Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| (A)
Holyoke Medical Center |
222520073 | 3 | Yes | 0 | 0 | |
| (B)
Valley Health Systems |
042103583 | 7 | Yes | 0 | 0 | |
| (C)
Western Mass Physician Assoc |
043202198 | 3 | Yes | 2,900,000 | 0 | |
|
Total 3
|
2,900,000 | 0 | ||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 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. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (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 VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (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.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (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 VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
|||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2018 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2018 |
(iii) Distributable Amount for 2018 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2018 from Section C, line 6 |
||||
|
2
Underdistributions, if any, for years prior to 2018 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2018: | ||||
| a From 2013....... | ||||
| b From 2014....... | ||||
| c From 2015....... | ||||
| d From 2016....... | ||||
| e From 2017....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2018 distributable amount | ||||
|
i
Carryover from 2013 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2018 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2018 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2018, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
||||
|
6
Remaining underdistributions for 2018. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
||||
|
7 Excess distributions carryover to 2019. Add lines 3j and 4c. |
||||
| 8 Breakdown of line 7: | ||||
| a Excess from 2014...... | ||||
| b Excess from 2015..... | ||||
| c Excess from 2016..... | ||||
| d Excess from 2017..... | ||||
| e Excess from 2018..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| Schedule A, Part I, Line 12g, Column v & Column vi: | The Organization supports its supported organizations by owning and operating non-profit medical clinics affiliated with Valley Health Systems, Inc. and Holyoke Medical Center, Inc. to provide obstetric-gynecology, pediatric and family medicine services, and other medical services to patients of Holyoke Medical Center and to residents of Holyoke Medical Center's service area. Additionally, the Organization treats Medicare and Medicaid patients and provides charity care to patients in accordance with its charity care policy. The Organization also participates in the educational programs of Holyoke Medical Center for its staff and for the community serviced by Holyoke Medical Center. Furthermore, the Organization engages generally in any activity which may lawfully be carried on by an organization which is organized under Chapter 180 of the General Laws of the Commonwealth of Massachusetts, as now in force or hereafter amended, and which is not inconsistent with the Organization's qualifications described in 501(c)(3) of the Internal Revenue Code as now in force or hereafter amended. During fiscal year September 30, 2019, the organization made an equity transfer to its supported organization, Western Mass Physician Associates, Inc. This amount approximates the amount of monetary support provided with respect to the above described support activities. |
| Part IV, Section A, Line 1: | One organization listed on Schedule A, Part I, Line 12(g), Western Mass Physician Associates, Inc., is not listed by name in MassWest Services, Inc.'s (MWS) governing documents as a supported organization. However, Western Mass Physician Associates, Inc., by virtue of being a wholly-owned subsidiary of Valley Health Systems, Inc., represents a designated class of supported organzations that is mentioned in MWS's governing documents. Accordingly, MWS's bylaws stipulate its purpose is to: Establish, own and operate non-profit medical clinics affiliated with Valley Health Systems, Inc. and Holyoke Medical Center, Inc.(HMC) to provide obstetrics, gynecology, pediatric and family medicine, and other medical services to patients of HMC and to residents of HMC's service area. To treat Medicare and Medicaid patients and to provide charity care to patients in accordance with the charity care policy of the Corporation. To participate in the educational programs of HMC for its staff and for the community served by HMC. To engage generally in any activity which may lawfully be carried on by an organization which is organized under Chapter 80 of the General Laws of the Commonwealth of Massachusetts, as now in force or hereafter amended, and which is not inconsistent with the corporation's qualification as an organization described in Section 501(c)(3) of the Internal Revenue Code as now in force or hereafter amended. |
| Part IV, Section C, Line 1: | For the current fiscal year end, control of MassWest Services, Inc. and its supported organizations were vested in the same persons that control by virtue of multiple shared board members and the same executive leadership. Furthermore, Valley Health Systems, Inc. (VHS) serves as the sole corporate member of the Organization and Holyoke Medical Center. MassWest Services, Inc. is the sole-corporate member of its other supported affiliated organization, Western Mass Physicians Associates, Inc. Pursuant to the Organization's bylaws the president and treasurer of MassWest Services, Inc. are appointed by the president of Valley Health Systems, Inc. pursuant to a management services agreement with the Organization. Appointment of the president of the Organization is submitted to its board of directors for approval. The clerk of the Organization is elected by its board of directors. Valley Health Systems, Inc. elects the remaining members of the governing body of the Organization. Valley Health Systems, Inc. also has the power to remove any member of the governing body, with or without cause, at any time by giving written notice to such governing body member. |
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Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| Form 990, Part VI, Section A, line 2 | Certain officers and directors of MassWest Services, Inc. are employed by a related tax-exempt organization which has common officers and/or directors. By virtue of this arrangement, certain individuals listed in Form 990, Part VII have a business relationship with one another. |
| Form 990, Part VI, Section A, line 6 | The sole member of the Organization is is Valley Health Systems, Inc. |
| Form 990, Part VI, Section A, line 7a | The president and treasurer of MassWest Services, Inc. are appointed by the president of Valley Health Systems, Inc. pursuant to a management services agreement with the Organization. Appointment of the president of the Organization is submitted to its board of directors for approval. The clerk of the Organization is elected by its board of directors. Valley Health Systems, Inc. elects the remaining members of the governing body of the Organization. Valley Health Systems, Inc. also has the power to remove any member of the governing body, with or without cause, at any time by giving written notice to such governing body member. |
| Form 990, Part VI, Section A, line 7b | Significant decisions of the governing body of MassWest Services, Inc. are subject to the approval of Valley Health Systems, Inc. as specified in the Organization's bylaws. |
| Form 990, Part VI, Section A, line 8b | There are no committees with the authority to act on behalf of the governing body of the Organization. |
| Form 990, Part VI, Section B, line 11b | A copy of MassWest Systems, Inc.'s Form 990 was provided to each voting member of the governing body prior to its filing with the Internal Revenue Service. The Form 990 was prepared with the assistance of an independent public accounting firm and thoroughly reviewed by the Senior Vice President of Finance and CFO and key financial staff of the Hospital prior to distibuting it to the governing body for review. |
| Form 990, Part VI, Section B, line 12c | The conflict of interest policy of MassWest Systems, Inc. (MWS) is monitored and enforced as part of the Valley Health Systems, Inc. System and is reviewed annually by the System's conflict of interest committee. MWS board members and officers complete and sign a conflict of interest questionnaire annually. All signed questionnaires are then submitted to MWS and to Valley Health Systems, Inc. (parent) for review and monitoring. |
| Form 990, Part VI, Section B, line 15 | The compensation committee of the Valley Health System, Inc. utilizes a market compensation survey to recommend to the Board the approval of its determination of the appropriate compensation of the Chief Executive Officer. During that process, the Committee also reviews the compensation levels of other senior management and key employees of the System. These individuals are not members of the compensation committee and do not participate in this process. The CEO, as a member of the Board of VHS, does not participate in the approval process of that officer's compensation. |
| Form 990, Part VI, Section C, line 19 | The governing documents, conflict of interest policy, and financial statements of Valley Health Systems and Affiliates, which includes supplemental information of the filing entity, are available to the public upon request at the Organization's administrative office at 575 Beech Street, Holyoke, MA. |
| Form 990, Part XI, line 9: | Equity Transfer from Affiliate 2,934,000. Equity Transfer to Affiliate -2,900,000. |
| Form 990, Part XII, Line 2c: | The audit process has not changed from the prior year. |
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