2011-08-15T17:03:32-05:00 2010-09-30 ERNST & YOUNG LLP 55 IVAN ALLEN JR BLVD SUITE 1000 ATLANTA GA 30308 990 2009-10-01 042791396 BERKSHIRE MEDICAL CENTER INC BERK 4134472081 725 NORTH STREET PITTSFIELD MA 01201 DARLENE RODOWICZ 4134472508 2011-08-15 0 PAULA BUSH 4048748300 2009 2016-02-24 21:20:13Z DARLENE RODOWICZ 725 NORTH ST PITTSFIELD MA 01201 335948874 0 X www.BHS1.org X 1983 MA THE MISSION OF BERKSHIRE MEDICAL CENTER IS TO IMPROVE THE HEALTH OF ALL PEOPLE IN THE BERKSHIRES AND SURROUNDING COMMUNITIES, REGARDLESS OF THEIR ABILITY TO PAY. 24 20 2963 204 0 0 1816437 2042733 326044514 305592033 -2024449 6684637 895069 799786 326731571 315119189 0 0 180296886 182633194 0 160876 148262531 134859008 328559417 317492202 -1827846 -2373013 360111853 370412006 185690449 193250439 174421404 177161567 THE MISSION OF BERKSHIRE MEDICAL CENTER IS TO IMPROVE THE HEALTH OF ALL PEOPLE IN THE BERKSHIRES AND SURROUNDING COMMUNITIES, REGARDLESS OF THEIR ABILITY TO PAY. 0 0 258405091 277891699 OPERATE AN ACUTE CARE GENERAL HOSPITAL AND MEDICAL EDUCATIONAL FACILITY, AND TO DELIVER THE HIGHEST QUALITY PATIENT CENTERED CARE IN A LEARINING ENVIRONMENT. TOTAL PATIENT DAYS FOR THE YEAR ARE 59,102, TOTAL LAB PROCEDURES 1,463,406, TOTAL RADIOLOGY PROCEDURES 177,818, TOTAL REHAB VISITS 54,761. HOURS OF OPERATION 24/HRS 365/DAYS PER YEAR. 15451132 17470460 OPERATION OF AN EMERGENCY DEPARTMENT AND TRAUMA CARE CENTER AVAILABLE TO ALL REGARDLESS OF ABILITY TO PAY. TOTAL VISITS FOR THE YEAR 56,179. ED IS IN OPERTION 24 HRS/DAY 365 DAYS/YEAR. 8814025 8186073 VISITING NURSE PROGRAM ALLOWING FOR THE CARE AND REHABILATION OF PATIENTS IN THEIR OWN HOME ENVIRONMENT. TOTAL VISITS FOR THE YEAR 57,980 DETAILED AS FOLLOWS SKILLED NURSING 31,661, HOME HEALTH AIDE 11,383, REHAB 14,671, AND SOCIAL SERVICE 265. HOURS OF OPERATION 7 DAYS/WEEK 8am-9pm WITH A NURSE ON CALL 24 HOURS. 2566377 2043801 OPERATE A SUBSTANCE ABUSE CENTER WITH PROVIDING THE HIGHEST QUALITY OF PATIENT CARE. TOTAL PATIENT DAYS FOR THE YEAR 6527. PROGRAM OPERATES 24 HRS/DAY 365 DAYS/YEAR. 2566377 2043801 285236625 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 1 0 0 0 0 1 0 0 0 1 214 0 1 2963 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 4134472809 725 NORTH STREET PITTSFIELD MA 012014109 DAVID E PHELPS 30.00 X X 0 529983 38266 THOMAS O ANDREWS 2.00 X 0 0 0 JEROME J ANDERSON 2.00 X 0 0 0 ALFRED A BARBALUNGA 2.00 X 0 0 0 BRONLY S BOYD 2.00 X X 0 0 0 BRIAN T BURKE MD 2.00 X 0 177940 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 FAIRBANKS 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 71865 0 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 PAUL E RAVERTA 2.00 X 0 0 0 CAROL G SIEGEL 2.00 X 0 0 0 GEORGE T SMITH 2.00 X 0 0 0 MARILYN L SPERLING 2.00 X 0 0 0 ANN H TRABULSI 2.00 X 0 0 0 ROBERT P WESPISER 2.00 X 129890 0 0 GINA C BIRCHALL 2.00 X 0 0 0 SHEPARD D RAINIE 2.00 X 0 0 0 ANGELO C STRACUZZI 2.00 X 0 0 0 THADDEUS TUCKER S WELCH 2.00 X 0 0 0 DARLENE RODOWICZ 37.00 X 0 323664 35300 CHERYL BOUDREAU 20.00 X 0 81074 13956 DIANE KELLY 50.00 X 247021 0 34724 RONALD HAYDEN 50.00 X 447051 0 36933 TIMOTHY COUNIHAN 50.00 X 401884 0 37901 ANTHONY G ELLRODT 50.00 X 372836 0 36612 ALEX N SABO 50.00 X 310557 0 39578 D JAMES THOMSON 50.00 X 305114 0 37938 2286218 1112661 346192 168 0 1 0 BHS MANAGEMENT SERVICES INC 725 NORTH ST PITTSFIELD MA 01201 MANAGEMENT 21822759 MEDQUIST INC 1000 BISHOPS GATE BLVD SUITE 300 MOUNT LAUREL NJ 08054 MEDICAL TRANSCRIPTION 1210299 ROBINSON & SMITH 335 NORTH MAIN ST GLOVERSVILLE NY 12078 LAUNDRY/LINEN SERVICE 842492 QUEST DIAGNOSTIC INC 415 MASSACHUSETTS AVE CAMBRIDGE MA 02139 MEDICAL LAB SERVICES 842295 DIVERSIFIED CLINICAL SERVICES PO BOX 85001 ORLANDO FL 32885 MANAGEMENT FEES 668765 35 50978 1110632 881123 99800 2042733 Patient Services Reven 621399 295511074 295511074 Other Ancillary 621399 4544605 4544605 Lab Revenue 621511 2200939 2200939 Health Promo Education 611710 1825064 1825064 Psych Prof Services 621112 1510351 1510351 305592033 3533773 3533773 429168 429168 1088201 1430012 -341811 -341811 -341811 22020467 52085 19350856 2669611 52085 2721696 2721696 48817 50978 48817 0 Cafeteria Income 722212 1141597 0 1141597 1141597 315119189 305592033 0 7484423 268851 259716 9135 144732602 139814709 4835527 82366 5515390 5327867 187523 19465009 18803197 661812 12651342 12221197 430145 21822759 21822759 1486 1486 48618 48618 2856668 2856668 176272 169795 5977 500 4512226 4358810 153416 729689 704880 24809 5453644 5268219 185425 665424 665424 23528056 22720191 807865 2382064 2301074 80990 SUPPLIES 48735684 46407034 2261218 67432 RECIPROCAL SUPPORT TEAC 11403062 11403062 0 0 BAD DEBT 5620240 5620240 EQUIP RENTAL REPAIR 4676440 4461891 214549 UNCOMPENSATED CARE POOL 1760556 1760556 486120 63477 412065 10578 317492202 285236625 32094701 160876 9804 10969 10524686 9924217 407187 131348 40754515 34310834 15560687 15811387 5835956 6388915 2829377 3159240 362914044 213491463 145941250 149422581 93615032 114315449 41300833 33796258 3332526 3140808 360111853 370412006 47692748 34031981 135579 419651 109130051 134807657 50000 14325 28682071 23976825 185690449 193250439 X 157756403 159373932 10024388 11018883 6640613 6768752 174421404 177161567 360111853 370412006 X 0 1 0 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 48618 48618 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: LOBBYING ACTIVITIES EXPENDITURES BERKSHIRE MEDICAL CENTER PAYS ANNUAL MEMBERSHI P 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 9/30/2011. 14530168 128139 1002929 18000 2081 15641155 14373083 40498 128713 7400 4726 14530168 0.56720 0.43280 1 0 6641413 6641413 143216851 78852883 64363968 178316336 128367057 49949280 34739444 6271523 28467920 149422581 BLACKROCK EQUITY INDEX FUND B 23587752 F ALLIANCE BERNSTIEN ACM IF 4026812 F AXA ROSENBERG SMALL/MID CAP FUND 6181694 F 33796258 DUE TO THIRD PARTIES 7425294 DEFERRED COMPENSATION 2127459 PENSION FORFEITURE ESCROW 97027 GIFT ANNUITY LIABILTIY 10427 INTEREST RATE SWAP LIABILITY 2455373 AMOUNT DUE TO AFFILIATE 10155443 ASSET RETIREMENT ACCRETION 1705802 23976825 315119189 317492202 -2373013 5286131 -172955 5113176 2740163 320405323 5286134 5286134 315119189 0 315119189 317492202 0 317492202 0 317492202 Part V, Line 4: Description of Intended Use of Endowment Funds: THE ORGANIZATION HOLDS, INVESTS AND UTILIZES ENDOWMENT FUNDS IN ACCORDANCE WITH ANY EXPRESSED WISH OF THE DONOR OF THOSE FUNDS. TO THE EXTENT THAT THE DONOR INSTRUCTIONS ALLOW THE EXPENDITURE OF THE ENDOWMENT FUNDS, THEY ARE EXPENDED FOR HEALTHCARE SERVICES PURPOSES CONSISTENT WITH THE TAX EXEMPTION OF THE ORGANIZATION. 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 BERKSHIRE MEDICAL CENTER) FOR THE YEARS ENDED SEPTEMBER 30, 2010 AND 2009 DOES NOT CONTAIN A FOOTNOTE ADDRESSING ANY LIABILITY FOR UNCERTAIN TAX PROVISIONS UNDER FIN 48. Part XI, Line 8 - Other Adjustments: ASSETS RELEASED FROM RESTRICTIONS FOR OPERATING PURPOSES GOLF TOURNAMENT 24084 6504 17580 466 11090 6024 golf tournament 75711 44474 31237 2360 21661 7216 99795 50978 48817 2826 32751 13240 48817 0 1 1 X 1 X 1 X 1 1 1 0 1 1 2905931 0 2905931 0.00920 39409739 33264836 6144903 0.01940 15323022 12004246 3318776 0.01050 57638692 45269082 12369610 0.03910 7854483 1837247 6063167 0.01900 12357405 4981822 7375583 0.02320 12225898 9811998 2413900 0.00760 89186 0 89186 0.00030 32526972 16631067 15941836 0.05010 90165664 61900149 28311446 0.08920 45932 45932 0.00010 1057533 1057533 0.00330 1103465 1103465 0.00340 1 5620241 0 94661918 98009259 -3347341 X 1 1 BERKSHIRE MEDICAL CENTER

725 NORTH ST PITTSFIELD MA 01201

X X X X Home Health, Substance Abuse, Mental Health Services, Dental Clinic, Renal D Services, Dental Clinic, Renal Dialysis, Occupational Health, Occupational Health, Acute Rehabilitation Program 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. Part I, Line 7g: SUBSTANCE ABUSE UNIT, DENTAL CLINIC, INPATIENT PYSCHIATRIC UNIT Part I, Line 7f: BAD DEBT EXPENSE OF $5,620,241 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: IF A PATIENT IS INELIGIBLE FOR CHARITY CARE OR CARE AT REDUCED RATES BECUASE THE PATIENT'S INCOME EXCEEDS THE ELIGIBILITY GUIDLINES, SERVCIES RENDERED ARE RECORDED AT ESTABLISHED RATES AND ANY UNPAID ACCOUNT RECEIVABLE BALANCE IS WRITTEN OFF TO BAD DEBT EXPENSE 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 BERKSHIRE MEDICAL CENTER'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. The Hospital used the standard medicare cost report to determine medicare costs based on a step-down methodology. The shortfall on the medicare program is related to programs and services provided for the community, many of which are only provided by the Hospital in the geographic region and include trauma services, renal dialysis services, psychiatric and geropsychiatric programs, and homecare services. The Hospital considers the full shortfall to be a community benefit. Part III, Line 9b: Populations Exempt from Collection ActivitiesThe 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 Medicaid1. Please note that BMC 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.2. BMC 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) BMC shall cease its billing or collection activities. 3. BMC 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, BMC will cease collection activity for services, previously billed, that now fall into the eligibility period. 4. BMC 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.5. BMC 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. BMC 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. BMC 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 VI, Line 2: Community Benefits Mission StatementFurthering our charitable purpose, the Berkshire Medical Center's Community Benefit Mission is to identify, prioritize and invest in our community's health needs by pursuing needed initiatives and programs. The Community Benefit goals include satisfying unmet needs in the Berkshires and improving the health status of our community with a particular focus on access to healthcare and "at risk" populations. Recognizing the value of BMC's partnership with our community, BMC will seek input and meaningful collaboration in our effort to meet community need. BMC will outline in an annual Community Benefit plan, the priorities to be addressed and the initiatives to be funded.BMC and Fairview hospital are both part of Berkshire Health Systems and therefore work together to meet community need. Community Benefit and Access CommitteeAs a committee of the board of Trustees, this committee is responsible for understanding the health needs and barriers to care in our service area. The Committee oversees the Community Benefit process of the organization, including health needs assessments, determining target populations and priorities, development of the Community Benefits plan and evaluating performance against goals and objectives. The committee is comprised of people from the Board of Trustees and the community at large, and meets monthly though out the year. Community Benefits Leadership/TeamRuth Blodgett, BHS Senior Vice President, Planning and Development; Michael Leary, BHS Director of Media Relations; Cathie McHugh, Planning Analyst; Bobbie Orsi, RN, Director, Community Outreach Services; Ed Perlak, Vice President, Community Services; Lee Santos, BHS Fiscal Administration; Program Directors of Community Benefit programs.Community Benefits Team MeetingsThe BHS Community Benefits and Access Committee meets monthly to discuss community benefit programs, potential new initiatives, community needs and outcomes. Throughout the year, internal community benefit and program leaders meet to coordinate the Community Benefit Plan and programs. Health Needs AssessmentBMC has utilized an active community needs assessment as part of its community Benefits Process since 1996. The Community Needs Assessment is updated annually, and the update in 2009 directed our efforts in 2010. We utilized all available clinical, health status, demographic, and socio-economic data available to form the foundation of our needs assessment. In addition we gathered available qualitative data from our many Advisory groups, community forums, surveys, and focus groups. Our wellness and outreach programs also supplement our understanding of the health status of our community, health risk factors, and barriers to health and health care. The needs data, along with State priorities are used to determine our annual community benefit priorities, which are established by the community Benefit and Access Committee of the Board. We leverage existing resources and providers as well as identify gaps in service. BMC works with internal resources and community and regional partners, with the help of evidenced based or best practice programs, to develop and implement programs and initiatives to meet community need. Data SourcesCommunity Focus Groups, Hospital data, Consumer and Advisory Groups, Interviews, MassCHIP, Public Health Personnel, Surveys, Other - Healthy People 2020; Department of Public Health Bureau of Family and Community Health Injury Report; Physician Manpower data; Workforce Needs Data; Wellness Data; Emergency Department/Trauma Registry; Berkshire United Way; Berkshire Regional Planning Commission; chamber of commerce blueprint study Goals: Statewide Priorities: As part of our planning process, BMC incorporates the MA statewide priorities as part of our local assessment, priorities and initiatives. The States priorities are : Address Unmet Health Needs of the Uninsured Chronic Disease Management in Disadvantage Populations Promoting Wellness of Vulnerable Populations Reducing Health Disparity, Supporting Healthcare ReformTarget PopulationsMedically underserved - Berkshire County has one of the highest number of medically underserved residents in Massachusetts. Uninsured - Due to its economic and employment status, Berkshire County has a significant number of individuals and families who are uninsured or underinsured.Senior population - Berkshire County has one of the largest elderly populations in the state. Racial and ethnic populations - The Berkshires is experiencing a steady rise in immigrant population, particularly Latin American and Russian immigrants. Entire geographic population of Berkshire County - Berkshire County is the most rural county in the state and is geographically isolated from larger communities. As a result, BMC is the primary provider of healthcare services to the region. Economically vulnerable - Berkshire County has one of the highest unemployment and underemployment rates in the state and low median income. Youth - Local healthcare statistics on youth at risk. Pregnancy and Childbirth - Local healthcare statistics on Maternal Child Health. Populations with health disparities - Local health data. Community Benefit Priorities* Cancer* Cardiovascular Health* Diabetes* Mental Health* Obesity* Stroke/Blood Pressure* Substance Abuse* Access to Healthcare Medical Professionals Under & Uninsured* Adolescent & Youth Health* Depression* Emergency Preparedness * Healthcare Disparities* Infectious Disease* Injury Prevention* Maternal/Child Health * SmokingCommunity PartnersPittsfield Public Schools, Pittsfield Board of Health, Head Start, Berkshire Community Action Council, Center for Ecological Technology, Teen Parent Program, Brien Center for Mental Health and Substance Abuse Services, Pittsfield Police, Massachusetts Coalition for Suicide Prevention, Massachusetts Department of Public Health, Local community pharmacists, Elder Services, Pittsfield Senior Center, Greylock Federal Credit Union, Boxcar Media, YMCA, Tri-Town Health Board, SHINE program, Berkshire Immigrant Center, Berkshire Community College, Berkshire County Sheriff's Department, Berkshire Breast Health Team, Community Health Program, Berkshire United Way, Berkshire Youth Development Project, CHNA(Community Health Network Association), local business community. Other resources and organizations include:Massachusetts Department of Public Health; University of Wisconsin Population Health Institute; Berkshire County Boards of Health; local school districts; Berkshire County Regional Planning Commission; Berkshire United Way; Berkshire, American Heart Association, American Stroke Association, American Diabetes Association, American Cancer Society, Chamber of Commerce; Massachusetts Medical Society; Regional Pain collaborative; Berkshire County Regional Emergency Operations Planning Committee.Program Planning and evaluationThe community Health Needs Assessment is used to focus our community benefit program and initiative planning as well as to monitor results and reprioritize for future efforts. Part VI, Line 3: Information regarding the availability of financial assistance is offered to our patients in the following manner.Notices of the availability of financial assistance are posted throughout the hospital, specifically in all service delivery areas, financial counseling offices throughout the clinical campuses and all Berkshire Faculty Services Physician practices. Advocacy for Access Program staff are available daily to meet with patients who present at the Emergency Department for services as requested. Appointments can be made with the Advocacy for Access Program office to assist them in filing an application through the Virtual Gateway for state financial assistance programs. At Pre-Registration, self-pay patients are offered an appointment with Advocacy for Access Program office along with an explanation of the service. Brochures are distributed at all access points informing patients of the availability of financial assistance with phone numbers to contact the Advocacy for Access Program office to set up appointments. Statements mailed to patients who have a self-pay balance will have a dunning message indicating that financial assistance may be available and the phone numbers to contact the Advocacy for Access office for additional Information. All Patient statements have a message on the back of the statement indicating the availability of financial assistance. Part VI, Line 4: Berkshire County is a largely rural area located at the far western end of Massachusetts, adjacent to New York State to the west, Vermont to the north and Connecticut to the south. Comprising roughly 15% of the land mass of Massachusetts, its approximately 135,000 residents account for 2% of the population of the Commonwealth.The population is relatively homogeneous ethnically:White non-Hispanic persons: 93.8%Black non-Hispanic persons : 2.5%Hispanic persons: 2.3%Asian persons: 1.3%The County is comprised of three distinct sub-regions: North, South and Central which form the overall County profile of a largely rural area with small urban, agrarian, and post-industrial towns and cities. While tied together economically, socially and politically, each sub-region reflects a degree of social and economic differences, primarily due to the 50-mile length of the county from north to south. Berkshire County is a community in transition from an economy relying on manufacturing to a service sector dependent economy. The General Electric Company, which at one point in the 1970s employed upwards of 15,000 people, sold the last segment of its business in the Berkshires (GE Plastics, which employed about 500 people) to a Saudi Arabian owned company, SABIC. Other major employers, for example, Sprague Electric (electrical components) and Beloit-Jones (paper making machinery) also closed.The last two years have seen the closing of five paper mills in the county, which had accounted for a large part of the remaining industrial base in the area.Subsequently, the county has tried to take advantage of its rural environment, cultural attractions, and its small town atmosphere to develop a three season tourist/vacation "destination" proximal to the New York and Boston metropolitan areas (within a three hour drive).Although this effort has been met with a reasonable level of success (upwards of 2 million tourists visit each year), the jobs created in this employment sector cannot adequately replace what has been lost due to the major deindustrialization of the county over the last two decades. This is reflected in the economic demographic of the county compared to the Commonwealth of Massachusetts:Per capita income is 16% below the state averageMedian household income is 23% below the state average% Population below 200% of the poverty level is 20% higher than the state% of children less than 18 years of age living below 100% of the poverty line is 10% higher than the state50.2% of pregnant women receive publicly financed prenatal care compared to 35.6% statewide.The population demographic has been similarly affected:2.8 % of a population decline in the county from 2000 to 2010 following a 3.25 % drop in population from 1990-2000. % Persons under the age of 20 years in the county is 10% lower than the statewide average.% Persons age 65 and older is approximately 1/3 higher than the state (18% vs. 13%)The education profile of county residents reflects the economic and population demographic:The percentage of residents age 25+ who have graduated high school (85.1%) is about the same as the state experience (84.8%).The percentage of residents age 25+ with a Bachelors degree or higher is approx. 27% lower than the commonwealth as a whole (26% vs. 33.2%).The cumulative impact of this transition has had a significant impact on the fabric of the community. Traditional support systems of family, schools and religion, have been challenged by these developments:Alcohol and drug abuse are significant issues. County residents are admitted into substance abuse treatment at a far greater rate than the state average.The suicide rate in Berkshire County is higher than the state average. (12.1 vs. 7.8 statewide)In 2008, the communities of North Adams and Pittsfield (the two largest communities in Berkshire County) were ranked 1rst and 2nd respectively statewide in Reporting Rate for Child Maltreatment. (North Adams at 156.9 reported per 1000 resident children and Pittsfield at 142.2 reported per 1000 resident children compared to a statewide rate of 52.9 per 1000.) In terms of Victimization Rates (supported allegations) North Adams at 68.3 and Pittsfield at 57.2 were 3rd and 6th statewide respectively compared to a statewide average of 24.4. (Mass. Department of Children and Families Jan. 2010)The city of Pittsfield is one of six cities in Massachusetts with the highest level of Division of Youth Services involvement in the Commonwealth. (Mass. Juvenile Justice Advisory Cte. Report to the Governor May 2007)In 8th grade in 2009, 45% of Berkshire county students self reported alcohol use. In 12th grade the percentage was 82% in 2009. (2009 Prevention Needs Assessment Survey Results: Berkshire County. Berkshire Youth Development Project)25% of 12th grade students reported being drunk or high at school in 2009.(2009 Prevention Needs Assessment Survey) The school population of the county has become increasingly mobile and unstable in response to an unprecedented increase in housing costs in southern Berkshire County due primarily to the influx of second home buyers. Families are relocating to lower cost housing in the central and northern parts of the counties disrupting established school support systems for their children (School Mobility Rates Berkshire Hills Regional School District).The Berkshire County Juvenile Resource Center truancy, intervention, and suspension/expulsion alternative program serves over 460 youths/year. (Mass. Juvenile Justice Advisory Cte. Report)1852 juvenile cases were opened in Berkshire Juvenile court (70% male, 30% female) (Office of Berkshire District Attorney David Capeless May 2010)9 Churches closed within the last two years.The impact of the local "environment" on youth and its implications for the future of the County is further magnified by two significant findings: The Massachusetts Department of Public Health has identified Berkshire County as being at high risk for youth suicide (one of eight areas out of 27 defined areas).A county-wide effort to address this issue has been initiated. Under the auspices of the Community Health Network of the Berkshires (comprised of members of the healthcare and juvenile services providers in the county), grant funding from the Massachusetts Department of Public Health has been obtained (one of only three proposals funded) to initiate a three year Youth Suicide Prevention Program. The focus of this effort is to help community organizations working with adolescents to establish sustainable activities to provide supportive environments for youth, identify youth at risk, and make appropriate referrals to the intervention safety net. The number of births in Berkshire County is declining but the percentages of births to adolescent mothers in Berkshire County as well as the teen birth rate are higher than the rest of the state.In Berkshire County, 10% of the births/yr are babies born to adolescents (121 births) compared 6% statewide. The teen pregnancy rate in Berkshire County has increased over 20% over the past decade compared to a 21% decline statewide over the same period of time. (United Way 2010 Community Impact Report completed by the Berkshire Regional Planning Commission)Health StatusThe Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute presented the 2010 County Health Rankings, a collection of 50 reports that reflect the overall health of counties in every state across the country.Summary Health Outcomes & Health Factors RankingsCounties receive two summary ranks: Health Outcomes Health Factors Each of these ranks represents a weighted summary of a number of measures. Health outcomes represent how healthy a county is while health factors are what influences the health of the county. The information below reflects the social and economic status of our community and influences our health status.Berkshire County ranked 10th for Mortality, 11th for Morbidity, Health Behaviors, Social & Ecomic Factors, 12th for Physical Environment and 1st for Clincial Care.Chronic Disease: Hypertension HTN prevalence in multiple worksites averages at approximately 30%. In worksites with active wellness programs, the percentage of employees with HTN is approximately 17%. 40% of employees have pre-hypertension In >2000 employees (worksites) with HTN, 26% have BP"s "not at goal"continued on schedule o. Part VI, Line 5: BHS recognizes that active involvement in the community is crucial to promoting and protecting the health of area residents. The delivery of healthcare services alone cannot achieve significant improvement in the health status of our community. BHS has engaged in community building activities with the goal of developing a societal infrastructure that engages all segments of the community with the ultimate purpose of bettering the lives of people in the community. These activities have revolved around three specific efforts:1. Participation in grassroots community wide initiatives focusing on locally identified concerns:Teen Pregnancy Prevention InitiativePittsfield Youth Prevention PartnershipCommunity Health Network of the BerkshiresYouth Suicide Prevention Program/Berkshire Coalition for Suicide Prevention.H1N1 Flu Vaccination ClinicsEmergency Response PlanningSchool partnerships with Reid middle School and Conte Elementary School 2. Serving in a Leadership Capacity with Community OrganizationsUnited Way of Berkshire CountyPittsfield YMCAElder Services of Berkshire CountyBerkshire Community CollegeBerkshire Community College FoundationLocal School Committees (Pittsfield and Central Berkshire)Local Boards of HealthBerkshire Regional Planning Commission Sustainable Berkshires InitiativeLocal School Wellness CommitteesAreas of economic development:Berkshire Regional Employment BoardChamber of CommerceBerkshire Economic Development Corporation 3. Working with area and regional institutions of higher learning to make educational opportunities available to area residents.Elms College RN to BSN programCareer ladder/ clinical technical training programs in nursing and allied health areasClinical Training site for area students in nursing and allied health disciplinesEMT-Training and re-certification programsBHS/BCC Nursing Assistant Program for members of the community at largeYouth Leadership Group Part VI, Line 6: The governing body of BMC consists of 25 community volunteers, three physician representatives of the hospitals medical staffs 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 interestsincluding social service providers, local business leaders, financial professionals, consumer advocates and educational leaders. Most committees of the Board of Trustees include additional community representatives. BMC maintains a patient and family council to provide input and advice on a wide range of service topics.The medical staff of BMC is open to all physicians who meet clinical and patient service criteria, although certain hospital based servicesradiology, anesthesia, emergency department and pathologyare functionally closed because of the manner in which those departments are structured.BMC 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. The Berkshire County community has long labored under a critical physician shortage in various specialties and BMC have in recent years expended significant personnel time and financial resources in recruiting physicians to the area as direct employees of BMC or its affiliates. Moreover, BMC has, in appropriate ways, provided substantial assistance to community medical practices to recruit and support the practice start-up of new physicians in needed specialties. As is discussed at greater length elsewhere in this Supplemental Information, BMC have extensive community outreach programs and support, comprehensive, community-based to address such diverse healthcare challenges as diabetes, heart failure and chronic pain management/narcotics misuse and diversion. Part VI, Line 7: BMC is a part of an integrated, non-profit healthcare system that includes (a) a teaching hospital, (b) a critical access community hospital, (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. BMC 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 systems component entities. BMC, 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 DAVID E PHELPS 0 491483 0 0 0 38500 0 11025 0 27241 0 568249 0 0 BRIAN T BURKE MD 0 163037 0 0 0 14903 0 8387 0 26597 0 212924 0 0 DARLENE RODOWICZ 0 284137 0 0 0 39527 0 11025 0 24275 0 358964 0 0 DIANE KELLY 202756 0 0 0 44265 0 10320 0 24404 0 281745 0 0 0 RONALD HAYDEN 423809 0 0 0 23242 0 11025 0 25908 0 483984 0 0 0 TIMOTHY COUNIHAN 364960 0 0 0 36924 0 10320 0 27581 0 439785 0 0 0 ANTHONY G ELLRODT 348772 0 0 0 24064 0 11025 0 25587 0 409448 0 0 0 ALEX N SABO 279968 0 0 0 30589 0 11025 0 28553 0 350135 0 0 0 D JAMES THOMSON 264545 0 0 0 40569 0 11025 0 26913 0 343052 0 0 0 Supplemental Information Part III RELATED COMPENSATION SCHEDULE J, PART II, SCHEDULE J-2 COMPENSATION REFLECTED ON THIS RETURN WITH RESPECT TO INDIVIDUAL OFFICERS AND KEY EMPLOYEES IS PAID BY BHS MANAGEMENT SERVIES, INC., IN CONSIDERATION OF SERVICES RENDERED WITH RESPECT TO AS MANY AS 25 DIFFERENT NON-PROFIT HEALTHCARE ORGANIZATIONS. AMOUNTS INCLUDED IN COLUMN F OF PART VII REPRESENT THE EMPLOYER'S PORTION OF HEALTH, DISABILITY, DENTAL, LIFE INSURANCE AND 403(B)PLANS. THE FOLLOWING LIST REPRESENTS THE ORGANIZATIONS TO WHICH THE INDENTIFIED OFFICER OR KEY EMPLOYEE PROVIDED SERVICES AND THE RESPECTIVE ALLOCABLE SHARE OF THE COMPENSATION. David E. Phelps: Total-58 hours per week $568,249 Berkshire Medical Center, Inc. =30/58 hours $293,922 Berkshire Faculty Services, Inc. ~10/58 hours $97,974 Fairview Hospital ~4/58 hours $39,190 Berkshire Indemnity Company, SPC, Ltd. ~2/58 hours $19,595 BHS Management Services, Inc. (for LTC) ~12/58 hours $117,569 Allocated as among LTC facilities as follows: Berkshire Healthcare Systems, Inc. $29,392 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 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. $ 8230 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: Total-50 hours per week $358,964 Berkshie Medical Center, Inc. = 37/50 hours $265,633 Berkshire Faculty Services, Inc. ~7/50 hours $50,255 Fairview Hospital ~3/50 hours $21,538 Berkshire Indemnity Company, SPC, Ltd. ~2.5/50 hours $17,948 BHS Management Services, Inc. (for LTC) ~0.5/50 hours $3,590 Allocated as among LTC facilities as follows- Berkshire Healthcare Systems, Inc. $3590 Cheryl Boudreau: Total-41 hours per week $95,030 Berkshire Medcial Center, Inc. =20/41 hours $46,356 Berkshire Faculty Services, Inc. ~8/41 hours $18,542 Fairview Hospital ~2/41 hours $4,636 Berkshire Indemnity Company, SPC, Ltd. ~1/41 hours $2,318 BHS Management Services, Inc.(for LTC) ~10/41 hours $23,178 Allocated as among LTC facilities as follows: Berkshire Healthcare Systems, Inc. $5792 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 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. $ 1622 Berkshire Retirement Community, Inc. $ 2318 Berkshire Extended Care Services, Inc. $ 1622 IntegriNurse, Inc. $ 695 IntegriScript, Inc. $ 695 HospiceCare in the Berkshires, Inc. $ 2318 Pittsfield Management Systems, Inc. $ 1159 MHEFA BHS SERIES F 042456011 57586cln3 2005-07-15 53089428 REFUND SERIES C AND D BONDS 0 0 mhefa bhs series a&b 042456011 noneAvail 2009-11-20 29600000 EQUIPMENT AND RELATED RENOVATIONS 0 0 54290451 5019000 37164406 1902595 73681 9003428 2008 1 0 1 1 29600000 6733055 307850 22559095 2010 0 0 0 1 0 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 0.00000 0.00000 0.00000 1 1 0 0 0 1 0 1 0 0 0 1 0 X 1 99800 ISSUING CORP VALUATION 0 0 0 Form 990, Part VI, Section A, line 3 Berkshire Medical Center, Inc. relies on BHS Management Services, Inc. to provide management and support services for the Chief Executive Officer, Chief Financial Officer, VP General Councel, and VP of Human Resources . Form 990, Part VI, Section A, line 6 BERKSHIRE HEALTH SYSTEMS, INC. IS THE SOLE CORPORATE MEMBER OF BERKSHIRE MEDICAL CENTER, INC. 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 BHS 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. In addition, BHS management will review the Forms 990 with the BHS finance committee and address questions and comments covering key elements of the Forms 990 that are of concern to all of the Forms 990, and any significant elements that are peculiar to one or more of the Affiliates' Forms 990. Form 990, Part VI, Section B, line 12c The organization enforces and monitors its conflict of interest policy by requiring all members of the governing body and senior management to disclose potential conflicts of interest (A) annually and (B) as potential conflicts arise. Senior employees are not permitted to have material conflicts of interest and members of the governing are to abstain from action that may be influenced by their conflict or potential conflict by (A) not voting or (B) not voting and leaving the room or (C) leaving the governing body as determined by the governing body. Form 990, Part VI, Section B, line 15 Performance and compensation of the senior executive 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 and approves the compensation of the senior executive. Every two or three years, the organization engages a nationally receognized healthcare compensation firm to provide information concerning market rates of compensation and assess the organization's compensaton structure against those independent benchmarks. The organization followed this process for year ended 9/30/10. Form 990, Part VI, Section C, line 19 GOVERNANCE DOCUMENTS, THE CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC AT THE OFFICE OF (A) THE CHIEF FINANCIAL OFFICER AND (B) THE VICE PRESIDENT AND GENERAL COUNSEL AT 725 NORTH STREET, PITTSFIELD MA 01201. SCHEDULE J-2, PART I AVERAGE HOURS DEVOTED TO RELATED ORGANIZATION BRIAN T BURKE, MD FAIRVIEW HOSPITAL, INC - 48 HOURS 990 schedule h line 4 Community Information Non-working populations with limited access to care (homeless, low socioeconomic, mental health conditions and substance abuse) share a disproportionate burden of risk as evidenced by data from the BHS Community Health Van: 47% (168 people out of 354) had a BP > 140/90 Of this group, 67% (113) were on BP meds and BP was not controlled 33% were unaware their BP was high Risk factor prevalence in a working population of more than 1,378 health care professionals: Very High Risk n=92(6%) Framingham Risk >20% Diabetes, CVD/Stroke CRF. Crisis Intervention High Risk Pregnancy Moderate Risk n=368 (27%) Presence of 1 or More FR <10%,BP 121/81-139/89, BMI 25-29 Non smoker High Risk n=585 (42%) Presence of 1 or More FR >10%, BP >140/90, Chol >240, HDL <40, Non-HDL >160, Smoking, BMI >30, Metabolic Syndrome Depression Low Risk n=333 (24%) FR <10%, BP <120/80, Cholesterol Normal, Non-smoker, BMI <25 In worksites and in the community, risk factor prevalence is driven by unhealthy eating behaviors, physical inactivity, and smoking. Strategies are aimed at assisting individuals to recognize their unique health risk profile and then take intentional steps to improve their health. In 365 patients with diabetes, 37% did not have BP at goal In patients seen with stroke, 63% have HTN as primary diagnosis. Approx 25% of renal patients have HTN as cause of renal failure. Lifetime risk of developing HBP is 90%. Health and clinical indicators Additional health information that helps depict the profile of Berkshire County includes: Berkshire County has higher than state averages for cardiovascular mortality rates, although through the efforts of our clinical care and outreach, the rate has declined consistently over the last ten years to closer with the state. Our age adjusted specific rate for all cancer deaths is 187.1 which exceeds the state rate of 178.9(per 100,000 persons) For substance abuse, our admission rate to DPH funded treatment programs is 2818.9 versus 1636.5 for the state, and alcohol and other drug related hospital discharges is 995.0 versus 362.0 (per 100,000 persons) Diabetes mortality rate also exceeds the state rate (20.68 versus 16.49) Workforce shortages and access to care In the last decade Berkshire County has experienced a shortage of physicians for our community, as well as shortages for key clinical specialties, such as nursing, radiology and laboratory. These shortages create access to care issues for the residents of Berkshire county. In the last 5-8 years, BMC has educated and trained hundreds of staff in its critical shortage programs as well as helped recruit approximately 150 physicians to the community, reducing the Countys exiting shortage of providers by 40 FTEs. Given national shortages, increased demand, and our rural location, BMC expects that this challenge of having an adequate number of health care professional to meet the community need will continue. BERKSHIRE HEALTH SYSTEMS INC 725 NORTH ST PITTSFIELD MA 01201 042442944 PARENT CORP MA 501 (C)(3) 11B N/A FAIRVIEW HOSPITAL INC 725 NORTH ST PITTSFIELD MA 01201 042133860 ACUTE CARE MA 501 (C)(3) 3 N/A BERKSHIRE FACULTY SERVICES INC 725 NORTH ST PITTSFIELD MA 01201 042995053 PHYSICIAN SVC MA 501 (C)(3) 11B N/A BHS MANAGEMENT SERVICE INC 725 NORTH ST PITTSFIELD MA 01201 222755258 MANAGEMENT MA 501 (C)(3) 11B N/A TRI-STATE MEDICAL MANAGEMENT INC 725 NORTH STREET PITTSFIELD MA 01201 042913352 REAL ESTATE MANAGEMENT MA N/A C 0 0 1 0 0 0 0 0 0 0 1 1 1 1 1 1 0 1