Gross Revenue Total Events | 71018 | GrossRevenueTotalEvents |
| Non Cash Prizes Total Events | 6563 | NonCashPrizesTotalEvents |
| Rent Facility Costs Total Events | 19435 | RentFacilityCostsTotalEvents |
| Food And Beverage Total Events | 19704 | FoodAndBeverageTotalEvents |
| Entertainment Total Events | 3923 | EntertainmentTotalEvents |
| Other Direct Expenses Total Events | 21393 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 71018 | DirectExpenseSummaryEvents |
| Net Income Summary | 0 | NetIncomeSummary |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent400 | X | Pcent400 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 498316 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 498316 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01240 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4560983 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3447674 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1113309 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02770 | PercentOfTotalExpense |
Unreimbursed Costs UnreimbursedCosts
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2385543 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1926939 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 458604 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01140 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 7444842 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5374613 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2070229 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05150 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 228269 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 228269 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00570 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1720892 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 735008 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 985884 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02450 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1949161 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 735008 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1214153 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03020 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 9394003 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6109621 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3284382 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08170 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 110810 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 110810 | DirectOffsettingRevenue |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Leadership Development LeadershipDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 7325 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 7325 | DirectOffsettingRevenue |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Coalition Building CoalitionBuilding
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 738 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 738 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 22513 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 22513 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00060 | PercentOfTotalExpense |
Other Other
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 8878 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 8878 | DirectOffsettingRevenue |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 150264 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 127013 | DirectOffsettingRevenue |
| Net Community Building Expense | 23251 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00060 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $794,268 | BadDebtExpenseAmount |
| Amount Attributable To | 0 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 14762081 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 14626290 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 135791 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
Form990 Schedule H Part V Form990ScheduleHPartV (5 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Licensed HospitalLicensedHospital | General Medical And SurgicalGeneralMedicalAndSurgical | Critical Access HospitalCriticalAccessHospital | Er24 HoursEr24Hours | OtherOther |
|---|---|---|---|---|---|---|---|---|
| FAIRVIEW HOSPITAL | ||||||||
| 29 LEWIS AVE | GREAT BARRINGTON | MA | 012301796 | X | X | X | X | |
| FAIRVIEW PHYSICAL & SPORTS THERAPY CENTR | ||||||||
| 710 STOCKBRIDGE RD STE 1 | LEE | MA | 01238 | OUTPATIENT SERVICES | ||||
| FAIRVIEW HOSPITAL'S AQUATIC THERAPY PROG | ||||||||
| 15 CHRISSEY RD | GREAT BARRINGTON | MA | 01230 | OUTPATIENT SERVICES | ||||
| FAIRVIEW HSP OUTPATIENT PHYSICAL THERAPY | ||||||||
| 10 MAPLE AVE | GREAT BARRINGTON | MA | 01230 | OUTPATIENT SERVICES | ||||
| FAIRVIEW HOSPITAL DIALYSIS CENTER | ||||||||
| 10 MAPLE AVE | GREAT BARRINGTON | MA | 01230 | OUTPATIENT SERVICES | ||||
Form990 Schedule H Part VI Form990ScheduleHPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Income Based Criteria | Part I, Line 3c: | IncomeBasedCriteria |
| Costing Method Used | 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. | CostingMethodUsed |
| Subsidized Health Services Expln | Part I, Line 7g: SUBSIDIZED HEALTH SERVICES: FAIRVIEW HOSPITAL RENAL DIALYSIS SERVICES | SubsidizedHealthServicesExpln |
| Percent Of Total Expense Expln | Part I, Line 7f: BAD DEBT EXPENSE OF $1,338,503 ATTRIBUTABLE TO PATIENT ACCOUNTS HAS BEEN EXCLUDED FROM THE COMPUTATION OF ALL COMMUNITY BENEFIT EXPENSE SHOWN IN PART I, LINE 7, COLUMN F. | PercentOfTotalExpenseExpln |
| Bad Debt Footnote | 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, 2010 AND 2009 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 GUIDLINES, 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. | BadDebtFootnote |
| Shortfall As Community Benefit | 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. | ShortfallAsCommunityBenefit |
| Debt Collection Policy | 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. | DebtCollectionPolicy |
| General Explanation | 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 2010 COMMUNITY BENEFITS REPORT CAN BE ACCESSED AT WWW.CBSYS.AGO.STATE.MA.US/CBPUBLIC/PUBLIC/ANNUAL_REPORTS_START.ASPX. | GeneralExplanation |
| Needs Assessment | 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 of behalf of specific communities. Among the organizations that have provided survey data are the Berkshire Health Systems Health Assessment Survey, Southern Berkshire Youth Coalition Youth Survey, United Way Community Impact (FY2010) Baseline Report, Massachusetts Statewide Falls Prevention Symposium (Fairview staff presented), Cross-Cultural Action Network, Southern Berkshire Educational Collaborative (presentation), and Southern Berkshire Quality Initiative. | NeedsAssessment |
| Patient Education Assistance | 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 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. | PatientEducationAssistance |
| Community Information | 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 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. | CommunityInformation |
| Community Building Activities | Part VI, Line 5: COMMUNITY BUILDING ACTIVITIES - FAIRVIEW HOSPITAL PARTICIPATES IN COMMUNITY-WIDE INITIATIVES FOCUSING ON EMERGENCY PREPAREDNESS, MEDICAL INTERPRETER AND CONVERSATIONAL SPANISH TRAINING, HEALTHCARE CAREER DEVELOPMENT PROGRAMS, AND COALITION BUILDING THROUGH THE BERKSHIRE PUBLIC HEALTH PARTNERSHIP. THE HOSPITAL HAS ALSO RESPONDED TO CRITICAL PHYSICIAN SHORTAGES IN ITS SERVICE AREA BY INVESTING IN REPLENISHING THE SUPPLY OF PRIMARY CARE AND SPECIALTY PHYSICIANS AVAILABLE TO THE COMMUNITY BY ASSISTING IN ESTABLISHING NEW PHYSICIANS IN THE SERVICE AREA. | CommunityBuildingActivities |
| Other Information | 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, a more sustainable on 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. | OtherInformation |
| Affiliated Health Care System | 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. | AffiliatedHealthCareSystem |
| Reports Filed With States | MA | ReportsFiledWithStates |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (10 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BRIAN T BURKE MD | |||||||||||||
| 163036 | 0 | 0 | 0 | 14903 | 0 | 8387 | 0 | 26597 | 0 | 212923 | 0 | 0 | 0 |
| DAVID E PHELPS | |||||||||||||
| 0 | 491483 | 0 | 0 | 0 | 38500 | 0 | 11025 | 0 | 27241 | 0 | 568249 | 0 | 0 |
| DARLENE RODOWICZ | |||||||||||||
| 0 | 284137 | 0 | 0 | 0 | 39527 | 0 | 11025 | 0 | 24275 | 0 | 358964 | 0 | 0 |
| EUGENE DELLEA | |||||||||||||
| 0 | 184564 | 0 | 0 | 0 | 70042 | 0 | 10968 | 0 | 12007 | 0 | 277581 | 0 | 0 |
| DOREEN HUTCHINSON | |||||||||||||
| 147326 | 0 | 0 | 0 | 14805 | 0 | 7639 | 0 | 26077 | 0 | 195847 | 0 | 0 | 0 |
| ALEC R BELMAN MD | |||||||||||||
| 207290 | 0 | 0 | 0 | 9158 | 0 | 10024 | 0 | 24965 | 0 | 251437 | 0 | 0 | 0 |
| GLEN R LOVEJOY MD | |||||||||||||
| 198126 | 0 | 0 | 0 | 18278 | 0 | 8364 | 0 | 24965 | 0 | 249733 | 0 | 0 | 0 |
| BRUCE E NAYOWITH MD | |||||||||||||
| 183530 | 0 | 0 | 0 | 12322 | 0 | 9400 | 0 | 30241 | 0 | 235493 | 0 | 0 | 0 |
| RAYMOND SABATELLI MD | |||||||||||||
| 254334 | 0 | 0 | 0 | 38500 | 0 | 11025 | 0 | 26077 | 0 | 329936 | 0 | 0 | 0 |
| STEPHEN TRACY MD | |||||||||||||
| 177793 | 0 | 0 | 0 | 24174 | 0 | 8452 | 0 | 23432 | 0 | 233851 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Supplemental Information | Identifier |
| Return Reference | Part III | ReturnReference |
| Explanation | Supplemental Compensation Information Schedule J, Part I, Question 3 Fairview Hospital, Inc. relies on BHS Management Services, Inc. to supply its Chief Executive Officer. The salary and benefits provided to CEO David Phelps have been (A) periodically reviewed and confirmed as well within the range of reasonableness by nationally recognized, independent third party compensation consulting firms and (B) approved by unanimous vote of the governing body. Compensation paid to Mr. Phelps by BHS Management Services, Inc., covers his duties as the Chief Executive Officer of both Berkshire Health Systems, Inc. and its 6 affiliated companies and Berkshire Healthcare Systems, Inc. and its 22 affiliated companies, located in Massachusetts and two other states. The approximately 6,000 individuals employed by these non-profit entities annually provide in excess of $500 million in healthcare services, including acute care hospital services, physician services, home health services and long-term care and other elder services. REPORTABLE COMPENSATION FROM RELATED ORGANIZATIONS - FORM 990 PART VII, COLUMNS E & F; SCHEDULE J PART II, COLUMN E; AND SCHEDULE J-2 PART I, COLUMNS E & F: COMPENSATION REPORTED ON THIS RETURN WITH RESPECT TO INDIVIDUAL OFFICERS IS PAID BY BHS Management Services, Inc. IN CONSIDERATION OF SERVICES RENDERED WITH RESPECT TO AS MANY AS 25 DIFFERENT NON-PROFIT HEALTHCARE ORGANIZATIONS. AMOUNTS INCLUDED IN FORM 990 PART VII, COLUMN F, SCHEDULE J PART II, COLUMNS C & D, AND SCHEDULE J-2 PART I, COLUMN F INCLUDE THE COST OF HEALTH & DENTAL INSURANCE, 403(B) PLAN CONTRIBUTIONS, AND HEALTH CARE SPENDING ACCOUNT CONTRIBUTIONS. 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 FOR CALENDAR 2009: DAVID E. PHELPS BERKSHIRE MEDICAL CENTER, INC: 30 WEEKLY HOURS/58 WEEKLY HOURS $293,922 FAIRVIEW HOSPITAL: 4 HOURS/58 HOURS $39,190 BERKSHIRE FACULTY SERVICES, INC: 10 HOURS/58 HOURS $97,974 BERKSHIRE INDEMNITY CO, SPC, LTD: 2 HOURS/58 HOURS $19,595 BHS MANAGEMENT SERVICES, INC (12 HOURS/58 HOURS) FOR BENEFIT OF: BERKSHIRE HEALTHCARE SYSTEMS, INC: $29,396 BOURNE MANAGEMENT SYSTEMS, INC: $2,351 GREENFIELD MANAGEMENT SYSTEMS, INC: $2,351 NEW BEDFORD MANAGEMENT SYSTEMS, INC: $2,351 NORTHAMPTON MANAGEMENT SYSTEMS, INC: $2,351 EAST LONGMEADOW MANAGEMENT SYSTEMS, INC: $2,351 DANVERS MANAGEMENT SYSTEMS, INC: $2,351 PEABODY MANAGEMENT SYSTEMS, INC: $2,351 SOUTH YARMOUTH MANAGEMENT SYSTEMS, INC: $2,351 BERKSHIRE PENNSYLVANIA, INC: $2,351 XENIA EAST MANAGEMENT SYSTEMS, INC: $2,351 WILLOWOOD OF GREAT BARRINGTON, INC: $4,702 WILLOWOOD OF NORTH ADAMS, INC: $3,527 WILLOWOOD OF WILLIAMSTOWN, INC: $3,527 HILLCREST EXTENDED CARE SERVICES, INC: $8,230 BERKSHIRE RETIREMENT COMMUNITY, INC: $11,757 BERKSHIRE EXTENDED CARE SERVICES, INC: $8,230 INTEGRINURSE, INC: $3,527 INTEGRISCRIPT, INC: $3,527 HOSPICECARE IN THE BERKSHIRES, INC: $11,757 PITTSFIELD MANAGEMENT SYSTEMS, INC: $5,878 DARLENE RODOWICZ BERKSHIRE MEDICAL CENTER, INC: 37 WEEKLY HOURS/50 WEEKLY HOURS $265,633 FAIRVIEW HOSPITAL: 3 HOURS/50 HOURS $21,538 BERKSHIRE FACULTY SERVICES, INC: 7 HOURS/50 HOURS $50,255 BERKSHIRE INDEMNITY CO, SPC, LTD: 2.5 HOURS/50 HOURS $17,948 BHS MANAGEMENT SERVICES, INC FOR BENEFIT OF BERKSHIRE HEALTHCARE SYSTEMS, INC: 0.5 HOUR/50 HOURS $3,590 CHERYL BOUDREAU BERKSHIRE MEDICAL CENTER, INC: 20 WEEKLY HOURS/41 WEEKLY HOURS $46,356 FAIRVIEW HOSPITAL: 2 HOURS/41 HOURS $4,636 BERKSHIRE FACULTY SERVICES, INC: 8 HOURS/41 HOURS $18,542 BERKSHIRE INDEMNITY CO, SPC, LTD: 1 HOUR/41 HOURS $2,318 BHS MANAGEMENT SERVICES, INC (10 HOURS/41 HOURS) FOR BENEFIT OF: BERKSHIRE HEALTHCARE SYSTEMS, INC: $5,792 BOURNE MANAGEMENT SYSTEMS, INC: $464 GREENFIELD MANAGEMENT SYSTEMS, INC: $464 NEW BEDFORD MANAGEMENT SYSTEMS, INC: $464 NORTHAMPTON MANAGEMENT SYSTEMS, INC: $464 EAST LONGMEADOW MANAGEMENT SYSTEMS, INC: $464 DANVERS MANAGEMENT SYSTEMS, INC: $464 PEABODY MANAGEMENT SYSTEMS, INC: $464 SOUTH YARMOUTH MANAGEMENT SYSTEMS, INC: $464 BERKSHIRE PENNSYLVANIA, INC: $464 XENIA EAST MANAGEMENT SYSTEMS, INC: $464 WILLOWOOD OF GREAT BARRINGTON, INC: $927 WILLOWOOD OF NORTH ADAMS, INC: $695 WILLOWOOD OF WILLIAMSTOWN, INC: $695 HILLCREST EXTENDED CARE SERVICES, INC: $1,622 BERKSHIRE RETIREMENT COMMUNITY, INC: $2,318 BERKSHIRE EXTENDED CARE SERVICES, INC: $1,622 INTEGRINURSE, INC: $695 INTEGRISCRIPT, INC: $695 HOSPICECARE IN THE BERKSHIRES, INC: $2,318 PITTSFIELD MANAGEMENT SYSTEMS, INC: $1,159 | Explanation |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MASS HEALTH & EDUCAT FACIL AUTHORITY SER F | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 042456011 | IssuerEIN |
| CUSIP Number | 57585CLN3 | CUSIPNumber |
| Date Issued | 2005-07-26 | DateIssued |
| Issue Price | 53089428 | IssuePrice |
| Description Of Purpose | REFUND SER C & D BONDS; CAPITAL EXP | DescriptionOfPurpose |
| Defeased | 0 | Defeased |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Proceeds | 54290451 | TotalProceeds |
| Amount In Reserve Fund | 5019000 | AmountInReserveFund |
| Amount Defeased | 37164405 | AmountDefeased |
| Issuance Costs From Proceeds | 1902595 | IssuanceCostsFromProceeds |
| Working Capital Expenditures | 73681 | WorkingCapitalExpenditures |
| Capital Expenditures | 9003428 | CapitalExpenditures |
| Year Of Subst Completion | 2008 | YearOfSubstCompletion |
| Current Refunding | 1 | CurrentRefunding |
| Advance Refunding | 0 | AdvanceRefunding |
| Final Allocation Made | 1 | FinalAllocationMade |
| Adequate Books And Recds Maintaind | 1 | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Owning Bond Financed Property | 0 | OwningBondFinancedProperty |
| Any Lease Arrangements | 0 | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | 0 | MngmentCntrctBondFinancdPrprty |
| Any Research Agreements | 0 | AnyResearchAgreements |
| Bond Counsel Routinely Engaged | 0 | BondCounselRoutinelyEngaged |
| Prcntge Prvt Business Use By Others | 0.00000 | PrcntgePrvtBusinessUseByOthers |
| Percentage Of Prvt Business Re UBI | 0.00000 | PercentageOfPrvtBusinessReUBI |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUse |
| Post Issuance Compliance Procdrs | 1 | PostIssuanceComplianceProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8038 T Filed | 1 | Form8038TFiled |
| Variable Rate Issue | 0 | VariableRateIssue |
| Hedge Identified In Books And Recds | 0 | HedgeIdentifiedInBooksAndRecds |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGIC |
| Gross Proceeds Invested | 1 | GrossProceedsInvested |
| Exception To Rebate | 0 | ExceptionToRebate |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| Form 990, Part VI, Section A, line 3 | FAIRVIEW HOSPITAL, INC. 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, Inc. 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 09/30/10. | |
| 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. | |
| Form 990, Part XI, Question 2C | THE COMMITTEE THAT HAS RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND THE SELECTION OF AN INDEPENDENT ACCOUNTANT PERFORMS ITS FUNCTIONS IN THE SAME WAY AS IN THE PRIOR FISCAL YEAR. | RESPONSIBILITY FOR OVERSIGHT OF AUDIT |
| Form 990, Part XI, Question 2b | Fairview Hospital, Incorporated's financial statements were audited by an independent accountant only as part of consolidated financial statements and other financial information for Berkshire Health Systems, Inc. and Affiliates. | Audited Financial Statements |
| FORM 990, PART VII, SECTION A & SCHEDULE J-2, PART I | 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 Schedule J-2, Part I are for services as a trustee, for which he receives no compensation. Dr. WESPISER receives payment from Berkshire Medical Center for physician services. | TRUSTEES RECEIVE NO COMPENSATION FOR SERVICES AS TRUSTEES |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (4 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|
| BERKSHIRE HEALTH SYSTEMS INC | |||||||||
| 725 NORTH ST | PITTSFIELD | MA | 01201 | 042442944 | PARENT CORP | MA | 501(C)(3) | 11B | N/A |
| BERKSHIRE MEDICAL CENTER INC | |||||||||
| 725 NORTH ST | PITTSFIELD | MA | 01201 | 042791396 | ACUTE CARE HOSPITAL | MA | 501(C)(3) | 3 | N/A |
| BERKSHIRE FACULTY SERVICES INC | |||||||||
| 725 NORTH ST | PITTSFIELD | MA | 01201 | 042995053 | PHYSICIAN SVCS | MA | 501(C)(3) | 11B | N/A |
| BHS MANAGEMENT SERVICES INC | |||||||||
| 725 NORTH ST | PITTSFIELD | MA | 01201 | 222755258 | MANAGEMENT | MA | 501(C)(3) | 11B | N/A |
Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Type Of EntityTypeOfEntity | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Percentage OwnershipPercentageOwnership | Address Line1AddressForeign/AddressLine1 | CityAddressForeign/City | CountryAddressForeign/Country | Postal CodeAddressForeign/PostalCode | Legal Domicile Foreign CountryLegalDomicileForeignCountry | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| TRI-STATE MEDICAL MANAGEMENT CORP | |||||||||||||||||
| 725 NORTH STREET | PITTSFIELD | MA | 01201 | 042913352 | REAL ESTATE MGMT | MA | FAIRVIEW HOSPITAL | C | -18348 | 334457 | 1.00000 | ||||||
| BERKSHIRE INDEMNITY CO SPC LTD | |||||||||||||||||
| 980663332 | INSURANCE | C | 23 LIME TREE BAY AVE | GEORGE TOWN, GRAND CAYMAN | CJ | KY1-1102 | CJ | N/A | |||||||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 1 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable
Name Of Other Organization NameOfOtherOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TRI-STATE MEDICAL MANAGEMENT CORP | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | R | TransactionType |
| Amount Involved | 52331 | AmountInvolved |