2011-08-15T17:03:32-05:00 2010-09-30 ERNST & YOUNG US LLP 55 IVAN ALLEN JR BLVD NW STE 1000 ATLANTA GA 303083051 990 2009-10-01 042133860 FAIRVIEW HOSPITAL FAIR 4134472508 725 NORTH STREET PITTSFIELD MA 012014109 DARLENE RODOWICZ 4134472809 2011-08-15 0 4048748300 2009 2016-02-24 21:20:13Z DARLENE RODOWICZ 725 NORTH ST PITTSFIELD MA 012014109 42912428 0 X WWW.BERKSHIREHEALTHSYSTEMS.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 20 320 50 0 0 532386 576768 38628673 39162376 -261191 600743 332941 519146 39232809 40859033 0 0 19385066 20750843 0 81652 18887434 19409642 38272500 40160485 960309 698548 26244976 28199684 18247521 18992731 7997455 9206953 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 36127779 39450387 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. 36127779 1 1 0 1 0 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 78 0 1 320 1 0 0 0 0 0 1 1 0 0 0 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 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 GINA C BIRCHALL 2.00 X 0 0 0 BRONLY S BOYD 2.00 X X 0 0 0 BRIAN T BURKE MD 50.00 X 177939 0 34984 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 71865 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 MOFFAT 2.00 X 0 0 0 DAVID E PHELPS 4.00 X X 0 529983 38266 SHEPARD D RAINIE 2.00 X 0 0 0 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 ANGELO C STRACUZZI 2.00 X 0 0 0 ANN H TRABULSI 2.00 X 0 0 0 THADDEUS S TUCKER WELCH 2.00 X 0 0 0 ROBERT P WESPISER MD 2.00 X 0 129890 0 CHERYL M BOUDREAU 4.00 X 0 81074 13956 DARLENE RODOWICZ 1.00 X 0 323664 35300 EUGENE DELLEA 50.00 X 0 254606 22975 DOREEN HUTCHINSON 50.00 X 162131 0 33716 ALEC R BELMAN MD 50.00 X 216448 0 34989 GLEN R LOVEJOY MD 50.00 X 216404 0 33329 BRUCE E NAYOWITH MD 50.00 X 195852 0 39641 RAYMOND SABATELLI MD 50.00 X 292834 0 37102 STEPHEN TRACY MD 50.00 X 201967 0 31884 1463575 1391082 356142 21 0 1 0 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 6 139636 121284 315848 1356 576768 NET PATIENT SVC REVENU 622110 39162376 39162376 39162376 300174 300174 32788 32788 83621 21242 62379 62379 62379 2227116 1800 1960147 988 266969 812 267781 267781 71018 139636 71018 0 CAFETERIA SALES 722212 168756 168756 PHARMACY SALES 446110 122710 122710 REIMBURSED EXPENSES 900099 60564 60564 104737 104737 456767 40859033 39450387 0 831878 432735 428611 3657 467 15948361 15611852 298423 38086 609072 596186 11428 1458 2633345 2584208 43934 5203 1127330 1103844 20828 2658 3401710 3401710 7764 7764 12755 12755 24687 24687 5557913 5536162 17462 4289 43814 30031 639 13144 3024893 2994962 19441 10490 336300 336300 658749 645025 12550 1174 184035 178868 3749 1418 372399 372399 1557067 1524628 32439 220479 215886 4074 519 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 659558 624085 32727 2746 40160485 36127779 3951054 81652 225013 5413 1527886 1280167 50 80 4301584 4155306 89256 143020 246348 301106 168498 161844 23068331 14243832 7550913 8824499 7743373 9705191 3944294 3225731 14849 13330 432912 383997 26244976 28199684 2930983 2835539 27361 49788 7448534 7172075 7840643 8935329 18247521 18992731 X 5702748 7507775 2036465 1440936 258242 258242 7997455 9206953 26244976 28199684 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 12755 12755 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: 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. 989912 56841 1046753 1028277 -22233 16132 989912 0.75330 0.24670 0 0 16887 16887 2137042 1975723 161319 11829987 7626770 4203217 9084415 4641339 4443076 8824499 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 3225731 DUE TO AFFILIATES 5527521 DUE TO THIRD PARTY PAYORS 2594598 ACCRUED FIN 47 ACCRETION 528721 INTEREST RATE SWAP LIABILITY 213511 DEFERRED COMPENSATION 47897 DEFERRED PENSION FORFEITURE 23081 8935329 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. GALA 162744 116477 46267 3300 19704 3923 19340 GOLF TOURNAMENT 47910 23159 24751 6563 16135 2053 0 0 210654 139636 71018 6563 19435 19704 3923 21393 71018 0 1 1 X 1 X 1 X 1 1 1 0 1 1 498316 498316 0.01240 4560983 3447674 1113309 0.02770 2385543 1926939 458604 0.01140 7444842 5374613 2070229 0.05150 228269 228269 0.00570 1720892 735008 985884 0.02450 1949161 735008 1214153 0.03020 9394003 6109621 3284382 0.08170 110810 110810 0.00000 7325 7325 0.00000 738 738 0.00000 22513 22513 0.00060 8878 8878 0.00000 150264 127013 23251 0.00060 1 794268 0 14762081 14626290 135791 X 1 1 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 Part I, Line 3c: 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, 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. 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. 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 2010 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 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. 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. 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. 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. 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. 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. MA X X X X X 0 0 0 0 0 0 0 0 0 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 Supplemental Information Part III 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 MASS HEALTH & EDUCAT FACIL AUTHORITY SER F 042456011 57585CLN3 2005-07-26 53089428 REFUND SER C & D BONDS; CAPITAL EXP 0 0 54290451 5019000 37164405 1902595 73681 9003428 2008 1 0 1 1 0 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, 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 RESPONSIBILITY FOR OVERSIGHT OF AUDIT 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. Form 990, Part XI, Question 2b Audited Financial Statements 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. FORM 990, PART VII, SECTION A & SCHEDULE J-2, PART I TRUSTEES RECEIVE NO COMPENSATION FOR SERVICES AS TRUSTEES 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. 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 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 23 LIME TREE BAY AVE GEORGE TOWN, GRAND CAYMAN CJ KY1-1102 980663332 INSURANCE CJ N/A C 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 TRI-STATE MEDICAL MANAGEMENT CORP R 52331