Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2010
Open to Public Inspection
A For the calendar year, or tax year beginning 10-01-2010 and ending 09-30-2011
BCheck if applicable:
CName of organization
NORTH ADAMS REGIONAL HOSPITAL
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
71 HOSPITAL AVENUE
 
Room/suite
City or town, state or country, and ZIP + 4
NORTH ADAMS, MA01247
D Employer identification number

04-1676720
E Telephone number

G Gross receipts $ 62,104,764
F Name and address of principal officer:
RICHARD PALMISANO
71 HOSPITAL AVENUE
NORTH ADAMS,MA01247
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.NBHEALTH.ORG
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1884
M State of legal domicile: MA
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: NORTH ADAMS REGIONAL HOSPITAL PROVIDES PRIMARY CARE AND SPECIALTY PHYSICIAN SERVICES TO INDIVIDUALS IN THE COMMUNITY. A WIDE RANGE OF INPATIENT AND OUTPATIENT SERVICES ARE AVAILABLE.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) .... 3 15
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 13
5 Total number of individuals employed in calendar year 2010 (Part V, line 2a) ... 5 566
6 Total number of volunteers (estimate if necessary) .... 6 116
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 136,213
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b 45,598
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 481,225 819,023
9 Program service revenue (Part VIII, line 2g) ......... 59,843,216 60,476,258
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 347,558 179,455
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 155,750 141,726
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 60,827,749 61,616,462
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 0 0
14 Benefits paid to or for members (Part IX, column (A), line 4) .... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 34,264,604 32,661,920
16a Professional fundraising fees (Part IX, column (A), line 11e).... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 31,152,663 30,383,419
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 65,417,267 63,045,339
19 Revenue less expenses. Subtract line 18 from line 12...... -4,589,518 -1,428,877
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............ 67,265,935 69,695,108
21 Total liabilities (Part X, line 26)............ 67,369,259 71,278,500
22 Net assets or fund balances. Subtract line 21 from line 20 ..... -103,324 -1,583,392
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid Preparer's Use Only Preparer's
signatureBig Right Arrow 		Date
right pointing bullet image Preparer’s taxpayer identification number
(see instructions)
Firm’s name (or yours
if self-employed),
address, and ZIP + 4Big Right Arrow




 		EIN right pointing bullet image
Phone no. right pointing bullet image
May the IRS discuss this return with the preparer shown above? (see instructions) .........
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2010)
Form 990 (2010)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III . . . . . . . . . .
1
Briefly describe the organization’s mission: THE MISSION OF NORTH ADAMS REGIONAL HOSPITAL IS TO PROVIDE EXCEPTIONAL HEALTHCARE FROM THE HEART.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the exempt purpose achievements for each of the organization’s three largest program services by expenses.
Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 22,237,745 including grants of $   ) (Revenue $ 22,667,539 )
THE ORGANIZATION PROVIDES INPATIENT SERVICES, INCLUDING INTERNAL MEDICINE, SURGERY, PEDIATRICS, GYNECOLOGY, OBSTETRICS, AND PSYCHIATRY ALONG WITH A CRITICAL-CARE UNIT FOR INTENSIVE-CARE AND CORONARY CARE PATIENTS. SEE SCHEDULE O FOR ADDITIONAL DETAILS ON PROGRAM SERVICE ACCOMPLISHMENTS AND COMMUNITY BENEFIT.
4b (Code:   ) (Expenses $ 13,746,439 including grants of $   ) (Revenue $ 26,901,409 )
THE HOSPITAL HAS A BROAD RANGE OF OUTPATIENT SERVICES, INCLUDING ONCOLOGY SERVICES, A DIAGNOSTIC IMAGING DEPARTMENT, CLINICAL LABORATORY SERVICES, CARDIAC TESTING, REHABILITATION CENTER, SPEECH THERAPY, ENDOSCOPY CENTER, AND SPECIALTY CLINICS. SEE SCHEDULE O FOR ADDITIONAL DETAILS ON PROGRAM SERVICE ACCOMPLISHMENTS AND COMMUNITY BENEFIT.
4c (Code:   ) (Expenses $ 9,055,676 including grants of $   ) (Revenue $ 10,771,097 )
THE ORGANIZATION OPERATES AN EMERGENCY ROOM, PROVIDING 24-HOUR SERVICE TO NEARLY 21,000 PATIENTS EACH YEAR. SEE SCHEDULE O FOR ADDITIONAL DETAILS ON PROGRAM SERVICE ACCOMPLISHMENTS AND COMMUNITY BENEFIT.
4d Other program services. (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet$ 45,039,860
Form 990 (2010)
Form 990 (2010)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment........
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part IIClick to see attachment.........................
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part III........................
5
 
 
6
Did the organization maintain any donor advised funds or any similar funds or accounts where donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete
Schedule D, Part IClick to see attachment.......................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IVClick to see attachment...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in term, permanent,or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
Yes
 
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click to see attachment
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
 
No
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, and program service activities outside the United States? If “Yes,” complete Schedule F, Part I.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II..
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III..
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II..........
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
Form 990 (2010)
Form 990 (2010)
Page 4
Part IV
Checklist of Required Schedules (continued)
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H..... Click to see attachment
20a
Yes
 
b
Did the organization attach its audited financial statement to this return? Note: All Form 990 filers that operate one or more hospitals must attach audited financial statements. ..... Click to see attachment
20b
Yes
 
21
Did the organization report more than $5,000 of grants and other assistance to governments and organizations in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II..
21
 
No
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III.....
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................ Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
No
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I......
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II...........................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor, or a grant selection committee member, or to a person related to such an individual? If “Yes,” complete Schedule L, Part III...............
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV .........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV...................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV..
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35
Is any related organization a controlled entity within the meaning of section 512(b)(13)? .....
35
 
No
a
Did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2........... Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2010)
Form 990 (2010)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V . . . . . . . . . .
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
157
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
566
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2010)
Form 990 (2010)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI . . . . . . . . . .
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year ..............
1a
15
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
13
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? ..
3
Yes
 
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Does the organization have members or stockholders? ................
6
Yes
 
7a
Does the organization have members, stockholders, or other persons who may elect one or more members of the governing body? .........................
7a
Yes
 
b
Are any decisions of the governing body subject to approval by members, stockholders, or other persons? ..
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Does the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” does the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with those of the organization? ....
10b
 
 
11a
Has the organization provided a copy of this Form 990 to all members of its governing body before filing the form?
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Does the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Are officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ...........................
12b
Yes
 
c
Does the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this is done ....................
12c
Yes
 
13
Does the organization have a written whistleblower policy? ...............
13
Yes
 
14
Does the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
 
No
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line a or b, describe the process in Schedule O. (See instructions.)
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If “Yes,” has the organization adopted a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and taken steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
MA
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you make these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization makes its governing documents, conflict of interest policy, and financial statements available to the public.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
CHRISTOPHER HICKEY
71 HOSPITAL AVENUE
NORTH ADAMS,MA01247
(413) 664-5507
Form 990 (2010)
Form 990 (2010)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII . . . . . . . . . .
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (check all that apply) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) BRUCE GRINNELL ESQ
CHAIR THROUGH 12/2010
 1.0 X   X       0 0 0
(2) STEPHEN FIX
TRUSTEE
 1.0 X           0 0 0
(3) JULIA BOLTON
TRUSTEE
 1.0 X           0 0 0
(4) JONATHAN CLUETT MD
VICE CHAIR BEG. 01/2011
 1.0 X           0 0 0
(5) ERWIN STUEBNER MD
TRUSTEE
 1.0 X           0 0 0
(6) STEPHEN KLASS
TRUSTEE THROUGH 01/2011
 1.0 X           0 0 0
(7) JANE ALLEN
TRUSTEE
 1.0 X           0 0 0
(8) WILLIAM GREENWALD
TRUSTEE
 1.0 X           0 0 0
(9) MARTHA STOREY
TRUSTEE
 1.0 X           0 0 0
(10) ARTHUR TURTON MD
CHAIR BEG. 01/2011
 10.0 X   X       0 0 0
(11) ELLEN BERNSTEIN
TRUSTEE
 1.0 X           0 0 0
(12) BRYON SHERMAN
SECRETARY
 1.0 X   X       0 0 0
(13) RICHARD JETTE
TRUSTEE
 1.0 X           0 0 0
(14) RICHARD PALMISANO
CEO/PRESIDENT
 10.0 X   X       523,126 27,533 38,081
(15) SUSAN YATES MD
TRUSTEE BEG. 01/2011
 1.0 X           0 249,808 17,889
(16) JEFFERY BATH MD
MEDICAL STAFF PRESIDENT
 1.0 X           5,000 0 0
(17) WILLIAM FRADO
TRUSTEE
 1.0 X           0 0 0
Form 990 (2010)
Form 990 (2010)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (check all that apply) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) CHRISTOPHER HICKEY
CFO/TREASURER
 10.0     X       269,262 0 6,387
(19) ROBERT CALWAY
VICE PRESIDENT OF BUSINESS DEV
 10.0       X     144,754 96,503 28,335
(20) ROBERT SILLS MD
ED PHYSICIAN
 36.0         X   267,125 0 28,923
(21) OSCAR RODRIGUEZ MD
ED PHYSICIAN
 36.0         X   284,743 0 35,280
(22) FRED LANDES MD
ED PHYSICIAN
 36.0         X   308,884 0 29,982
(23) FERNANDO PONCE MD
HOSPITAL PHYSICIAN
 36.0         X   258,090 0 23,028
(24) PAUL DONOVAN MD
ED PHYSICIAN
 36.0         X   331,727 0 37,779












1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 2,392,711 373,844 245,684
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 in reportable compensation from the organizationMediumBullet26
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
MOLARI INC
 
  		TEMP EMPLOYMENT SVCS 586,157
SCHWARTZ HANNUM PC
 
  		LEGAL SERVICES 1,083,339
SOUND PHYSICIANS OF MASSACHUSETTS
 
  		HOSPITALIST MGMT CO 1,428,889
NATIONAL WOUND CARE INC
 
  		WOUND CARE MGMT 554,094
SODEXHO USA
 
  		DIETARY & HSKP MGMT 882,191
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 in compensation from the organization MediumBullet13
Form 990 (2010)
Form 990 (2010)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, gifts, grants and other similar amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d  
e Government grants (contributions)1e 126,765
f All other contributions, gifts, grants, and
similar amounts not included above1f 		692,258
g Noncash contributions included in lines 1a-1f:$  
h Total. Add lines 1a-1f.......MediumBullet 819,023
Program Service Revenue Business Code
2a PATIENT SERVICE REVENUE 624,100 58,952,402 58,952,402    
b OTHER REVENUE 624,100 1,387,643 1,387,643    
c MAINTENANCE INCOME 811,000 45,188   45,188  
d HOUSEKEEPING INCOME 812,900 91,025   91,025  
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 60,476,258
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 68,770     68,770
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties............MediumBullet 0      
(i) Real (ii) Personal
6a Gross Rents 141,726  
b Less: rental expenses    
c Rental income or (loss) 141,726  
d Net rental income or (loss).......MediumBullet 141,726     141,726
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 598,987  
b Less: cost or other basis and sales expenses 488,302  
c Gain or (loss) 110,685  
d Net gain or (loss)..........MediumBullet 110,685     110,685
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Miscellaneous Revenue Business Code
11a            
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ......MediumBullet 0
12 Total revenue. See Instructions....MediumBullet 61,616,462 60,340,045 136,213 321,181
Form 990 (2010)
Form 990 (2010)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the U.S. See Part IV, line 21 0  
2 Grants and other assistance to individuals in the U.S. See Part IV, line 22 0  
3 Grants and other assistance to governments, organizations, and individuals outside the U.S. See Part IV, lines 15 and 16 0  
4 Benefits paid to or for members 0  
5 Compensation of current officers, directors, trustees, and key employees .... 996,707   996,707  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0      
7 Other salaries and wages 23,385,096 18,314,556 5,070,540  
8 Pension plan contributions (include section 401(k) and section 403(b) employer contributions) .... 2,697,264 2,053,752 643,512  
9 Other employee benefits ....... 3,625,064 2,751,790 873,274  
10 Payroll taxes ........... 1,957,789 1,474,208 483,581  
11 Fees for services (non-employees):        
a Management ...... 3,527,389   3,527,389  
b Legal ......... 872,763   872,763  
c Accounting ........... 19,219   19,219  
d Lobbying ........... 0      
e Professional fundraising. See Part IV, line 17.. 0  
f Investment management fees ...... 7,290   7,290  
g Other .......... 9,366,647 7,053,051 2,313,596  
12 Advertising and promotion .... 125,337 94,378 30,959  
13 Office expenses ....... 5,370,717 4,044,130 1,326,587  
14 Information technology ...... 6,454 4,860 1,594  
15 Royalties .. 0      
16 Occupancy ........... 926,400 697,576 228,824  
17 Travel ............ 57,135 43,022 14,113  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 79,257 59,680 19,577  
20 Interest ........... 2,405,453 1,811,297 594,156  
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 3,201,996 2,411,091 790,905  
23 Insurance .............. 540,729 407,167 133,562  
24 Other expenses. Itemize expenses not covered above. (Expenses grouped together and labeled miscellaneous may not exceed 5% of total expenses shown on line 25 below.)
a BAD DEBT 1,713,089 1,713,089    
b LICENSES, DUES & SUBSCRIPTIONS 231,217 174,106 57,111  
c RECRUITING 891 671 220  
d MEDICAL SUPPLIES & DRUGS 1,931,436 1,931,436    
e
f All other expenses        
25 Total functional expenses. Add lines 1 through 24f 63,045,339 45,039,860 18,005,479 0
26 Joint costs. Check here MediumBullet if following
SOP 98-2 (ASC 958-720). Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation 		       
Form 990 (2010)
Form 990 (2010)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing .......... 715,826 1 4,742,293
2 Savings and temporary cash investments ....... 5,556,882 2 4,820,789
3 Pledges and grants receivable, net ......... 5,000 3 0
4 Accounts receivable, net ......... 5,533,666 4 5,955,719
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..........   5  
6 Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
Schedule L ..........   6  
7 Notes and loans receivable, net .............   7  
8 Inventories for sale or use .............. 1,288,171 8 1,281,948
9 Prepaid expenses and deferred charges ............ 1,133,175 9 1,208,426
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 82,251,162
b Less: accumulated depreciation. ..... 10b 50,262,769 33,494,647 10c 31,988,393
11 Investments—publicly traded securities .......... 1,954,657 11 0
12 Investments—other securities. See Part IV, line 11 ......   12  
13 Investments—program-related. See Part IV, line 11 ..   13  
14 Intangible assets .........   14  
15 Other assets. See Part IV, line 11 ........... 17,583,911 15 19,697,540
16 Total assets. Add lines 1 through 15 (must equal line 34)... 67,265,935 16 69,695,108
Liabilities 17 Accounts payable and accrued expenses . 30,054,486 17 32,753,327
18 Grants payable ..........   18  
19 Deferred revenue .......... 631,274 19 153,784
20 Tax-exempt bond liabilities .......... 28,731,896 20 28,773,476
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22  
23 Secured mortgages and notes payable to unrelated third parties .. 6,491,554 23 7,558,065
24 Unsecured notes and loans payable to unrelated third parties .... 384,262 24 200,956
25 Other liabilities. Complete Part X of Schedule D..... 1,075,787 25 1,838,892
26 Total liabilities. Add lines 17 through 25..... 67,369,259 26 71,278,500
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets ..... -1,899,160 27 -3,423,052
28 Temporarily restricted net assets ..... 536,137 28 573,543
29 Permanently restricted net assets ..... 1,259,699 29 1,266,117
Organizations that do not follow SFAS 117, check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ..... -103,324 33 -1,583,392
34 Total liabilities and net assets/fund balances ..... 67,265,935 34 69,695,108
Form 990 (2010)
Form 990 (2010)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI . . . . . . . . . .
1
Total revenue (must equal Part VIII, column (A), line 12) . . .
1
61,616,462
2
Total expenses (must equal Part IX, column (A), line 25) . . . . .
2
63,045,339
3
Revenue less expenses. Subtract line 2 from line 1 . . . .
3
-1,428,877
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) . .
4
-103,324
5
Other changes in net assets or fund balances (explain in Schedule O) . . . .
5
-51,191
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) . . . . . .
6
-1,583,392
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII . . . . . . . . . .
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?..
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
 
No
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O............................
2c
 
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
 
 
Form 990 (2010)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
NORTH ADAMS REGIONAL HOSPITAL
 
Employer identification number

04-1676720
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization? ................
11g(i)
 
 
(ii) a family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
(i)
Name of supported organization 		(ii)
EIN 		(iii)
Type of organization (described on lines 1- 9 above or IRC section (see instructions)) 		(iv)
Is the organization in col. (i) listed in your governing document? 		(v)
Did you notify the organization in col. (i) of your support? 		(vi)
Is the organization in col. (i) organized in the U.S.? 		(vii)
Amount of support?
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3..            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..            
6 Public Support. Subtract line 5 from line 4.            
Section B. Total Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public Support (Subtract line 7c from line 6.)            
Section B. Total Support
Calendar year (or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)            
13 Total support (Add lines 9, 10c, 11 and 12.).            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2010
Name of organization
NORTH ADAMS REGIONAL HOSPITAL
 
Employer identification number

04-1676720
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule—
Special Rules
......................... Arrow Bullet   $    
Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990, or check the box in the heading of its
Form 990-EZ, or on line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part I
Name of organization
NORTH ADAMS REGIONAL HOSPITAL
  		Employer identification number

04-1676720
Part I
Contributors (see Instructions)
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part II
Name of organization
NORTH ADAMS REGIONAL HOSPITAL
  		Employer identification number

04-1676720
Part II
Noncash Property (see Instructions)
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part III
Name of organization
NORTH ADAMS REGIONAL HOSPITAL
  		Employer identification number

04-1676720
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
aggregating more than $1,000 for the year. (Complete columns (a) through (e) and the following line entry.)
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet $  
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.
SchCMd Bullet Attach to Form 990 or Form 990-EZ. SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
If the organization answered “Yes,” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes,” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes,” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35a (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
NORTH ADAMS REGIONAL HOSPITAL
 
Employer identification number

04-1676720
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization's direct and indirect political campaign activities on behalf of or in opposition to candidates for public office in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c) except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt funtion activities ....................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2010

Schedule C (Form 990 or 990-EZ) 2010
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check
B Check
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
Organization's
Totals 		(b) Affiliated Group
Totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in) 		(a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) Total
             
2a Lobbying non-taxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		         
             
c Total lobbying expenditures          
             
d Grassroots non-taxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		          
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2010


Schedule C (Form 990 or 990-EZ) 2010
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
(a)
Yes
No
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? If "Yes," describe in Part IV ..........................
Yes
 
 
j
Total. lines 1c through 1i ...................................
 
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carryover lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) if BOTH Part III-A, lines 1 and 2 are answered “No” OR if Part III-A, line 3 is answered “Yes”.
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) non-deductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ...........................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; and Part ll-B, line 1i.
Also, complete this part for any additional information.
Identifier Return Reference Explanation
OTHER LOBBYING ACTIVITIES SCHEDULE C, PART II-B, LINE 1(I) THE ORGANIZATION IS A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION AND THE MASSACHUSETTS HOSPITAL ASSOCIATION. THESE ORGANIZATIONS LOBBY ON MEMBERS' BEHALF USING 24.60% AND 20.52%, RESPECTIVELY, OF THEIR TIME.
Schedule C (Form 990 or 990EZ) 2010

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11, or 12.
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
NORTH ADAMS REGIONAL HOSPITAL
 
Employer identification number

04-1676720
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .......    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) ...    
4 Aggregate value at end of year .......    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds may be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit. ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a–2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06 ........ 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the taxable year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................
9
In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116, not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116, to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 52283D
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIV.
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current Year (b)Prior Year (c)Two Years Back (d)Three Years Back (e)Four Years Back
1a Beginning of year balance .... 913,063 863,063 843,063
b Contributions ........   50,000 20,000
c Investment earnings or losses ... 170    
d Grants or scholarships .....      
e Other expenditures for facilities
and programs ........ 		     
f Administrative expenses ....      
g End of year balance ...... 913,233 913,063 863,063
2
Provide the estimated percentage of the year end balance held as:
a
Board designated or quasi-endowment: SchDMd Bullet  
b
Permanent endowment: SchDMd Bullet100.000 %
c
Term endowment: SchDMd Bullet  
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
Yes
 
(ii) related organizations ........................
3a(ii)
 
No
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Investments—Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of investment (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   24,830 24,830
b Buildings ................   45,023,740 23,788,333 21,235,407
c Leasehold improvements ............        
d Equipment ................   34,477,566 25,451,657 9,025,909
e Other .................   2,725,026 1,022,779 1,702,247
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........SchDMdBullet 31,988,393
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) should equal Form 990, Part X, col.(B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) should equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) SECURITY DEPOSITS 10,000
(2) LIFE INSURANCE CSV 89,811
(3) OTHER ASSETS 11,272
(4) BENEFICIAL INT IN TRUSTS 599,811
(5) DUE FROM RELATED PARTY 18,726,989
(6) OTHER RECEIVABLES 259,657



Total. (Column (b) should equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 19,697,540
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Amount
Federal Income Taxes 0
EST DUE TO 3RD PARTIES 1,511,700
ASSET RETIREMENT OBLIGATION 327,192







Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)Small Bullet 1,838,892
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 4
Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1 Total revenue (Form 990, Part VIII, column (A), line 12) .................... 1  
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2  
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3  
4 Net unrealized gains (losses) on investments .......................... 4  
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV) ................................. 8  
9 Total adjustments (net). Add lines 4 - 8 ............................. 9  
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10  
Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV): ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIV): ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total Revenue. Add lines 3 and 4c. (This should equal Form 990, Part I, line 12.) ...... 5  
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIV): ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIV): ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This should equal Form 990, Part I, line 18.) ...... 5  
Part XIV
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
INTENDED USES OF ENDOWMENT FUNDS SCHEDULE D, PART V, LINE 4 ENDOWMENT FUNDS ARE RESTRICTED, BUT THE INCOME GENERATED IS AVAILABLE FOR USE BY THE ORGANIZATION. IT IS USUALLY UNRESTRICTED WITH A SPENDING CAP ON THE AMOUNT OF INCOME. THE EARNINGS MAY BE USED FOR A NUMBER OF USES INCLUDING DAY TO DAY OPERATIONS AND CAPITAL EXPENDITURES.
Schedule D (Form 990) 2010

Additional Data


Software ID:  
Software Version:  




SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
NORTH ADAMS REGIONAL HOSPITAL
 
Employer identification number

04-1676720
Part I
Charity Care and Certain Other Community Benefits at Cost
Yes
No
1a
Does the organization have a charity care policy? If "No," skip to question 6a...........
1a
Yes
 
b
If "Yes," is it a written policy? .......................
1b
Yes
 
2
If the organization has multiple hospitals, indicate which of the following best describes application of the charity care policy to the various hospitals.
3
Answer the following based on the charity care eligibility criteria that applies to the largest number of the organization's patients.
a
Does the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care to low
income individuals? If "Yes," indicate which of the following is the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Does the organization use FPG to determine eligibility for providing discounted care to low income individuals? If
"Yes," indicate which of the following is the family income limit for eligibility for discounted care: .....
3b
Yes
 
c
If the organization does not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization uses an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.
4
Does the organization's policy provide free or discounted care to the "medically indigent"? ......
4
Yes
 
5a
Does the organization budget amounts for free or discounted care provided under its charity care policy? ...
5a
Yes
 
b
If "Yes," did the organization's charity care expenses exceed the budgeted amount?.........
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discounted
care to a patient who was eligibile for free or discounted care?...............
5c
 
No
6a
Does the organization prepare an annual community benefit report?.............
6a
Yes
 
6b
If "Yes," does the organization make it available to the public? ..............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Charity Care and Certain Other Community Benefits at Cost
Charity Care and
Means-Tested Government Programs		 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Charity care at cost (from
Worksheets 1 and 2) .. 		    1,082,906 287,731 795,175 1.300 %
b Unreimbursed Medicaid (from
Worksheet 3, column a) . 		    8,196,239 7,707,456 488,783 0.800 %
c Unreimbursed costs—other means-tested government programs (from Worksheet 3, column b) ....     2,002,099 1,294,700 707,399 1.150 %
dTotal Charity Care and
Means-Tested Government Programs ..... 		    11,281,244 9,289,887 1,991,357 3.250 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) .... 		    122,309   122,309 0.200 %
f Health professions education
(from Worksheet 5) .. 		           
g Subsidized health services
(from Worksheet 6) .. 		    6,288,832 4,918,351 1,370,481 2.230 %
h Research (from Worksheet 7)            
i Cash and in-kind contributions
to community groups
(from Worksheet 8) .. 		           
jTotal Other Benefits ...     6,411,141 4,918,351 1,492,790 2.430 %
kTotal. Add lines 7d and 7j. ..     17,692,385 14,208,238 3,484,147 5.680 %
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 2
Part II
Community Building Activities Complete this table if the organization conducted any community building activities.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total            
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Does the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
 
No
2
Enter the amount of the organization's bad debt expense (at cost).....
2
679,504
3
Enter the estimated amount of the organization's bad debt expense (at cost) attributable to patients eligible under the organization's charity care policy ..
3
78,822
4
Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
18,116,293
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
21,614,928
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
-3,498,635
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.
Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.
Check the box that describes the method used:
Section C. Collection Practices
9a
Does the organization have a written debt collection policy? ...............
9a
Yes
 
b
If "Yes," does the organization's collection policy contain provisions on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance? Describe in Part VI......
9b
Yes
 
Part IV
Management Companies and Joint Ventures
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership% 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 3
Part VFacility Information
Section A. Hospital Facilities
(list in order of size, measured by total revenue per facility, from largest to smallest)
How many hospital facilities did the organization operate during the tax year?1
Name and address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe)
1 NORTH ADAMS REGIONAL HOSPITAL
71 HOSPITAL AVENUE
NORTH ADAMS,MA01247 		X X         X    
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:NORTH ADAMS REGIONAL HOSPITAL
Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 7
Part VFacility Information (continued)

Section C. Other Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, measured by total revenue per facility, from largest to smallest)
How many non-hospital facilities did the organization operate during the tax year?1
Name and address Type of Facility (Describe)
1 ADAMS REHABILITATION CENTER
1 COMMERCIAL STREET
ADAMS,MA01220 		PHYSICAL THERAPY
2
3
4
5
6
7
8
9
10
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 8
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the description required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 2, 4c, 6i, 7, 11i, 13i, 17l, 18l, 19e, 21d, 25, and 26.
2 Community health needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any community health needs assessments reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Identifier ReturnReference Explanation
PERCENT OF TOTAL EXPENSE SCHEDULE H, PART I, LINE 7, COLUMN F TO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, THE DENOMINATOR WHICH EQUALS TOTAL OPERATING EXPENSES PER PART IX, LINE 25 OF THE FORM 990 WAS REDUCED BY BAD DEBT EXPENSE.
COST TO CHARGE RATIO SCHEDULE H, PART I, LINE 7 THE COST TO CHARGE RATIO COMPUTED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATIONS ON IRS WORKSHEETS 1, 3, AND 6.
BAD DEBT EXPENSE SCHEDULE H, PART III, SECTION A, LINE 4 THERE WAS NOT A FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS AS NO FORMAL REPORT WAS PREPARED. HOWEVER, THE COSTING METHODOLOGY IS THE HOSPITAL'S COST TO CHARGE RELATIONSHIP APPLIED TO THE BAD DEBT PROVISION WHICH APPEARS ON THE INCOME STATEMENT. THIS SHOULD BE CONSIDERED A COMMUNITY BENEFIT SINCE SERVICE IS PROVIDED REGARDLESS OF ABILITY TO PAY AND FAILURE TO PAY DOES NOT RESULT IN ANY ACTION OTHER THAN SENDING STATEMENTS AND USING A COLLECTIONS AGENCY, TO ATTEMPT TO COLLECT THE PAYMENT. THE HOSPITAL DOES NOT PUT LIENS ON PATIENT ASSETS, REPORT NON PAYMENT TO CREDIT REPORTING AGENCIES, AND DOES NOT CHARGE INTEREST ON PATIENT DEBT. THE HOSPITAL WILL NOT REFUSE TO TREAT A PATIENT THAT CURRENTLY IS IN A BAD DEBT STATUS REGARDING PREVIOUS SERVICES AT THE HOSPITAL. LINE 2 WAS CALCULATED USING THE COST TO CHARGE RATIO TIMES BAD DEBT EXPENSE. BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY WAS DETERMINED USING POVERTY LIMIT DEMOGRAPHIC INFORMATION OBTAINED THROUGH THE US CENSUS BUREAU.
COMMUNITY BENEFIT SCHEDULE H, PART III, SECTION B, LINE 8 ALL OF THE SHORTFALL REPORTED ON LINE 7 SHOULD BE CONSIDERED A COMMUNITY BENEFIT. MEDICARE PAYMENTS DO NOT COVER THE COST OF DELIVERING THE SERVICE. PAYMENTS ARE DICTATED NOT BY ACTUAL COST BUT BY WHAT THE GOVERNMENT HAS TO SPEND. THE SHORTFALL HAS TO BE MADE UP BY OTHER PAYORS, IF POSSIBLE, SINCE MEDICARE BENEFICIARIES CANNOT BE BILLED FOR THE MEDICARE SHORTFALL. MEDICARE AS THE LARGEST PAYOR RESULTS IN A SIGNIFICANT SHORTFALL WHICH IS NOT RECOVERABLE GIVEN THAT OTHER PAYORS ARE BARELY PAYING AT COST. THE HOSPITAL DOES NOT DENY ANYONE SERVICE BECAUSE OF THEIR ABILITY TO PAY OR INSURANCE COVERAGE. THE AMOUNT FOR LINE 6 WAS TAKEN FROM THE MEDICARE COST REPORT WORKSHEET D-1 PART II AND WORKSHEET E PART B.
COLLECTION POLICY SCHEDULE H, PART III, SECTION C, LINE 9B PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE ARE EXEMPT FROM ANY COLLECTION OR BILLING PROCEDURES PURSUANT TO STATE REGULATIONS. THE HOSPITAL MAY SEEK COLLECTION ACTION FOR REQUIRED CO-PAYMENTS AND DEDUCTIBLES THAT ARE SET FORTH BY THE FINANCIAL ASSISTANCE PROGRAM THE PATIENT IS ENROLLED IN. THE HOSPITAL WILL NOT UNDERTAKE COLLECTION ACTION AGAINST ANY INDIVIDUAL THAT HAS BEEN APPROVED FOR MEDICAL HARDSHIP. THE HOSPITAL WILL NOT GARNISH LOW INCOME PATIENTS OR THEIR GUARANTOR'S WAGES OR EXECUTE LIENS. THE HOSPITALS INTERNAL FINANCIAL ASSISTANCE PROGRAM ALLOWS THE HOSPITAL TO CEASE ANY COLLECTION OR BILLING ACTIONS AGAINST A PATIENT WHO IS UNABLE TO PAY THE HOSPITAL BILL AT ANY TIME DURING THE BILLING PROCESS.
NEEDS ASSESSMENT:   REACH FOR COMMUNITY HEALTH, A DEPARTMENT OF NORTH ADAMS REGIONAL HOSPITAL, HAS OVERSIGHT RESPONSIBILITY FOR THE ORGANIZATION'S COMMUNITY BENEFITS PROGRAM. THE MISSION OF REACH IS TO IMPROVE THE HEALTH OF THE NORTHERN BERKSHIRE COMMUNITY THROUGH EDUCATION, OUTREACH, ADVOCACY, AND TREATMENT, IN PARTNERSHIP WITH COMMUNITY MEMBERS AND ORGANIZATIONS. REACH EXECUTES THE MAJORITY OF COMMUNITY BENEFITS PROGRAMS AND RESPONDS TO THE NEEDS OF THE COMMUNITY WITH ITS DIRECT HEALTH-RELATED PROGRAMMING, MUCH OF WHICH IS GRANT FUNDED. AS A DEPARTMENT OF NORTH ADAMS REGIONAL HOSPITAL, REACH HAS FINANCIAL SUPPORT FOR ITS CORE ADMINISTRATIVE FUNCTIONS; THIS SUPPORT ALLOWS REACH TO MAXIMIZE ITS CAPACITY TO DEVELOP, IMPLEMENT, AND EVALUATE THE NUMEROUS PROGRAMS AND INTERVENTIONS THAT IT PROVIDES IN THE COMMUNITY. A COMMUNITY NEEDS ASSESSMENT WAS CONDUCTED BY THE DIRECTOR OF REACH AND THE VP OF EXTERNAL AFFAIRS OF NORTH ADAMS REGIONAL HOSPITAL IN SEPTEMBER 2009 THAT INCLUDED DATA GATHERING AS WELL AS COMMUNITY SURVEYS. INFORMATION WAS COLLECTED FROM NARH DISCHARGE DATA, MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH (MASSCHIP DATA AND BUREAU OF ENVIRONMENTAL HEALTH DATA), BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS) DATA , U.S. CENSUS 2000 AND NORTHERN BERKSHIRE COMMUNITY COALITION 2009 PREVENTION NEEDS ASSESSMENT SURVEY, WHICH FOCUSES ON YOUTH. THE PROCESS INCLUDED A SURVEY THAT ASKED RESPONDENTS TO RATE DISEASES/HEALTH RISKS BY MOST CONCERN AND RATE CONTRIBUTING FACTORS TO HEALTH BY MOST CONCERN (E.G.: PCP AVAILABILITY). RESPONDENT GROUPS INCLUDED 13 AREA PHYSICIANS (15.6% RESPONSE RATE), 78 COMMUNITY ORGANIZATIONS, AND 1235 NBH CORPORATORS (30% RESPONSE RATE); THEY WERE SURVEYED USING AN INTERNET-BASED SURVEY. TWO GROUPS WERE SURVEYED THROUGH THE NORTHERN BERKSHIRE COMMUNITY COALITION. AT A COMMUNITY PLANNING MEETING THERE WERE 68 RESPONDENTS AND THE COALITION COMMUNITY OUTREACH WORKERS SURVEYED 69 AREA RESIDENTS. BASED UPON ALL OF THE COLLECTED DATA, THE COMMUNITY BENEFITS COMMITTEE IDENTIFIED THE FOLLOWING TARGET POPULATIONS: LOWER INCOME RESIDENTS, YOUTH, 18-34 YEAR OLD, AND ELDERS. THE COMMITTEE SELECTED THE FOLLOWING COMMUNITY BENEFITS PRIORITIES: HEALTHY EATING, PHYSICAL ACTIVITY, EMOTIONAL WELL-BEING & SUPPORT, AND SAFE CHOICES, ALL OF WHICH FALL UNDER THE UMBRELLA OF HEALTHY LIFESTYLES. REACH TARGETS ALL RESIDENTS OF NORTHERN BERKSHIRE COUNTY, WITH A PARTICULAR EMPHASIS ON THE UNINSURED AND UNDERINSURED. PRIMARY PREVENTION AND EARLY DETECTION ARE AT THE CORE OF REACH'S COMMUNITY INITIATIVES. EACH OF REACH'S NUMEROUS PROGRAMS IS BASED ON ASSESSMENT OF COMMUNITY NEED AND INCLUDES SPECIFIC PROCESS AND OUTCOME MEASURES.
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE:   IN NORTH BERKSHIRE COUNTY, ECU-HEALTH CARE, WHICH IS THE AREA'S ENROLLMENT SITE FOR ALL PUBLIC HEALTH PROGRAMS, PROVIDES FINANCIAL COUNSELING SERVICES FOR THE PATIENTS OF NORTH ADAMS REGIONAL HOSPITAL. ALL SELF-PAY PATIENTS, AT TIME OF SERVICE, ARE GIVEN INFORMATION ABOUT ECU-HEALTH CARE'S SERVICES AND ECU-HEALTH CARE CONTACTS PATIENTS IMMEDIATELY. ECU-HEALTH CARE'S PROGRAM SERVICES INCLUDE: - PROVIDING ONE-TO-ONE ENROLLMENT ASSISTANCE FOR ALL PUBLIC HEALTH PROGRAMS. THIS INCLUDES CASE-MANAGEMENT TO INSURE THAT PATIENTS COMPLETE APPLICATION PROCESSES. - CONDUCTING COMMUNITY OUTREACH AND MARKETING CAMPAIGNS FOR MASSHEALTH, COMMONWEALTH CARE, THE MEDICAL SECURITY PLAN, COMMONWEALTH CHOICE, PRESCRIPTION ADVANTAGE, AND ALL OTHER MEDICARE ASSISTANCE PROGRAMS. - WORKING CLOSELY WITH AREA PHYSICIAN GROUPS TO ENSURE THAT APPLICANTS HAVE PRIMARY CARE PROVIDERS. ECU-HEALTH CARE ALSO MAINTAINS A VOLUNTARY PHYSICIAN PROGRAM FOR THOSE NOT ELIGIBLE FOR PUBLIC HEALTH COVERAGE. IN ADDITION, WE HAVE AN AGREEMENT WITH A NUMBER OF LOCAL DENTISTS WHO HAVE AGREED TO PROVIDE SERVICES AT A REDUCED FEE TO LOWER INCOME RESIDENTS WITHOUT DENTAL COVERAGE.
COMMUNITY INFORMATION:   THE PRIMARY SERVICE AREA (PSA) FOR NORTH ADAMS REGIONAL HOSPITAL (NARH) IS COMPRISED OF THE FOLLOWING TOWNS: NORTH ADAMS, ADAMS, FLORIDA, CLARKSBURG, AND WILLIAMSTOWN. COMPARED TO MASSACHUSETTS, NORTH ADAMS REGIONAL HOSPITAL SERVES A POORER AND LESS EDUCATED POPULATION OF RESIDENTS. THIS IS IMPORTANT BECAUSE RESEARCH HAS DEMONSTRATED THAT SOCIOECONOMIC STATUS AFFECTS HEALTH. ACCORDING TO THE U.S. CENSUS IN 2000, 726 FAMILIES IN THE PSA LIVED BELOW THE FEDERAL POVERTY LEVEL. OF THOSE, 603 INCLUDED RELATED CHILDREN UNDER 18 AND 298 CHILDREN UNDER FIVE. THE RATES OF ELDERS AGE 65 PLUS WHO LIVE BELOW THE POVERTY LEVEL ALSO EXCEED STATE RATES. RESIDENTS WITH LESS THAN A NINTH GRADE EDUCATION EXCEED THAT FOR THE STATE IN ALL BUT WILLIAMSTOWN, AND EVEN THERE THE PERCENTAGE IS ONLY 5/10THS LESS THAN THE STATE RATE. IN ADAMS AND NORTH ADAMS, THE PERCENTAGE OF PEOPLE WITHOUT A HIGH SCHOOL DIPLOMA EXCEEDS THE STATE RATE BY 5.9 PERCENTAGE POINTS AND 6.7 PERCENTAGE POINTS, RESPECTIVELY. BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS) DATA (2002-2007) INDICATES THE RATE OF INSURED PEOPLE IN THE BERKSHIRES COMMUNITY HEALTH NETWORK ASSOCIATION (CHNA) IS BELOW THE STATE FOR MEN BUT ABOVE THE STATE RATE OVERALL AND FOR WOMEN. WHILE 13 PERCENT OF MASSACHUSETTS RESIDENTS 18-34 REPORTED BEING WITHOUT INSURANCE, THE RATE IS 19 PERCENT IN THE BERKSHIRES. THE RATE OF UNINSURED PEOPLE 55-64 IS 25 PERCENT HIGHER IN THE BERKSHIRES THAN IN THE STATE, AND TWO PERCENT OF PEOPLE 65+ IN THE BERKSHIRES REPORT BEING UNINSURED. FURTHER, ACCORDING TO BRFSS DATA, THE PERCENTAGE OF RESPONDENTS REPORTING THEY WERE UNABLE TO SEE A DOCTOR IN THE PAST YEAR (2003-2007) DUE TO COST WAS HIGHER OVERALL AND FOR WOMEN THAN THE STATE AND THE PERCENTAGE OF RESPONDENTS IN THE BERKSHIRES AGES 45-54 WHO SAID THEY COULD NOT SEE A DOCTOR BECAUSE OF COST WAS 49 PERCENT HIGHER THAN THE STATE RATE. THE ELDER POPULATION IN NORTHERN BERKSHIRE COMPRISES A MUCH HIGHER PERCENTAGE OF THE POPULATION AS A WHOLE THAN IT DOES FOR THE STATE OF MASSACHUSETTS. THE PERCENTAGE OF THE ELDERLY PEOPLE 85 AND OLDER, IS MORE THAN 1% HIGHER IN NORTHERN BERKSHIRE. THE PERCENTAGES OF THE YOUNGER ELDERS ARE HIGHER IN NORTHERN BERKSHIRE AS WELL.
COMMUNITY BUILDING ACTIVITIES:   THE NORTHERN BERKSHIRE COMMUNITY IS KNOWN FOR ITS COLLABORATIVE APPROACH IN WORKING ON VARIOUS PROBLEMS. TO SERVE OUR TARGET POPULATION, REACH AND NORTH ADAMS REGIONAL HOSPITAL OFTEN COLLABORATE WITH LOCAL ENTITIES, INCLUDING THE FOLLOWING: NORTHERN BERKSHIRE COMMUNITY COALITION; ECU HEALTH CARE; CHILDCARE OF THE BERKSHIRES; BERKSHIRE COMMUNITY ACTION COUNCIL; WILLIAMSTOWN MEDICAL ASSOCIATES AND OTHER MEDICAL GROUPS; BERKSHIRE NURSING FAMILIES; THE HORIZON ADVISORY BOARD AND ELDER SERVICES OF BERKSHIRE COUNTY; AREA COUNCILS ON AGING; NORTHERN BERKSHIRE UNITED WAY; TARGET: HUNGER; WILLIAMS COLLEGE; MASSACHUSETTS COLLEGE OF LIBERAL ARTS (MCLA); THE NORTH ADAMS PUBLIC SCHOOLS, ADAMS AND CHESHIRE REGIONAL SCHOOL DISTRICT, MASS MOCA AND THE BERKSHIRE FOOD PROJECT, AMONG OTHERS.
OTHER INFORMATION:   IN ADDITION TO THE GOVERNING BOARD, THE NBH BOARD OF TRUSTEES, A COMMUNITY BOARD, NORTHERN BERKSHIRE HEALTHCARE CORPORATORS, SERVES AS LIAISON TO THE NORTHERN BERKSHIRE COMMUNITY AND HAS THE AUTHORITY TO APPROVE NOMINATIONS TO THE BOARD OF CORPORATORS AND THE NBH BOARD OF TRUSTEES, AND MAKE ADJUSTMENTS IN THE BYLAWS GOVERNING NBH. CORPORATORS ARE ELECTED FROM THE COMMUNITIES SERVED BY NBH AND ITS AFFILIATES.
AFFILIATED HEALTH CARE SYSTEM ROLES:   NORTH ADAMS REGIONAL HOSPITAL IS A SUBSIDIARY OF NORTHERN BERKSHIRE HEALTHCARE, LOCATED IN BERKSHIRE COUNTY IN THE NORTHWESTERN CORNER OF MASSACHUSETTS. THE HEALTH SYSTEM, IN ADDITION TO THE HOSPITAL, INCLUDES THE VISITING NURSE ASSOCIATION AND HOSPICE OF NORTHERN BERKSHIRE. REACH FOR COMMUNITY HEALTH EXECUTES THE MAJORITY OF COMMUNITY BENEFITS PROGRAMS AND RESPONDS TO THE NEEDS OF THE COMMUNITY WITH ITS DIRECT HEALTH-RELATED PROGRAMMING, MUCH OF WHICH IS GRANT FUNDED. AS A DEPARTMENT OF NORTH ADAMS REGIONAL HOSPITAL, REACH HAS FINANCIAL SUPPORT FOR ITS CORE ADMINISTRATIVE FUNCTIONS; THIS SUPPORT ALLOWS REACH TO MAXIMIZE ITS CAPACITY TO DEVELOP, IMPLEMENT, AND EVALUATE THE NUMEROUS PROGRAMS AND INTERVENTIONS THAT IT PROVIDES IN THE COMMUNITY. THE REACH COMMUNITY BENEFITS COMMITTEE, IS A STANDING COMMITTEE OF THE NBH BOARD OF TRUSTEES AND HAS DIRECT OVERSIGHT OF THE NARH COMMUNITY BENEFIT PLAN AND SUBSEQUENT ACTIVITY. REACH FOR COMMUNITY HEALTH IS MANAGED BY A DIRECTOR WITH OVERSIGHT BY THE SENIOR EXECUTIVE GROUP OF NORTHERN BERKSHIRE HEALTHCARE.
ALL STATES IN WHICH ORGANIZATION FILES A COMMUNITY BENEFIT REPORT:   MASSACHUSETTS
Schedule H (Form 990) 2010
Additional Data


Software ID:  
Software Version:  
Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
NORTH ADAMS REGIONAL HOSPITAL
 
Employer identification number

04-1676720
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement orprovision of all the expenses described above? If "No," complete Part III to explain....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....
2
 
 
3
Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ...............
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regs. section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2010

Schedule J (Form 990) 2010
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use Schedule J-1 if additional space needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) must equal the applicable column (D) or column (E) amounts on Form 990, Part VII, line 1a.
(A) Name (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported in prior
Form 990 or
Form 990-EZ
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) RICHARD PALMISANO (i)
(ii)		 340,527
17,922 		47,500
2,500 		135,099
7,111 		17,480
920 		18,697
984 		559,303
29,437 		122,695
6,458
(2) CHRISTOPHER HICKEY (i)
(ii)		 232,072
0 		34,800
0 		2,390
0 		5,756
0 		631
0 		275,649
0 		0
0
(3) ROBERT SILLS MD (i)
(ii)		 265,556
0 		0
0 		1,569
0 		12,500
0 		16,423
0 		296,048
0 		0
0
(4) OSCAR RODRIGUEZ MD (i)
(ii)		 281,049
0 		0
0 		3,694
0 		15,946
0 		19,334
0 		320,023
0 		0
0
(5) FRED LANDES MD (i)
(ii)		 304,375
0 		0
0 		4,509
0 		10,648
0 		19,334
0 		338,866
0 		0
0
(6) FERNANDO PONCE MD (i)
(ii)		 255,492
0 		0
0 		2,598
0 		15,000
0 		8,028
0 		281,118
0 		0
0
(7) ROBERT CALWAY (i)
(ii)		 128,113
85,409 		15,302
10,201 		1,339
893 		6,939
4,626 		10,062
6,708 		161,755
107,837 		0
0
(8) SUSAN YATES MD (i)
(ii)		 0
245,758 		0
0 		0
4,050 		0
7,500 		0
10,389 		0
267,697 		0
0
(9) PAUL DONOVAN MD (i)
(ii)		 327,218
0 		0
0 		4,509
0 		19,293
0 		18,486
0 		369,506
0 		0
0







Schedule J (Form 990) 2010

Schedule J (Form 990) 2010
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
COMPENSATION DETERMINATION SCHEDULE J, PART I, LINE 3 NORTHERN BERKSHIRE HEALTHCARE, A RELATED ORGANIZATION, DETERMINES COMPENSATION FOR THE CEO USING THE FOLLOWING METHODS: -COMPENSATION COMMITTEE -INDEPENDENT COMPENSATION CONSULTANT -FORM 990 OF OTHER ORGANIZATIONS -WRITTEN EMPLOYMENT CONTRACT -COMPENSATION SURVEY OR STUDY -APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE
SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN SCHEDULE J, PART I, LINE 4B RICHARD PALMISANO, CEO/PRESIDENT, PARTICIPATES IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN. IN THE CURRENT YEAR, HE TOOK A DISTRIBUTION FROM THE PLAN OF $129,153. THIS AMOUNT WAS INCLUDED IN HIS COMPENSATION IN PART VII AND SCHEDULE J, PART II, AND IS SHOWN IN SCHEDULE J, PART II, COLUMN F, AS IT WAS INCLUDED IN INCOME ON PRIOR FORM 990'S AS CONTRIBUTIONS.
BONUSES SCHEDULE J RICHARD PALMISANO, CHRISTOPHER HICKEY, AND ROBERT CALWAY RECEIVE AN ANNUAL BONUS OF UP TO A CERTAIN PERCENT OF BASE SALARY UPON ACCOMPLISHMENT OF GOALS AND OBJECTIVES ESTABLISHED ANNUALLY BY THE BOARD. THEY ARE PAID BY NORTHERN BERKSHIRE HEALTHCARE, WITH A PORTION OF COMPENSATION, INCLUDING BONUS, ALLOCATED TO RELATED ORGANIZATIONS.
Schedule J (Form 990) 2010

Additional Data


Software ID:  
Software Version:  
Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Schedule O (Form 990).
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
NORTH ADAMS REGIONAL HOSPITAL
 
Employer identification number
04-1676720
Part I
Bond Issues
(a) Issuer Name (b) Issuer EIN (c) CUSIP # (d) Date Issued (e) Issue Price (f) Description of Purpose (g) Defeased (h) On
Behalf of
Issuer 		(i) Pool
financing
Yes No Yes No Yes No
A MASSACHUSETTS HEALTH & FACILITIES AUTH
  		04-2456011 57586CDS1 10-13-2004 26,014,649 CAPITAL IMPROVEMENTS, REFUND PRIOR   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired. . . . .        
2 Amount of bonds defeased . . . .        
3 Total proceeds of issue . . . . 26,014,649      
4 Gross proceeds in reserve funds . . 2,607,120      
5 Capitalized interest from proceeds.        
6 Proceeds in refunding escrow. . . . . 5,988,818      
7 Issuance costs from proceeds . . . 555,293      
8 Credit enhancement from proceeds.        
9 Working capital expenditures from proceeds . .        
10 Capital expenditures from proceeds . . 16,863,419      
11 Other spent proceeds . .        
12 Other unspent proceeds. . .        
13 Year of substantial completion . . . 2006
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? X              
15 Were the bonds issued as part of an advance refunding issue?   X            
16 Has the final allocation of proceeds been made? . . X              
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . X              
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . .   X            
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . .   X            
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2010
Schedule K (Form 990) 2010
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use?   X            
b Are there any research agreements that may result in private business use of bond-financed property? . .   X            
c Does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts or research agreements relating to the financed property? .   X            
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . . . . . . . . . . . . SchKMediumBullet 0 %      
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . SchKMediumBullet 0 %      
6 Total of lines 4 and 5 . . .. . . . . . 0 %      
7 Has the organization adopted management practices and procedures to ensure the post-issuance compliance of its tax-exempt bond liabilities?   X            
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue? . . .   X            
2 Is the bond issue a variable rate issue?   X            
3a Has the organization or the governmental issuer entered into a hedge with respect to the bond issue?   X            
b Name of provider .  
  		 
  		 
  		 
 
c Term of hedge . .        
d Was the hedge superintegrated? .                
e Was a hedge terminated? .                
4a Were gross proceeds invested in a GIC? .   X            
b Name of provider .  
  		 
  		 
  		 
 
c Term of GIC . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? .                
5 Were any gross proceeds invested beyond an available temporary period? .   X            
6 Did the bond issue qualify for an exception to rebate? . . .   X            
Schedule K (Form 990) 2010

Schedule K (Form 990) 2010
Page 3
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
Schedule K (Form 990) 2010

Additional Data


Software ID:  
Software Version:  

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
NORTH ADAMS REGIONAL HOSPITAL
 
Employer identification number

04-1676720
Identifier Return Reference Explanation
MISSION FORM 990, PART I, LINE 1 THE MISSION OF NORTHERN BERKSHIRE HEALTHCARE IS TO PROVIDE EXCEPTIONAL HEALTHCARE FROM THE HEART. NORTHERN BERKSHIRE HEALTHCARE INCLUDES NORTH ADAMS REGIONAL HOSPITAL, THE VISITING NURSE ASSOCIATION & HOSPICE OF NORTHERN BERKSHIRE, NORTHERN BERKSHIRE COMMUNITY SERVICES, NORTHERN BERKSHIRE REALTY, AND THE NBH PHYSICIANS GROUP. A FULL SERVICE COMMUNITY HOSPITAL, NARH INCLUDES 24 HOUR EMERGENCY CARE, DIAGNOSTIC IMAGING, LABORATORY, BIRTHING CENTER, OB, SURGERY, PSYCHIATRY, PHYSICAL REHABILITATION, INPATIENT, AND OUTPATIENT CARE. IT IS THE PRIMARY HOSPITAL FOR OVER 40,000 RESIDENTS OF NORTHERN BERKSHIRE COUNTY. REACH IS THE HEALTH EDUCATION AND HEALTH PROMOTION ARM OF NORTHERN BERKSHIRE HEALTHCARE AND OVERSEES THE COMMUNITY BENEFITS PROGRAM FOR NORTH ADAMS REGIONAL HOSPITAL. THE MISSION OF REACH IS TO IMPROVE THE HEALTH OF THE NORTHERN BERKSHIRE COMMUNITY THROUGH EDUCATION, OUTREACH, ADVOCACY AND TREATMENT, IN PARTNERSHIP WITH COMMUNITY MEMBERS AND ORGANIZATIONS. REACH IS NOW A DEPARTMENT OF NARH AND THEY CONTINUE TO HAVE THE RESPONSIBILITY OF OVERSEEING COMMUNITY HEALTH BENEFITS AND NEEDS.
PROGRAM SERVICE ACCOMPLISHMENTS FORM 990, PART III, LINE 4 NORTH ADAMS REGIONAL HOSPITAL (NARH) IS A NON-PROFIT, ACUTE-CARE, COMMUNITY HOSPITAL LICENSED BY THE MASSACHUSETTS DEPARTMENT OF HEALTH TO PROVIDE PRIMARY-CARE SERVICES, SPECIALTY-PHYSICIAN SERVICES, DIAGNOSTIC AND TREATMENT SERVICES, AND WOUND CARE SERVICES. NARH IS A DESIGNATED MEDICARE-DEPENDENT HOSPITAL. IN ADDITION, THE ADAMS AND NORTH ADAMS ARE DESIGNATED AS A LOW INCOME PRIMARY CARE HEALTH PROFESSIONAL SHORTAGE AREA FOR ADULT PRIMARY CARE, OBSTETRICS AND DENTISTRY AND MAINTAINS A HPSA SCORE OF 13. THE HOSPITAL PROVIDES A RANGE OF INPATIENT AND OUTPATIENT SERVICES, INCLUDING THE MAJOR SPECIALTIES OF INTERNAL MEDICINE, SURGERY, PEDIATRICS, GYNECOLOGY, OBSTETRICS, AND PSYCHIATRY. IN ADDITION, IT HAS A CRITICAL-CARE UNIT, WHICH CARES FOR BOTH INTENSIVE-CARE PATIENTS AND CORONARY-CARE PATIENTS. MEDICAL/SURGICAL SERVICES: THE HOSPITAL HAS ONE MEDICAL/SURGICAL FLOOR WITH 25 BEDS INCLUDING 5 BEDS FOR PEDIATRIC PATIENTS. THERE ARE 14 DUAL OCCUPANCY PATIENT ROOMS AND 3 PRIVATE ROOMS. THIS FLOOR WAS MOST RECENTLY RENOVATED IN 2009. CRITICAL CARE & TELEMETRY UNIT: THIS UNIT CAN MONITOR 8 CCU AND 4 TELEMETRY PATIENTS. THE UNIT WAS FULLY RENOVATED IN 2006 AND IS LICENSED FOR 13 BEDS. FIVE BEDS ARE NON-MONITORED AND USED FOR TELEMETRY OR STEP-DOWN BEDS AND 8 ARE CRITICAL CARE BEDS. TELEMETRY PATIENTS REQUIRE CARDIAC MONITORING BUT DO NOT REQUIRED CRITICAL CARE NURSING. NARH DOES NOT CARE FOR TRAUMA PATIENTS. THESE PATIENTS ARE REFERRED OUT TO TERTIARY CARE FACILITIES IN EITHER ALBANY OR SPRINGFIELD, MASSACHUSETTS. PEDIATRICS: THE HOSPITAL'S PEDIATRIC UNIT IS LOCATED ON THE MEDICAL/SURGICAL FLOOR OF THE HOSPITAL. OBSTETRICAL SERVICES: THE HOSPITAL'S MATERNITY WARD OFFERS FAMILY-CENTERED MATERNITY CARE, WHICH IS A FLEXIBLE PROGRAM DESIGNED TO MEET THE NEEDS OF NEW PARENTS AND INFANTS. THE HOSPITAL CURRENTLY HAS FIVE BOARD CERTIFIED OBSTETRICIANS/GYNECOLOGISTS ON STAFF. THE ENTIRE SUITE WAS RENOVATED IN 2007. IMPROVEMENTS INCLUDED THE ENLARGEMENT OF THE INDIVIDUAL PATIENT ROOMS AND THE ADDITION OF PRIVATE BATHROOMS AND OTHER AMENITIES. RENOVATIONS INCLUDED FIVE PRIVATE POST-PARTUM ROOMS, A MODERNIZED NURSERY, THREE LABOR AND DELIVERY ROOMS, A NEW NURSES' STATION AND A NEW FATHERS' AND FAMILY WAITING AREA. SURGERY DEPARTMENT: THE HOSPITAL MAINTAINS THREE FULL-SERVICE OPERATING ROOMS (WITH A FOURTH USED TO IMPROVE CASE TURNAROUND AND FOR FUTURE EXPANSION) AND SIXTEEN PRE- AND POST-OPERATIVE AMBULATORY-CARE OPERATING ROOMS WITH NINE RECOVERY BEDS FOR USE IN THE POST-SURGICAL STABILIZATION OF PATIENTS. THE HOSPITAL HAS 30 BOARD CERTIFIED SURGEONS, 3 BOARD ELIGIBLE SURGEONS, AND 1 ADDITIONAL SURGEON ON STAFF, REPRESENTING MAJOR SURGICAL SPECIALTIES SUCH AS GENERAL SURGERY, UROLOGY, GYNECOLOGY AND ORTHOPEDIC SURGERY. THE AMBULATORY SURGERY DEPARTMENT WAS COMPLETELY RENOVATED IN 2007 AND CONTAINS THREE FULLY-EQUIPPED OPERATING ROOMS, TWO FULLY-EQUIPPED ENDOSCOPY SUITES, PRIVATE EXAMINATION, CONSULTATION AND RECOVERY ROOMS, AND A NEW WAITING LOUNGE. PSYCHIATRIC SERVICES: THE HOSPITAL'S PSYCHIATRIC UNIT, GREYLOCK PAVILION ("GREYLOCK"), COMMENCED OPERATION IN 1989. IT IS A LOCKED UNIT WITH 20 BEDS. GREYLOCK TREATS A RANGE OF PATIENTS FROM AGE 16 AND UP AND OPERATES A UNIT SPECIALIZING IN THE TREATMENT OF PATIENTS DUALLY DIAGNOSED WITH MENTAL ILLNESS AND SUBSTANCE ABUSE. EILEEN A. BARRETT ONCOLOGY CENTER: IN 1994, THE HOSPITAL OPENED THE EILEEN A. BARRETT ONCOLOGY CENTER, WHICH WAS FINANCED BY PRIVATE CONTRIBUTIONS, TO PROVIDE TREATMENT OF AND SERVICES TO CANCER PATIENTS. TREATMENT AVAILABLE AT THE HOSPITAL FOR ONCOLOGY CARE INCLUDES CHEMOTHERAPY AND SURGERY. OUTPATIENT CHEMOTHERAPY IS AVAILABLE AT THE HOSPITAL THROUGH COLLABORATION WITH NORTHERN BERKSHIRE HEMATOLOGY AND ONCOLOGY. THE HOSPITAL HAS FIVE BOARD CERTIFIED ONCOLOGISTS AND REFERRAL ARRANGEMENTS WITH VARIOUS HOSPITAL AND HOSPICE PROGRAMS. DIAGNOSTIC IMAGING SERVICES: THE HOSPITAL PROVIDES A RANGE OF DIAGNOSTIC AND THERAPEUTIC SERVICES TO BOTH INPATIENTS AND OUTPATIENTS, INCLUDING 64-SLIDE CT SCAN, DIGITAL ECHOCARDIOGRAPHY, NUCLEAR MEDICINE, DIGITAL X-RAY, DIGITAL ULTRASOUND, DIGITAL MAMMOGRAPHY, MRI, STEREOTACTIC BREAST BIOPSY AND DIGITAL BONE DENSITOMETRY. TO MEET THE GROWING DEMAND FOR DIAGNOSTIC IMAGING SERVICES, THE HOSPITAL ADDED A PICTURE ARCHIVING AND COMMUNICATIONS SYSTEMS (PACS) IN 2007. MAMMOGRAPHY, ECHOCARDIOLOGY, ULTRASOUND AND BONE DENSITOMETRY WERE UPGRADED TO DIGITAL TECHNOLOGY IN 2009 AND THE MRI IS SCHEDULED TO BE REPLACED WITH A FIXED UNIT, LARGE BORE OPEN MAGNET IN THE SUMMER OF 2010. THE HOSPITAL HAS 3 BOARD CERTIFIED RADIOLOGISTS ON STAFF. CLINICAL LABORATORY: THE LABORATORY OFFERS BOTH ANATOMICAL AND CLINICAL PATHOLOGY PROGRAMS AND THERE ARE 3 BOARD CERTIFIED PATHOLOGISTS ON STAFF. THE LABORATORY PERFORMS 400,000 TESTS EACH YEAR. PHARMACY: THE HOSPITAL PHARMACY MAINTAINS AN INPATIENT LICENSE ONLY AND SERVES AN EMPLOYEE BENEFIT FUNCTION BY FILLING PRESCRIPTION REQUESTS FOR EMPLOYEES. PHARMACY SERVICES TO THE BEDSIDE ARE DELIVERED VIA OMNICELL MEDICATION CABINETS ON EACH OF THE MEDICAL FLOORS AND UTILIZATION OF THE MEDITECH PHARMACY MODULE. PHARMACY SERVICES ARE AVAILABLE SIXTEEN HOURS PER DAY AND NIGHT HOURS ARE COVERED BY CARDINAL HEALTH SERVICES VIA REMOTE ACCESS TO MEDITECH. REHABILITATION PROGRAMS: THE HOSPITAL HAS A LONG HISTORY AS AN OUTPATIENT REHABILITATION PROVIDER. THE HOSPITAL'S OUTPATIENT REHABILITATION CENTER INCLUDES A FULL RANGE OF SPEECH THERAPY, OCCUPATIONAL THERAPY, AND PHYSICAL THERAPY. THE HOSPITAL MAINTAINS A COMMUNITY REHABILITATION SERVICE IN ADAMS, MASSACHUSETTS. ENDOSCOPY CENTER: THE ENDOSCOPY UNIT OF THE HOSPITAL HOUSES ONE OF THE FASTEST GROWING SERVICES OFFERED BY THE HOSPITAL. THE ENDOSCOPY SUITE WAS RENOVATED AS PART OF THE ORGANIZATION'S 2004-7 RENOVATION PROJECT AND FULL HIGH-DEFINITION ENDOSCOPY IMAGING WAS ADDED IN 2009. OUTPATIENT SERVICES: THE HOSPITAL HAS A BROAD RANGE OF OUTPATIENT SERVICES. THESE SERVICES INCLUDE THE EMERGENCY DEPARTMENT; ONCOLOGY SERVICES; A DIAGNOSTIC IMAGING DEPARTMENT, INCLUDING MRI, 64-SLICE CT SCAN, DIGITAL X-RAY, DIGITAL MAMMOGRAPHY, DIGITAL ULTRASOUND, DIGITAL BONE DENSITY; NUCLEAR MEDICINE AND A PACS SYSTEM; CLINICAL LABORATORY SERVICES; CARDIAC TESTING; REHABILITATION CENTER FOR PHYSICAL OCCUPATIONAL, AND SPEECH THERAPY; ENDOSCOPY CENTER; AND SPECIALTY CLINICS. EMERGENCY SERVICES: THE HOSPITAL'S EMERGENCY DEPARTMENT IS AN ACTIVE COMPONENT OF THE HOSPITAL. THE HOSPITAL'S EMERGENCY DEPARTMENT PROVIDES 24-HOUR SERVICE TO NEARLY 21,0000 PATIENTS EACH YEAR. ALL PHYSICIANS WORKING IN THE EMERGENCY DEPARTMENT ARE CERTIFIED IN ADVANCED CARDIAC LIFE SUPPORT AND ADVANCED TRAUMA LIFE SUPPORT. ALL NURSES WORKING IN THE EMERGENCY DEPARTMENT ARE CERTIFIED IN ADVANCED CARDIAC LIFE SUPPORT AND PEDIATRIC EMERGENCY NURSING. THE EMERGENCY DEPARTMENT UNDERWENT A SIGNIFICANT RENOVATION AND EXPANSION IN 2007. THE IMPROVEMENTS INCLUDED AN EXPANSION OF THE SERVICE AREA BY 50% WITH ADDITIONAL EXAM ROOMS AND THE ADDITION OF RADIOLOGY SERVICES IN THE DEPARTMENT TO EXPEDITE DIAGNOSTIC SERVICES. THESE RENOVATIONS CREATED AN EMERGENCY DEPARTMENT THAT CONTAINS SEVENTEEN ROOMS, INCLUDING FOUR NEW CARDIAC OBSERVATION ROOMS, FIVE ACUTE- AND SUB-ACUTE EXAMINATION AREAS, TWO PRIVATE CARDIAC EXAMINATION ROOMS, A NEW GYNECOLOGICAL EXAMINATION AREA AND A PRIVATE OBSERVATION ROOM.
AUDITED FINANCIAL STATEMENTS FORM 990, PART IV, LINE 20B THE ORGANIZATION ATTACHED ITS MOST RECENT AUDITED FINANCIAL STATEMENTS FOR FISCAL YEAR ENDED 9/30/09. THE ORGANIZATION DID NOT HAVE AUDITED FINANCIAL STATEMENTS FOR FISCAL YEARS ENDED 9/30/10 OR 9/30/11. MANAGEMENT SERVICES FORM 990, PART VI, SECTION A, LINE 3 NORTHERN BERKSHIRE HEALTHCARE, A RELATED ORGANIZATION, PROVIDES MANAGEMENT SERVICES TO THE ORGANIZATION. THE MANAGEMENT FEES PAID ASSOCIATED WITH THIS SERVICE IS SHOWN ON PART IX, LINE 11A.
MEMBERS FORM 990, PART VI, SECTION A, LINES 6, 7A & 7B NORTHERN BERKSHIRE HEALTHCARE IS THE SOLE MEMBER OF THE CORPORATION. THE ACT OF A MAJORITY OF THE MEMBER'S TRUSTEES PRESENT AT ANY MEETING OF THE MEMBER AT WHICH A QUORUM IS PRESENT SHALL BE THE ACT OF THE MEMBER, EXCEPT WHERE OTHERWISE PROVIDED BY LAW OR THE GOVERNING DOCUMENTS OF THE ORGANIZATION. IN ADDITION, THERE ARE APPROXIMATELY 132 CORPORATORS OF NBH ("CORPORATORS"). THESE CORPORATORS ARE DRAWN FROM THE PROFESSIONAL AND BUSINESS COMMUNITY OF NORTHERN BERKSHIRE COUNTY AND ARE ELECTED EACH YEAR AT THE NBH ANNUAL MEETING. CORPORATORS ARE EMPOWERED TO ADOPT OR AMEND NBH CORPORATE ARTICLES AND BYLAWS AND TO ELECT INDIVIDUALS TO SERVE AS TRUSTEES OF NBH. NBH IS GOVERNED BY A SEVENTEEN MEMBER BOARD OF TRUSTEES, FIFTEEN OF WHOM ARE ELECTED BY THE CORPORATORS, ONE OF WHOM IS THE PRESIDENT AND CHIEF EXECUTIVE OFFICER OF NBH, AND ONE OF WHOM IS THE PRESIDENT OF THE HOSPITAL'S MEDICAL STAFF. ELECTED TRUSTEES SERVE FOR TERMS OF THREE YEARS, AND MAY BE ELECTED FOR UP TO TWO ADDITIONAL, CONSECUTIVE THREE-YEAR TERMS. EACH MEMBER OF THE BOARD OF TRUSTEES RESIDES IN THE SYSTEM'S PRIMARY SERVICE AREA AND HAS DEMONSTRATED A STRONG COMMITMENT TO THE COMMUNITY AND TO ENSURING THE AVAILABILITY OF LOCALLY MANAGED HEALTH CARE SERVICES. THE HEALTH SYSTEM HAS CORPORATORS WHICH ARE MEMBERS OF THE COMMUNITY THAT APPROVE THE SELECTION OF THE BOARD OF TRUSTEES.
FORM 990 REVIEW PROCESS FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. THE FORM 990 IS INITIALLY INTERNALLY REVIEWED BY THE CFO. AFTER THIS REVIEW, THE FORM 990 IS GIVEN TO THE BOARD OF DIRECTORS AT THEIR JULY MEETING. THIS ALLOWS FOR BOARD MEMBERS TO ASK QUESTIONS, PROVIDE COMMENTS, OR MAKE CHANGES BEFORE THE FINAL FORM 990 IS FILED.
CONFLICT OF INTEREST POLICY COMPLIANCE FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY BOARD MEMBERS AND THE SENIOR EXECUTIVE TEAM ARE REQUIRED TO FILL OUT A QUESTIONNAIRE REGARDING CONFLICTS OF INTEREST. THIS YEAR THESE INDIVIDUALS ALSO RESPONDED TO A QUESTIONNAIRE DESIGNED SPECIFICALLY FOR THE FORM 990. IF THERE IS A CONFLICT OF INTEREST, THE BOARD MEMBERS OR EXECUTIVE TEAM MEMBER WOULD RECUSE THEMSELVES FROM THE VOTE.
COMPENSATION DETERMINATION FORM 990, PART VI, SECTION B, LINES 15A & 15B THE BOARD COMPENSATION COMMITTEE OF NORTHERN BERKSHIRE HEALTHCARE, A RELATED ORGANIZATION, IS COMPOSED OF INDEPENDENT TRUSTEES. THIS COMMITTEE CONDUCTS AN ANNUAL PERFORMANCE EVALUATION. THE EVALUATION IS BASED ON DIRECT OBSERVATION, THE CEO'S COMPLETION OF PRE-DETERMINED GOALS, A CEO SELF-EVALUATION, AND THE RESULTS OF WRITTEN SURVEYS DISTRIBUTED BY THE COMMITTEE TO ALL TRUSTEES, HOSPITAL AND HEALTH SYSTEM EXECUTIVES, AND EMPLOYED PHYSICIANS. THE COMMITTEE ALSO REVIEWS INDEPENDENTLY COLLECTED AND PUBLISHED MARKET DATA FOR CEO COMPENSATION AT SIMILAR FACILITIES, SUCH AS THE ANNUAL MASSACHUSETTS HOSPITAL ASSOCIATION EXECUTIVE COMPENSATION AND/OR SIMILAR DOCUMENTS. CONSIDERING THE PERFORMANCE EVALUATION AND THE MARKET DATA, THE COMPENSATION COMMITTEE THEN MAKES A RECOMMENDATION FOR ANY CHANGES TO THE CEO'S COMPENSATION, WHICH THEN REQUIRES APPROVAL BY A VOTE OF THE FULL BOARD. DURING THE ANNUAL REVIEW PROCESS, THE COMPENSATION COMMITTEE ALSO DEVELOPS THE CEO'S PERFORMANCE GOALS FOR THE UPCOMING YEAR. THE CEO CONDUCTS ANNUAL PERFORMANCE EVALUATIONS FOR EACH EXECUTIVE OR OFFICER, CONSIDERING PERFORMANCE AGAINST PRE-DETERMINED ANNUAL PERFORMANCE GOALS, PERFORMANCE AGAINST THE JOB DESCRIPTION, AND FEEDBACK SURVEYS DISTRIBUTED BY THE HUMAN RESOURCES STAFF TO A GROUP OF PEERS AND SUBORDINATES. AT THIS TIME, THE CEO ALSO REVIEWS INDEPENDENTLY COLLECTED AND PUBLISHED MARKET DATA FOR SIMILAR POSITIONS IN SIMILAR ORGANIZATIONS. BASED ON THE MERITS OF THE PERFORMANCE EVALUATION AND THE COMPARISON TO MARKET DATA, THE CEO DETERMINES ANY CHANGE TO THE OFFICERS' COMPENSATION. COMPENSATION FOR ALL EXECUTIVES AND OFFICERS IS PRESENTED TO THE BOARD OF TRUSTEES ANNUALLY FOR THEIR REVIEW AND COMMENT, BUT CHANGES TO EXECUTIVE COMPENSATION, WITH THE EXCEPTION OF THE CEO, DO NOT REQUIRE BOARD APPROVAL. ALL EXECUTIVE COMPENSATION DECISIONS ARE GUIDED BY THE ORGANIZATION'S STATEMENT OF COMPENSATION PHILOSOPHY AS WELL AS BY GUIDELINES AND REGULATIONS REGARDING EXECUTIVE COMPENSATION IN NON-PROFIT ORGANIZATIONS PUT FORWARD BY THE IRS, THE ATTORNEY GENERAL, AND OTHER RELEVANT GOVERNING BODIES.
DOCUMENT AVAILABILITY FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. THE ORGANIZATION'S 990 IS AVAILABLE FOR VIEWING ON-SITE UPON WRITTEN REQUEST TO THE CFO.
BOARD MEMBERS FORM 990, PART VII, SECTION A RICHARD PALMISANO, CEO/PRESIDENT, AND CHRISTOPHER HICKEY, CFO/TREASURER, WORK APPROXIMATELY 40 HOURS PER WEEK BETWEEN NORTH ADAMS REGIONAL HOSPITAL, NORTHERN BERKSHIRE HEALTHCARE, NORTHERN BERKSHIRE REALTY, NORTHERN BERKSHIRE HEALTHCARE PHYSICIANS, NORTHERN BERKSHIRE COMMUNITY SERVICES, AND VISITING NURSE ASSOCIATION & HOSPICE. ROBERT CALWAY, VP OF BUSINESS DEVELOPMENT, WORKS APPROXIMATELY 40 HOURS PER WEEK BETWEEN NORTH ADAMS REGIONAL HOSPITAL, NORTHERN BERKSHIRE HEALTHCARE, AND NORTHERN BERKSHIRE HEALTHCARE PHYSICIANS. IN ADDITION, MANY OF THE BOARD MEMBERS SPLIT THEIR TIME BETWEEN THESE RELATED ORGANIZATIONS.
OTHER CHANGES IN NET ASSETS FORM 990, PART XI, LINE 5 UNREALIZED LOSS ON INVESTMENTS $(49,970) PRIOR PERIOD ADJUSTMENTS (89,469) NET TRANSFERS TO/FROM AFFILIATES 88,248 --------- $(51,191)
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2010

Additional Data


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SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
NORTH ADAMS REGIONAL HOSPITAL
 
Employer identification number

04-1676720
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)
(a)
Name, address, and EIN of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income
(e)
End-of-year assets


 		(f)
Direct controlling
entity

















Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled organization
Yes No
(1) NORTHERN BERKSHIRE HEALTHCARE

71 HOSPITAL AVENUE

NORTH ADAMS,MA01247
22-2563466 		MANAGEMENT CO MA 501(C)(3) 7 NA
 
 
 
(2) NORTHERN BERKSHIRE REALTY CO

71 HOSPITAL AVENUE

NORTH ADAMS,MA01247
22-2563465 		PROPERTY MGMT MA 501(C)(3) 11A I NA
 
 
 
(3) NORTHERN BERKSHIRE HEALTHCARE PHYSICIANS

71 HOSPITAL AVENUE

NORTH ADAMS,MA01247
74-3253218 		PHYS SERVICES MA 501(C)(3) 9 NA
 
 
 
(4) NORTHERN BERKSHIRE COMMUNITY SERVICES

71 HOSPITAL AVENUE

NORTH ADAMS,MA01247
22-2563464 		RESIDENT CARE MA 501(C)(3) 9 NA
 
 
 
(5) VISITING NURSE ASSOCIATION & HOSPICE

71 HOSPITAL AVENUE

NORTH ADAMS,MA01247
04-2910547 		HOME HEALTH MA 501(C)(3) 9 NA
 
 
 




For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of related organization



 		(b)
Primary activity



 		(c)
Legal domicile
(state or
foreign
country)
 		(d)
Direct controlling
entity


 		(e)
Type of entity
(C corp, S corp,
or trust)

 		(f)
Share of total income



 		(g)
Share of
end-of-year
assets

 		(h)
Percentage
ownership












Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III or IV.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
 
No
d Loans or loan guarantees to or for other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
Yes
 
e Loans or loan guarantees by other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
Yes
 
f Sale of assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Performance of services or membership or fundraising solicitations for other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations by other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Sharing of facilities, equipment, mailing lists, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of paid employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Reimbursement paid to other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid by other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Other transfer of cash or property to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
r Other transfer of cash or property from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type(a-r) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1)
(2)
(3)
(4)
(5)
(6)
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Are all
partners
section
501(c)(3)
organizations? 		(e)
Share of
end-of-year
assets 		(f)
Disproprtionate allocations? 		(g)
Code V—UBI
amount in box
20 of Schedule K-1
(Form 1065) 		(h)
General or
managing
partner?
Yes No Yes No Yes No






























Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation
Additional Data


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