2011-08-10T15:44:20-05:00 2010-09-30 FEELEY & DRISCOLL PC 200 PORTLAND STREET BOSTON MA 02114 990 2009-10-01 042103604 MILTON HOSPITAL INC MILT 6176964600 199 Reedsdale Road Milton MA 02186 joseph v morrissey 6176964600 2011-07-13 1 Alan Garofalo 6177427788 2009 2016-02-24 21:20:13Z Joseph V Morrissey 199 reedsdale road milton MA 02186 67582648 0 X www.miltonhospital.org X 1952 MA Milton Hospital, Inc. and Affiliates are commited to improving the health of our community by providing high quality, personalized health care with compassion, dignity and respect for patient rights in a cost effective and safe environment, the hospital strives to continuously provide personalized health care with compassion, dignity and respect for patient rights in a cost effective and safe environment. 20 18 743 141 0 0 518986 328585 61471036 65661678 -1409606 193994 1267377 1386865 61847793 67571122 0 0 31941628 31095201 0 0 34787820 35425685 66729448 66520886 -4881655 1050236 103905322 101793873 68876018 68257778 35029304 33536095 Milton Hospital, Inc. and Affiliates are commited to improving the health of our community by providing high quality, personalized health care with compassion, dignity and respect for patient rights in a cost effective and safe enviroment, the hospital strives to continuously personalized health care with compassion, dignity and respect for patient rights in a cost effective and safe enviroment. 0 0 32507507 30027892 Inpatient healthcare services - Providing general medical and surgical inpatient care for people of all ages in Milton, Quincy, Braintree, Randolph, Canton, Hyde Park, Dorchester and other local communities consistent with our core values of patient convenience, comfort and confidentiality. During FY10, Milton Hospital, Inc. provided 16,191 patient days of inpatient services, with 4,741 discharges. 16839882 25204976 Outpatient healthcare services - Providing a complete complement of outpatient health services for people of all ages in Milton, Quincy, Braintree, Randolph, Canton, Hyde Park, Dorchester and other local communities consistent with our core values of patient convenience, comfort and confidentiality. During FY10, Milton Hospital, Inc. had 29,633 outpatient visits. 6967764 10428910 Emergency room services - Providing 24-hour emergency services in our renovated and expanded Emergency Department for people of all ages in Milton, Quincy, Braintree, Randolph, Canton, Hyde Park, Dorchester and other local communities consistent with our core values of patient convenience, comfort and confidentiality. These services are provided to all patients regardless of their ability to pay for the care provided. During FY10, Milton Hospital, Inc. had 22,640 emergency room visits, representing a 5% increase in emergency room visits from prior year. 56315153 1 1 0 1 0 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 1 0 0 0 1 198 0 743 1 0 0 0 0 0 0 0 0 0 20 18 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X X jason radzevich 6176964600 Milton Hospital 199 Reedsdale Rd Milton MA 02186 michael Brady 1.00 X X 0 0 0 Jane K Hodgman 1.00 X X 0 0 0 ellen needham 1.00 X X 0 0 0 katie conlon 1.00 X 0 0 0 Joseph V Morrissey 40.00 X X 471548 0 32744 george barrett md 1.00 X 0 0 0 carol fallon 1.00 X 0 0 0 Frank l Davis iii 1.00 X 0 0 0 christopher heavy 1.00 X 0 0 0 mary joyce 1.00 X 0 0 0 brook longmaid md 1.00 X 0 0 0 mario marsano 1.00 X 0 0 0 mitchell rabkin md 1.00 X 0 0 0 John J Looney MD 1.00 X 1700 40000 0 stuart rosenberg md 1.00 X 0 0 0 Stanley Lewis MD 1.00 X 0 0 0 richard ward 1.00 X 0 0 0 bruce alexander 1.00 X 0 0 0 helene haddad 1.00 X 0 0 0 patrick stapleton 1.00 X 0 0 0 James C Holleran 40.00 X 299091 0 6348 doris sinkevich 40.00 X 159805 0 258 Kathleen M Harrington 40.00 X 138951 0 10797 CYNTHIA M PAGE 40.00 X 131858 0 21580 anne marie drysdale 40.00 X 125643 0 9152 JEAN M FERNANDEZ 40.00 X 128569 0 19603 REGINA CARNATHAN 40.00 X 154973 0 19854 1612138 40000 120336 29 0 1 0 farnam street financial 240 pondview plaza 5850 opus parkw minnetonka MN 55343 financial services 994957 medtronic usa 4642 collections center dr chicago IL 60693 medical services 797403 south shore anesthesia associates 163 libbey parkway suite 301 weymouth MA 02189 anesthesia group 696667 Quest Diagnostics 12436 collections center drive chicago IL 60693 Lab Services 450624 leaders for today 38 resnick road suite 104 plymouth MA 02360 executive placement services 350565 25 100000 228585 328585 net Patient Care Reven 623000 65181484 65181484 other ancillary servic 621110 480194 480194 65661678 196394 196394 600287 600287 600287 600287 9126 11526 9126 -11526 -2400 -2400 cafeteria/ Vending Mac 722210 279313 279313 rebates and refunds 900099 69522 69522 education income 611710 5859 5859 431884 431884 786578 67571122 65667537 0 1575000 1475507 1475507 24998151 21695135 3303016 204172 177630 26542 2507668 2181671 325997 1909703 1661442 248261 171275 171275 93092 93092 57294 57294 108333 108333 7442774 6085186 1357588 362449 362449 12820919 11571258 1249661 978470 851269 127201 1706488 1484645 221843 10007 7563 2444 36169 10862 25307 2518978 2191511 327467 4655136 4011939 643197 750112 750112 bad debt expense 2070870 2070870 other expenses 1050409 913856 136553 uncompensated care 592910 592910 66520886 56315153 10205733 0 1510973 1401549 530462 396842 7325609 7045024 1014900 868045 2502825 1669781 1056340 1009218 709387 973714 112189238 52687649 61857833 59501589 22229976 23750782 5167017 5177329 103905322 101793873 7498429 7976315 7000 42486179 41285060 7365641 6678343 11518769 12318060 68876018 68257778 X 23051960 20968901 9210010 9799860 2767334 2767334 35029304 33536095 103905322 101793873 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 57882 57882 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: Milton Hospital has contracted during the year a consultant to directly lobby for healthcare issues. The Hospital also indirectly contributes for lobbying through membership dues paid to various healthcare organizations. 13570314 1300596 14870910 22702395 -1050341 8081740 13570314 0 0 1297475 1297475 64233205 17337346 46895859 2815 2815 0 35859400 30144292 5715108 10796343 5203196 5593147 59501589 Short-term investments 10892650 F Board designated investments 602461 F Donor restricted investments 12255671 F 23750782 Debt Service Reserve Funds 4392479 Deferred Financing Costs, net 461234 Other Intangible Assets 49000 security deposits 105863 other assets 168753 5177329 Obligation under capital lease 141074 Pension Liability 9534664 Asset Retirement Obligation 120785 Due to Third party payors 2521537 12318060 67571122 66520886 1050236 -2543445 -2543445 -1493209 68338474 756379 10973 767352 67571122 0 67571122 66520886 0 66520886 0 66520886 Part V, Line 4: Description of Intended Use of Endowment Funds: The intended use of the organization's endowment funds are directed in accordance with the donor's intent including the preservation of the original gift and various purposes. Part X: Description of Uncertain Tax Positions Under FIN 48: The Hospital has been determined to be a not-for-profit corporation as described in Section 501(c)(3) of the Internal Revenue Code (the 'Code') and is exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. Accordingly, no provision for federal income taxes has been recorded in the accompanying financial statements. The Hospital annually evaluates its tax status and tax positions taken with respect to its operations and financial position. Tax years from 2006 through the current year remain open for examination by federal and state taxing authorities. Part XI, Line 8 - Other Adjustments: adjustment to Additional Minimun Pension Liability: -1090725. unrealized unrestricted appreciation on investments: 756379. Unrealized temp restricted appreciation on investments: 326890. net transfer to affiliates: -2731740. net unrealized loss on funds held by others: 195751. Part XII, Line 2d - Other Adjustments: net assets released from restrictions used in operations 1 1 1 X 1 X 1 1 1 0 1 1 814569 287292 527277 0.00790 3499284 2905611 593673 0.00890 4313853 3192903 1120950 0.01680 87042 6618 80424 0.00120 24148 24148 0.00040 111190 6618 104572 0.00160 4425043 3199521 1225522 0.01840 1 834182 0 26128586 24618152 1510434 X 1 1 Milton Hospital Inc

199 Reedsdale Road Milton MA 02186

X X X Part I, Line 3c: The Hospital follows the Commonwealth of MA (DHCFP's) regulations for eligibility free & discounted care. The regulations do consider Federal Poverty Guidelines in determining eligibility for services. Part I, Line 7: The cost/charge ratio was derived from the FY 10 DHCFP 403 cost report Schedule II. Part III, Line 4: The Hospital provides an allowance for doubtful accounts equal to estimated bad debt losses. The estimated losses are based upon historical collection experience together with a review of the current status of the existing receivables. The bad debt cost is based on the cost/charge ratio which was derived from the FY 10 DHCFP 403 cost report Schedule II. Part III, Line 8: The allocation of costs to the Medicare program is based on Medicare charges to total charges from the FY 10 HCFA-2552. There is no Medicare shortfall for this year to report as a community benefit. Part III, Line 9b: These patients would be excluded from the collection process based on much they would be eligible for financial assistance. Part VI, Line 2: The Hospital's last assessment was completed in 2008 using data collected from the Hospital's primary & secondary service towns in collaboration with a research firm. Currently the Hospital is working with graduate students from Boston University's School of Public Health to determine its current needs in the community. Part VI, Line 3: The Hospital posts information about financial assistance programs throughout the Hospital. During the registration process, the patient is notified that they may be eligible for financial assistance if they do not have insurance. In addition, the patient is notified on their bill to contact the Hospital's credit office to pursue assistance programs they feel they may be eligible for. Part VI, Line 4: Milton Hospital serves both an urban & suburban community south of Boston. Large portions of the Hospital's patients are Medicare, the Hospital also serves patients whom are uninsured or qualify for Medicaid. Part VI, Line 6: Almost all the Hospital's governing body resides in the primary & secondary service area. Milton Hospital extends privileges to all health care providers/physicians whom qualify based on its medical credentialing policies. MA X X X X 1 0 0 0 0 0 0 0 0 Joseph V Morrissey 471548 0 0 0 0 0 0 0 32744 0 504292 0 0 0 James C Holleran 299091 0 0 0 0 0 0 0 6348 0 305439 0 0 0 doris sinkevich 159805 0 0 0 0 0 0 0 258 0 160063 0 0 0 CYNTHIA M PAGE 131858 0 0 0 0 0 0 0 21580 0 153438 0 0 0 REGINA CARNATHAN 154973 0 0 0 0 0 0 0 19854 0 174827 0 0 0 massachusetts health & educational facilities authority 042456011 57586Cnm3 2005-11-01 33000000 MHEFA Series D Bonds for Capital Expenditures 0 0 32392907 1752287 94655 502360 28410735 2010 0 0 0 1 0 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 0 Richard Brooks split dollar life insurance policy X 73823 73823 0 1 1 robert duncan split dollar life insurance policy X 256966 256966 0 1 1 samuel b edelstein split dollar life insurance policy X 144512 144512 0 1 1 george geary split dollar life insurance policy X 272451 272451 0 1 1 dennis e smith split dollar life insurance policy X 120293 120293 0 1 1 868045 Bruce Alexander Board Member 253676 Purchased insurance from B.R. Alexander & Co. 0 mark t hodgman mark is the husband of a board member, jane hodgman 14375 mark t. hodgman was paid by the organization for his position as chief of medicine 0 Form 990, Part VI, Section A, line 6 milton hospital foundation, inc. is the sole member of the Organization and elects the board of directors. There are no classes of directors. milton hospital foundation, inc. has the power to remove directors, to fill vacancies, and to increase or decrease the size of the board. Form 990, Part VI, Section A, line 7a milton hospital foundation, inc. is the sole member of the Organization and elects the board of directors. There are no classes of directors. milton hospital foundation, inc. has the power to remove directors, to fill vacancies, and to increase or decrease the size of the board. Form 990, Part VI, Section A, line 7b milton hospital foundation, inc. is the sole member of the Organization and elects the board of directors. There are no classes of directors. milton hospital foundation, inc. has the power to remove directors, to fill vacancies, and to increase or decrease the size of the board. Form 990, Part VI, Section B, line 11 The organization prepares the Form 990 and the related disclosures with assistance and guidance from the hospital's tax advisors (CPA firm). The Form 990 is reviewed by the entities management team prior to submission to the board of directors and the IRS. Form 990, Part VI, Section B, line 12c The organization requires that employees, members and officers of the board of directors and any member of any committee disclose in writing (and update annually) all business and other relationships which might potentially create a conflict of interest as defined by the policy. The written disclosure shall include an itemization of any substantive conflict of interest for such individual by virtue of his or her activities. The conflict of interest policy is reviewed and communicated to ensure individuals with outside relationships do not inappropriately participate in business decisions of the Organization in which they are not independent. There have been no compliance issues to address, however if one did occur management would investigate the situation and address it as deemed necessary. Form 990, Part VI, Section B, line 15 The Executive Committee of the Board of Directors selects an executive compensation survey vendor to supply the committee with comparative detail on the compensation and benefit plan levels of the CEO, CFO and other senior level positions within the organization. The comparative data from this survey, which includes organizational size and scope of responsibilities,is assessed and the Executive Committee then determines the salary level for the CEO and CFO. Form 990, Part VI, Section C, line 19 The organization makes its governing documents, conflict of interest policy and financial statements available to the public upon request. Additionally, the organization's financial statements are available on the public charities website maintained by the Commonwealth of Massachusetts Attorney General. Form 990, Part I, Line 1 Continuation Also, a physician-led lecture added a final component to Milton Hospital's awareness campaign. Topics covered included the risks of colorectal cancer and the importance of colonoscopies in early detection and prevention. Milton Hospital Physician Organization 199 Reedsdale Road milton MA 02186 043213042 physician organization MA milton hospital inc Milton Hospital Foundation 199 Reedsdale Road Milton MA 02186 222566792 promote healthcare MA 501(C)3 supporting - type 1 Milton hospital development fund 199 Reedsdale Road milton MA 02186 222567057 fundraising MA 501(C)3 supported org. Milton Hospital Foundation community physician associates 199 Reedsdale Road milton MA 02186 043243146 provide medical care MA 501(C)3 medical care provide Milton Hospital Foundation horizon ventures 199 reedsdale road milton MA 02186 042853249 physician billing MA milton hospital foundation inc C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1