TY 2010 Form 990

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)	(C) Position (check all that apply)
(1) Eric N Berkowitz Board Member	1	X	0	0
(2) Thomas P Caine Board Member	1	X	0	0
(3) Mary Ann P Cofrin Board Member	1	X	0	0
(4) James Donnelly MD Board Member	1	X	0	0
(5) William Gorth Board Member	1	X	0	0
(6) Mahnaz Mahdavi Board Member	1	X	0	0
(7) John Nunnelly Board Member	1	X	0	0
(8) Nancy Reeves Board Member	1	X	0	0
(9) Jennifer Reynolds Board Member	1	X	0	0
(10) Henry Rosenberg MD Board Member	1	X	45,903	21,196
(11) Margaret Russo MD Board Member	1	X	103,377	16,119
(12) Kathleen Scoble Board Member	1	X	0	0
(13) Peter Siersma MD Board Member	1	X	187,871	21,505
(14) William Stapleton Board Member	1	X	0	0
(15) Marilyn Tracy Board Member	1	X	0	0
(16) Margo Welch Board Member	1	X	0	0
(17) Geoffrey Zucker MD Board Member	1	X	0	0

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)	(C) Position (check all that apply)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) Matthew Pitoniak Chair	2	X	X			0	0
(19) Sanford Belden Vice Chair	2	X	X			0	0
(20) Kevin Lake Secretary	2	X	X			0	0
(21) Charles Staelin Treasurer	2	X	X			0	0
(22) Craig N Melin Asst. Secretary/CEO	40	X	X			462,578	32,127
(23) Edith Peter Asst. Treasurer/CFO	40		X			257,274	33,698
(24) Carol Smith Chief Operating Officer	40			X		372,018	18,039
(25) Wayne Freeberg Chief Information Officer	40			X		227,915	30,321
(26) Kenneth Guilbault Vice Pres, Clinical & Professional Services	40			X		189,758	16,660
(27) Leesa-Lee Keith Vice Pres Patient Care Services	40			X		176,009	8,109
(28) Wilmont Davis Vice President, Human Resources	40			X		173,588	10,756
(29) Mary Ellen Just Executive Director, CD Practice Associates	40			X		157,980	21,703
(30) John Zebrun MD Psychiatrist	40				X	272,046	26,240
(31) Sanford Levy PhD Medical Physicist	40				X	240,361	23,024
(32) Catherine Durie MD Psychiatrist	40				X	204,087	13,556
(33) Mark Novotny MD Vice President Medical Affairs/Chief Medical Officer	40				X	176,092	22,483
(34) Catherine Neumann Admin Director Emergency Services	40				X	156,415	27,809

(A) Name and business address	(B) Description of services	(C) Compensation
Mayo Collaborative Service Inc PO Box 9146 Minneapolis,MN554809146	lab testing service	1,800,973
AABB Consulting Services Division of Consulting Services 8101 Glenbrook road Bethesda,MD20814	consulting & agency staffing	834,206
Purity Services Inc 405 Myrtle Street New Bedford,MA02746	laundry service	527,863
Clinical Pharmacy Associates Inc 316 Talbot Avenue Suite A Laurel,MD20707	agency staffing	361,489
Vitalize 248 Main Street Suite 101 Reading,MA01867	consulting	285,341
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 19

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	25,000	25,000
2	Grants and other assistance to individuals in the U.S. See Part IV, line 22	0	0
3	Grants and other assistance to governments, organizations, and individuals outside the U.S. See Part IV, lines 15 and 16	0	0
4	Benefits paid to or for members	0	0
5	Compensation of current officers, directors, trustees, and key employees ....	1,945,877	0	1,945,877	0
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	0	0	0
7	Other salaries and wages	61,892,164	51,619,045	10,273,119	0
8	Pension plan contributions (include section 401(k) and section 403(b) employer contributions) ....	4,319,321	3,452,433	866,888	0
9	Other employee benefits .......	6,251,783	4,930,787	1,320,996	0
10	Payroll taxes ...........	5,408,382	4,322,920	1,085,462	0
11	Fees for services (non-employees):
a	Management ......	1,499,861	869,107	630,754	0
b	Legal .........	402,913	37,744	365,169	0
c	Accounting ...........	410,092	0	410,092	0
d	Lobbying ...........	0	0	0	0
e	Professional fundraising. See Part IV, line 17..	0			0
f	Investment management fees ......	102,665	0	102,665	0
g	Other ..........	11,308,460	9,220,249	2,088,211	0
12	Advertising and promotion ....	370,918	347,063	23,855	0
13	Office expenses .......	30,171,064	27,676,525	2,494,539	0
14	Information technology ......	2,839,489	2,269,604	569,885	0
15	Royalties ..	0	0	0	0
16	Occupancy ...........	3,518,897	1,812,298	1,706,599	0
17	Travel ............	156,788	86,203	70,585	0
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	0	0	0	0
19	Conferences, conventions, and meetings ....	148,868	43,237	105,631	0
20	Interest ...........	2,431,309	2,431,309	0	0
21	Payments to affiliates .......	0	0	0	0
22	Depreciation, depletion, and amortization .....	12,236,883	8,688,647	3,548,236	0
23	Insurance ..............	620,730	0	620,730	0
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	3,182,317	3,182,317	0	0
b	dues, licenses, & fees	764,410	131,573	632,837	0
c	purchased maintenance services	685,769	332,236	353,533	0
d	medical equipment repairs & maintenance	415,574	415,574	0	0
e	other misc expenses	13,038	8,012	5,026	0
f	All other expenses
25	Total functional expenses. Add lines 1 through 24f	151,122,572	121,901,883	29,220,689	0
26	Joint costs. Check here 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

Part X Balance Sheet
	1	Cashnon-interest-bearing ..........	4,306,775	1	2,879,724
2	Savings and temporary cash investments .......	27,812,078	2	35,400,208
3	Pledges and grants receivable, net .........	507,549	3	53,406
4	Accounts receivable, net .........	14,259,574	4	12,525,454
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........	0	5	0
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 ..........	0	6	0
7	Notes and loans receivable, net .............	0	7	0
8	Inventories for sale or use ..............	1,648,899	8	1,720,627
9	Prepaid expenses and deferred charges ............	2,804,547	9	1,685,552
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	191,929,285
b	Less: accumulated depreciation. .....	10b	115,838,937	84,779,707	10c	76,090,348
11	Investments—publicly traded securities ..........	48,777,863	11	58,542,214
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 ...........	7,166,175	15	7,957,942
16	Total assets. Add lines 1 through 15 (must equal line 34)...	192,063,167	16	196,855,475
	17	Accounts payable and accrued expenses .	18,840,605	17	18,092,039
18	Grants payable ..........	0	18	0
19	Deferred revenue ..........	0	19	0
20	Tax-exempt bond liabilities ..........	68,918,980	20	17,840,811
21	Escrow or custodial account liability. Complete Part IV of Schedule D..	0	21	0
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........	0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	0	23	47,999,387
24	Unsecured notes and loans payable to unrelated third parties ....	0	24	0
25	Other liabilities. Complete Part X of Schedule D.....	39,429,684	25	50,551,355
26	Total liabilities. Add lines 17 through 25.....	127,189,269	26	134,483,592
		Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....	59,479,521	27	55,558,494
28	Temporarily restricted net assets .....	4,884,296	28	6,303,208
29	Permanently restricted net assets .....	510,081	29	510,181
	Organizations that do not follow SFAS 117, check here 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 .....	64,873,898	33	62,371,883
34	Total liabilities and net assets/fund balances .....	192,063,167	34	196,855,475

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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.

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

COOLEY DICKINSON HOSPITAL INC

Employer identification number

22-2617175

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.)

A church, convention of churches, or association of churches. section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in

section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

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.)

An organization organized and operated exclusively to test for public safety. Seesection 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.

Type I

Type II

Type III - Functionally integrated

Type III - Other

By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).

If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box ..................................................

Since August 17, 2006, has the organization accepted any gift or contribution from any of the
following persons?

(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)

Yes

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)

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(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?
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of support?


Total

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 11285F

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).

Gross receipts from related activities, etc. (See instructions.) ..................

First Five Years If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.......................................... right arrow

Section C. Computation of Public Support Percentage

Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f)) .........

Public Support Percentage for 2009 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2010. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ...................... right arrow

33 1/3% support test—2009. If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2010. If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization .................................................. right arrow

10%-facts-and-circumstances test—2009. If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly
supported organization .............................................. right arrow

Private Foundation If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions ................................................... right arrow

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.).

Section C. Computation of Public Support Percentage

Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f)) .........

Public support percentage from 2009 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f)) ......

Investment income percentage from 2009 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2010. If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .......... right arrow

33 1/3% support tests—2009. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private Foundation If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions ..... right arrow

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:	10000077
Software Version:	v1.00

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

OMB No. 1545-0047

2010

Name of organization

COOLEY DICKINSON HOSPITAL INC

Employer identification number

22-2617175

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

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

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II.

Special Rules

For a section 501(c)(3) organization filing Form 990 or 990-EZ, that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), and received from any one contributor, during the year, a contribution of the
greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ, that received from any one contributor,
during the year, aggregate contributions of more than $1,000 for use exclusively for religious, charitable,
scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. Complete Parts I, II, and
III.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ, that received from any one contributor,
during the year, contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did
not aggregate to more than $1,000. If this box is checked, enter here the total contributions that were received during
the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule
applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more
during the year. ......................... 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)

Name of organization COOLEY DICKINSON HOSPITAL INC
Schedule B (Form 990, 990-EZ, or 990-PF) (2010) Page 1 of 1 of Part I
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	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Name of organization COOLEY DICKINSON HOSPITAL INC
Schedule B (Form 990, 990-EZ, or 990-PF) (2010) Page 1 of 1 of Part II
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
COOLEY DICKINSON HOSPITAL INC

Employer identification number

22-2617175

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

(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

(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

(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

(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:	10000077
Software Version:	v1.00

- TIN:

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

COOLEY DICKINSON HOSPITAL INC

Employer identification number

22-2617175

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

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.

Political expenditures .................................... SchCMd Bullet

Volunteer hours ........................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ......... SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ...... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............

Yes No

Was a correction made? .........................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c) except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt funtion activities .................................... SchCMd Bullet

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

Did the filing organization file Form 1120-POL for this year? ..........................

Yes No

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

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 if the filing organization belongs to an affiliated group.
B Check if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(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? ......................................	Yes No

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

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

(b)

Amount

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:

Volunteers? .........................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....

Media advertisements? ....................................

Mailings to members, legislators, or the public? .........................

Publications, or published or broadcast statements? .......................

Grants to other organizations for lobbying purposes? .......................

Direct contact with legislators, their staffs, government officials, or a legislative body? ........

Yes

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......

Yes

29,772

Other activities? If "Yes," describe in Part IV ..........................

Total. lines 1c through 1i ...................................

29,772

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 .................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....

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

Were substantially all (90% or more) dues received nondeductible by members? ................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ................

Did the organization agree to carryover lobbying and political expenditures from the prior year? ..........

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”.

Dues, assessments and similar amounts from members .....................

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).

Current year .........................................

Carryover from last year ....................................

Total ...........................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

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? ................................

Taxable amount of lobbying and political expenditures (see instructions) ..............

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
SchC_P2B_S00_L01	Schedule C, Part II-B, Line 1	Cooley Dickinson Hospital, through membership dues paid to the Massachusetts Hospital Association (MHA) and the American Hospital Association (AHA), supports the lobbying activities carried out by these organizations. MHA and AHA have reported to Cooley Dickinson Hospital the portion of the dues that are used for lobbying purposes on behalf of member hospitals.

Schedule C (Form 990 or 990EZ) 2010

Additional Data

Software ID:	10000077
Software Version:	v1.00

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

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

COOLEY DICKINSON HOSPITAL INC

Employer identification number

22-2617175

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 .......

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? ............

Yes No

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. ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or pleasure) Preservation of an historically importantly land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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.


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

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the taxable year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year SchDMd Bullet

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)? ....................................

Yes No

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.

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.

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

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:

Revenues included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

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

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

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):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.

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?........

Yes No

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.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIV and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21? .....................

Yes No

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
1a	Beginning of year balance ....	3,953,056	3,892,904	3,913,781
b	Contributions ........	100	150	10,720
c	Investment earnings or losses ...	8,786	125,417	30,998
d	Grants or scholarships .....	1,395	1,500	1,100
e	Other expenditures for facilities and programs ........	80,950	63,915	61,495
f	Administrative expenses ....	0	0	0
g	End of year balance ......	3,879,597	3,953,056	3,892,904

Provide the estimated percentage of the year end balance held as:

Board designated or quasi-endowment: SchDMd Bullet

50 %

Permanent endowment: SchDMd Bullet

13 %

Term endowment: SchDMd Bullet

37 %

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

Yes

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

Yes

Describe in Part XIV the intended uses of the organization's endowment funds.

Part VI

InvestmentsLand, 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 .................	0	1,783,897		1,783,897
b	Buildings ................	0	63,409,955	19,001,946	44,408,009
c	Leasehold improvements ............	0	44,567,246	27,120,685	17,446,561
d	Equipment ................	0	78,898,793	68,245,425	10,653,368
e	Other .................	0	3,269,394	1,470,881	1,798,513
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........					76,090,348

Schedule D (Form 990) 2010

Page 3

Part VII

InvestmentsOther 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.)

Part VIII

InvestmentsProgram 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.)

Part IX

Other Assets. See Form 990, Part X, line 15.

(a) Description				(b) Book value









Total. (Column (b) should equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. See Form 990, Part X, line 25.

1.(a) Description of Liability		(b) Amount
Federal Income Taxes		0
pension liability		38,605,468
estimated settlements due to 3rd parties		8,433,178
other liabilities		3,512,709






Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)		50,551,355
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

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	159,634,559
2	Total expenses (Form 990, Part IX, column (A), line 25) .....................	2	151,122,572
3	Excess or (deficit) for the year. Subtract line 2 from line 1 .............	3	8,511,987
4	Net unrealized gains (losses) on investments ..........................	4	140,707
5	Donated services and use of facilities .............................	5	0
6	Investment expenses ...................................	6	0
7	Prior period adjustments ..................................	7	0
8	Other (Describe in Part XIV) .................................	8	-11,154,709
9	Total adjustments (net). Add lines 4 - 8 .............................	9	-11,014,002
10	Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 .........	10	-2,502,015

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	160,104,693
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains on investments ..........	2a	0
b	Donated services and use of facilities .........	2b	0
c	Recoveries of prior year grants ...........	2c	0
d	Other (Describe in Part XIV): ............	2d	0
e	Add lines 2a through 2d .....................			2e	0
3	Subtract line 2e from line 1.....................			3	160,104,693
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	0
b	Other (Describe in Part XIV): ...........	4b	-470,134
c	Add lines 4a and 4b.......................			4c	-470,134
5	Total Revenue. Add lines 3 and 4c. (This should equal Form 990, Part I, line 12.) ......			5	159,634,559

Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1	Total expenses and losses per audited financial statements .............			1	151,122,572
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities ..........	2a	0
b	Prior year adjustments ..............	2b	0
c	Other losses ................	2c	0
d	Other (Describe in Part XIV): ............	2d	0
e	Add lines 2a through 2d......................			2e	0
3	Subtract line 2e from line 1.....................			3	151,122,572
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	0
b	Other (Describe in Part XIV): ............	4b	0
c	Add lines 4a and 4b.......................			4c	0
5	Total expenses. Add lines 3 and 4c. (This should equal Form 990, Part I, line 18.) ......			5	151,122,572

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
SchD_P05_S00_L04	Schedule D, Part V, Line 4	The income from endowed funds is expendable to support healthcare services and nursing scholarships in furtherance of the organization's exempt mission.
SchD_P10_S00_L01	Schedule D, Part X, Line 1	Liabilities not detailed in Form 990 Part X lines 17 through 24; pension liability, estimated settlements to 3rd parties, etc.
SchD_P11_S00_L08	Schedule D, Part XI, Line 8	Minimum pension liability adjustment, (9,946,366); Transfers to CD Practice Associates for start up operations, (2,846,621); Transfers from Cooley Dickinson Health Care Corporation to finance property and equipment, 54,266; Net assets released from restriction used for capital additions, 165,000; Change in beneficial interest, temp restricted, 1,418,912; Change in beneficial interest, perm restricted, 100.
SchD_P12_S00_L04b	Schedule D, Part XII, Line 4b	Non-operating gains, 727,101; Loss on bond refinancing, (1,197,235)

Schedule D (Form 990) 2010

Additional Data

Software ID:	10000077
Software Version:	v1.00

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

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

COOLEY DICKINSON HOSPITAL INC

Employer identification number

22-2617175

Part I

Charity Care and Certain Other Community Benefits at Cost

Yes

Does the organization have a charity care policy? If "No," skip to question 6a...........

Yes

If "Yes," is it a written policy? .......................

Yes

If the organization has multiple hospitals, indicate which of the following best describes application of the charity care policy to the various hospitals.

Applied uniformly to all hospitals Applied uniformly to most hospitals Generally tailored to individual hospitals

Answer the following based on the charity care eligibility criteria that applies to the largest number of the organization's patients.

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:

Yes

100% 150% 200% Other

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: .....

200% 250% 300% 350% 400% Other

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.

Does the organization's policy provide free or discounted care to the "medically indigent"? ......

Yes

Does the organization budget amounts for free or discounted care provided under its charity care policy? ...

Yes

If "Yes," did the organization's charity care expenses exceed the budgeted amount?.........

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?...............

Does the organization prepare an annual community benefit report?.............

Yes

If "Yes," does the organization make it available to the public? ..............

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Charity Care and Certain Other Community Benefits at Cost

	(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) ..			3,111,859	578,056	2,533,803	1.71 %
b Unreimbursed Medicaid (from Worksheet 3, column a) .			13,503,792	11,216,345	2,287,477	1.55 %
c Unreimbursed costs—other means-tested government programs (from Worksheet 3, column b) ....			4,348,686	3,019,361	1,329,325	0.9 %
dTotal Charity Care and Means-Tested Government Programs .....	0	0	20,964,337	14,813,762	6,150,605	4.16 %
Other Benefits e Community health improvement services and community benefit operations (from (Worksheet 4) ....			1,517,624	372,262	1,145,362	0.77 %
f Health professions education (from Worksheet 5) ..
g Subsidized health services (from Worksheet 6) ..			3,439,686	3,041,275	398,411	0.27 %
h Research (from Worksheet 7)
i Cash and in-kind contributions to community groups (from Worksheet 8) ..			4,569	0	4,569	0 %
jTotal Other Benefits ...	0	0	4,961,879	3,413,537	1,548,342	1.04 %
kTotal. Add lines 7d and 7j. ..	0	0	25,926,216	18,227,299	7,698,947	5.20 %

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			3,274	0	3,274	0 %
8	Workforce development
9	Other
10	Total	0	0	3,274	0	3,274	0 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Does the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Enter the amount of the organization's bad debt expense (at cost).....

1,345,383

Enter the estimated amount of the organization's bad debt expense (at cost) attributable to patients eligible under the organization's charity care policy ..

550,716

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

Enter total revenue received from Medicare (including DSH and IME).....

36,426,919

Enter Medicare allowable costs of care relating to payments on line 5.....

44,102,163

Subtract line 6 from line 5. This is the surplus or (shortfall)........

-7,675,244

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:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Does the organization have a written debt collection policy? ...............

Yes

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......

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

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		Other (Describe)
1	Cooley Dickinson Hospital Inc 30 Locust Street Northampton,MA01060	X	X	X

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:Cooley Dickinson Hospital Inc

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

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

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

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?
Name and address		Type of Facility (Describe)
1
2
3
4
5
6
7
8
9
10

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
SchH_P01_S00_L03c	Schedule H, Part I, Line 3c	Service recovery activities occasionally include discounted care.
SchH_P01_S00_L07	Schedule H, Part I, Line 7	The costing methodology used was the ratio of patient service expense to patient service revenue from the FY2011 Massachusetts Division of Health Care Finance and Policy 403 cost report of Cooley Dickinson Hospital.
SchH_P01_S00_L072f	Schedule H, Part I, Line 7, Column f	Bad debt expense totaling $3,182,317 is included in Form 990, Part IX, line 25, column A, but pursuant to IRS instruction, has been excluded from the expense figure for the purpose of calculating the percentage of total expenses in Schedule H, Part I, line 7, column (f).
SchH_P02_S00_L00	Schedule H, Part II	Cooley Dickinson's vision is to make the community it serves the nation's model healthy community. One step toward making that vision real is to include consumer-friendly preventive, screening, or general health information in every issue of the Community Pulse newsletter that the hospital publishes. Some of the health information is linked to the community's health status. For example, heart disease is the leading cause of death in our county and Community Pulse newsletters in 2011 included information about heart attack warning signs, understanding high blood pressure, and eating less and moving more to maintain health. The newsletter also helps promote the health of the community by informing residents of health-related classes, such as a heart-smart cooking class at which healthy recipes were distributed. Cancer is the leading cause of death in two of the larger communities that Cooley Dickinson serves, so other articles explained the importance of colorectal and breast cancer screening and the importance of regular sunscreen use. Injury prevention is also covered in issues of the Community Pulse. In 2011, readers learned how to fit their child with a backpack so as not to cause injury; how to prevent tick bites and dehydration, and how to avoid injuries while gardening.
SchH_P03_S0A_L04	Schedule H, Part III, Section A, Line 4	The audited financial statements for Cooley Dickinson Hospital do not contain a footnote describing bad debt expense. The costing methodology was the ratio of patient service expense to patient service revenue from the FY2011 Massachusetts Division of Health Care Finance and Policy 403 cost report of Cooley Dickinson Hospital.
SchH_P03_S0B_L08	Schedule H, Part III, Section B, Line 8	The full unsubsidized cost of providing care to Medicare patients should be included as a community benefit. The source for line 6 is the Cooley Dickinson Hospital FY2011 Medicare Cost Report.
SchH_P03_S0C_L09b	Schedule H, Part III, Section C, Line 9b	The Hospital will not bill patients enrolled in MassHealth, patients receiving governmental benefits under the Emergency Aid to the Elderly, Disabled and Children program, or participants in the Healthy Start program except that the Hospital may bill patients for any co-pays and deductibles required under the program of assistance. The Hospital may initiate billing for a patient who alleges that he or she is a participant in any of these programs but fails to provide proof of such participation (including receipt or verification of signed application). Upon receipt of satisfactory proof that a patient is enrolled in any of the above listed programs, or receipt of the signed application, the Hospital shall cease its collection activities. Participants in the Children's Medical Security Plan (CMSP) whose Family Income is equal to or less than 400% of the Federal Poverty Level (FPL) are also exempt from Collection Action. The Hospital may initiate billing for a patient who alleges that he or she is a participant in the CMSP, but fails to provide proof of such participation. Upon receipt of satisfactory proof that a patient is a participant in the CMSP, the Hospital shall cease all collection activities. Low Income Patients are exempt from Collection Action for any Eligible services received during the period in which they are determined to be Low Income Patients and eligible for payment by the Health Safety Net, except for co-pays and deductibles. Low Income Patients with Family Income between 201 to 400% of the FPL are exempt from Collection Action for the portion of his or her Hospital bill that exceeds the deductible except for Health Safety Net co-payments and deductibles as set forth in 114.6 CMR 13.04. The Hospital may bill for services received outside of the period in which they are determined to be Low Income Patients. The Hospital may bill Low Income Patients for services rendered prior to the Low Income Patient determination, provided that the current Low Income Patient status has been terminated, expired, or not otherwise identified on the state Virtual Gateway or Eligibility Verification System. The Hospital may seek collection action against any of the patients participating in the programs listed above for non-covered services that the patient has agreed to be responsible for, provided that the Hospital obtained the patient's prior written consent to be billed for the service. The Hospital may not undertake a Collection Action against an individual that has qualified for Medical Hardship under the Massachusetts Health Safety Net program with respect to the amount of the bill that exceeds the Medical Hardship contribution. The Hospital will further cease any collection efforts against an emergency bad debt claim that is approved for Medical Hardship under the Health Safety Net program. The Hospital and its agents shall not continue collection or billing on a patient who is a member of a bankruptcy proceeding except to secure its rights as a creditor in the appropriate order, provided that the state of Massachusetts will file its own recovery action for those patients enrolled in MassHealth or the Health Safety Net. The Hospital complies with all applicable billing requirements including those in the Department of Public Health regulations (105 CMR 130.332) for non payment of services or readmissions that the Hospital determines to be a result of a Serious Reportable Event (SRE). SREs that do not occur at the Hospital are excluded from this determination of non-payment. Additionally, the Hospital does not bill low income patients eligible for the Health Safety Net when claims are denied by an insurance company as a result of an administrative billing error by the Hospital.
SchH_P06_S00_L02	Schedule H, Part VI, Line 2	Cooley Dickinson Hospital designates the Healthy Communities Committee to oversee the assessment. The Committee is a Board committee and includes Board members, staff, and community representatives. The health assessment project is staffed by the Western Massachusetts Center for Healthy Communities, a program of Cooley Dickinson Hospital. There are two main goals of the committee, with respect to the assessment: 1) Evaluate existing community programs; 2) Assess community needs and design programming and interventions based on findings. The Committee confirmed the major categories for community benefit programs as follows: 1) Health access; 2) Health equity; 3) Healthcare reform; 4) Chronic disease; 5) Behavioral Health; 6) Healthy eating and active living. Programs within these categories were reviewed and scored with regard to criteria such as fit with Healthy Communities mission, Hospital's service area, clinical priorities, community need, focus on a specific target population (e.g. uninsured, elderly, poor, racial, linguistic, ethnic minority, etc.). Each program was asked to complete a detailed questionnaire about program operations and outcomes and met with two or three committee members to review and discuss the responses. The committee rank ordered programs based on the above criteria and made decisions about priorities for continued inclusion as a community program. This process is formally completed every other year and was last completed for all programs in fiscal year 2010 and is scheduled again for 2012. The major health assessment focus for 2011 was completion and public dissemination of a comprehensive community health assessment. The rationale selected for the design of the assessment is that chronic diseases account for 70% of all deaths in the nation, whereas diabetes, heart disease, and certain types of cancer are largely preventable with changes in lifestyle and behavior. Further, the committee oriented the assessment to focus on the social determinants of health because research shows that behavior is influenced by environmental conditions such as local policy, systems, and culture. Social determinants may include housing, access to services and transportation, affordability of healthy food, quality of education, and so on. The design for the health assessment included several phases. The first phase is a comprehensive review of secondary health data in existing local, state, and national databases. The 66-page report includes sections on demographics, birth and death, chronic disease, substance abuse, food and fitness, and health care access. Demographic indicators: Population; Income and employment; Education; Language and civic engagement; Birth and Death indicators (Mortality; Infant mortality; Low birth weight; Teen birth rate). Chronic Disease Indicators: Cancer incidence and mortality; Breast cancer; Prostate cancer; Lung cancer; Colon cancer; Adult asthma; Childhood asthma; Cholesterol; Diabetes; Heart disease high blood pressure; Stroke; Perception of health. Substance Abuse Indicators: Youth substance use; Tobacco use. Food and Fitness Indicators: Food and fitness environment; Health behaviors; Adults overweight and obesity; Childhood overweight and obesity. Health Care Access: Latino Health Care assessment; Barriers to health care. The health assessment findings were disseminated to the public at a community forum in March, 2011, at smaller forums for community programs, in the media, and via the Hospital's website. Copies were distributed to all Board members and made widely available to community based programs. In phase two, the health assessment design includes collecting primary data using qualitative methods such as surveys, interviews, meetings, and events. A community survey, which focused broadly on food and fitness issues, was begun in 2010 and the results were disseminated in 2011, including via the Hospital's website.
SchH_P06_S00_L03	Schedule H, Part VI, Line 3	Cooley Dickinson Hospital posts signs in the inpatient, clinic, and emergency admissions/registration areas and in business office areas that are customarily used by patients that conspicuously inform patients of the availability of financial assistance programs and the Hospital location at which to apply for such programs. All signs and notices are translated into English and Spanish. The signs notify patients of the availability of financial assistance and of other programs of public assistance. Hampshire HealthConnect (HHC), a Cooley Dickinson Hospital based program, has a mission to help uninsured and underinsured people access health coverage and care. HHC case managers assist uninsured patients to enroll with MassHealth, Health Safety Net and other state healthcare programs. HHC also administers the Hampshire Health Physician Network, a group of local physicians who offer health care to local residents who are low income and cannot qualify for MassHealth or other health insurance. Participating physicians agree to accept reduced fees and are not reimbursed by the Health Safety Net for their services. HHC flyers are distributed to all self pay patients in the emergency department and throughout the Hospital. The Hospital provides an individual notice of the availability of financial assistance programs, including Medical Hardship, to patients expected to incur charges. The Hospital will include a notice about eligible services to Low Income Patients and programs of public assistance in its initial bill and in all written collection actions stating: "If you are unable to pay this Hospital bill, you may be eligible for coverage through a financial assistance program. Enrollment in many programs is time-sensitive, so please contact our Hampshire HealthConnect Department as soon as possible. To speak with someone in the Hampshire HealthConnect Department, please call (413) 582-2848, Monday through Friday 9:00 am to 5:00 pm. You may also obtain information at the Cashier's Office located in the main entrance of the Hospital."
SchH_P06_S00_L04	Schedule H, Part VI, Line 4	Cooley Dickinson Hospital (CDH) serves a population (2010) of 136,383 residents of Hampshire and Franklin counties in the Pioneer Valley region of Massachusetts. Its primary service area (PSA) is comprised of 15 Hampshire and one Franklin community and secondary service area (SSA) of five Hampshire and six Franklin communities. The PSA includes the following communities from which 50 percent or more of inpatient hospital admissions were to CDH for the three years from fiscal 2008 through fiscal 2010. Amherst, Chesterfield, Cummington, Easthampton, Florence, Goshen, Hadley, Hatfield, Haydenville, Leeds, North Amherst, North Hatfield, Northampton, West Hatfield, Whately, Williamsburg. The following communities, from which 25 percent of more of inpatient hospital admissions were to CDH for the three-year period, comprise the SSA. Belchertown does not meet the 25 percent share threshold, but is included because it has the seventh highest volume of discharges. Ashfield, Belchertown, Huntington, Leverett, Plainfield, Shutesbury, South Deerfield, Southampton, Sunderland, West Chesterfield, and Worthington. Population Trends, Overall; The PSA population is expected to decline by 0.37 percent by 2015 after growing by 1.7 percent from 2000 to 2010. Growth of 0.70 percent is expected for the SSA, according to population data from ESRI Business Information Solutions. This projected stability follows a period of growth, by 4.67 percent, of the SSA population between 2000 and 2010. Factors of interest in planning hospital services and projecting use of hospital services are highlighted below. Aging; The service area is graying, consistent with national trends. * 11.79 percent of the PSA population and 11.71 percent of the SSA was 65 or older in 2010. These rates are lower than for Massachusetts (13.8 percent) and the United States (13 percent). (By 2015, 13.84 percent of the PSA population and 14.62 percent of the SSA is expected to be 65+; for Massachusetts the percentage will be 15.3 and US, 14.43). * The age cohorts starting at traditional retirement age (65) are growing the fastest. The compound annual growth rate for area residents 65-79 is 5.51 percent in the primary service area and 6.38 percent in the secondary service area. (This means that by 2015, there will be 2,328 more 65-79 year-olds in the PSA and 1,177 more in the SSA). * By contrast, the number of residents in the primary and secondary service areas at the upper end of the age spectrum is expected to decline by 2015. The population age 80+ will have a negative compound annual growth rate, amounting to 400 fewer adults 80 or older (351 in the PSA alone) by 2015. * Children and Young Adults; The population up to age 14 and that 15-24 will both decline by 2015, amounting to 215 fewer children (133 from PSA; 82 from SSA) and 1,469 fewer young adults (1,212 from PSA and 257 from SSA). The decline in the population under 24 is not surprising given lower birth rates in our service area. Rates are reported by the Massachusetts Department of Public Health for the state and state-defined community health network areas in our region and compared to the US rate reported by the National Center for Health Statistics. The Franklin rate of 9.2 is higher than it was in 2008 (8.8 births per 1000 residents), while the Hampshire rate of 7.1 - the lowest among Massachusetts community health networks in 2009 - declined from 8.0 in 2008. The Massachusetts rate of 11.4 was down slightly from 11.8 in 2008. Demographic Profile of Service Area Income; The communities Cooley Dickinson serves have higher median household incomes than Hampshire and Franklin counties, Massachusetts, and the nation, according to ESRI and US Census data. The US rate is $50,046; Franklin County, $52,002; Hampshire County, $58,449; Cooley Dickinson Primary Service Area, $61,625; Massachusetts, $62,072; CDH Combined Service Area, $64,187; and CDH Secondary Service Area, $70,392. The range of median household incomes in the PSA in 2010 was from $43,148 in North Amherst to $82,139 in the 01063 zip code in Northampton, the Smith College neighborhood. For the SSA, the range is from $48,002 in Sunderland to $89,849 in Southampton. The US census has not yet released 2010 information about residents living below the poverty level for all communities in the service area. Two of the four areas for which data is available report rates well above the 2010 Massachusetts percentage of 10.5 percent of residents living below poverty level and US rate, 13.8 percent. They are Amherst Center (30.8 percent) and North Amherst (43 percent). The rate for Northampton is 13.1 percent and for Easthampton, 6.2 percent. The toll of the recession is evident here: the 2000 Census reported the percentages of people living below the poverty level as 6.7 in Massachusetts and 9.2 in the nation. Race and Ethnicity; The Census Bureau has developed a Diversity Index to compute the differences in diversity among populations. The Diversity Index is expressed as a ratio and reports the percentage of times two randomly selected people would differ by race/ethnicity. An area's Diversity Index would be 1.0 when the population is evenly divided into two or more race/ethnic groups. According to ESRI, the 2010 Diversity Index for the United States was 0.60 (55.51 in the Northeast). The CDH service area is becoming increasingly diverse. For the Primary Service Area, the Diversity Index is 0.30, expected to increase to 0.33 by 2015, with a compound annual growth rate of 1.87 percent. While the Secondary Service Area was less diverse in 2010 (0.13), it is expected to diversify more, with a compound annual growth rate of 3.14, by 2015 than the PSA. In 2000, 97 percent of PSA residents and 95 percent of SSA residents were white. Those percentages declined to 83 and 93 percent, respectively, by 2010 and are expected to be 81 and 92 by 2015. It is expected there will be 2,208 fewer white residents in the PSA and 218 less in the SSA. The next largest group in the PSA was Asian in 2000 (4.62 percent of the population) and Hispanic in the SSA (1.5 percent); in both service areas, Hispanic was second in 2010. By 2015, the Hispanic population in the PSA is expected to increase from 6.2 percent of the 2010 population to 7.25 percent, representing an increase of 1,017 individuals. The percentages of the Black and Asian populations are expected to grow by less than 1 percent by 2015, with net increases of 288 and 275 persons. Diversity changes in the SSA include Hispanic population growth from 2.29 to 2.79 percent, representing 194 individuals. More growth is expected in the Asian SSA population, from 1.92 to 2.24 percent, or 126 persons. Cooley Dickinson spent more than $388,000 on medical interpreter services during the year to assist non-English speaking patients.
SchH_P06_S00_L04a	Schedule H, Part VI, Line 4 (Cont.)	Recession Impact; Despite that the CDH service area income is relatively high, a snapshot of data from the Massachusetts Division of Insurance shows the economic slowdown has affected the insurance coverage that area residents carry. Insurance enrollment by county as of the quarter ending Sept. 30 for 2009, 2010, and 2011 indicates a shift from commercial HMOs and the Commonwealth Connector program to Medicaid. Enrollment in commercial HMOs declined by 7 percent in both Hampshire and Franklin counties between 2009 and 2011. Enrollment in the Commonwealth Connector program increased over that period by 3.24 percent in Hampshire and 8 percent in Franklin County. Medicaid saw double digit increases from 2009 to 2011, 14 percent in Hampshire County and 22 percent in Franklin. Educational Attainment; Cooley Dickinson serves a population with higher levels of educational attainment than Massachusetts and the nation. Fifty percent of PSA residents have a college degree or higher, compared to 38 percent for Massachusetts and 27 percent U.S. Employment; Not surprisingly given the educational attainment of residents of the service area, the occupational makeup of the population differs from that of the nation. Educational services and health care are the largest employment sectors in Hampshire and Franklin counties. In the United States, 23.24 percent of the population is employed in education, health care, and social assistance. That rate is higher (28.69 percent) in Hampshire County and lower (21.53 percent) in Franklin. Both Hampshire and Franklin Counties have lower percentages than the nation of people employed in the second largest sector, retail trade (US 11.65 percent; Hampshire 8.88 percent; and Franklin 8.47 percent). (US Census; counties, Economic Development Data & Information for Connecticut and Western Massachusetts [EDDI]). The top 10 employers in Hampshire and Franklin Counties include three health facilities, including Cooley Dickinson, and nine educational facilities, including five colleges, two private secondary schools, and two public school districts. Service Area Health Status; The Cooley Dickinson Community Health Assessment, published March 2011, provides detailed data about health status in Hampshire and Franklin Counties. Residents of the Cooley Dickinson Hospital service areas are generally healthier than the population of Massachusetts and the United States. The federal Community Health Status Reports for 2009 for Hampshire and Franklin Counties indicate better average life expectancy, fewer deaths per 100,000 residents, and lower rates of self-reported fair or poor health than the United States. In both counties, the rate of reported unhealthy days in the previous month was slightly higher than the U.S. median. The reports also compare both counties on 19 indicators of health to both the United States and a group of peer counties. Hampshire County's results are better than both the U.S. and peer counties on 16 of the indicators. Franklin County's results are better than both for 10 indicators. The two counties share unfavorable data compared to peers and the United States on three indicators: births to women age 40-54, breast cancer, and colon cancer. Franklin also has unfavorable rates of very low birth weight babies. As described in the hospital's Community Needs Assessment, a deeper look at the health status data reveals increasing obesity rates, increasing diabetes rates, and disparities in asthma prevalence (based on location). Access to Care; Cooley Dickinson is one of two not-for-profit hospitals in Hampshire County. The second, Baystate Mary Lane Hospital, is 50 minutes to 1 hour driving time away from Cooley Dickinson. Baystate Health also has facilities about 30 minutes away in northern Franklin County's Greenfield and south of the Cooley Dickinson service area in Hampden County's Springfield. The U.S. Health Resources and Services Administration has designated three communities (Chesterfield, Cummington, and Williamsburg) in Cooley Dickinson's primary service area and four (Ashfield, Huntington, Plainfield, and Worthington) in the secondary service area as Medically Underserved Areas (MUAs). A corporate affiliate, CD Practice Associates, employs two primary care physicians and a nurse practitioner in one of the MUAs, Williamsburg, and the hospital provides rehabilitation services in another, Worthington. In addition, US HRSA has designated one primary service area community (Whately) and three secondary service area communities (Leverett, Shutesbury, and Sunderland) as having Medically Underserved Populations (MUPs). While CD Practice Associates does not have providers located in Sunderland, its primary care providers have 1,261 of Sunderland's 3,781 residents as patients. Massachusetts' health insurance mandate means the percentage of uninsured residents in the service area is low. Nevertheless, the hospital provides a safety net for the uninsured and underinsured through some use of the emergency department for primary care - approximately 10 percent of visits - and actively seeks to enroll patients and residents in coverage through Hampshire Health Connect. The value of Free Care provided in fiscal 2011 was $4,833,037.
SchH_P06_S00_L05	Schedule H, Part VI, Line 5	Cooley Dickinson Hospital's mission, "To provide our patients and communities with the best health care in the most appropriate environment," is carried out by 315 physicians and more than 1,600 employees, including 348 nurses, and 400 volunteers. Together, they cared for 81,234 community members in the year ending Sept. 30, 2011. The medical staff of Cooley Dickinson is organized in the public interest. Medical staff privileges are available to all qualified physicians in the community for all of our departments. In addition, the hospital furthered its exempt purpose through partnerships with our affiliated organization, VNA & Hospice of Cooley Dickinson, and community organizations, ranging from Aging Services Access Points and Councils on Aging to long-term care facilities and boards of health. With these partnerships, we worked toward achieving the best health care through projects such as coordinating care for residents with complex medical and psychosocial issues to improve the quality of life of those residents and prevent their avoidable use of health care services. These partnerships are in addition to those created through the processes of assessing community health needs and developing and implementing our community benefits plan. Funds the hospital generates are reinvested in programs or services that meet the healthcare needs of the community, promote improved health, or prevent illness or injury. For example, in 2011, the hospital published four issues of its Community Pulse newsletter, which provides health prevention and screening information to encourage residents to maintain or improve their health. The hospital also invested funds - to name a few examples - to increase access to primary care physicians and allied health professionals to meet community need; to upgrade equipment for patients requiring cardiac and pulmonary rehabilitation; and to invest in electronic medical records to improve coordination and safety of care. Cooley Dickinson focuses on responsiveness to the healthcare needs of our community. When surveyed in 2010, residents report we succeed at that goal, rating us 3.55 on a 4.0 scale on how well we respond to needs. This research will be repeated in Fiscal 2012 to ensure community members still find the hospital responsive. Strong community involvement in our organization is also demonstrated by the fact that 73 percent of the 22 voting members of the Board of Trustees are independent (the president and three physician trustees are employees of the organization; two other physician trustees are contractors). A total of 95 percent of the current of trustees live in the hospital's primary or secondary service area. In addition, other residents are involved as volunteers through the Board of Trustees' Healthy Communities and Development and Public Relations Committees. A Patient and Family Advisory Council, consisting of additional residents, is involved in decisions regarding their non-profit community hospital.
SchH_P06_S00_L06	Schedule H, Part VI, Line 6	Cooley Dickinson Hospital, Inc. (the "Hospital") is an acute care, not-for-profit 140 bed community hospital located in Northampton Massachusetts and a wholly owned subsidiary of Cooley Dickinson Health Care Corporation (the "Corporation"). The Hospital provides a broad range of patient services and a number of health related community services, including acute and critical medicine, surgery, psychiatry, and rehabilitation. The Corporation provides fund raising support and maintains donor-restricted funds for the benefit of the Hospital. Other related entities of the Hospital include CD Practice Associates, Inc. ("CDPA"), a not-for-profit organization established to own and manage operating groups of physicians; and VNA and Hospice of Cooley Dickinson, Inc. ("VNA/Hospice"), a not-for-profit organization established to provide home health and hospice care services.
SchH_P06_S00_L07	Schedule H, Part VI, Line 7	Cooley Dickinson Hospital annually files a Community Benefits report with the Office of the Attorney General of the Commonwealth of Massachusetts.

Schedule H (Form 990) 2010

Additional Data

Software ID:	10000077
Software Version:	v1.00

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990

OMB No. 1545-0047

2010

Open to Public
Inspection

Name of the organization
COOLEY DICKINSON HOSPITAL INC

Employer identification number
22-2617175

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet

(a) Name and address of organization or government	(b) EIN	(d) Amount of cash grant	(e) Amount of non-cash assistance	(h) Purpose of grant or assistance
(1) SPIFFY97 Hawley Street Attn Sue Cairn Northampton,MA01060	04-2562893	7,500	0	To provide an infrastructure that will build capacity for local leadership to effect change at the system and policy levels in Hampshire County around food and fitness. This includes increases in and access to healthy eating and physical activity for children, families and adults, and in particular for underserved populations such as low income residents and recent immigrants.
(2) Community Coalition for Teens425 Main Street Suite 20 Greenfield,MA01301	04-6001424	7,500	0	To allow the Communities That Care Coalition to transition from a focus on youth substance abuse prevention to a broader healthy communities focus, capitalizing on established membership, structures, and experience while adding new partners, goals, objectives, and strategies.

Enter total number of section 501(c)(3) and government organizations ......................... Bullet Image

Enter total number of other organizations ................................ . Bullet Image

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2010

Page 2

Part III

Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.

(a)Type of grant or assistance	(b)Number of recipients	(c)Amount of cash grant	(d)Amount of non-cash assistance	(e)Method of valuation (book, FMV, appraisal, other)	(f)Description of non-cash assistance

Part IV

Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.

Identifier	Return Reference	Explanation
SchI_P01_S00_L02	Schedule I, Part I, Line 2	The grant recipient provided a presentation to the Board of Trustees Subcommittee for Healthy Communities. Recipients are also expected to submit a written annual report to the Committee.

Schedule I (Form 990) 2010

Additional Data

Software ID:	10000077
Software Version:	v1.00

- TIN:

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

COOLEY DICKINSON HOSPITAL INC

Employer identification number

22-2617175

Part I

Questions Regarding Compensation

Yes

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.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

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....

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? ....

Yes

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.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

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:

Receive a severance payment or change-of-control payment? ...............

Yes

Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? ........

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.

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:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

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:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

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 ............

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 .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 50053T

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
(A) Name		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
(1) Craig N Melin	(i) (ii)	368,469 0	0 0	94,109 0	14,700 0	18,042 0	495,320 0	0 0
(2) Carol Smith	(i) (ii)	323,430 0	7,684 0	40,904 0	10,413 0	8,829 0	391,260 0	0 0
(3) Edith Peter	(i) (ii)	213,655 0	0 0	43,619 0	14,356 0	20,332 0	291,962 0	0 0
(4) Wayne Freeberg	(i) (ii)	220,218 0	5,000 0	2,697 0	13,674 0	17,430 0	259,019 0	0 0
(5) Kenneth Guilbault	(i) (ii)	143,879 0	0 0	45,880 0	8,145 0	9,023 0	206,927 0	0 0
(6) Leesa-Lee Keith	(i) (ii)	169,629 0	0 0	6,380 0	7,984 0	711 0	184,704 0	0 0
(7) Wilmont Davis	(i) (ii)	153,445 0	0 0	20,143 0	8,748 0	2,291 0	184,627 0	0 0
(8) Mary Ellen Just	(i) (ii)	124,439 0	29,500 0	4,042 0	7,155 0	14,549 0	179,685 0	0 0
(9) John Zebrun MD	(i) (ii)	271,517 0	0 0	519 0	8,290 0	18,202 0	298,528 0	0 0
(10) Sanford Levy PhD	(i) (ii)	238,304 0	0 0	2,057 0	9,906 0	13,823 0	264,090 0	0 0
(11) Catherine Durie MD	(i) (ii)	190,689 0	0 0	13,398 0	1,874 0	11,805 0	217,766 0	0 0
(12) Mark Novotny MD	(i) (ii)	148,699 0	12,000 0	15,393 0	0 0	22,686 0	198,778 0	0 0
(13) Catherine Neumann	(i) (ii)	155,679 0	0 0	737 0	9,037 0	19,287 0	184,740 0	0 0
(14) Peter Siersma MD	(i) (ii)	0 186,683	0 0	0 1,189	0 5,665	0 16,074	0 209,611	0 0

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
SchJ_P01_S00_L01a	Schedule J, Part I, Line 1a	The housing allowance benefit was included in a contract that was negotiated and approved by the Chief Executive Officer and the Vice President of Human Resources. The benefits were then paid in accordance with the contract.
SchJ_P01_S00_L01b	Schedule J, Part I, Line 1b	The housing allowance benefit was included in a contract that was negotiated and approved by the Chief Executive Officer and the Vice President of Human Resources. The benefits were then paid in accordance with the contract.
SchJ_P01_S00_L04	Schedule J, Part I, Line 4	The organization offers a Supplemental Retirement Plan (SRP) for Senior Executives. Annually, the organization provides the SRP benefit contribution amounts to the participant. The benefit contribution amounts for 2010 are as follows: Craig Melin $70,683; Carol Smith $19,368; Edith Peter $21,551; Leesa-Lee Keith $6,043. Kenneth Guilbault received severance payments totaling $30,881.
SchJ_P02_S00_L00	Schedule J, Part II	Other reportable compensation, Column B(iii), may include Supplemental Retirement Plan benefit contributions, employee deferrals to Section 457 plans, taxable life or disability, and the taxable benefit of an employer provided automobile.

Schedule J (Form 990) 2010

Additional Data

Software ID:	10000077
Software Version:	v1.00

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

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
COOLEY DICKINSON HOSPITAL INC

Employer identification number
22-2617175

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
(a) Issuer Name		(b) Issuer EIN	(c) CUSIP #	(d) Date Issued	(e) Issue Price	(f) Description of Purpose	Yes	No	Yes	No	Yes	No
A	Massachusetts Health and Educational Facilities Authority	04-2456011	none00000	09-17-2007	1,488,727	surgical equipment		X		X		X
B	Massachusetts Health and Educational Facilities Authority	04-2456011	none00000	03-08-2007	2,116,171	MRI equipment		X		X		X
C	Massachusetts Health and Educational Facilities Authority	04-2456011	none00000	12-23-2008	3,500,000	energy efficiency equipment		X		X		X
D	Massachusetts Health and Educational Facilities Authority	04-2456011	none00000	06-30-2009	7,040,000	medical equipment		X		X		X
	Massachusetts Health and Educational Facilities Authority	04-2456011	none00000	02-20-2009	3,125,000	building renovations & equipment		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired. . . . .	953,727		1,364,455		834,494		2,113,160
2 Amount of bonds defeased . . . .	0		0		0		0
3 Total proceeds of issue . . . .	1,488,727		2,116,171		3,517,470		7,042,583
4 Gross proceeds in reserve funds . .	0		0		0		0
5 Capitalized interest from proceeds.	0		0		0		0
6 Proceeds in refunding escrow. . . . .	0		0		0		0
7 Issuance costs from proceeds . . .	21,727		37,012		20,847		19,951
8 Credit enhancement from proceeds.	0		0		0		0
9 Working capital expenditures from proceeds . .	0		0		0		0
10 Capital expenditures from proceeds . .	1,467,000		2,049,539		3,374,123		7,022,632
11 Other spent proceeds . .	0		29,620		0		0
12 Other unspent proceeds. . .	0		0		122,516		0
13 Year of substantial completion . . .	2007		2007		2010		2009
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue?		X		X	X		X
15 Were the bonds issued as part of an advance refunding issue?		X		X		X		X
16 Has the final allocation of proceeds been made? . .	X		X			X	X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? .	X		X		X		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		X		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . .		X		X		X		X

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

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		X		X		X
b Are there any research agreements that may result in private business use of bond-financed property? . .		X		X		X		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? .
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 . . . . . . . . . . . . .	0 %		0 %		0 %		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 .	0 %		0 %		0 %		0 %
6 Total of lines 4 and 5 . . .. . . . . .	0 %		0 %		0 %		0 %
7 Has the organization adopted management practices and procedures to ensure the post-issuance compliance of its tax-exempt bond liabilities?	X		X		X		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		X		X		X
2 Is the bond issue a variable rate issue?		X		X		X		X
3a Has the organization or the governmental issuer entered into a hedge with respect to the bond issue?		X		X		X		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		X		X		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		X	X			X
6 Did the bond issue qualify for an exception to rebate? . . .		X		X		X		X

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
SchK_P02_S00_L03	Schedule K, Part II, Line 3	The total proceeds reported in Part II, Line 3, Columns C, D and E include investment earnings of $17,470, $2,583, and $11,220 respectively. Therefore they differ from the issue price listed in Part I, Column (e).
SchK_P03_S00_L07	Schedule K, Part III, Line 7	Cooley Dickinson Hospital has performed an extensive review of all activities conducted within its bond financed facilities. Upon review, the organization has determined that except for a de minimis amount of incidental use, there is no private business use.

Schedule K (Form 990) 2010

Additional Data

Software ID:	10000077
Software Version:	v1.00

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

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
COOLEY DICKINSON HOSPITAL INC

Employer identification number
22-2617175

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
(a) Issuer Name		(b) Issuer EIN	(c) CUSIP #	(d) Date Issued	(e) Issue Price	(f) Description of Purpose	Yes	No	Yes	No	Yes	No
A	Massachusetts Health and Educational Facilities Authority	04-2456011	none00000	09-17-2007	1,488,727	surgical equipment		X		X		X
B	Massachusetts Health and Educational Facilities Authority	04-2456011	none00000	03-08-2007	2,116,171	MRI equipment		X		X		X
C	Massachusetts Health and Educational Facilities Authority	04-2456011	none00000	12-23-2008	3,500,000	energy efficiency equipment		X		X		X
D	Massachusetts Health and Educational Facilities Authority	04-2456011	none00000	06-30-2009	7,040,000	medical equipment		X		X		X
	Massachusetts Health and Educational Facilities Authority	04-2456011	none00000	02-20-2009	3,125,000	building renovations & equipment		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired. . . . .	953,727		1,364,455		834,494		2,113,160
2 Amount of bonds defeased . . . .	0		0		0		0
3 Total proceeds of issue . . . .	1,488,727		2,116,171		3,517,470		7,042,583
4 Gross proceeds in reserve funds . .	0		0		0		0
5 Capitalized interest from proceeds.	0		0		0		0
6 Proceeds in refunding escrow. . . . .	0		0		0		0
7 Issuance costs from proceeds . . .	21,727		37,012		20,847		19,951
8 Credit enhancement from proceeds.	0		0		0		0
9 Working capital expenditures from proceeds . .	0		0		0		0
10 Capital expenditures from proceeds . .	1,467,000		2,049,539		3,374,123		7,022,632
11 Other spent proceeds . .	0		29,620		0		0
12 Other unspent proceeds. . .	0		0		122,516		0
13 Year of substantial completion . . .	2007		2007		2010		2009
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue?		X		X	X		X
15 Were the bonds issued as part of an advance refunding issue?		X		X		X		X
16 Has the final allocation of proceeds been made? . .	X		X			X	X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? .	X		X		X		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		X		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . .		X		X		X		X

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

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		X		X		X
b Are there any research agreements that may result in private business use of bond-financed property? . .		X		X		X		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? .
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 . . . . . . . . . . . . .	0 %		0 %		0 %		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 .	0 %		0 %		0 %		0 %
6 Total of lines 4 and 5 . . .. . . . . .	0 %		0 %		0 %		0 %
7 Has the organization adopted management practices and procedures to ensure the post-issuance compliance of its tax-exempt bond liabilities?	X		X		X		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		X		X		X
2 Is the bond issue a variable rate issue?		X		X		X		X
3a Has the organization or the governmental issuer entered into a hedge with respect to the bond issue?		X		X		X		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		X		X		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		X	X			X
6 Did the bond issue qualify for an exception to rebate? . . .		X		X		X		X

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
SchK_P02_S00_L03	Schedule K, Part II, Line 3	The total proceeds reported in Part II, Line 3, Columns C, D and E include investment earnings of $17,470, $2,583, and $11,220 respectively. Therefore they differ from the issue price listed in Part I, Column (e).
SchK_P03_S00_L07	Schedule K, Part III, Line 7	Cooley Dickinson Hospital has performed an extensive review of all activities conducted within its bond financed facilities. Upon review, the organization has determined that except for a de minimis amount of incidental use, there is no private business use.

Schedule K (Form 990) 2010

Additional Data

Software ID:	10000077
Software Version:	v1.00

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ. MediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

COOLEY DICKINSON HOSPITAL INC

Employer identification number

22-2617175

Part I

Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(b) Description of transaction	(c) Corrected?
1(a) Name of disqualified person	(b) Description of transaction	Yes	No

Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.

(a) Name of interested person and purpose	(b) Loan to or from the organization?		(c)Original principal amount	(d)Balance due	(e) In default?		(f) Approved by board or committee?		(g)Written agreement?
(a) Name of interested person and purpose	To	From	(c)Original principal amount	(d)Balance due	Yes	No	Yes	No	Yes	No






Total ............... $

Part III

Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b)Relationship between interested person and the organization	(c)Amount of grant or type of assistance

For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2010

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) Ten Main St Florence LLC	Ownership of more than 5% by a Trustee	284,296	lease office space		No

Part V

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule L (see instructions).

Identifier	Return Reference	Explanation

Schedule L (Form 990 or 990-EZ) 2010

Additional Data

Software ID:	10000077
Software Version:	v1.00

- TIN:

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

COOLEY DICKINSON HOSPITAL INC

Employer identification number

22-2617175

Identifier	Return Reference	Explanation
F990_P00_S00_L0L	Form 990, Header, Line L	Cooley Dickinson Hospital, Inc. was reorganized in 1984, however, the Hospital has been in operation since 1918.
F990_P01_S00_L06	Form 990, Part I, Line 6	391 is the actual number of individuals who gave their time through our Volunteer Services between October 1, 2010 and September 30, 2011. In addition, 18 individuals served as voluntary Trustees on the organization's Board of Trustees.
F990_P04_S00_L11f	Form 990, Part IV, Line 11f	The organization did not have a FIN48 liability, therefore a footnote was not needed in the audited financial statements.
F990_P06_S0A_L02	Form 990, Part VI, Section A, Line 2	The same individuals serve as Officers and Trustees on the Boards of Cooley Dickinson Health Care Corporation, Cooley Dickinson Hospital, and VNA & Hospice of Cooley Dickinson. Six of the eleven Trustees who served on the Board of CD Practice Associates also serve on the Board of Cooley Dickinson Health Care Corporation, Cooley Dickinson Hospital, and VNA & Hospice of Cooley Dickinson.
F990_P06_S0A_L06	Form 990, Part VI, Section A, Line 6	The sole member of the corporation shall be Cooley Dickinson Health Care Corporation.
F990_P06_S0A_L07a	Form 990, Part VI, Section A, Line 7a	The Trustees of the corporation shall be those persons serving as ex officio trustees and elected trustees of the member.
F990_P06_S0A_L07b	Form 990, Part VI, Section A, Line 7b	The sole member has governing powers as set forth in the corporate bylaws.
F990_P06_S0B_L11b	Form 990, Part VI, Section B, Line 11b	Cooley Dickinson Hospital prepared the Form 990. The Form was then reviewed internally by management and following that review, the Hospital's management presented the Form 990 to the Board of Trustees Audit and Compliance Committee for review and comment. The completed Form 990, including required schedules, was provided electronically to each member of the Board of Trustees prior to filing with the IRS.
F990_P06_S0B_L12c	Form 990, Part VI, Section B, Line 12c	All employees of CDHCC are provided copies of the organization's Conflict of Interest Policy as well as a questionnaire upon hire. Each individual is required to sign that they have received and understand the policy. They are also asked to disclose any real or perceived conflict of interest. The completed forms are returned to the organization's Compliance Officer who is responsible for monitoring and enforcing the Conflict of Interest Policy. Annually thereafter, employees are asked if they understand the policy and have anything to report as part of the annual performance evaluation. There is ongoing monitoring to ensure all new employees fill out the questionnaire and ongoing employees are asked as part of the review process. Trustees and Senior Managers have the additional requirement of completing an annual questionnaire. All completed questionnaires are reviewed by the Compliance Officer who consults with legal counsel and takes action as appropriate to understand the relationships and raise awareness. The Compliance Officer also reports annually to the Board of Trustees on policy enforcement.
F990_P06_S0B_L15	Form 990, Part VI, Section B, Line 15	The organization has a Board Compensation Committee that reviews the compensation for these individuals on an annual basis. Committee meeting minutes were taken and decisions were documented. In addition, an outside independent consulting firm is retained to review compensation and benefits for reasonableness and comparability
F990_P06_S0C_L19	Form 990, Part VI, Section C, Line 19	The organization's governing documents are filed with the Massachusetts Secretary of State and the financial statements are filed with the Massachusetts Attorney General, all of which are open to public inspection. Further, the Form 990, financial statements, and conflict of interest policy are available to the public upon request.
F990_P07_S0A_L01a	Form 990, Part VII, Section A, Line 1a	Henry Rosenberg MD, Margaret Russo, MD, and Peter Siersma, MD are compensated by CD Practice Associates, working an average of 13 hours, 22 hours, and 40 hours per week respectively.
F990_P11_S00_L05	Form 990, Part XI, Line 5	Unrealized appreciation of investments (net), 140,707; Minimum pension liability adjustment, (9,946,366); Transfers to CD Practice Associates for start up operations, (2,846,621); Transfers from Cooley Dickinson Health Care Corporation to finance property and equipment, 54,266; Net assets released from restriction used for capital additions, 165,000; Change in beneficial interest, temp restricted, 1,418,912; Change in beneficial interest, perm restricted, 100.

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

Software ID:	10000077
Software Version:	v1.00

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

COOLEY DICKINSON HOSPITAL INC

Employer identification number

22-2617175

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
(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	Yes	No
(1) Cooley Dickinson Health Care Corporation 30 Locust Street Northampton,MA01060 04-2103561	fundraising to support Cooley Dickinson Hospital	MA	501(c)(3)	11, Type II	N/A		No
(2) VNA & Hospice of Cooley Dickinson Inc 168 Industrial Drive Northampton,MA01060 04-2104788	provide home care & hospice services	MA	501(c)(3)	9	Cooley Dickinson Health Care Corporation	Yes
(3) CD Practice Associates Inc 30 Locust Street Northampton,MA01060 04-3194547	physician practice support	MA	501(c)(3)	9	Cooley Dickinson Health Care Corporation	Yes

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

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	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	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

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

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 . . . . . . . . . . . . . . . . . . . . . . .

b Gift, grant, or capital contribution to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

c Gift, grant, or capital contribution from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

d Loans or loan guarantees to or for other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e Loans or loan guarantees by other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Sale of assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Purchase of assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Exchange of assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Lease of facilities, equipment, or other assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

j Lease of facilities, equipment, or other assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

k Performance of services or membership or fundraising solicitations for other organization(s) . . . . . . . . . . . . . . . . . . . . . .

Yes

l Performance of services or membership or fundraising solicitations by other organization(s) . . . . . . . . . . . . . . . . . . . . . .

Yes

m Sharing of facilities, equipment, mailing lists, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

n Sharing of paid employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

o Reimbursement paid to other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

p Reimbursement paid by other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

q Other transfer of cash or property to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

r Other transfer of cash or property from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

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) CD Practice Associates Inc	b	2,846,621	actual cost
(2) CD Practice Associates Inc	i	267,738	fair market value
(3) CD Practice Associates Inc	k	2,581,714	actual cost
(4) CD Practice Associates Inc	l	3,325,674	actual cost
(5) CD Practice Associates Inc	o	61,066	actual cost
(6) CD Practice Associates Inc	p	5,364,471	actual cost
(7) VNA & Hospice of Cooley Dickinson Inc	k	235,201	actual cost
(8) VNA & Hospice of Cooley Dickinson Inc	p	162,088	actual cost

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 VUBI amount in box 20 of Schedule K-1 (Form 1065)	(h) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(e) Share of end-of-year assets	Yes	No	(g) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

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

Software ID:	10000077
Software Version:	v1.00

1	Briefly describe the organization’s mission or most significant activities: Cooley Dickinson Hospital's mission is to provide it's patients and communities with the best health care services in the most appropriate setting with a vision to become a model community hospital by; 1) delivering on exceptional standards for quality and safety; 2) developing cutting edge improvement knowledge (learn from others and develop new approaches); and 3) teaching other community hospitals how to improve.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ....	3	22
4	Number of independent voting members of the governing body (Part VI, line 1b) ....	4	16
5	Total number of individuals employed in calendar year 2010 (Part V, line 2a) ...	5	1,624
6	Total number of volunteers (estimate if necessary) ....	6	409
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ..	7a	0
b	Net unrelated business taxable income from Form 990-T, line 34 ..	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	1,411,252	909,246
9	Program service revenue (Part VIII, line 2g) .........	161,937,885	157,610,232
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	888,092	1,096,509
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	2,276,364	18,572
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	166,513,593	159,634,559
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	31,772	25,000
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)	87,637,114	79,817,527
16a	Professional fundraising fees (Part IX, column (A), line 11e)....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f)....	73,174,078	71,280,045
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	160,842,964	151,122,572
19	Revenue less expenses. Subtract line 18 from line 12......	5,670,629	8,511,987
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16)............	192,063,167	196,855,475
21	Total liabilities (Part X, line 26)............	127,189,269	134,483,592
22	Net assets or fund balances. Subtract line 21 from line 20 .....	64,873,898	62,371,883

Sign Here

	Signature of officer	Date

	Type or print name and title.

Paid Preparer's Use Only	Preparer's signature	Date	Check if self- employed	Preparer’s taxpayer identification number (see instructions)
	Firm’s name (or yours if self-employed), address, and ZIP + 4			EIN
				Phone no.


4a	(Code: ) (Expenses $ 121,901,883 including grants of $ 25,000 ) (Revenue $ 157,610,232 )
	Cooley Dickinson Hospital, Inc. is a not for profit 140 bed community hospital in the city of Northampton Massachusetts, serving the counties of Franklin, Hampden, Hampshire, and others in western Massachusetts. It is fully accredited by the Joint Commission. Medical services at the hospital include: emergency, medical, cardiac care, cancer care, childbirth, women's health, diagnostic imaging services, behavioral health, rehabilitation, and outpatient services. CDH provides medical and hospital services for the sick and disabled of any race, creed, color, nationality, and sexual identity regardless of an individual's ability to pay. In 2011 CDH provided over $7.7 million dollars in the form of free medical care. During the last year CDH assisted uninsured and underinsured patients with facilitating access to health care services. Cooley Dickinson Hospital provides leadership to communities in the Hampshire County area to assess health needs, resources, and gaps in services and to promote health access for vulnerable populations. CDH provides a full range of hospital services. Community programs include health screening and support groups, health education programs, behavioral health services, HIV/AIDS care and support, and other free clinical services. CDH serves approximately 9,600 medical and surgical patients annually, 3,400 patients underwent outpatient surgery. Outpatient visits include 36,000 visits to the Emergency Department. As of September 30, 2011, CDH Medical Staff consisted of 474 practicing physicians and dentists, of whom 259 are members of the active and associate staffs. (140 beds)

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services. (Describe in Schedule O.)
	(Expenses $ 0 including grants of $ 0 ) (Revenue $ 0 )
4e	Total program service expenses$ 121,901,883

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	3,066,121	337,151	343,345

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512, 513, or 514
1a	Federated campaigns..1a		0
b	Membership dues....1b		0
c	Fundraising events....1c		0
d	Related organizations...1d		0
e	Government grants (contributions)1e		909,246

f	All other contributions, gifts, grants, and similar amounts not included above1f		0
g	Noncash contributions included in lines 1a-1f:$ 0
h	Total. Add lines 1a-1f.......			909,246
			Business Code
2a	patient service revenue		622,000	156,876,536	156,876,536	0	0
b
c
d
e
f	All other program service revenue .			733,696	733,696	0	0
g	Total. Add lines 2a–2f........			157,610,232
3	Investment income (including dividends, interest
	and other similar amounts).....			1,096,509	0	0	1,096,509
4	Income from investment of tax-exempt bond proceeds..			0	0	0	0
5	Royalties............			0	0	0	0
		(i) Real	(ii) Personal
6a	Gross Rents
b	Less: rental expenses
c	Rental income or (loss)	0	0
d	Net rental income or (loss).......
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory
b	Less: cost or other basis and sales expenses
c	Gain or (loss)	0	0
d	Net gain or (loss)..........
8a	Gross income from fundraising events (not including $ 0 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..
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...
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..
Miscellaneous Revenue			Business Code
11a	loss on bond refinancing		622,000	-1,197,235	0	0	-1,197,235
b	vendor rebates		622,000	402,353	0	0	402,353
c	cafeteria sales/dietary events		622,000	268,032	0	0	268,032
d	All other revenue ....			545,422	0	0	545,422
e	Total. Add lines 11a–11d ......			18,572
12	Total revenue. See Instructions....			159,634,559	157,610,232	0	1,115,081


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing ..........			4,306,775	1	2,879,724
2	Savings and temporary cash investments .......			27,812,078	2	35,400,208
3	Pledges and grants receivable, net .........			507,549	3	53,406
4	Accounts receivable, net .........			14,259,574	4	12,525,454
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........			0	5	0
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 ..........			0	6	0
7	Notes and loans receivable, net .............			0	7	0
8	Inventories for sale or use ..............			1,648,899	8	1,720,627
9	Prepaid expenses and deferred charges ............			2,804,547	9	1,685,552
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	191,929,285
b	Less: accumulated depreciation. .....	10b	115,838,937	84,779,707	10c	76,090,348
11	Investments—publicly traded securities ..........			48,777,863	11	58,542,214
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 ...........			7,166,175	15	7,957,942
16	Total assets. Add lines 1 through 15 (must equal line 34)...			192,063,167	16	196,855,475
17	Accounts payable and accrued expenses .			18,840,605	17	18,092,039
18	Grants payable ..........			0	18	0
19	Deferred revenue ..........			0	19	0
20	Tax-exempt bond liabilities ..........			68,918,980	20	17,840,811
21	Escrow or custodial account liability. Complete Part IV of Schedule D..			0	21	0
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........			0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..			0	23	47,999,387
24	Unsecured notes and loans payable to unrelated third parties ....			0	24	0
25	Other liabilities. Complete Part X of Schedule D.....			39,429,684	25	50,551,355
26	Total liabilities. Add lines 17 through 25.....			127,189,269	26	134,483,592
	Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....			59,479,521	27	55,558,494
28	Temporarily restricted net assets .....			4,884,296	28	6,303,208
29	Permanently restricted net assets .....			510,081	29	510,181
	Organizations that do not follow SFAS 117, check here 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 .....			64,873,898	33	62,371,883
34	Total liabilities and net assets/fund balances .....			192,063,167	34	196,855,475