TY 2012 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) Frank Cook........................................................................ Board Member	2 .......................1	X			0	0	0
(2) Kevin Dumas........................................................................ Board Member	2 .......................1	X			0	0	0
(3) Donna Kimmel........................................................................ Board Member	2 .......................1	X			0	0	0
(4) John Korona........................................................................ Board Member	2 .......................1	X			0	0	0
(5) Michael Poissant........................................................................ Board Member	2 .......................2	X			0	0	0
(6) Mark Robbin MD........................................................................ Board Member	2 .......................7	X			0	0	0
(7) Ethel Sandbach........................................................................ Board Member	2 .......................1	X			0	0	0
(8) Thomas Sprague........................................................................ Board Member	2 .......................1	X			0	0	0
(9) Robert Thresher........................................................................ Board Member	2 .......................1	X			0	0	0
(10) Catherine White........................................................................ Board Member	2 .......................1	X			0	0	0
(11) Mark Young MD........................................................................ Board Member	2 .......................41	X			0	55,746	25,463
(12) Timothy O'Neill........................................................................ Chairman	6 .......................4	X	X		0	0	0
(13) Rick Digiacomo........................................................................ Clerk	2 .......................1		X		0	0	0
(14) Linda Shyavitz........................................................................ President & CEO (see Schedule O)	38 .......................10		X		866,934	0	71,122
(15) Joseph Casey........................................................................ Treasurer & CFO (see Schedule O)	40 .......................9		X		485,705	0	61,101
(16) Bruce Auerbach MD........................................................................ VP/Medical Director (see Schedule O)	45 .......................2			X	693,392	0	73,476
(17) Brian Kelly MD........................................................................ VP/Chief of ER & Ambulatory	45 .......................0			X	358,846	0	55,427

(A) Name and business address	(B) Description of services	(C) Compensation
Attleboro Gastroenterology PC150 Emory StreetAttleboroMA02703	Surgical services	1,492,994
Arup Laboratories Inc500 Chipeta WaySalt Lake CityUT84108	Lab sendouts	830,888
New England Inpatient Specialists LLC120 Water StreetSuite 404North AndoverMA01845	Hospitalist services	695,316
Purity Services Inc405 Myrtle StreetNew BedfordMA02746	Laundry Services	562,423
Medical Management Resources Inc9485 Regency Square BlvdSuite 200JacksonvilleFL32225	ECC coding	239,894
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 19

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.	(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses
1	Grants and other assistance to governments and organizations in the United States. See Part IV, line 21	29,710	29,710
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	0	0
3	Grants and other assistance to governments, organizations, and individuals outside the United States. 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 ....	3,771,093	0	3,771,093	0
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	0	0	0	0
7	Other salaries and wages	69,868,818	66,003,171	3,865,647	0
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	6,469,337	5,798,442	670,895	0
9	Other employee benefits .......	11,892,849	10,659,515	1,233,334	0
10	Payroll taxes ...........	5,326,523	4,774,142	552,381	0
11	Fees for services (non-employees):
a	Management ......	0	0	0	0
b	Legal .........	127,329	1,940	125,389	0
c	Accounting ...........	140,725	0	140,725	0
d	Lobbying ...........	29,891	29,891	0	0
e	Professional fundraising services. See Part IV, line 17	0			0
f	Investment management fees ......	382,536	0	382,536	0
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........	4,621,757	3,755,983	865,774	0
12	Advertising and promotion ....	463,273	437,117	26,156	0
13	Office expenses .......	5,233,901	4,646,409	587,492	0
14	Information technology ......	1,812,623	1,276,042	536,581	0
15	Royalties ..	0	0	0	0
16	Occupancy ...........	2,785,459	2,111,656	673,803	0
17	Travel ............	57,872	32,238	25,634	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 ....	57,454	39,822	17,632	0
20	Interest ...........	0	0	0	0
21	Payments to affiliates .......	0	0	0	0
22	Depreciation, depletion, and amortization .....	10,161,069	7,703,106	2,457,963	0
23	Insurance ..............	1,168,674	1,125,869	42,805	0
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	Medical Supplies	19,519,854	19,519,854	0	0
b	Maintenance & Repairs	2,180,064	2,163,387	16,677	0
c	Medical Purchased Services	1,406,641	1,406,641	0	0
d
e	All other expenses	1,725,961	1,555,336	170,625	0
25	Total functional expenses. Add lines 1 through 24e	149,233,413	133,070,271	16,163,142	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet Check if Schedule O contains a response to any question in this Part X ...............
	1	Cashnon-interest-bearing .............	1,438	1	1,598
2	Savings and temporary cash investments .........	9,690,430	2	18,872,229
3	Pledges and grants receivable, net ...........	0	3	0
4	Accounts receivable, net .............	16,044,167	4	15,385,415
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
		0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
		0	6	0
7	Notes and loans receivable, net .............	0	7	0
8	Inventories for sale or use ..............	2,783,457	8	2,920,002
9	Prepaid expenses and deferred charges ..........	3,665,494	9	46,652,326
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	178,756,504
b	Less: accumulated depreciation .....	10b	116,222,713	68,884,495	10c	62,533,791
11	Investments—publicly traded securities ..........	179,963,447	11	206,897,045
12	Investments—other securities. See Part IV, line 11 .....	7,055,191	12	7,910,801
13	Investments—program-related. See Part IV, line 11 .....	349,369	13	231,636
14	Intangible assets ...............	0	14	0
15	Other assets. See Part IV, line 11 ...........	2,402,743	15	3,120,899
16	Total assets. Add lines 1 through 15 (must equal line 34)......	290,840,231	16	364,525,742
	17	Accounts payable and accrued expenses .........	25,175,623	17	24,757,961
18	Grants payable .................	0	18	0
19	Deferred revenue ................	75,000	19	75,000
20	Tax-exempt bond liabilities .............	0	20	0
21	Escrow or custodial account liability. Complete Part IV of Schedule D..	0	21	0
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........	0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	0	23	0
24	Unsecured notes and loans payable to unrelated third parties ....	0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................	5,561,690	25	5,382,217
26	Total liabilities. Add lines 17 through 25.........	30,812,313	26	30,215,178
		Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............	260,009,940	27	334,250,974
28	Temporarily restricted net assets ...........	17,978	28	59,590
29	Permanently restricted net assets ...........	0	29	0
	Organizations that do not follow SFAS 117 (ASC 958), 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 ...........	260,027,918	33	334,310,564
34	Total liabilities and net assets/fund balances ........	290,840,231	34	364,525,742

- 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

2012

Open to Public
Inspection

Name of the organization

STURDY MEMORIAL HOSPITAL INC

Employer identification number

04-2768252

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 described in 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. See section 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 - Non-functionally integrated

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


Total

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2012

Page 2

Part II

Support Schedule for Organizations Described in Sections 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) 2008	(b) 2009	(c) 2010	(d) 2011	(e) 2012	(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) 2008	(b) 2009	(c) 2010	(d) 2011	(e) 2012	(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. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
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 2012 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2011 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2012. 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—2011. If the organization did not check a 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—2012. 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—2011. 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) 2012

Page 3

Part III

Support Schedule for Organizations Described in Section 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) 2008	(b) 2009	(c) 2010	(d) 2011	(e) 2012	(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) 2008	(b) 2009	(c) 2010	(d) 2011	(e) 2012	(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.)..

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 2012 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2011 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2011 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2012. 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—2011. 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) 2012

Page 4

Part IV

Supplemental Information. Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and 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) 2012

Additional Data

Software ID:	12000197
Software Version:	v1.00

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public
Inspection

If the organization answered “Yes” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35c (Proxy Tax), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

STURDY MEMORIAL HOSPITAL INC

Employer identification number

04-2768252

Part I-A

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

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

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

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

Part I-B

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

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

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

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

Yes No

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

Yes No

If "Yes," describe in Part IV.

Part I-C

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

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

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

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

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

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2012

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......
b	Total lobbying expenditures to influence a legislative body (direct lobbying) .......
c	Total lobbying expenditures (add lines 1a and 1b) ...................
d	Other exempt purpose expenditures ........................
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ......................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2009	(b) 2010	(c) 2011	(d) 2012	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2012

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

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

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

Yes

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

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

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

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

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

Yes

3,119

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

Other activities? ..........................

Yes

29,891

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

33,010

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

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

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

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

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

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

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

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered “No” OR (b) Part III-A, line 3, is answered “Yes."

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

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).

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

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

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

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

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................

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

Part IV

Supplemental Information

Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, line 2; and Part ll-B, line 1. Also, complete this part for any additional information.

Identifier	Return Reference	Explanation
SchC_P2B_S00_L01	Schedule C, Part II-B, Line 1	Line 1g: Certain employees of the Hospital meet quarterly at the hospital with local and state representatives to discuss current issues affecting the delivery of healthcare. These employees also make periodic phone calls and write letters to state and federal legislature officials as necessary. These expenses are approximately $3,119. Line 1i: The Hospital pays dues to the Massachusetts Hospital Association, American Hospital Association and Associated Industries of Massachusetts. A portion of these dues, $29,891, is used to support lobbying by the associations.

Schedule C (Form 990 or 990EZ) 2012

Additional Data

Software ID:	12000197
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, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet

Attach to Form 990. SchDMd Bullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization

STURDY MEMORIAL HOSPITAL INC

Employer identification number

04-2768252

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 can 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 education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 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, and not on a historic structure listed in the National Register ....................	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax 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 section 170(h)(4)(B)(ii)? .......................................

Yes No

In Part XIII, 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 (ASC 958), 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 XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), 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 (ASC 958) 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 Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2012

Page 2

Part III

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

Using the organization’s acquisition, 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 XIII.

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 XIII 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 XIII. Check here if the explanation has been provided in Part XIII ........

Part V

Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	b (c)Two years back	(d)Three years back	(e)Four years back
1a	Beginning of year balance ....	0	0	0	0	0
b	Contributions ........	0	0	0	0	0
c	Net investment earnings, gains, and losses	0	0	0	0	0
d	Grants or scholarships .....	0	0	0	0	0
e	Other expenditures for facilities and programs ........	0	0	0	0	0
f	Administrative expenses ....	0	0	0	0	0
g	End of year balance ......	0	0	0	0	0

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

0 %

Permanent endowment SchDMd Bullet

100 %

Temporarily restricted endowment SchDMd Bullet

0 %

The percentages in lines 2a, 2b, and 2c should equal 100%.

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

Yes

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

3a(i)

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

3a(ii)

Yes

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

Yes

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

Part VI

Land, Buildings, and Equipment. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	0	1,262,721		1,262,721
b	Buildings ................	0	115,783,463	65,629,155	50,154,308
c	Leasehold improvements ............	0	0	0	0
d	Equipment ................	0	58,103,129	47,328,449	10,774,680
e	Other .................	0	3,607,191	3,265,109	342,082
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......					62,533,791

Schedule D (Form 990) 2012

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) must 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) must 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) must 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) Book value
Federal income taxes		0
Accrued postretirement health benefits		1,909,600
Insurance claims, long term		1,894,963
Workers' compensation self-insurance reserves		1,135,765
Asset retirement obligation		441,889





Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		5,382,217
2. Fin 48 (ASC 740) Footnote. In Part XIII, 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 (ASC 740). Check here if the text of the footnote has been provided in Part XIII .....................................................

Schedule D (Form 990) 2012

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1	Total revenue, gains, and other support per audited financial statements .......			1	169,442,352
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains on investments ..........	2a	0
b	Donated services and use of facilities .........	2b	0
c	Recoveries of prior year grants ...........	2c	0
d	Other (Describe in Part XIII.) ............	2d	0
e	Add lines 2a through 2d .....................			2e	0
3	Subtract line 2e from line 1.....................			3	169,442,352
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a	0
b	Other (Describe in Part XIII.) ...........	4b	132,681
c	Add lines 4a and 4b.......................			4c	132,681
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	169,575,033

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1	Total expenses and losses per audited financial statements ...........			1	149,233,413
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities ..........	2a	0
b	Prior year adjustments ..............	2b	0
c	Other losses ................	2c	0
d	Other (Describe in Part XIII.) ............	2d	0
e	Add lines 2a through 2d......................			2e	0
3	Subtract line 2e from line 1.....................			3	149,233,413
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a	0
b	Other (Describe in Part XIII.) ............	4b	0
c	Add lines 4a and 4b.......................			4c	0
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	149,233,413

Part XIII

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, line 2; Part XI, lines 2d and 4b; and Part XII, 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	Sturdy Memorial Foundation maintains endowment funds (restricted to principal) for the benefit of Sturdy Memorial Hospital and affiliated organizations. The investment earnings on the endowment funds are almost entirely unrestricted. As income is earned on endowment funds (unrestricted as to income), it is transferred to the unrestricted fund (within the Foundation). From time to time, the Board of Directors has authorized transfers from the unrestricted fund in the Foundation to Sturdy Memorial Hospital and Sturdy Memorial Associates. A small portion of the endowment is held in a fund with the income restricted for "free care" for patients. The income on this fund is transferred on a semi-annual basis to Sturdy Memorial Hospital and used as free care in accordance with the hospital's free care policy.
SchD_P10_S00_L02	Schedule D, Part X, Line 2	The Hospital is recognized as an organization exempt from income tax under Section 501(c)(3) of the Internal Revenue Code. However, certain activities of exempt organizations, to the extent profitable, may be subject to federal and state taxation as unrelated busines income. Accordingly, no provision for income taxes has been made in these financial statements. The Hospital recognizes the financial statement benefit of a tax position only after determining that the relevant tax authority would more than likely not sustain the position following an audit. For tax positions meeting the more-than-likely-not threshold, the amount recognized in the financial statements is the largest benefit that has a greater than 50 percent likelihood of being realized upon ultimate settlement with the relevant tax authority. The Hospital has applied this more-than-likely-not threshold to all tax positions for which the statute of limitations remained open and determined there were no material unrecognized tax benefits as of that date. In addition there have been no material changes in unrecognized benefits since adoption.
SchD_P11_S00_L04b	Schedule D, Part XI, Line 4b	This is the total of "unrestricted net assets released from restrictions and expended for capital purposes" = $91,069; "temporarily restricted net assets: contributions" = $148,164; "temporarily restricted net assets: interest income" = $6,537 and "temporarily restricted net assets: net assets released from restrictions" = -$113,089.

Schedule D (Form 990) 2012

Additional Data

Software ID:	12000197
Software Version:	v1.00

- TIN:

SCHEDULE F(Form 990)

Department of the Treasury
Internal Revenue Service

Statement of Activities Outside the United States

Complete if the organization answered "Yes" to Form 990,Part IV, line 14b, 15, or 16. Right pointing arrow large image

Attach to Form 990. Right pointing arrow large image

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization
STURDY MEMORIAL HOSPITAL INC

Employer identification number

04-2768252

Part I

General Information on Activities Outside the United States. Complete if the organization answered “Yes” to Form 990, Part IV, line 14b.

For grantmakers. 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

For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of grant funds outside
the United States.

Activites per Region. (The following Part I, line 3 table can be duplicated if additional space is needed.)

(a) Region		(b) Number of offices in the region	(c) Number of employees, agents, and independent contractors in region	(d) Activities conducted in region (by type) (e.g., fundraising, program services, investments, grants to recipients located in the region)	(e) If activity listed in (d) is a program service, describe specific type of service(s) in region	(f) Total expenditures for and investments in region
	Central America and the Caribbean	0	0	Investments	N/A	441,000
	East Asia and the Pacific	0	0	Investments	N/A	449,000
	Europe (including Iceland and Greenland)	0	0	Investments	N/A	3,082,000
	Middle East and North Africa	0	0	Investments	N/A	4,000
	North America (including Canada and Mexico, but not the United States)	0	0	Investments	N/A	1,009,000












3a	Sub-total .....
b	Total from continuation sheets to Part I ...
c	Totals (add lines 3a and 3b)	0	0			4,985,000

For Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2012

Schedule F (Form 990) 2012

Page 2

Part II

Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered “Yes” to Form 990, Part IV, line 15, for any recipient who received more than $5,000. Part II can be duplicated if additional space is needed.

1 (a) Name of organization		(b) IRS code section and EIN (if applicable)	(c) Region	(d) Purpose of grant	(e) Amount of cash grant	(f) Manner of cash disbursement	(g) Amount of of non-cash assistance	(h) Description of non-cash assistance	(i) Method of valuation (book, FMV, appraisal, other)

Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .... MediumBullet

Enter total number of other organizations or entities ....................... MediumBullet

Schedule F (Form 990) 2012

Schedule F (Form 990) 2012Page 3

Part III

Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 16.

Part III can be duplicated if additional space is needed.

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

Schedule F (Form 990) 2012

Page 4

Part IV

Foreign Forms

Schedule F (Form 990) 2012

Page 5

Part V

Supplemental Information
Complete this part to provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information (see instructions).

Identifier	ReturnReference	Explanation

Schedule F (Form 990) 2012

Additional Data

Software ID:	12000197
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

2012

Open to Public Inspection

Name of the organization

STURDY MEMORIAL HOSPITAL INC

Employer identification number

04-2768252

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...

Yes

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

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: .........

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

Yes

If "Yes," did the organization's financial assistance 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 discountedcare to a patient who was eligibile for free or discounted care? ..............

Did the organization prepare a community benefit report during the tax year? ..........

Yes

If "Yes," did 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.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) ..	3,872,018	1,049,059	2,822,959	1.89 %
b	Medicaid (from Worksheet 3, column a) ....	19,007,918	14,207,001	4,800,917	3.22 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) .	3,792,791	2,990,897	801,894	0.54 %
d	Total Financial Assistance and Means-Tested Government Programs .	26,672,727	18,246,957	8,425,770	5.65 %
Other Benefits		227,406	0	227,406	0.15 %
e	Community health improvement services and community benefit operations (from Worksheet 4) ..	227,406	0	227,406	0.15 %
f	Health professions education (from Worksheet 5) ..	256,467	11,000	245,467	0.16 %
g	Subsidized health services (from Worksheet 6) ..	1,319,396	311,072	1,008,324	0.68 %
h	Research (from Worksheet 7)	0	0	0	0 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8)	29,710	0	0	0.02 %
j	Total. Other Benefits ..	1,832,979	322,072	1,481,197	1.01 %
k	Total. Add lines 7d and 7j .	28,505,706	18,569,029	9,906,967	6.66 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2012

Schedule H (Form 990) 2012

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing	0	0	0 %
2	Economic development	0	0	0 %
3	Community support	9,864	9,864	0.01 %
4	Environmental improvements	0	0	0 %
5	Leadership development and training for community members	0	0	0 %
6	Coalition building	9,720	9,720	0.01 %
7	Community health improvement advocacy	1,965	1,965	0 %
8	Workforce development	0	0	0 %
9	Other	23,579	23,579	0.02 %
10	Total	45,128	45,128	0.04 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

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

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

3,136,547

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

912,735

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

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

51,815,253

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

58,185,382

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

-6,370,129

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

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(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) 2012

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions) How many hospital facilities did the organization operate during the tax year?1 Name, address, and primary website address
1	Sturdy Memorial Hospital Inc PO Box 2963 211 Park Street Attleboro,MA02703 www.sturdymemorial.org	X	X	X

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	Sturdy Memorial Hospital Inc
Name of hospital facility or facility reporting group

For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A)

Yes

Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9....................

Yes

If “Yes,” indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Part VI)

Indicate the tax year the hospital facility last conducted a CHNA: 20 13

In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? 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 ....................

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................

Did the hospital facility make its CHNA report widely available to the public? .............

Yes

If “Yes,” indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website

Available upon request from the hospital facility

Other (describe in Part VI)

If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):

Adoption of an implementation strategy that addresses each of the community health needs identified through the CHNA

Execution of the implementation strategy

Participation in the development of a community-wide plan

Participation in the execution of a community-wide plan

Inclusion of a community benefit section in operational plans

Adoption of a budget for provision of services that address the needs identified in the CHNA

Prioritization of health needs in its community

Prioritization of services that the hospital facility will undertake to meet health needs in its community

Other (describe in Part VI)

Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ...........................

If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ......

If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

Financial Assistance Policy			Yes	No
9	Did the hospital facility have in place during the tax year a written financial assistance policy that:
	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?	9	Yes
10	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........	10	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 200% If "No," explain in Part VI the criteria the hospital facility used.
11	Used FPG to determine eligibility for providing discounted care?.................	11	Yes
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400% If "No," explain in Part VI the criteria the hospital facility used.
12	Explained the basis for calculating amounts charged to patients?.................	12	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)
13	Explained the method for applying for financial assistance?...................	13	Yes
14	Included measures to publicize the policy within the community served by the hospital facility?.......	14	Yes
	If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a	The policy was posted on the hospital facility’s website
b	The policy was attached to 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 on admission to the hospital facility
f	The policy was available upon request
g	Other (describe in Part VI)
Billing and Collections
15	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?.......	15	Yes
16	Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Part VI)
17	Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?..........	17		No
	If “Yes,” check all actions in which the hospital facility or a third party engaged:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Part VI)

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the patients regarding the patients’ bills

Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Part VI)

Policy Relating to Emergency Medical Care

Yes

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?..........

Yes

If “No,” indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)

Other (describe in Part VI)

Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Part VI)

During the tax year, did the hospital facility charge any FAP-eligible individuals 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? ............................

If “Yes,” explain in Part VI.

During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? .........................

If “Yes,” explain in Part VI.

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?2
Name and address		Type of Facility (describe)
1	Mansfield Health Center 200 Copeland Drive Mansfield,MA02488	Licensed outpt clinic under the same Medicare # as the Hospital.
2	Radiation Therapy of Southeastern MA LLC 89 Forbes Boulevard Mansfield,MA02048	Outpt radiation therapy clinic. This is part of a joint venture the Hospital participates in.
3	Attleboro High School Clinic 100 Rathburn Willard Drive Attleboro,MA02703	Licensed school-based clinic under the same Medicare # as the Hospital.
4
5
6
7
8
9
10

Schedule H (Form 990) 2012

Page

Part VI

Supplemental Information

Complete this part to provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; Part V, Section A; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any 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.
8	Facility reporting group(s). If applicable, for each hospital facility in a facility reporting group provide the descriptions required for Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.

Identifier	ReturnReference	Explanation
SchH_P01_S00_L07	Schedule H, Part I, Line 7	Lines 7a/b/c were calculated using Worksheets 1,2,3 provided in the instructions. Lines 7e/f/h/i were calculated by taking the number of hours spent on each program multiplied by a standard rate (direct cost), plus a benefits factor (indirect cost). Line 7g was calculated using expenses and revenues from the general ledger.
SchH_P02_S00_L00	Schedule H, Part II	Sturdy Memorial Hospital enjoys positive, cooperative relationships with area businesses, civic organizations, local and regional health care associations, and affiliated medical staff. We actively seek out and facilitate strong partnerships that promote the health and wellbeing of the people in our communities. Key organizations we collaborated or partnered with in FY 2013 include: AARP; American Cancer Society; American Heart Association; American Red Cross; American Stroke Association; Area Elementary Schools (HealthyChoices); Attleboro Area Community Council; Attleboro Area School-to-Career Partnership; Attleboro High School; Attleboro YMCA; Bristol Community College; Bristol County Homeland Security Task Force; Brown University School of Medicine; Councils on Aging; EMTs (training for municipalities); Greater Attleboro Area Council on Churches; Hockomock Area YMCAs; Mothers Against Drunk Driving (MADD); National Multiple Sclerosis Society; Reach Out and Read (ROAR); Southeastern Massachusetts Homeland Security Regional Council; Town Health Agents; United Way of Greater Attleboro/Taunton; and Wheaton College. Major community building activities with some of the aforementioned partners in FY 2013 included: Sturdy ER physicians and nurses training area EMTs (at no cost to them); diabetes prevention and education programming involving Sturdy's medical staff in conjunction with the Hockomock YMCA; hosting a day-long Nurse's Day event with Attleboro Area School-to-Career Partnership for high school students considering nursing careers; youth mentoring programs with area secondary schools; a multi-dimensional public awareness campaign on proper hand hygiene and appropriate antibiotic usage; public and clinician education about palliative care, including distribution of materials and a guest speaker from The Conversation Project; sharps disposal program with area fire departments; a multi-dimensional public stroke awareness campaign; educating town health and safety officials, and the public, about flu and vaccination; regional disaster planning with area municipalities; Healthy Choices, a school-based health fair education program done in conjunction with the area's elementary schools; continuing to educate people about access to health care in Massachusetts and their options under the new health reform law; and running a school-based health center at Attleboro High School. Three examples of initiatives undertaken: Community health improvement advocacy - hand washing/antibiotic resistance campaign: continued public education campaign, using multiple forms of paid media, to promote proper hand hygiene and appropriate antibiotic usage. Care packages with hand sanitizer, tissues, antibacterial cleaning wipes, and posters were distributed to area elementary schools in the fall of 2013. Promoting proper hand hygiene in the community helps people protect themselves and others. Hand washing is the single most effective way to prevent the spread of germs and many types of infection and illness. Educating health professionals and the public about why they need to use antibiotics appropriately, and as directed, are necessary to preserve antibiotics' effectiveness and present antibiotic resistance. Repeated and improper use of antibiotics has created antibiotic resistance, which renders some bacteria stronger and less responsive to medications. This is one of the nation's most pressing public health problems, according to the CDC. Spent approximately $13,000. Stroke awareness - multi-faceted initiative to provide the community with pertinent information relevant to the prevention, warning signs, risks and symptoms of a Stroke. Educated the community about the need to act F.A.S.T. when Stroke symptoms are present (i.e.: Call 9-1-1). Time is of the essence. Spent approximately $4,500. Physical activity for youth - partnered with the Attleboro YMCA on its annual youth step challenge. Spent approximately $3,000. Also worked with Hockomock YMCAs and Sturdy pediatric and family practice physicians using a "prescription" to promote the concept of moving more and eating less.
SchH_P03_S0A_L04	Schedule H, Part III, Section A, Line 4	The Hospital's audited financial statements do not contain a footnote describing bad debt expense. The Hospital's bad debt expense (Schedule H, Part III, Section A, Line 2) was estimated as the product of the Hospital's bad debt (stated as revenue) multiplied by the Hospital's overall cost-to-charge ratio calculated on Worksheet 2 of the instructions. Estimated bad debt expense attributable to patients eligible for financial assistance (Schedule H, Part III, Section A, Line 3) was calculated as the ratio of, accounts for which patients were unemployed to the total patient accounts, multiplied by bad debt expense.
SchH_P03_S0B_L08	Schedule H, Part III, Section B, Line 8	The shortfall experienced by the Hospital from providing care to Medicare beneficiaries should be treated as a community benefit as it represents the Hospital's contribution to providing care to Medicare eligible citizens of the community it serves beyond the amount it receives from the Medicare program. This contribution is consistent with the Hospital's overall charitable mission to provide care to all individuals, regardless of the level of payment receieved for providing that care. The Hospital's Medicare Cost Report was used to determine the amount reported on line 6.
SchH_P03_S0C_L09b	Schedule H, Part III, Section C, Line 9b	The Hospital's collection policy contains procedures to be followed for patients who are known to qualify for financial assistance. Once it is determined that a patient qualifies for free care, all collection procedures cease and the full balance is written off. If the patient qualifies for partial free care, the amount that qualifies under partial free care is written off and the remaining balance is subject to normal collection procedures. Massachusetts hospitals are required to adopt credit and collection policies. State regulations (114.6 CMR 13.08(1)(c)) outline the specific process for determining eligibility for public assistance programs and hospital collection practices. The Hospital provides patients with information about free care available through the hospital (a significant portion of which is coordinated through the state's Health Safety Net program, as well as financial assistance programs, such as MassHealth and Commonwealth Care, that are available through the Massachusetts Executive Office of Health and Human Services. The Hospital employs two full-time financial counselors that assist patients in applying for free care and state financial assistance programs through the state's uniform application. The Hospital credit and collection policy, that outlines its charity care practices, is filed with the Massachusetts Center for Health Information and Analysis and also available to patients upon request.
SchH_P05_S0B_L03	Schedule H, Part V, Section B, Line 3	In 2013, Sturdy conducted a needs assessment in collaboration with city/town health agents; city/town public health nurses; public schools; area councils on aging; area Ys; Community VNA; Women, Infants and Children (WIC); and our Patient Family Advisory Council. Surveys were mailed and/or emailed to 38 individuals/entities. Eighteen responses were received. The Hospital also utilized other data about its service area and participated in community advisory groups, boards, medical committees, and partnerships as part of the assessment. For Sturdy, needs assessment involves review and analysis of various data such as patient satisfaction surveys, Hospital service utilization statistics, clinical issues, health insurer data, and other local and State health data. We also take into account the results of feedback from and conversations and interactions with a multitude of other sources, actively soliciting information and ideas from area public health professionals, members of the Hospital's Patient and Family Advisory Council (PFAC), members of the Hospital's Medical Management Committee, social services agency personnel, school nurses, as well as participating in professional forums. Findings are reviewed for trends or needs in the community. Clinical trend data and patient education needs recognized by clinicians while providing medical or follow up care are also considered. Additionally, members of the community are encouraged to, and often do, relay programming suggestions directly to the Hospital or through program evaluation tools. The Hospital has drawn from this extensive bank of information to make recommendations for community benefits activities and programs. As a result of ongoing needs assessment, Sturdy can continue to focus its health programming resources and services to most effectively meet the needs of the communities we serve.
SchH_P05_S0B_L05	Schedule H, Part V, Section B, Line 5	http://www.sturdymemorial.org/images/pdfs/SMH2013_CHNA_Report.pdf
SchH_P05_S0B_L07	Schedule H, Part V, Section B, Line 7	One of several criteria used to prioritize the important needs in the communities served by Sturdy included our ability to effectively impact and improve the identified health issue, e.g. represents an issue we can address. CHNA respondents identified two issues identified as important to improving the health of the community that could not be addressed in Sturdy's implementation plan, largely because Sturdy lacks the necessary expertise or the needs are better addressed by another community or State organization. These included behavioral health disorders or related issues; cost of/affordable medications; and substance/alcohol abuse or addiction. We will continue to facilitate care and referral to the necessary resources.
SchH_P05_S0B_L16	Schedule H, Part V, Section B, Line 16	The Hospital could also garnish the wages of a patient or their gaurantor and place liens on motor vehicles of the patient or their gaurantor, under certain cirumstances, with approval from the Board of Managers. The Hospital is not allowed to report a patient's debt to a credit agency or collect interest on patient balances. The Hospital does not typically use any of the collection practices in its Billing and Collections policy other than using collection agencies to recover bad debt on old patient balances.
SchH_P05_S0B_L18	Schedule H, Part V, Section B, Line 18	For planned admissions, patients are notified of the financial assistance policy prior to admission if it's determined that they qualify for financial assistance. For emergent admissions, patients are notified prior to discharge. For outpatient visits, patients are notified of the financial assistance policy with the bill that is mailed to them.
SchH_P05_S0B_L20	Schedule H, Part V, Section B, Line 20	All patients (including FAP-eligible patients), whether insured or not, are charged the same amount for services rendered. For uninsured patients, a bill is sent with all charges included, less a 22% discount, with a letter stating to contact the Financial Services office to discuss a payment arrangement that will work best for the patient. The discount is calculated based on the average reimbursement from the Hospital's three largest insurance payers.
SchH_P05_S0B_L22	Schedule H, Part V, Section B, Line 22	See line 20 explanation.
SchH_P06_S00_L02	Schedule H, Part VI, Line 2	Sturdy has voluntarily submitted a Community Benefits Report to the Massachusetts Office of the Attorney General since the 1990s. In addition, Sturdy has completed a Community Health Needs Assessment as required by the IRS. With guidance and oversight from the Hospital's Planning Committee, Sturdy's Community Benefits Report is constructed to reflect on activities from the prior year and provide recommendations for the Hospital's community benefits focus for the subsequent year. Community benefits planning is integrated into Sturdy's annual planning and budgeting processes to ensure we effectively support community benefits programming. Sturdy Memorial Hospital is involved in ongoing assessment of health needs in our communities. Continually being engaged in and attuned to our communities provides us with opportunities to identify health issues of greatest concern to our care providers and community partners, and consider committing resources to those areas, if appropriate, to guide efforts to improve community health and wellness. At the core of Sturdy's community benefits activities and planning are the Hospital's Statement of Purpose, which is attached, and Community Benefits Mission, which is: "Sturdy Memorial Hospital is dedicated to providing safe, high quality, cost efficient health care and the broadest range of diagnostic, inpatient, outpatient, and emergency services appropriate for a community hospital. The Hospital works to ensure that ample, high quality primary and specialty physician services are accessible to area residents. Additionally, we try to avoid costly duplication of health care services by coordinating with other area health care providers to the extent practicable. The Hospital provides leadership while working in cooperation with public and private health organizations, as well as civic and business organizations, to meet the health care needs of our communities." For Sturdy, needs assessment involves review and analysis of various data such as patient satisfaction surveys, Hospital service utilization statistics, clinical issues, health insurer data, and other local and State health data. We also take into account the results of feedback from and conversations and interactions with a multitude of other sources, actively soliciting information and ideas from area public health professionals, members of the Hospital's Patient and Family Advisory Council (PFAC), members of the Hospital's Medical Management Committee, social services agency personnel, school nurses, as well as participating in professional forums. Findings are reviewed for trends or needs in the community. Clinical trend data and patient education needs recognized by clinicians while providing medical or follow up care are also considered. Additionally, members of the community are encouraged to, and often do, relay programming suggestions directly to the Hospital or through program evaluation tools. The Hospital has drawn from this extensive bank of information to make recommendations for community benefits activities and programs.
SchH_P06_S00_L03	Schedule H, Part VI, Line 3	Patients are informed of the availability of financial assistance by way of posted notices throughout the hospital. All itemized bills and patient statements are printed with financial assistance information. Upon discharge from the Emergency Care Center (ECC), uninsured patients are encouraged to meet with a Financial Counselor. If unable to see a Financial Counselor following discharge, the patient is given a financial assistance letter outlining the application process, the documents required, telephone numbers and directions to the financial counselor's office. Following an ECC visit, uninsured patients receive a phone call from a Credit Representative encouraging the patient to meet with a Financial Counselor for financial assistance. Scheduled Self Pay Surgical Day Care (SDC) & Inpatients are reviewed prior to admission to determine payment arrangement or to coordinate a meeting with a Financial Counselor. SDC & Inpatients who are unable to leave a deposit or make a payment arrangement towards a large out of pocket expense are also encouraged to meet with a Financial Counselor.
SchH_P06_S00_L04	Schedule H, Part VI, Line 4	The Hospital serves a population base of 170,000 in suburban communities located between Boston, MA and Providence, RI that is largely educated (completed high school), employed, and English speaking. As a community resource, the Hospital has a primary commitment to serve the residents of Attleboro, Foxboro, Mansfield, North Attleboro, Norfolk, Norton, Plainville, Seekonk, Sharon, Rehoboth, Walpole, Wrentham, and nearby Rhode Island. However, anyone who requires care will receive it, regardless of place of residence.
SchH_P06_S00_L05	Schedule H, Part VI, Line 5	In addition to offering a vast array of community benefits programming and providing more than $8 million in free care in FY13, Sturdy furthered its exempt purpose by promoting the health of the community in numerous other ways, including having an open medical staff that is required to provide free care and accept Medicare and Medicaid patients; sharing the expertise of its leadership on various community non-profit boards including members of the community on hospital committees that influence health promotion activities, i.e. Planning Committee, Patient Family Advisory Council, etc.; and using surplus funds to appropriately expand our facilities (without borrowing) and acquire the technology our clinicians need to care for patients in our service area so that they can get their care locally.
SchH_P06_S00_L07	Schedule H, Part VI, Line 7	Massachusetts.

Schedule H (Form 990) 2012

Additional Data

Software ID:	12000197
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

2012

Open to Public
Inspection

Name of the organization
STURDY MEMORIAL HOSPITAL INC

Employer identification number
04-2768252

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. Part II can be duplicated if additional space is needed.

(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	(h) Purpose of grant or assistance
(1) Attleboro Area Council of Churches 95 Pine Street Attleboro,MA02703	04-2301039	501(c)3	6,000	0	The Hospital contributed to help support the Protestant Chaplaincy program at the Hospital.
(2) City of Attleboro 77 Park Street Attleboro,MA02703	04-6001378		15,000	0	The Hospital contributed to help support city programs.

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

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

Cat. No. 50055P

Schedule I (Form 990) 2012

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.
Part III can be duplicated 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, Part III, column (b), and any other additional information.

Identifier	Return Reference	Explanation
SchI_P01_S00_L02	Schedule I, Part I, Line 2	The Hospital rarely provides outright grants, but rather concentrates in coordinating care in the community and delivering substantial uncompensated care (see Schedule H). On the rare occasion when grants are made, they are either approved or discussed by or with the Board of Managers. The low volume of grants awarded enables the Hospital to monitor their use.

Schedule I (Form 990) 2012

Additional Data

Software ID:	12000197
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

2012

Open to Public Inspection

Name of the organization

STURDY MEMORIAL HOSPITAL INC

Employer identification number

04-2768252

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 or provision of all of the expenses described above? If "No," complete Part III to explain....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all officers,
directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? .......

Yes

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

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? .........

Yes

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

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

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

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

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

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

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

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

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

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Yes

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

Cat. No. 50053T

Schedule J (Form 990) 2012

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is 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) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(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 as deferred in prior Form 990
(A) Name and Title		(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)	(F) Compensation reported as deferred in prior Form 990
(1)Mark Young MDBoard Member	(i) (ii)	0 37,554	0 702	0 17,490	0 617	0 24,846	0 81,209	0 0
(2)Linda ShyavitzPresident & CEO (see Schedule O)	(i) (ii)	465,020 0	330,692 0	71,221 0	61,258 0	9,864 0	938,055 0	0 0
(3)Joseph CaseyTreasurer & CFO (see Schedule O)	(i) (ii)	310,747 0	72,692 0	102,266 0	36,205 0	24,896 0	546,806 0	0 0
(4)Bruce Auerbach MDVP/Medical Director (see Schedule O)	(i) (ii)	400,326 0	70,692 0	222,373 0	50,636 0	22,840 0	766,867 0	0 0
(5)Brian Kelly MDVP/Chief of ER & Ambulatory	(i) (ii)	308,615 0	9,346 0	40,885 0	31,041 0	24,386 0	414,273 0	0 0
(6)Lisa McCluskieVP/Marketing & Planning (see Sched O)	(i) (ii)	162,736 0	24,796 0	7,568 0	30,635 0	22,803 0	248,538 0	0 0
(7)Cheryl BarrowsVP/Human Resources (see Schedule O)	(i) (ii)	159,739 0	18,846 0	20,390 0	21,344 0	25,803 0	246,122 0	0 0
(8)Marita PraterVP/Patient Services	(i) (ii)	166,141 0	5,546 0	23,253 0	18,321 0	23,113 0	236,374 0	0 0
(9)Robin MorrisVP/Clinical Services (see Schedule O)	(i) (ii)	142,737 0	6,546 0	22,627 0	18,938 0	12,633 0	203,481 0	0 0
(10)Peter Fischer MDPhysician	(i) (ii)	302,215 0	47,160 0	16,603 0	22,415 0	23,393 0	411,786 0	0 0
(11)Mark McGuire MDPhysician	(i) (ii)	304,595 0	17,064 0	34,268 0	15,721 0	23,262 0	394,910 0	0 0
(12)Brian Patel MDPhysician	(i) (ii)	291,864 0	22,121 0	33,687 0	13,619 0	23,115 0	384,406 0	0 0
(13)Allan Raskin MDPhysician	(i) (ii)	220,974 0	12,456 0	35,635 0	51,145 0	23,062 0	343,272 0	0 0
(14)Kristina McAteer MDPhysician	(i) (ii)	227,645 0	15,546 0	17,831 0	10,436 0	0 0	271,458 0	0 0
(15)Daniel Pietro MDFormer Medical Director (see Schedule O)	(i) (ii)	116,307 0	397 0	31,027 0	55,510 0	17,388 0	220,629 0	0 0

Schedule J (Form 990) 2012

Page 3

Part III

Supplemental Information

Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.

Identifier	Return Reference	Explanation
SchJ_P01_S00_L01a	Schedule J, Part I, Line 1a	When the Hospital makes payments to retirement plans that are taxable upfront, they are partially grossed up for taxes. During CY 2012, such payments were made for some senior managers (see Schedule J, Part I, line 4 explanation for more detail). Also, the Hospital paid a flat bonus (the same amount to each employee prorated for hours worked) to all hospital employees, and announced the net amount (effectively paying the taxes). The Hospital also provides its senior managers with long-term disability insurance. The cost of this insurance is grossed up to effectively pay for the related taxes and is added to the managers' gross earnings. This benefit was provided to Linda Shyavitz, Joseph Casey, Robin Morris, Marita Prater, Lisa McCluskie, Cheryl Barrows, Brian Kelly MD, Bruce Auerbach MD and Daniel Pietro MD during CY 2012.
SchJ_P01_S00_L01b	Schedule J, Part I, Line 1b	As explained in 1(a) above, there are few instances where a gross up is used. The Board of Managers approves the hospital bonus (net of taxes) and the Executive Committee approved the supplemental retirement plan.
SchJ_P01_S00_L03	Schedule J, Part I, Line 3	See Schedule O - line reference: Form 990, Part VI, Section B, line 15.
SchJ_P01_S00_L04	Schedule J, Part I, Line 4	also Form 990, Part VII, Section A - Supplemental retirement contributions were made through a non-qualified retirement plan for senior managers in calendar year 2012. The total of non-qualified retirement contributions in 2012 were as follows: Bruce Auerbach, M.D. - $179,223; Joseph Casey - $61,281; Lisa McCluskie - $5,181; and Brian Kelly, MD - $574. All such amounts have been reported on Form W2.
SchJ_P01_S00_L07	Schedule J, Part I, Line 7	Bonus payments to the CEO and Senior Managers are based on attainment of performance based goals. As noted elsewhere in this filing, the hospital operates a walk-in clinic in the town of Mansfield. Dr. Fischer is a physician at the clinic and is eligible for a bonus based on his revenues less expenses for personally performed services (or directly supervised services), subject to attainment of certain other factors (i.e., efficiency, quality), and subject to a compensation cap. In addition, the Hospital's Emergency Room physicians (including physicians McGuire, Patel, McAteer and Raskin listed on Section VII and Schedule J) are eligible for a bonus based on revenues less expenses for personally preformed services, subject to an overall cap.

Schedule J (Form 990) 2012

Additional Data

Software ID:	12000197
Software Version:	v1.00

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

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

Attach to Form 990 or Form 990-EZ. MediumBullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization

STURDY MEMORIAL HOSPITAL INC

Employer identification number

04-2768252

Part I

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

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

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

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

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

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






Total ...... $

Part III

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

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

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

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2012

Page 2

Part IV

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

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) Attleboro Gastroenterology PC	Board member	1,427,272	See Part V.		No

Part V

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

Identifier	Return Reference	Explanation
SchL_P04_S00_L00	Schedule L, Part IV	Mark Robbin MD is on the Hospital's Board of Managers (non-independent voting member) and is a physician at Attleboro Gastroenterology PC. Dr. Robbin performs endoscopy services at the Hospital and is compensated through payments from the Hospital to Attleboro Gastroenterology PC, a professional group consisting of four physicians. The Hospital engaged an independent third party to determine the fair market value of this arrangement.

Schedule L (Form 990 or 990-EZ) 2012

Additional Data

Software ID:	12000197
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

2012

Open to Public
Inspection

Name of the organization

STURDY MEMORIAL HOSPITAL INC

Employer identification number

04-2768252

Identifier	Return Reference	Explanation
F990_P03_S00_L04a	Form 990, Part III, Line 4a	The hospital provides high quality care to the sick and injured, on both an inpatient and outpatient basis, without regard to race, creed, national origin, age, gender, disability, or ability to pay. In fiscal year 2013, the hospital provided 7,348 free care visits and 569 partial free care visits. The hospital treated 9,040 inpatients and observation patients, including births, of which there were 751. The hospital treated 51,325 patients in the emergency room during the year. The hospital performed surgery on 2,007 inpatients and 7,208 outpatients. The hospital provides many other services of which the following is a partial list: Oncology - 7,698 visits; Mansfield Health Center - 21,800 visits; Cardiac Rehabilitation - 13,446 visits; Wound Care - 4,527 visits; and Cardiac Catheterizations - 151 procedures. In addition, the hospital provides a variety of ancillary services - a partial list includes: laboratory, radiology, mammography, computerized tomography, MRI, nuclear medicine, vascular, ultrasound, sleep study and physical therapy. The hospital provided $8,020,054 in services for those who could not pay (free care) or would not pay (bad debt) in fiscal year 2013. In addition, the hospital also provided approximately $4,800,917 in un-reimbursed MassHealth (Medicaid) services during the year. Further, the hospital provides a number of programs to benefit our community either at no charge or at reduced rates. The hospital also provides leadership in the integration of health services for the communities it serves.
F990_P05_S00_L02a	Form 990, Part V, Line 2a	Sturdy Memorial Hospital is a common paymaster for Sturdy Memorial Associates and Sturdy Memorial Foundation. Therefore, the total number of employees listed in Part V, line 2a includes only employees from the Hospital (1,571). The total number of employees on the Form W-3 is 1,910.
F990_P06_S0A_L01a	Form 990, Part VI, Section A, Line 1a	The bylaws of Sturdy Memorial Hospital state that "the Executive Committee shall have the power to transact all regular business of the Hospital during the interim between the meetings of the Board of Managers except for such matters as are specified in Section 55 of the [Massachusetts] General Laws, Chapter 156B." The Executive Committee consists only of members of the Board of Managers of Sturdy Memorial Hospital.
F990_P06_S0A_L06	Form 990, Part VI, Section A, Line 6	Sturdy Memorial Foundation, Inc., a Massachusetts charitable corporation, acting through its Board of Directors, is the sole Member of the Sturdy Memorial Hospital Corporation.
F990_P06_S0A_L07a	Form 990, Part VI, Section A, Line 7a	The Board of Managers of Sturdy Memorial Hospital consists of those persons who serve as the Directors of Sturdy Memorial Foundation, Inc. Foundation Members are eligible to attend all meetings of the Corporation and to hold office. New Members are elected to membership by the existing Members for 3 year terms.
F990_P06_S0B_L11b	Form 990, Part VI, Section B, Line 11b	The preparation of the Form 990 is the responsibility of the CFO and the Sturdy Fiscal Services department, with review by Sturdy's tax providers, Grant Thornton. The Form 990 is prepared by the finance staff upon completion of Sturdy's annual independent audit and reviewed by the Controller, CFO, and Grant Thornton. In addition, compensation and benefit sections are reviewed by the Vice President of Human Resources for Sturdy Memorial Hospital. Prior to filing the Form 990, the complete form and all schedules are provided to every board member and any questions are answered.
F990_P06_S0B_L12c	Form 990, Part VI, Section B, Line 12c	The hospital adopted a Conflict of Interest Policy on May 5, 1995. Under the direction of the Integrity Officer, all managers and supervisors (including officers and key employees) must complete and sign an annual Conflict of Interest Disclosure Statement. The Statement requires disclosure of any outside interests in any business, outside activity, gifts, or entertainment that may have influenced the employee. In addition, the employee must disclose if they have shared any hospital information for their own personal advantage or if they had any knowledge of any integrity or ethical issues not previously reported. These signed Statements are reviewed by the Integrity Officer and any potential conflicts are resolved. The Integrity Officer discusses disclosed conflicts with the reporter, so that reporter knows what business activities they cannot participate in (e.g. purchasing decisions, board votes, etc.). Any gifts received that create a conflict or are in violation of the Conflict of Interest Policy, must be returned or paid for by the individual at fair market value. The Integrity Officer reports annually to the Board of Managers of any new conflicts. Article V, Section 12 of the Hospital by-laws requires Board members to disclose any potential conflict. Board members, officers and key employees must attest in writing each year, to any potential conflict. The conflict of interest statements are reviewed by the President and Chief Financial Officer and any potential conflicts are resolved.
F990_P06_S0B_L14	Form 990, Part VI, Section B, Line 14	The hospital does not have a written document retention and destruction policy but does comply with Massachusetts law with respect to record retention requirements. For example, Massachusetts law requires that the hospital maintain its medical records for a minimum of 20 years. Where state law does not require retention limits, the hospital uses the "Business Records Retention Schedule" from the Office of the Federal Register and other relevant and reliable sources (such as attorney letters and recommendations from accounting firms). The hospital has begun drafting a formal policy.
F990_P06_S0B_L15	Form 990, Part VI, Section B, Line 15	The CEO and senior managers, as well as all other hospital employees, are compensated on a merit system. The CEO and senior managers prepare goals at the start of each fiscal year and are evaluated for merit increases based on those goals and their accomplishments relative to the goals. The CEO's evaluation extends to her responsibilities as the Chief Executive of Sturdy Memorial Associates (a approximately fifty-six physician multi-specialty group practice) as well as her responsibilities at the remaining affiliated corporations. Her compensation is paid entirely by the hospital (there is no additional compensation from the related organizations). Several of the other senior managers have responsibilities that extend to the affiliated corporations. The CEO's accomplishments (relative to the established goals) are documented in an annual report which is submitted to the Chairman of the Board of Managers. The Board Chairman is provided with comparative market data, obtained through compensation surveys prepared by an independent consultant specializing in such matters. The comparative data is for similar hospitals in Massachusetts and is sent directly from the independent consultant to the Board Chairman. The data includes comprehensive salary and benefits information for CEOs and senior managers (key employees) including comparison of base pay, incentive pay, benefits and total compensation. In addition, the Chairman is provided with performance information for Massachusetts hospitals obtained through the Center for Health Information and Analysis. The Vice President of Human Resources provides the Chairman with the CEO's current actual salary and benefits. The Chairman of the Board of Managers provides the above information along with the annual report of the CEO's accomplishments (relative to established goals) and a history of the CEO's compensation to the Executive Committee, which serves as the Compensation Committee for this purpose. The Executive Committee reviews the comparative data for CEO base salary, bonus (incentive) and total compensation, along with the survey data for benefits. Based on the goals achieved and the comparative data provided, the Executive Committee votes to approve the salary, bonus, and benefits of the CEO. A summary of the discussion and the decision of the Executive Committee are reflected in the meeting minutes. The Chairman of the Board of Managers communicates the decision regarding compensation changes in a letter to the Vice President of Human Resources to execute the change. The CEO uses comparative market data, obtained from an independent consultant, for the hospital senior managers (key employees). The CEO compares the senior managers' current base salary and bonus (incentive pay) to the survey data. The senior managers' performance is evaluated based on the goals established at the start of the year. The CEO determines the base pay amount and bonus for each senior manager based on performance and the compensation survey. Base salary and bonus payments for each senior manager, including survey information, are reviewed with the Executive Committee by the CEO. The Executive Committee votes to accept the recommendations of the CEO except for the CFO, the Executive Committee votes to approve the CFO's compensation.
F990_P06_S0B_L16b	Form 990, Part VI, Section B, Line 16b	The hospital does not have a written policy or procedure requiring the hospital to evaluate its participation in joint venture arrangements under applicable federal law; however, any joint venture agreement would be reviewed and approved by outside counsel. The hospital currently has two partnership agreements. The first agreement provides radiation therapy services (LLC). The patient volume, from the hospital's service area alone, would not have justified the cost of purchasing the radiation therapy building and equipment as well as providing the service. The hospital partnered with another local not-for-profit hospital and a for-profit company which specializes in building and managing radiation therapy services. The LLC is governed by a Board consisting of three persons, one from each of the organizations, thus ensuring that the two not-for-profit hospitals together have sufficient control over the organization to ensure their exempt purpose. In addition, Article I of the LLC Agreement, requires that the LLC "shall operate under a charity care policy that is consistent with the charity care policies of its charitable Members". The LLC has not engaged in activites that would jeopardize the hospital's exemption, such as lobbying activities. The second agreement is an investment in Yankee Alliance Supply Chain Solutions LLC. This investment produces unrelated business income which has been reported on the Hospital's 990T.
F990_P06_S0C_L19	Form 990, Part VI, Section C, Line 19	The Hospital makes available copies of its by-laws, conflict of interest policy, and financial statements to the general public upon request.
F990_P11_S00_L09	Form 990, Part XI, Line 9	Pension and other postretirement benefit adjustment.

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2012

Additional Data

Software ID:	12000197
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

2012

Open to Public Inspection

Name of the organization

STURDY MEMORIAL HOSPITAL INC

Employer identification number

04-2768252

Part I

Identification of Disregarded Entities (Complete if the organization answered "Yes" to Form 990, Part IV, line 33.)

(a) Name, address, and EIN (if applicable) 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" to 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 entity?
(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) Sturdy Memorial Associates Inc 211 Park Street PO Box 2963 Attleboro,MA02703 04-2709501	Multi-specialty physician group.	MA	501(c)(3)	11 Type II	N/A		No
(2) Sturdy Memorial Foundation Inc 211 Park Street PO Box 2963 Attleboro,MA02703 04-2103631	Foundation for SMH & affiliates.	MA	501(c)(3)	11 Type II	N/A		No
(3) Emory Street Radiology Associates Inc 211 Park Street PO Box 2963 Attleboro,MA02703 04-3137282	Radiology services.	MA	501(c)(3)	11 Type II	N/A		No

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

Cat. No. 50135Y

Schedule R (Form 990) 2012

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to 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" to 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	(i) Section 512(b)(13) controlled entity?
(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		Yes	No
(1) SHV Inc 127 Pearl Street Attleboro,MA02703 04-2855097	See Part VII explanation.	MA	N/A	C			0 %

Schedule R (Form 990) 2012

Page 3

Part V

Transactions With Related Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34, 35b, or 36.)

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

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 or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .

m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .

Yes

o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

s Other transfer of cash or property from related 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-s)	(c) Amount involved	(d) Method of determining amount involved

Schedule R (Form 990) 2012

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to 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)	(e) Are all partners section 501(c)(3) organizations?		(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 entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(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

Schedule R (Form 990) 2012

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
SchR_P02_S00_L00	Schedule R, Part II	Emory Street Radiology Associates' primary activities: Provided radiology services - operations have been suspended as of June 1998.
SchR_P04_S00_L00	Schedule R, Part IV	SHV Inc, which does business under the trade name Attleboro Area Medical Equipment Co, is a for-profit corporation actively engaged in the sale and rental of medical equipment and accessories in the Greater Attleboro Area. The company extends credit to its customers and is paid directly or by private insurance.

Additional Data

Software ID:	12000197
Software Version:	v1.00

1	Briefly describe the organization’s mission or most significant activities: Sturdy Memorial Hospital is dedicated to providing safe, high quality, cost-efficient health care, and the broadest range of diagnostic, inpatient, outpatient and emergency services, appropriate for a community hospital.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	12
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	10
5	Total number of individuals employed in calendar year 2011 (Part V, line 2a) ......	5	1,571
6	Total number of volunteers (estimate if necessary) .............	6	565
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	73,592
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	311,704	212,164
9	Program service revenue (Part VIII, line 2g) .........	158,582,795	160,716,733
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	7,291,595	8,646,136
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	0	0
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	166,186,094	169,575,033
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	36,710	29,710
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)	95,294,343	97,328,620
16a	Professional fundraising fees (Part IX, column (A), line 11e).....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	50,252,518	51,875,083
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	145,583,571	149,233,413
19	Revenue less expenses. Subtract line 18 from line 12.......	20,602,523	20,341,620
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	290,840,231	364,525,742
21	Total liabilities (Part X, line 26).............	30,812,313	30,215,178
22	Net assets or fund balances. Subtract line 21 from line 20.....	260,027,918	334,310,564

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 133,070,271 including grants of $ 0 ) (Revenue $ 159,277,256 )
	Sturdy Memorial Hospital, Inc. is a not-for-profit acute care community hospital which is dedicated to providing a broad range of health care services to the residents of Attleboro, Massachusetts and surrounding communities. The Hospital generates virtually all of its revenues in pursuit of its exempt purposes, which is to provide comprehensive diagnostic, therapeutic, and educational health care services to residents of its communities.

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 expenses133,070,271

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)				(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
(A) Name and Title
(18) Cheryl Barrows........................................................................ VP/Human Resources (see Schedule O)	38 .......................7	X			198,976	0	47,147
(19) Lisa McCluskie........................................................................ VP/Marketing & Planning (see Sched O)	30 .......................17	X			195,100	0	53,438
(20) Marita Prater........................................................................ VP/Patient Services	45 .......................0	X			194,940	0	41,435
(21) Robin Morris........................................................................ VP/Clinical Services (see Schedule O)	45 .......................0	X			171,910	0	31,571
(22) Peter Fischer MD........................................................................ Physician	40 .......................0		X		365,978	0	45,808
(23) Mark McGuire MD........................................................................ Physician	40 .......................0		X		355,927	0	38,983
(24) Brian Patel MD........................................................................ Physician	40 .......................0		X		347,672	0	36,734
(25) Allan Raskin MD........................................................................ Physician	40 .......................0		X		269,065	0	74,207
(26) Kristina McAteer MD........................................................................ Physician	40 .......................0		X		261,022	0	10,436
(27) Daniel Pietro MD........................................................................ Former Medical Director (see Schedule O)	26 .......................0			X	147,731	0	72,898

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	4,913,198	55,746	739,246

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512, 513, or 514
1a	Federated campaigns..1a		0
b	Membership dues....1b		0
c	Fundraising events....1c		0
d	Related organizations...1d		0
e	Government grants (contributions)1e		64,000

f	All other contributions, gifts, grants, and similar amounts not included above1f		148,164

g	Noncash contributions included in lines 1a-1f:$		0
h	Total. Add lines 1a-1f.......			212,164
			Business Code
2a	Net Patient Service Revenue		622000	157,645,653	157,645,653	0	0
b	Medicare/Medicaid EHR Stimulus		622000	1,184,585	1,184,585	0	0
c	Cafeteria Sales		900099	853,479	0	0	853,479
d	Patient Related Revenue, Other		622000	447,018	447,018	0	0
e	Rebates, Refunds and Discounts		900099	318,661	0	0	318,661
f	All other program service revenue .			267,337	0	73,592	193,745
g	Total. Add lines 2a–2f........			160,716,733
3	Investment income (including dividends, interest, and other similar amounts).......			4,473,901	0	0	4,473,901
4	Income from investment of tax-exempt bond proceeds..			0	0	0	0
5	Royalties...........			0	0	0	0
		(i) Real	(ii) Personal
6a	Gross rents	0	0
b	Less: rental expenses	0	0
c	Rental income or (loss)	0	0
d	Net rental income or (loss).......			0	0	0	0
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	92,161,068	0
b	Less: cost or other basis and sales expenses	87,988,833	0
c	Gain or (loss)	4,172,235	0
d	Net gain or (loss)..........			4,172,235	0	0	4,172,235
8a	Gross income from fundraising events (not including $ 0 of contributions reported on line 1c). See Part IV, line 18 ..
	a		0
b	Less: direct expenses ...b		0
c	Net income or (loss) from fundraising events..			0		0	0
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
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			0
12	Total revenue. See Instructions......			169,575,033	159,277,256	73,592	10,012,021


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing .............			1,438	1	1,598
2	Savings and temporary cash investments .........			9,690,430	2	18,872,229
3	Pledges and grants receivable, net ...........			0	3	0
4	Accounts receivable, net .............			16,044,167	4	15,385,415
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
				0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
				0	6	0
7	Notes and loans receivable, net .............			0	7	0
8	Inventories for sale or use ..............			2,783,457	8	2,920,002
9	Prepaid expenses and deferred charges ..........			3,665,494	9	46,652,326
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	178,756,504
b	Less: accumulated depreciation .....	10b	116,222,713	68,884,495	10c	62,533,791
11	Investments—publicly traded securities ..........			179,963,447	11	206,897,045
12	Investments—other securities. See Part IV, line 11 .....			7,055,191	12	7,910,801
13	Investments—program-related. See Part IV, line 11 .....			349,369	13	231,636
14	Intangible assets ...............			0	14	0
15	Other assets. See Part IV, line 11 ...........			2,402,743	15	3,120,899
16	Total assets. Add lines 1 through 15 (must equal line 34)......			290,840,231	16	364,525,742
17	Accounts payable and accrued expenses .........			25,175,623	17	24,757,961
18	Grants payable .................			0	18	0
19	Deferred revenue ................			75,000	19	75,000
20	Tax-exempt bond liabilities .............			0	20	0
21	Escrow or custodial account liability. Complete Part IV of Schedule D..			0	21	0
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........			0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..			0	23	0
24	Unsecured notes and loans payable to unrelated third parties ....			0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................			5,561,690	25	5,382,217
26	Total liabilities. Add lines 17 through 25.........			30,812,313	26	30,215,178
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............			260,009,940	27	334,250,974
28	Temporarily restricted net assets ...........			17,978	28	59,590
29	Permanently restricted net assets ...........			0	29	0
	Organizations that do not follow SFAS 117 (ASC 958), 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 ...........			260,027,918	33	334,310,564
34	Total liabilities and net assets/fund balances ........			290,840,231	34	364,525,742

1	Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If “Yes,”the organization may be required to file Form 926, Return by a U.S. Transferor of Property to a Foreign Corporation (see Instructions for Form 926)......................................	Yes	No
2	Did the organization have an interest in a foreign trust during the tax year? If “Yes,” the organizationmay be required to file Form 3520, Annual Return to Report Transactions with Foreign Trusts and Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With a U.S. Owner (see Instructions for Forms 3520 and 3520-A).......................................	Yes	No
3	Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with Respect to Certain Foreign Corporations. (see Instructions for Form 5471)..............................	Yes	No
4	Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If "Yes," the organization may be required to file Form 8621, Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see Instructions for Form 8621)	Yes	No
5	Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with Respect to Certain Foreign Partnerships. (see Instructions for Form 8865)....................................	Yes	No
6	Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to file Form 5713, International Boycott Report (see Instructions for Form 5713)................................................	Yes	No