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)	(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) Daniel M Asquino Chairman	0	X						0	0	0
(2) Gerald L Bankowski Treasurer	0	X						0	0	0
(3) JoAnne Parks Clerk	0	X						0	0	0
(4) Kenneth J Pierce Vice Chairman	0	X						0	0	0
(5) James A Faust MD Trustee	0	X						0	0	0
(6) Joyce Fletcher Trustee	0	X						0	0	0
(7) John Flick Trustee	0	X						0	0	0
(8) James Garrison Trustee	0	X						0	0	0
(9) Paul P Harasimowicz DDS Trustee	0	X						0	0	0
(10) Stephen Hemman Trustee	0	X						0	0	0
(11) Glenn A Hunt Trustee	0	X						0	0	0
(12) Brian Knuuttila Trustee	0	X						0	0	0
(13) Anthony P Kraskouskas Jr Trustee	0	X						0	0	0
(14) Janet Latour Trustee	0	X						0	0	0
(15) Michele Parker Trustee	0	X						0	0	0
(16) Tina Sbrega Trustee	0	X						0	0	0
(17) John Skrzypczak MD Trustee	0	X						0	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)
(18) Karl Sorenson MD Trustee	0	X			0	0
(19) Edmund Taylor MD Trustee	0	X			0	0
(20) Winfield Brown President /CEO (hired 8/1/11)	40	X	X		0	0
(21) Daniel P Moen President / CEO (termed 1/24/11)	40	X	X		550,766	30,788
(22) Tina Santos VP of Patient Care Srvcs/CNO (hired 9/12/11)	40		X		0	0
(23) Michael Grimmer VP of Support Services (hired 9/19/11)	40		X		0	0
(24) Robert Crosby Sr VP of Finance / CFO	40		X		213,767	24,004
(25) Thomas Cady VP of Human Resources	40		X		150,829	24,316
(26) Rose Kavalchuck VP of Quality Services	40		X		150,399	22,272
(27) James Mullen Sr VP of Patient Care / CNO (termed 5/27/11)	40		X		232,463	29,283
(28) Lorie Martiska VP of Community Relations (termed 8/25/11)	30		X		108,398	11,118
(29) David Gill Staff Phychologist	40			X	247,343	26,043
(30) Sheila Ebert Oncology Physician	24			X	183,429	14,073
(31) Alice Vaine OR Nurse Practitioner	30			X	146,764	12,707
(32) Dianne Cormier Endo Registered Nurse	32			X	140,058	12,253
(33) Tina Griffin Director of Oncology	40			X	130,199	21,458

(A) Name and business address	(B) Description of services	(C) Compensation
William A Berry & Sons Inc 99 Conifer Hill Drive Danvers,MA01923	Construction Services	17,502,149
Quartulli and Associates Inc PO Box 423 Gardner,MA01440	Physical Therapy	2,720,684
Bay State Emergency Medical Inc 44 Crosby Road Ashburnham,MA01430	Emergency Room Physicians	2,534,967
Alliance Healthcare Services 100 Bay View Circle Newport Beach,CA92660	MRI	1,221,673
Quest Diagnostics Inc 5763 Collection Center Drive Chicago,IL60693	Lab Contracted Services	755,533
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 37

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	231,428	231,428
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 ....	1,615,386	546,059	1,069,327	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
7	Other salaries and wages	41,196,774	39,485,794	1,647,790	63,190
8	Pension plan contributions (include section 401(k) and section 403(b) employer contributions) ....	648,228	614,653	32,756	819
9	Other employee benefits .......	5,920,891	5,722,707	187,706	10,478
10	Payroll taxes ...........	3,239,195	3,106,123	128,678	4,394
11	Fees for services (non-employees):
a	Management ......	241,900	0	241,900	0
b	Legal .........	169,305	10,452	158,853	0
c	Accounting ...........	100,629	0	100,629	0
d	Lobbying ...........	0	0		0
e	Professional fundraising. See Part IV, line 17..	21,806			21,806
f	Investment management fees ......	0	0	0	0
g	Other ..........	11,426,554	11,426,554	0	0
12	Advertising and promotion ....	98,668	92,717	5,951	0
13	Office expenses .......	14,694,685	14,474,576	208,590	11,519
14	Information technology ......	865,077	865,077	0	0
15	Royalties ..	0	0	0	0
16	Occupancy ...........	1,699,110	1,679,140	19,970	0
17	Travel ............	67,051	61,524	5,527	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 ....	18,938	16,692	2,246	0
20	Interest ...........	827,777	827,777	0	0
21	Payments to affiliates .......	0	0	0	0
22	Depreciation, depletion, and amortization .....	3,919,410	3,903,506	15,904	0
23	Insurance ..............	795,045	754,526	40,519	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	Professional Fees	5,052,549	3,702,742	1,349,807	0
b	Provisions for Bad Debt	3,889,532	3,889,532	0	0
c	Free Care	3,172,834	3,172,834	0	0
d	Subscriptions and Dues	592,014	186,117	405,897	0
e	Laundry and Uniforms	467,094	467,094	0	0
f	All other expenses	970,769	914,494	56,275	0
25	Total functional expenses. Add lines 1 through 24f	101,942,649	96,152,118	5,678,325	112,206
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 ..........	2,453,099	1	1,853,123
2	Savings and temporary cash investments .......	0	2	0
3	Pledges and grants receivable, net .........	4,601,826	3	3,023,263
4	Accounts receivable, net .........	9,520,061	4	10,745,265
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 .............	235,927	7	59,961
8	Inventories for sale or use ..............	1,677,640	8	1,366,412
9	Prepaid expenses and deferred charges ............	1,357,529	9	1,024,514
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	100,861,772
b	Less: accumulated depreciation. .....	10b	44,805,939	54,067,784	10c	56,055,833
11	Investments—publicly traded securities ..........	15,174,420	11	11,923,586
12	Investments—other securities. See Part IV, line 11 ......	2,306,506	12	493,046
13	Investments—program-related. See Part IV, line 11 ..	2,408,235	13	124,289
14	Intangible assets .........	0	14	0
15	Other assets. See Part IV, line 11 ...........	0	15	0
16	Total assets. Add lines 1 through 15 (must equal line 34)...	93,803,027	16	86,669,292
	17	Accounts payable and accrued expenses .	16,865,672	17	13,381,637
18	Grants payable ..........	0	18	0
19	Deferred revenue ..........	0	19	0
20	Tax-exempt bond liabilities ..........	26,264,155	20	26,230,945
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 ..	1,052,456	23	812,024
24	Unsecured notes and loans payable to unrelated third parties ....	0	24	0
25	Other liabilities. Complete Part X of Schedule D.....	3,621,447	25	3,766,911
26	Total liabilities. Add lines 17 through 25.....	47,803,730	26	44,191,517
		Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....	38,407,900	27	36,836,852
28	Temporarily restricted net assets .....	6,585,434	28	4,634,890
29	Permanently restricted net assets .....	1,005,963	29	1,006,033
	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 .....	45,999,297	33	42,477,775
34	Total liabilities and net assets/fund balances .....	93,803,027	34	86,669,292

- TIN:

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

HENRY HEYWOOD MEMORIAL HOSPITAL

Employer identification number

04-2103581

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

HENRY HEYWOOD MEMORIAL HOSPITAL

Employer identification number

04-2103581

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 HENRY HEYWOOD MEMORIAL HOSPITAL
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 HENRY HEYWOOD MEMORIAL HOSPITAL
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
HENRY HEYWOOD MEMORIAL HOSPITAL

Employer identification number

04-2103581

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 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

HENRY HEYWOOD MEMORIAL HOSPITAL

Employer identification number

04-2103581

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 ....	17,367,013	16,786,738	18,164,728
b	Contributions ........	5,000	4,875	5,250
c	Investment earnings or losses ...	-128,702	958,017	-686,973
d	Grants or scholarships .....	0	0	0
e	Other expenditures for facilities and programs ........	5,345,880	382,617	696,267
f	Administrative expenses ....	0	0	0
g	End of year balance ......	11,897,431	17,367,013	16,786,738

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

Board designated or quasi-endowment: SchDMd Bullet

82 %

Permanent endowment: SchDMd Bullet

8 %

Term endowment: SchDMd Bullet

10 %

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)

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

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	125,271		125,271
b	Buildings ................	0	63,327,319	19,290,685	44,036,634
c	Leasehold improvements ............	0	0	0	0
d	Equipment ................	0	36,881,826	25,515,254	11,366,572
e	Other .................	0	527,356	0	527,356
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........					56,055,833

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
Estimated Settlement with 3rd Party		3,766,911








Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)		3,766,911
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
2	Total expenses (Form 990, Part IX, column (A), line 25) .....................	2
3	Excess or (deficit) for the year. Subtract line 2 from line 1 .............	3
4	Net unrealized gains (losses) on investments ..........................	4
5	Donated services and use of facilities .............................	5
6	Investment expenses ...................................	6
7	Prior period adjustments ..................................	7
8	Other (Describe in Part XIV) .................................	8
9	Total adjustments (net). Add lines 4 - 8 .............................	9
10	Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 .........	10

Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains on investments ..........	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIV): ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1.....................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIV): ...........	4b
c	Add lines 4a and 4b.......................		4c
5	Total Revenue. Add lines 3 and 4c. (This should equal Form 990, Part I, line 12.) ......		5

Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1	Total expenses and losses per audited financial statements .............		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities ..........	2a
b	Prior year adjustments ..............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIV): ............	2d
e	Add lines 2a through 2d......................		2e
3	Subtract line 2e from line 1.....................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIV): ............	4b
c	Add lines 4a and 4b.......................		4c
5	Total expenses. Add lines 3 and 4c. (This should equal Form 990, Part I, line 18.) ......		5

Part XIV

Supplemental Information

Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.

Identifier	Return Reference	Explanation
SchD_P05_S00_L04	Schedule D, Part V, Line 4	Perm endow funds are established by donor restricted gifts and maintained to provide a permanent source of income. The principal of which is kept in perpetuity. Board Designated endow funds are established by the governing body to fund capital projects and or improvements of the organization. Temp restricted funds are established by donor restricted gifts that maintain a source of income for a specified period of time.
SchD_P10_S00_L02	Schedule D, Part X, Line 2	FIN 48 (ASC 740) Footnote states "The Hospital and HMG have been determined to be not for profit corporations as described in Section 501(c)(3), and the Realty Corp has been determined to be a not for profit corporation as described in Section 501(c)(2) of the IRS code, and are exempt from federal income taxes on related income pursuant to Section 501(a) of the code. The IRS has also previously determined that the Hospital is not a private foundation because it is an organization described under the IRC section 170(i)(A)(iii). Any income not substantialy related to these Organizations' exempt purposes may be considered unrelated business income under IRC Section 511 and, as such, subject to tax at normal corporate rates. In accordance with generally accepted accounting principals, the Organization annually evaluates its tax status and tax positions taken with respect to its operations and financial position. Tax years from 2007 through the current year remain open for examination by federal and state taxing authorities."

Schedule D (Form 990) 2010

Additional Data

Software ID:	10000077
Software Version:	v1.00

- TIN:

SCHEDULE G
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information Regarding
Fundraising or Gaming Activities

Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19,
or if the organization entered more than $15,000 on Form 990-EZ, line 6a.
right arrow

Attach to Form 990 or Form 990-EZ. right arrow

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization
HENRY HEYWOOD MEMORIAL HOSPITAL

Employer identification number

04-2103581

Part I

Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17.

Indicate whether the organization raised funds through any of the following activities. Check all that apply.

a	Mail solicitations	e	Solicitation of non-government grants
b	Internet and e-mail solicitations	f	Solicitation of government grants
c	Phone solicitations	g	Special fundraising events
d	In-person solicitations

Did the organization have a written or oral agreement with any individual (including officers, directors, trustees

or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?

Yes

If “Yes,” list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization. Form 990-EZ filers are not required to complete this table.

(i) Name and address of individual or entity (fundraiser)	(ii) Activity	(iii) Did fundraiser have custody or control of contributions?		(iv) Gross receipts from activity	(v) Amount paid to (or retained by) fundraiser listed in col. (i)	(vi) Amount paid to (or retained by) organization
	(ii) Activity	Yes	No	(iv) Gross receipts from activity		(vi) Amount paid to (or retained by) organization
Total .................

List all states in which the organization is registered or licensed to solicit funds or has been notified it is exempt from registration or licensing.

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

Cat. No. 50083H

Schedule G (Form 990 or 990-EZ) 2010

Page 2

Part II

Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000 on Form 990-EZ, line 6a. List events with gross receipts greater than $5,000.

		(a) Event #1 Golf Classic (event type)	(c) Other Events (total number)	(d) Total Events (Add col. (a) through col. (c))
1	Gross receipts . . .	67,632		67,632
2	Less: Charitable contributions . . .	38,032		38,032
3	Gross income (line 1 minus line 2) . . .	29,600		29,600
4	Cash prizes . . .	2,060		2,060
5	Non-cash prizes . .	6,174		6,174
6	Rent/facility costs . .	13,485		13,485
7	Food and beverages . .	15,207	0	15,207
8	Entertainment . . .	0	0	0
9	Other direct expenses .	1,595		1,595
10	Direct expense summary. Add lines 4 through 9 in column (d) ...........			38,521
11	Net income summary. Combine lines 3 and 10 in column (d)............			-8,921

Part III

Gaming. Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.

(a) Bingo

(b) Pull tabs/Instant
bingo/progressive bingo

(c) Other gaming

(d) Total gaming (Add col. (a) through col. (c))

Gross revenue . . . .

Cash prizes . . . .

Non-cash prizes . . .

Rent/facility costs . . .

Other direct expenses . .

Volunteer labor . . .

	Yes
	No

	Yes
	No

	Yes
	No

Direct expense summary. Add lines 2 through 5 in column (d) ........... right arrow

Net gaming income summary. Combine lines 1 and 7 in column (d) .......... right arrow

Enter the state(s) in which the organization operates gaming activities:

Is the organization licensed to operate gaming activities in each of these states? ............

YesNo

If "No," Explain:

10a

Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? .....

YesNo

If "Yes," Explain:

Does the organization operate gaming activities with nonmembers? .................

YesNo

Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity

formed to administer charitable gaming? ...........................

YesNo

Schedule G (Form 990 or 990-EZ) 2010

Page 3

Indicate the percentage of gaming activity operated in:

The organization's facility ......................

13a

An outside facility ........................

13b

Provide the name and address of the person who prepares the organization's gaming/special events books and records:

Name

Address

15a

Does the organization have a contract with a third party from whom the organization receives gaming

revenue? ......................................

YesNo

If "Yes," enter the amount of gaming revenue received by the organization right arrow

$ and the

amount of gaming revenue retained by the third party right arrow

$ .

If "Yes," enter name and address:

Name

Address

Gaming manager information:

Name

Gaming manager compensation right arrow

Description of services provided right arrow

Director/officer Employee Independent contractor

Mandatory distributions:

Is the organization required under state law to make charitable distributions from the gaming proceeds to

retain the state gaming license? ............................

YesNo

Enter the amount of distributions required under state law distributed to other exempt organizations or spent

in the organization's own exempt activities during the tax year right arrow

Part IV

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

Identifier	ReturnReference	Explanation

Schedule G (Form 990 or 990-EZ) 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

HENRY HEYWOOD MEMORIAL HOSPITAL

Employer identification number

04-2103581

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: .....

Yes

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?.........

Yes

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) ..			2,019,098	1,014,439	1,004,659	0.99 %
b Unreimbursed Medicaid (from Worksheet 3, column a) .			14,108,984	12,115,212	1,993,772	1.95 %
c Unreimbursed costs—other means-tested government programs (from Worksheet 3, column b) ....			0	0	0	0 %
dTotal Charity Care and Means-Tested Government Programs .....	0	0	16,128,082	13,129,651	2,998,431	2.94 %
Other Benefits e Community health improvement services and community benefit operations (from (Worksheet 4) ....			1,665,992	122,071	1,543,921	1.52 %
f Health professions education (from Worksheet 5) ..			100,634	2,792	97,842	0.1 %
g Subsidized health services (from Worksheet 6) ..			0	0	0	0 %
h Research (from Worksheet 7)			0	0	0	0 %
i Cash and in-kind contributions to community groups (from Worksheet 8) ..			14,857	0	14,857	0.01 %
jTotal Other Benefits ...	0	0	1,781,483	124,863	1,656,620	1.63 %
kTotal. Add lines 7d and 7j. ..	0	0	17,909,565	13,254,514	4,655,051	4.57 %

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			0	0	0	0 %
2	Economic development			0	0	0	0 %
3	Community support			1,240	0	1,240	0 %
4	Environmental improvements			74	0	74	0 %
5	Leadership development and training for community members			0	0	0	0 %
6	Coalition building			238,777	0	238,777	0.23 %
7	Community health improvement advocacy			59,515	15,400	44,115	0.04 %
8	Workforce development			99,411	0	99,411	0.1 %
9	Other			0	0	0	0 %
10	Total	0	0	399,017	15,400	383,617	0.37 %

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

Yes

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

1,735,665

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

111,083

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).....

27,664,501

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

26,887,397

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

777,104

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	Henry Heywood Memorial Hospital 242 Green Street Gardner,MA01440	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:Henry Heywood Memorial Hospital

Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

				Yes	No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1	During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. .....................		1
	If “Yes,” indicate what the Needs Assessment describes (check all that apply):
	a	A definition of the community served by the hospital facility
	b	Demographics of the community
	c	Existing health care facilities and resources within the community that are available to respond to the health needs of the community
	d	How data was obtained
	e	The health needs of the community
	f	Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
	g	The process for identifying and prioritizing community health needs and services to meet those needs
	h	The process for consulting with persons representing the community’s interests
	i	Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
	j	Other (describe in Part VI)
2	Indicate the tax year the hospital facility last conducted a Needs Assessment: 20
3	In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted.		3
4	Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................		4
5	Did the hospital facility make its Needs Assessment widely available to the public? ...........		5
	If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
	a	Hospital facility’s website
	b	Available upon request from the hospital facility
	c	Other (describe in Part VI)
6	If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
	a	Adoption of an implementation strategy to address the health needs of the hospital facility’s community
	b	Execution of the implementation strategy
	c	Development of a community benefit plan for the facility
	d	Participation in community-wide community benefit plan
	e	Inclusion of a community benefit section in operational plans
	f	Adoption of a budget for provision of services that address the needs identified in the CHNA
	g	Prioritization of health needs in the community
	h	Prioritization of services that the hospital facility will undertake to meet health needs in its community
	i	Other (describe in Part VI)
7	Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs.		7
Financial Assistance Policy
	Did the hospital facility have in place during the tax year a written financial assistance policy that:
8	Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?		8	Yes
9	Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?..		9	Yes
	If “Yes,” indicate the FPG family income limit for eligibility for free care: 100%

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	Yes
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400%
11	Explained the basis for calculating amounts charged to patients?.................		11	Yes
	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	Yes
13	Included measures to publicize the policy within the community served by the hospital facility?.......		13	Yes
	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	Yes
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	Yes
	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	Yes
	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		No
	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		No
	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_L06a	Schedule H, Part I, Line 6a	The organization makes it's annual Community Benefit Report available to the public by transmitting the report electronically to the Attorney General's Community Benefit office which then makes it public on their website.
SchH_P01_S00_L07	Schedule H, Part I, Line 7	The costing methodology used to calculate the amounts reported in the table in Part I, for lines 7a through 7c was based on the cost to charge ratio derived from the supplied Worksheet 2, in the IRS schedule H instructions. The costs for lines 7e through 7i were actual costs incurred.
SchH_P02_S00_L00	Schedule H, Part II	The Heywood Hospital's Community Benefits Mission Statement is "Heywood Hospital is dedicated to the community benefit goals of improving the health status of our community, addressing the special health needs of the underserved and collaborating with others to enhance quality and contain the growth of community healthcare costs."
SchH_P02_S00_L03	Schedule H, Part II, Line 3	The Hospital established a Domestic Violence Task Force to help the community in violence prevention. Also, a Substance Abuse Support Group was established for the community to reach out to help.
SchH_P02_S00_L04	Schedule H, Part II, Line 4	Heywood Hospital assisted the Gardner Board of Health and Police Department in a state-wide project called "Operation Medicine Cabinet". This was to work on safely removing unused prescription medications from the community.
SchH_P02_S00_L06	Schedule H, Part II, Line 6	Heywood's approach to Community Benefits has been to collaborate with others through the Joint Coalition on Health and other coalitions to develop our plan, goals and strategies. Partners include the Joint Coalition on Health, Greater Gardner Interagency Team, the CHNA 9, the Minority Coalition, Montachusetts Opportunity Council, Mount Wachusetts Community College, the Community Health Connections Health Centers, North Central Human Services, Luk, Inc, Community Health Link, Gardner VNA, the Gardner Public Schools, the Winchendon Public Schools, the Health Foundation of Central MA, Kresge Foundation, the Department of Publich Health, AHEC and others. At this time, we continue to focus our efforts on mental health and substance abuse, insuring those without jobs and/or insurance, addressing the needs of underserved populations, focusing on the needs of youth and children, and targeting adults and children with overweight and obesity issues which lead to chronic disease and diabetes.
SchH_P02_S00_L07	Schedule H, Part II, Line 7	Heywood Hospital had representation at Career Centers and Unemployment Office Workshops to provide education and knowledge about our Ghap program which provides the community with access for health care services. Additionally, Heywood Hospital's Emergcy department includes a community health promotion advocate under the SBIRT project. This advocate screens emergency room patients and community members for health risks and substance abuse, and makes appropriate referrals. The SBIRT program assisted 1,056 ER patients through Screening and Brief Intervention model. 23% screened were positive and 38% of those were admitted into a substance abuse program.
SchH_P02_S00_L08	Schedule H, Part II, Line 8	Heywood Hospital serves a Medically Underserved Population Area. Because of this, the Hospital is constantly working to recruit and search out physicians to serve our community.
SchH_P03_S0A_L04	Schedule H, Part III, Section A, Line 4	Footnote "The Organization provides an allowance for doubtful accounts equal to estimated bad debt losses. The estimated losses are based upon historical collection experience together with a review of the current status of the existing receivables." The costing methodology used for line 2 was based on the cost to charge ratio derived from the supplied worksheet 2 in the IRS sch H instructions. The methodology used for line 3 was to take the percentage of financial assistance applications that were denied due to inadequate documentation divided by the total applications received for FY11. This amounted to approximately 6.4percent which was applied against the number on line 2. It is our belief that $110,083 amount of bad debt should be included as community benefit. As a tax exempt hospital, we must provide necessary services regardless of the patient's ability to pay for the service provided. As a not for profit, patient care is provided to all, regardless of ability to pay for that care, making quality patient care available to all in our community, regardless of their economic means, qualifies bad debts as a community benefit.
SchH_P03_S0B_L08	Schedule H, Part III, Section B, Line 8	The allowable costs on line 6 were obtained from our FY2011 Medicare Cost Report, worksheet D schedules.
SchH_P03_S0C_L09b	Schedule H, Part III, Section C, Line 9b	Heywood Hospital provides patients with information about financial assistance programs that are available through the Commonwealth of MA or through Heywood Hospital's own financial assistance program, which may cover all or some of their unpaid hospital bills. For those patients that request such assistance, Heywood Hospital assists patients by screening them for eligibility in an available public program and assisting them in applying for the program. These programs include, but are not limited to MassHealth, Commonwealth Care, Children's Medical Security Plan, Healthy Start, Health Safety Net and others. It is the patient's obligation to provide Heywood Hospital with accurate and timely information to determine if the patient is eligible to apply for certain health insurance programs. If the patient or guarantor is unable to provide the necessary information, Heywood Hospital may make reasonable efforts to obtain any additional information from other sources. Information that Heywood obtains will be maintained in accordance with applicable federal and state privacy and security laws. The screening and application process for a public health insurance program is done through the Virtual Gateway, which is an internet portal designed by the MA Executive Office of Health and Human Services. The Virtual Gateway manages the application process from the programs listed above, which is available for children, adults, seniors, veterans, homeless and disabled individuals. Heywood specifically assists the patient in completing the application and securing the necessary documentation required by the applicable financial assistance program. Heywood Hospital will then submit this document to the Commonwealth Office of Medicaid and assist the patient in any additional documentation if such is requested by the Commonwealth after completing the application. All Virtual Gateway applications are reviewed and processed by the Commonwealth of MA, Office of Medicaid. Special circumstance applications are reviewed and approved by the MA division of Health Care Finance and Policy. Hospitals have no role in the determination of program eligibility made by the Commonwealth, but at the patient's request may take a direct role in appealing or seeking information related to the coverage decisions. It is still the patient's responsibility to inform Heywood Hospital of all coverage decisions made by the Commonwealth to ensure accurate and timely adjudication of all hospital bills. If the patient does not comply with the request for documentation, then our standard collection procedures apply.
SchH_P05_S0B_L17	Schedule H, Part V, Section B, Line 17	The Hospital posts general notices throughout the hospital about the financial assistance policy.
SchH_P06_S00_L02	Schedule H, Part VI, Line 2	Heywood Hospital co chairs the Joint Coalition on Health which undertakes comprehensive assessments of community needs and assets every three to five years. The Steering Committees of the JCOH and the CHNA, with support from the Minority Coalition of North Central MA, collaborated to finalize a comprehensive health assessment of a 27 town region in north central MA. After the addition of pertinent sections to the report originally completed in January 2011, a final report was made available to the public in the fall of 2011. It was published in hard copy and as an electronic file on the web sites of participating organizations. More than 20 focus groups and interviews were conducted by vendors whoe were responsible for teh qualitative portion of the assessment. This data was gathered and analyzed by Blue Cross Blue Shield of MA. The Central MA Area Health Education Center intergrated the results of the qualitative work with the quantitative date to produce a final report.
SchH_P06_S00_L03	Schedule H, Part VI, Line 3	Heywood has a very aggressive and comprehensive program called GHAP to inform patients and members of the community about their eligibility for assistance and to assist them with enrollment and access to care. The goal is to inform the community about insurance options before they present to the Hospital for care. Many referrals come from area physicians to the program. The GHAP program was begun at Heywood in 1998 to connect uninsured patients with insurance and care. In addition to postings within the Hospital, the GHAP program is marketed throughout the community and selp-pay patients who present too the eD receive a follow-up call from GHAP staff to offer assistance. In addition, the GHAP program does outreach to community organizations and presents information monthly to the newly unemployed at the local unemployment office. GHAP also works collaboratively with Patient Accounts to assist patients who have difficulty paying their bill. GHAP has been nationally recognized by AHA and is part of a five organization network model for patient access that has received state grant funding.
SchH_P06_S00_L04	Schedule H, Part VI, Line 4	The Greater Gardner area, comprised of the City of Gardner and five surrounding towns, has a population of 60,000 people, a median income below the state average, and an unemployment rate above the state average. The community has been affected by the loss of the furniture industry over the past few decades, and by the current economic downturn. Mental Health and Substance Abuse are significant challenges for many residents of the area. The Hospital is the largest employer in the area, with around 1,000 employees. The community is largely white, non hispanic, but has a growing hispanic population. Gardner is one of three cities in teh region, the others are Fitchburg and Leominster, which frequently collaborate for the betterment of the region. Heywood Hospital collaoborates with the competing hospital in the Fitchburg Leominster area, HealthAlliance, on community health improvement activities, and provides the GHAP program onsite at HealthAlliance.
SchH_P06_S00_L05	Schedule H, Part VI, Line 5	The Heywood Hospital's Community Benefit Mission Statement states Heywood Hospital is dedicated to the community benefit goals of improving the health status of our community, addressing the special health needs of the underserved and collaborating with others to enhance quality and contain the growth of community healthcare costs. The Hospital dedicates our organization to the community benefit goals by improving the health status of our comminty; addressing the special health problems of minorities, the poor, uninsured and other underserved populations; contianing the growth of community health care costs. Such goals will be undertaken within the framework of a Community Benefit Plan which shall include sugh elements as comitment on the part of the Board of Trustees and CEO; specific goals and objectives; annual evaluation processes; commitment of hospital resources through normal budgeting process; consideration of community served in all operational and policy decisions; defined community; health status and needs assessment; opportunity for public input and comment; the promotion of cooperative and collaborative relationships with other providers and agencies in order to carry out a borad health agenda in our community. Such community benefit goals are elements and are herby adopeted and endorsed by the Board of Trustees of Heywood Hospital.
SchH_P06_S00_L06	Schedule H, Part VI, Line 6	not applicable
SchH_P06_S00_L07	Schedule H, Part VI, Line 7	Heywood Hospital files an annual Community Benefit Report to the Attorney General's Community Benefit Office in 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
HENRY HEYWOOD MEMORIAL HOSPITAL

Employer identification number
04-2103581

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	(c) IRC Code section if applicable	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of non-cash assistance	(h) Purpose of grant or assistance
(1) Montachusett Home Care Corp680 Mechanic Street Leominster,MA01453	04-2551175	501(c)(3)	147,885	0	not applicable	not applicable	The funds will be used by the Community Health Network of North Central MA as support and collaborative community health assessment work.
(2) Montachusett Opportunity Council133 Pritchard Street Fitchburg,MA01420	04-2401111	501(c)(3)	83,543	0	not applicable	not applicable	The funds will be used by Joint Coalition on Health as support of operations, to provide Community Health grants in conjunction with identified priorities of the JCOH service area, and to support the Gardner Area InterAgency Team.

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	Montachusett Home Care Corp and the Community Health Network of MA file an annual report with the office of the Healthy Communities that contains a summary of how the funds are allocated.

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

HENRY HEYWOOD MEMORIAL HOSPITAL

Employer identification number

04-2103581

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? ....

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

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

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) Robert Crosby	(i) (ii)	212,672 0	0 0	1,095 0	0 0	24,004 0	237,771 0	0 0
(2) Thomas Cady	(i) (ii)	150,041 0	0 0	788 0	1,591 0	22,725 0	175,145 0	182,238 0
(3) Rose Kavalchuck	(i) (ii)	149,877 0	0 0	522 0	3,100 0	19,172 0	172,671 0	163,810 0
(4) David Gill	(i) (ii)	246,052 0	0 0	1,291 0	4,900 0	21,143 0	273,386 0	0 0
(5) Sheila Ebert	(i) (ii)	182,378 0	0 0	1,051 0	3,668 0	10,405 0	197,502 0	0 0
(6) Alice Vaine	(i) (ii)	146,560 0	0 0	204 0	3,048 0	9,659 0	159,471 0	0 0
(7) Dianne Cormier	(i) (ii)	132,491 0	7,567 0	0 0	2,730 0	9,523 0	152,311 0	0 0
(8) Tina Griffin	(i) (ii)	129,964 0	0 0	235 0	2,696 0	18,762 0	151,657 0	0 0
(9) Daniel P Moen	(i) (ii)	464,254 0	74,300 0	12,212 0	4,900 0	25,888 0	581,554 0	386,126 0
(10) James Mullen	(i) (ii)	230,306 0	0 0	2,157 0	4,900 0	24,383 0	261,746 0	225,929 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

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
HENRY HEYWOOD MEMORIAL HOSPITAL

Employer identification number
04-2103581

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	MA Health and Educational Facilitiy Authority	04-2456011	57586EGT2	03-31-2009	17,785,000	Funds used for new Watkins Bldg project		X		X		X
B	MA Health and Educational Facility Authority	04-2456011	57586C7E9	06-19-2008	6,715,000	Refunding and new Watkins Bldg project		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired. . . . .	0		0
2 Amount of bonds defeased . . . .	0		0
3 Total proceeds of issue . . . .	66,235		19,154
4 Gross proceeds in reserve funds . .	0		0
5 Capitalized interest from proceeds.	0		0
6 Proceeds in refunding escrow. . . . .	0		0
7 Issuance costs from proceeds . . .	281,690		329,467
8 Credit enhancement from proceeds.	0		0
9 Working capital expenditures from proceeds . .	0		3,597,891
10 Capital expenditures from proceeds . .	17,569,545		2,806,796
11 Other spent proceeds . .	0		0
12 Other unspent proceeds. . .	0		0
13 Year of substantial completion . . .	2010		2008
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue?		X	X
15 Were the bonds issued as part of an advance refunding issue?		X		X
16 Has the final allocation of proceeds been made? . .	X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? .	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
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . .		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
b Are there any research agreements that may result in private business use of bond-financed property? . .		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? .		X		X
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . . . . . . . . . . . .	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 %
6 Total of lines 4 and 5 . . .. . . . . .	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

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
2 Is the bond issue a variable rate issue?	X		X
3a Has the organization or the governmental issuer entered into a hedge with respect to the bond issue?	X		X
b Name of provider .	TD Bank		Piper Jaffrey
c Term of hedge . .	18.7		18.7
d Was the hedge superintegrated? .		X		X
e Was a hedge terminated? .		X		X
4a Were gross proceeds invested in a GIC? .		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
6 Did the bond issue qualify for an exception to rebate? . . .	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_P01_S00_L00	Schedule K, Part I	The bond issued on line B was a bond issued partially to refund a previous bond balance that was issued on November 9, 1999 and to pay for a portion of the new Watkins Building.

Schedule K (Form 990) 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

HENRY HEYWOOD MEMORIAL HOSPITAL

Employer identification number

04-2103581

Identifier	Return Reference	Explanation
F990_P06_S0A_L03	Form 990, Part VI, Section A, Line 3	The Heywood Hospital President, Daniel Moen, left the organization in January 2011. During the search for a new CEO/President, the Hospital acquired the services of Leaders for Today, LLC (a management company) to employ an interim CEO. In August 2011 a new CEO, Winfield Brown, was hired and the contract with Leaders for Today was terminated.
F990_P06_S0B_L11b	Form 990, Part VI, Section B, Line 11b	The Accountant at Heywood Hospital prepares the form 990 and provides it to the controller for review. The form is then sent to the CFO for final review. Once approved and signed, copies are provided to the governing body at their monthly meeting. The 990 is then approved for final submission by the accounting department.
F990_P06_S0B_L12c	Form 990, Part VI, Section B, Line 12c	Annually, a Conflict of Interest form is sent out to the managers, trustees and employees with broad discretionary authority. These forms are required to be signed and are monitored by the VP of Professional Services for completion.
F990_P06_S0B_L15	Form 990, Part VI, Section B, Line 15	The new CEO's salary was determined by the market data provided to the search committee by our search firm, an independent third party named Philips DiPisa. This data supplemented the first hand knowledge of other comparable facilities in New England that the search firm had based on prior searches. The search committee and the Board of Trustees had in-depth discussions and conversations surrounding this issue. The final vote on what the base compensation would be (predicated on input from Philips DiPisa) in addition to the possibility of a bona fide incentive compensation program was determined by the Board. The new officers salary were determined by existing data for comparable positions. Sources as the Massachusetts Hospital Salary Survey and intimate knowledge of the going salaries for senior executives in healthcare also played a major role in the determination of these salaries.
F990_P06_S0C_L19	Form 990, Part VI, Section C, Line 19	The organization makes the governing documents, conflict of interest policy and financial statements available to the public by providing completed copies to the Executive Assistant, who provides copies upon request.
F990_P11_S00_L05	Form 990, Part XI, Line 5	The amount that makes up the changes in net assets or fund balances is from gains and losses on investments, discounts on pledge receivables and transfers to Heywood Medical Group to help support the organization as they employ physicians that serve the hospital.

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

HENRY HEYWOOD MEMORIAL HOSPITAL

Employer identification number

04-2103581

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) Heywood Affiliated Medical Group 242 Green Street Gardner,MA01440 04-3163589	employ physicians	MA	501(c)(3)	9	N/A	Yes
(2) Heywood Hospital Realty Corporation 242 Green Street Gardner,MA01440 04-3327447	property holding company	MA	501(c)(2)		N/A	Yes
(3) HHMH Aid Association 242 Green Street Gardner,MA01440 04-2198019	raise funds for the Hospital	MA	501(c)(3)	9	N/A		No
(4) Winchendon Health Foundation 87 Central Street Winchendon,MA01475 04-2113276	supporting organization	MA	501(c)(3)	9	N/A		No

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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

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) . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

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) Heywood Hospital Realty Corporation	r	198,000	Cash
(2) Heywood Affiliated Medical Group	p	387,557	Actual cost
(3) Heywood Affiliated Medical Group	q	2,284,000	Cash
(4) Heywood Affiliated Medical Group	r	50,000	Cash
(5) Heywood Affiliated Medical Group	o	616,768	Actual cost
(6) Heywood Hospital Realty Corporation	p	207,175	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

- TIN:

TY 2010 ReasonableCauseExplanation

Name:

HENRY HEYWOOD MEMORIAL HOSPITAL

EIN: 04-2103581

Software ID:10000077

Software Version:v1.00

Explanation:

On January 23, 2012 Heywood Hospital filed a form 8868 requesting an automatic 3 month extension of time, delaying the filing due date to May 15, 2012. An approval notice was submitted to Henry Heywood Memorial Hospital on February 27, 2012 accepting the May 15th deadline.

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	2,930,001	995,825
9	Program service revenue (Part VIII, line 2g) .........	95,394,047	98,848,732
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	167,930	-135,263
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	1,133,754	1,044,642
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	99,625,732	100,753,936
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	50,000	231,428
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)	48,844,530	52,620,474
16a	Professional fundraising fees (Part IX, column (A), line 11e)....	1,196	21,806
b	Total fundraising expenses (Part IX, column (D), line 25) 112,206
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f)....	45,560,571	49,068,941
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	94,456,297	101,942,649
19	Revenue less expenses. Subtract line 18 from line 12......	5,169,435	-1,188,713
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16)............	93,803,027	86,669,292
21	Total liabilities (Part X, line 26)............	47,803,730	44,191,517
22	Net assets or fund balances. Subtract line 21 from line 20 .....	45,999,297	42,477,775

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 $ 96,152,118 including grants of $ 231,428 ) (Revenue $ 98,848,732 )
	Heywood Hospital is dedicated to the community benefit goals of improving the health status of our community, adressing the specific health care needs of the under-served and collaborating with others to enhance quality and contain the growth of community health care costs. Details to this are published in "The Community Benefit Report of Heywood Hospital - Fiscal Year 2011" filed with the MA Attorney General Office.

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$ 96,152,118

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	2,254,415	0	228,315

1	Briefly describe the organization’s mission or most significant activities: Heywood Hospital is a community oriented and supported not-for-profit acute care hospital governed by a local Board of Trustees. Our mission is to be our communities' trusted choice for exceptional patient-centered care.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ....	3	20
4	Number of independent voting members of the governing body (Part VI, line 1b) ....	4	19
5	Total number of individuals employed in calendar year 2010 (Part V, line 2a) ...	5	980
6	Total number of volunteers (estimate if necessary) ....	6	281
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

				(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		38,032
d	Related organizations...1d		0
e	Government grants (contributions)1e		209,356

f	All other contributions, gifts, grants, and similar amounts not included above1f		748,437
g	Noncash contributions included in lines 1a-1f:$ 0
h	Total. Add lines 1a-1f.......			995,825
			Business Code
2a	Ancillary O/P Service		622,110	55,018,371	55,018,371	0	0
b	Ancillary I/P Service		622,110	43,038,691	43,038,691	0	0
c	Contracted Services		900,099	528,918	528,918	0	0
d	HMG Patient Revenue (net)		621,111	128,848	128,848	0	0
e	Lifeline		624,120	71,906	71,906	0	0
f	All other program service revenue .			61,998	61,998	0	0
g	Total. Add lines 2a–2f........			98,848,732
3	Investment income (including dividends, interest
	and other similar amounts).....			209,788	0	0	209,788
4	Income from investment of tax-exempt bond proceeds..			252	0	0	252
5	Royalties............			0	0	0	0
		(i) Real	(ii) Personal
6a	Gross Rents	37,596	0
b	Less: rental expenses	0	0
c	Rental income or (loss)	37,596	0
d	Net rental income or (loss).......			37,596	0	0	37,596
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	10,072,191	7,246
b	Less: cost or other basis and sales expenses	10,417,383	7,357
c	Gain or (loss)	-345,192	-111
d	Net gain or (loss)..........			-345,303	0	0	-345,303
8a	Gross income from fundraising events (not including $ 38,032 of contributions reported on line 1c). See Part IV, line 18 ...
	a		29,600
b	Less: direct expenses ...b		38,521
c	Net income or (loss) from fundraising events..			-8,921		0	-8,921
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a		0
b	Less: direct expenses ...b		0
c	Net income or (loss) from gaming activities...			0	0	0	0
10a	Gross sales of inventory, less returns and allowances .
	a		0
b	Less: cost of goods sold ..b		0
c	Net income or (loss) from sales of inventory..			0	0	0	0
Miscellaneous Revenue			Business Code
11a	Meals Revenue		722,212	731,844	0	0	731,844
b	Purchase Discounts		900,099	193,900	0	0	193,900
c	Medical Record Copies		561,499	24,392	0	0	24,392
d	All other revenue ....			65,831	0	0	65,831
e	Total. Add lines 11a–11d ......			1,015,967
12	Total revenue. See Instructions....			100,753,936	98,848,732	0	909,379


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing ..........			2,453,099	1	1,853,123
2	Savings and temporary cash investments .......			0	2	0
3	Pledges and grants receivable, net .........			4,601,826	3	3,023,263
4	Accounts receivable, net .........			9,520,061	4	10,745,265
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 .............			235,927	7	59,961
8	Inventories for sale or use ..............			1,677,640	8	1,366,412
9	Prepaid expenses and deferred charges ............			1,357,529	9	1,024,514
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	100,861,772
b	Less: accumulated depreciation. .....	10b	44,805,939	54,067,784	10c	56,055,833
11	Investments—publicly traded securities ..........			15,174,420	11	11,923,586
12	Investments—other securities. See Part IV, line 11 ......			2,306,506	12	493,046
13	Investments—program-related. See Part IV, line 11 ..			2,408,235	13	124,289
14	Intangible assets .........			0	14	0
15	Other assets. See Part IV, line 11 ...........			0	15	0
16	Total assets. Add lines 1 through 15 (must equal line 34)...			93,803,027	16	86,669,292
17	Accounts payable and accrued expenses .			16,865,672	17	13,381,637
18	Grants payable ..........			0	18	0
19	Deferred revenue ..........			0	19	0
20	Tax-exempt bond liabilities ..........			26,264,155	20	26,230,945
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 ..			1,052,456	23	812,024
24	Unsecured notes and loans payable to unrelated third parties ....			0	24	0
25	Other liabilities. Complete Part X of Schedule D.....			3,621,447	25	3,766,911
26	Total liabilities. Add lines 17 through 25.....			47,803,730	26	44,191,517
	Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....			38,407,900	27	36,836,852
28	Temporarily restricted net assets .....			6,585,434	28	4,634,890
29	Permanently restricted net assets .....			1,005,963	29	1,006,033
	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 .....			45,999,297	33	42,477,775
34	Total liabilities and net assets/fund balances .....			93,803,027	34	86,669,292