TY 2018 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)
(1) GARY CAMPBELL...................................................................... CHAIR	1.00 ................. 1.00	X	X	0	0
(2) RAYMOND ANSTISS JR...................................................................... VICE CHAIR	1.00 ................. 1.00	X	X	0	0
(3) DANIEL J MANSUR ESQ...................................................................... CLERK	1.00 ................. 3.00	X	X	0	0
(4) JOHN CARSON...................................................................... BOARD MEMBER	1.00 ................. 1.00	X		0	0
(5) JACK CLANCY...................................................................... BOARD MEMBER	1.00 ................. 1.00	X		0	0
(6) MARK COCHRAN...................................................................... BOARD MEMBER	1.00 ................. 1.00	X		0	0
(7) SHAMIM DAHOD MD...................................................................... BOARD MEMBER	1.00 ................. 1.00	X		0	0
(8) MICHAEL DUBUQUE...................................................................... BOARD MEMBER	1.00 ................. 1.00	X		0	0
(9) BOPHA MALONE...................................................................... BOARD MEMBER	1.00 ................. 1.00	X		0	0
(10) GEORGE MELTSAKOS MD...................................................................... BOARD MEMBER	1.00 ................. 1.00	X		0	0
(11) TUSHAR PATEL MD...................................................................... BOARD MEMBER	1.00 ................. 2.00	X		0	0
(12) LUIS PEDROSO...................................................................... BOARD MEMBER (UNTIL 11/19)	1.00 ................. 1.00	X		0	0
(13) NAOMI PRENDERGAST...................................................................... BOARD MEMBER	1.00 ................. 2.00	X		0	0
(14) BRUCE ROBINSON...................................................................... BOARD MEMBER	1.00 ................. 1.00	X		0	0
(15) DAVID WALLACE...................................................................... BOARD MEMBER	1.00 ................. 1.00	X		0	0
(16) JOSEPH WHITE...................................................................... PRESIDENT	48.00 ................. 2.00	X	X	1,324,761	20,921
(17) WILLIAM WYMAN...................................................................... SR. VP OF FINANCE/TREAS./ASST. CLERK	46.00 ................. 4.00		X	366,595	19,990

(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
(18) SABRINA GRANVILLE........................................................................ CHO	12.00 .......................38.00			X			119,986	359,956	27,519
(19) AMY HOEY........................................................................ CHIEF OPERATING OFFICER	50.00 .......................0.00			X			759,458	0	26,414
(20) CECELIA LYNCH........................................................................ CNO	50.00 .......................0.00			X			409,111	0	26,914
(21) ARTHUR LAURETANO........................................................................ CMO	50.00 .......................0.00			X			400,926	0	1,122
(22) MICHELLE DAVIS........................................................................ VP EXTERNAL AFFAIRS	49.00 .......................1.00			X			233,198	0	21,509
(23) WENDY MITCHELL........................................................................ MEDICAL DIR. COMMUNITY HOME	50.00 .......................0.00				X		312,213	0	24,520
(24) EMILY YOUNG........................................................................ DIRECTOR OF HEALTHCARE OPS	50.00 .......................0.00				X		261,055	0	22,469
(25) YISHIS REN........................................................................ CHIEF MEDICAL PHYSICIST	50.00 .......................0.00				X		252,271	0	20,706
(26) RAMYA PRABHAKAR........................................................................ PHYSICIAN	50.00 .......................0.00				X		272,947	0	25,755
(27) JAMES WOOLMAN........................................................................ DIRECTOR ACO PERFORMANCE MGMT	50.00 .......................0.00				X		261,532	0	23,383
(28) WILLIAM GALVIN III MD........................................................................ BOARD MEMBER/MEDICAL DIRECTOR	1.00 .......................1.00	X					523,540	0	26,413
(29) SUSAN GREEN........................................................................ FMR. SENIOR VP & CFO & TREAS. - THE LGH	0.00 .......................50.00					X	0	731,087	27,467
(30) NORMAND DESCHENE........................................................................ FMR. PRES. OF BOARD & CEO	0.00 .......................50.00		X				0	1,656,224	20,921

(A) Name and business address	(B) Description of services	(C) Compensation
MCKESSON CORPORATION 6555 STATE HWY 161 IRVING,TX75039	MEDICAL SUPPLIES SERVICES	29,543,849
CERNER CORPORATION 2800 ROCKCREEK PARKWAY NORTH KANSAS CITY,MO64117	INFORMATION SYSTEMS PROVIDER	25,166,656
CLAFLIN COMPANY 455 WARWICK INDUSTRIAL DR WARWICK,RI02886	MEDICAL SUPPLIES SERVICES	13,349,616
SODEXO INC & AFFILIATES 9801 WASHINGTONIAN BLVD GAITHERSBURG,MD20878	FOOD & FACILITIES SERVICES	4,336,166
MERRIMACK VALLEY EMERGENCY ASSOCIATES 1 HOSPITAL DR LOWELL,MA01852	PHYSICIAN SERVICES	4,186,663
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 296

- 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.
right arrow

Attach to Form 990 or Form 990-EZ.
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Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization

THE LOWELL GENERAL HOSPITAL

Employer identification number

04-2103590

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 12, 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 (Form 990 or 990-EZ).)

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 agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

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 in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

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

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2018

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv), 170(b)(1)(A)(vi), and 170(b)(1)(A)(ix)
(Complete only if you checked the box on line 5, 7, 8, or 9 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) 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.

Section B. Total Support

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

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 section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2018 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2017 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2018. 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—2017. 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—2018. 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 VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2017. 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 VI 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) 2018

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 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) 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.)

Section B. Total Support

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.)..

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

Section C. Computation of Public Support Percentage

Public support percentage for 2018 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2017 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2018 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2017 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2018. 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—2017. 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) 2018

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 12a or 12b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2018

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2018

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	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

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2018

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)

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.
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.....

Schedule A (Form 990 or 990-EZ) (2018)

Schedule A (Form 990 or 990-EZ) 2018

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2018

Additional Data

Software ID:
Software Version:

- TIN:

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

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Name of the organization

THE LOWELL GENERAL HOSPITAL

Employer identification number

04-2103590

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

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

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

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

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

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

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution. An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

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

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018) Page 2

Name of organization THE LOWELL GENERAL HOSPITAL

Part I	Contributors (See instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Page 3

Name of organization THE LOWELL GENERAL HOSPITAL		Employer identification number 04-2103590

Part II	Noncash Property (See instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Page 4


Name of organization THE LOWELL GENERAL HOSPITAL			Employer identification number 04-2103590
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Additional Data

Software ID:
Software Version:

- 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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

If the organization answered "Yes" on 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" on 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" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

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

Name of the organization

THE LOWELL GENERAL HOSPITAL

Employer identification number

04-2103590

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 (see instructions for definition of “political campaign activities")

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

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-.
1
2
3
4
5
6

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

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2018

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 separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2015	(b) 2016	(c) 2017	(d) 2018	(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) 2018

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 on 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)? ........

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

257,940

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

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

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

257,940

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

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, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
PART II-B, LINE 1(G), DIRECT CONTACT WITH LEGISLATORS, THEIR STAFFS,	GOVERNMENT OFFICIALS, OR A LEGISLATIVE BODY: A PORTION OF THE HOSPITAL'S MASSACHUSETTS HOSPITAL ASSOCIATION (MHA) DUES SUPPORTS LOBBYING ACTIVITIES. THE MHA WORKS ON BEHALF OF THE INDUSTRY TO INFLUENCE MATTERS OF IMPORTANCE TO MASSACHUSETTS HEALTHCARE.

Schedule C (Form 990 or 990EZ) 2018

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on 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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

THE LOWELL GENERAL HOSPITAL

Employer identification number

04-2103590

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of 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" on 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 7/25/06, 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, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, 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" on 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)

Revenue included on 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:

Revenue included on 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) 2018

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" on 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


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

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" on Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	(c)Two years back	(d)Three years back	(e)Four years back

1a	Beginning of year balance ....	76,021,699	77,572,133	69,687,775	63,685,872	65,774,190
b	Contributions ...	8,074	16,191	19,850	10,148	10,489
c	Net investment earnings, gains, and losses	2,930,857	8,139,178	978,039	1,050,057	1,015,170
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...	234,264	9,705,803	-6,886,469	-4,941,698	3,113,977
f	Administrative expenses ....
g	End of year balance ......	78,726,366	76,021,699	77,572,133	69,687,775	63,685,872

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

Board designated or quasi-endowment SchDMd Bullet

96.230 %

Permanent endowment SchDMd Bullet

3.770 %

Temporarily restricted endowment SchDMd Bullet

0 %

The percentages on 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)

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

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

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. 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 .....	5,377,764		5,377,764
b	Buildings ....	300,579,445	139,836,022	160,743,423
c	Leasehold improvements	4,430,938	2,976,937	1,454,001
d	Equipment ....	166,401,160	122,216,530	44,184,630
e	Other .....	6,506,742	2,761,830	3,744,912
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				215,504,730

Schedule D (Form 990) 2018

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. 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........
(3) Other (A) BENEFICIAL INTEREST IN PERPETUAL TRUSTS	1,423,402	F
(B) CERTIFICATES OF DEPOSIT	18,895,346	F
(C) MUTUAL FUNDS	73,263,134	F
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	93,581,882

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1) OTHER ASSETS				33,889,724
(2) DUE FROM AFFILIATES				13,967,412
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				47,857,136

Part X

Other Liabilities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
CAPITAL LEASE OBLIGATIONS	9,935,056
ACCRUED PENSION EXPENSE	53,070,582
OTHER LONG-TERM LIABILITIES	16,701,927
DUE TO AFFILIATES	5,879,038
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	85,586,603
2. Liability for uncertain tax positions. 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) 2018

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......			1	489,971,008
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a	-296,235
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d	6,477,194
e	Add lines 2a through 2d .....................			2e	6,180,959
3	Subtract line 2e from line 1..................			3	483,790,049
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	342,295
b	Other (Describe in Part XIII.) ...........	4b	1,019,234
c	Add lines 4a and 4b....................			4c	1,361,529
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	485,151,578

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........			1	513,173,302
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d	55,892,532
e	Add lines 2a through 2d....................			2e	55,892,532
3	Subtract line 2e from line 1...................			3	457,280,770
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	342,295
b	Other (Describe in Part XIII.) ............	4b	998,097
c	Add lines 4a and 4b.....................			4c	1,340,392
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	458,621,162

Part XIII

Supplemental Information

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.

Return Reference	Explanation
PART V, LINE 4:	THE HOSPITAL CLASSIFIES AS PERMANENTLY RESTRICTED NET ASSETS (A) THE ORIGINAL VALUE OF THE GIFTS DONATED TO THE PERMANENT ENDOWMENT WHEN EXPLICIT DONOR STIPULATIONS REQUIRING PERMANENT MAINTENANCE OF THE HISTORICAL FAIR VALUE ARE PRESENT, AND (B) THE ORIGINAL VALUE OF THE SUBSEQUENT GIFTS TO THE PERMANENT ENDOWMENT WHEN EXPLICIT DONOR STIPULATIONS REQUIRING PERMANENT MAINTENANCE OF THE HISTORICAL FAIR VALUE ARE PRESENT. THE REMAINING PORTION OF THE DONOR-RESTRICTED ENDOWMENT FUND COMPRISED OF ACCUMULATED GAINS NOT REQUIRED TO BE MAINTAINED IN PERPETUITY IS CLASSIFIED AS TEMPORARILY RESTRICTED NET ASSETS UNTIL THOSE AMOUNTS ARE APPROPRIATED FOR EXPENDITURE IN A MANNER CONSISTENT WITH THE DONOR'S STIPULATIONS. THE HOSPITAL CONSIDERS THE FOLLOWING FACTORS IN MAKING A DETERMINATION TO APPROPRIATE OR ACCUMULATE DONOR-RESTRICTED ENDOWMENT FUNDS: DURATION AND PRESERVATION OF THE FUND, PURPOSES OF THE DONOR-RESTRICTED ENDOWMENT FUNDS, GENERAL ECONOMIC CONDITIONS, THE POSSIBLE EFFECT OF INFLATION AND DEFLATION, THE EXPECTED TOTAL RETURN FROM INCOME AND THE APPRECIATION OF INVESTMENTS, OTHER RESOURCES OF THE HOSPITAL, AND THE INVESTMENT POLICIES OF THE HOSPITAL.
PART XI, LINE 2D - OTHER ADJUSTMENTS:	RENTAL EXPENSE 2,049,640. SPECIAL EVENT EXPENSE 786,887. NET ASSETS RELEASED FROM RESTRICTIONS USED FOR OPERATIONS 1,728,230. NET ASSETS RELEASED FROM RESTRICTIONS USED FOR CAPITAL 1,327,904. LOSS ON EXTINGUISHMENT OF DEBT 584,533.
PART XI, LINE 4B - OTHER ADJUSTMENTS:	CHANGE IN BENEFICIAL INTEREST IN PERPETUAL TRUST 21,137. PHILANTHROPY EXPENSES NETTED WITH CONTRIBUTIONS 998,097.
PART XII, LINE 2D - OTHER ADJUSTMENTS:	RENTAL EXPENSES 2,049,640. SPECIAL EVENTS EXPENSE 786,887. NET ASSETS RELEASED FROM RESTRICTIONS USED FOR OPERATIONS 1,728,230. NET ASSETS RELEASED FROM RESTRICTIONS FOR CAPITAL 1,327,904. TRANSFERS TO AFFILIATES 24,616,222. PROVISION FOR UNCOLLECTIBLE ACCOUNTS- PATIENTS 12,984,894. LOSS ON EXTINGUISHMENT OF DEBT 584,533. PENSION RELATED ADJUSTMENTS 11,814,222.
PART XII, LINE 4B - OTHER ADJUSTMENTS:	PHILANTHROPY EXPENSES NETTED WITH CONTRIBUTIONS 998,097.

Schedule D (Form 990) 2018

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE G (Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information Regarding
Fundraising or Gaming Activities

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

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization
THE LOWELL GENERAL HOSPITAL

Employer identification number

04-2103590

Part I

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

Form 990-EZ filers are not required to complete this part.

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

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

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

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

YesNo

If "Yes," list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.

(i) Name and address of individual or entity (fundraiser)	(iii) Did fundraiser have custody or control of contributions?
	Yes	No










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

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

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

Cat. No. 50083H

Schedule G (Form 990 or 990-EZ) 2018

Page 2

Part II

Fundraising Events. Complete if the organization answered "Yes" on Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.

		(a) Event #1 TEAM WALK FOR CANCER CARE (event type)	(b) Event #2 BALL (event type)	(c) Other events 1 (total number)	(d) Total events (add col. (a) through col. (c))
1	Gross receipts . . . . .	834,277	420,599	401,669	1,656,545
2	Less: Contributions . . . .	200,000	100,000		300,000
3	Gross income (line 1 minus line 2) . . . . . .	634,277	320,599	401,669	1,356,545

4	Cash prizes . . . . .	2,500		5,000	7,500
5	Noncash prizes . . . .	13,193	8,075	868	22,136
6	Rent/facility costs . . . .	22,055	171,001	114,577	307,633
7	Food and beverages . . .	4,160	130		4,290
8	Entertainment . . . .	28,756	8,025		36,781
9	Other direct expenses . . .	253,881	106,321	48,345	408,547
10	Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . .				786,887
11	Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . .				569,658

Part III

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

		(a) Bingo	(b) Pull tabs/Instant bingo/progressive bingo	(c) Other gaming	(d) Total gaming (add col.(a) through col.(c))
1	Gross revenue . . . . .

2	Cash prizes . . . . .
3	Noncash prizes . . . .
4	Rent/facility costs . . . .
5	Other direct expenses . . .

Volunteer labor . . . .

	Yes %
	No

	Yes %
	No

	Yes %
	No

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

Net gaming income summary. Subtract line 7 from line 1, column (d). . . . . . . . . right arrow

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

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

YesNo

If "No," explain:

10a

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

YesNo

If "Yes," explain:

Schedule G (Form 990 or 990-EZ) 2018

Page 3

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

YesNo

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

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

YesNo

Indicate the percentage of gaming activity conducted in:

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

13a

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

13b

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

Name

Address

15a

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

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

YesNo

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

$ and the

amount of gaming revenue retained by the third party right arrow

$ .

If "Yes," enter name and address of the third party:

Name

Address

Gaming manager information:

Name

Gaming manager compensation right arrow

Description of services provided right arrow

Director/officer Employee Independent contractor

Mandatory distributions:

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

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

YesNo

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

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

Part IV

Supplemental Information. Provide the explanations required by Part I, line 2b, columns (iii) and (v); and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also provide any additional information. See instructions.

Return Reference	Explanation

Schedule G (Form 990 or 990-EZ) 2018

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

THE LOWELL GENERAL HOSPITAL

Employer identification number

04-2103590

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 criteria used 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) . . .	11,265,465	4,164,474	7,100,991	1.550 %
b	Medicaid (from Worksheet 3, column a) . . . . .	841,744		841,744	0.180 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .	4,697,470		4,697,470	1.020 %
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	16,804,679	4,164,474	12,640,205	2.750 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	1,116,304	23,822	1,092,482	0.240 %
f	Health professions education (from Worksheet 5) . . .	1,269,559	12,100	1,257,459	0.270 %
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .	429,817	57,485	372,332	0.080 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	918,650	100,000	818,650	0.180 %
j	Total. Other Benefits . .	3,734,330	193,407	3,540,923	0.770 %
k	Total. Add lines 7d and 7j .	20,539,009	4,357,881	16,181,128	3.520 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2018

Schedule H (Form 990) 2018

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
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development	328,062	328,062	0.070 %
9	Other	200,000	200,000	0.040 %
10	Total	528,062	528,062	0.110 %

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

Yes

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

12,984,894

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. ......

779,094

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).....

109,806,087

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

122,046,572

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

-12,240,485

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) 2018

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?2Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)					Other (describe)	Facility reporting group
1	THE LOWELL GENERAL HOSPITAL 275-319 VARNUM AVENUE LOWELL,MA01854	X	X	X	ALSO DESIGNATED AS A TRAUMA CENTER	A
2	THE LOWELL GENERAL HOSPITAL 1-2 HOSPITAL DRIVE LOWELL,MA01852	X	X			A

Schedule H (Form 990) 2018

Page 4

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)

	THE LOWELL GENERAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

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 12......................

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 significant 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

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 17

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

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 (list url): WWW.LOWELLGENERAL.ORG

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 17

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): WWW.LOWELLGENERAL.ORG

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

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

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, 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) 2018

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	THE LOWELL GENERAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

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 included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.000000000000% and FPG family income limit for eligibility for discounted care of 400.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

WWW.LOWELLGENERAL.ORG

The FAP application form was widely available on a website (list url):

A plain language summary of the FAP was widely available on a website (list url):
WWW.LOWELLGENERAL.ORG

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2018

Page 6

Part VFacility Information (continued)

Billing and Collections

	THE LOWELL GENERAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

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 all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

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 individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs

Made a reasonable effort to orally notify individuals about the FAP and FAP application process

Processed incomplete and complete FAP applications

Made presumptive eligibility determinations

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required 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 Section C)

Other (describe in Section C)

Schedule H (Form 990) 2018

Page 7

Part VFacility Information (continued)

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

	THE LOWELL GENERAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

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 a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual 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 Section C.

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

If "Yes," explain in Section C.

Schedule H (Form 990) 2018

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
PART V, SECTION B	FACILITY REPORTING GROUP A
FACILITY REPORTING GROUP A CONSISTS OF:	- FACILITY 1: THE LOWELL GENERAL HOSPITAL, - FACILITY 2: THE LOWELL GENERAL HOSPITAL
THE LOWELL GENERAL HOSPITAL PART V, SECTION B, LINE 3J:	LOWELL GENERAL HOSPITAL COMPLETES A COMMUNITY HEALTH NEEDS ASSESSMENT EVERY THREE YEARS. INFORMATION FOR THE NEEDS ASSESSMENT WAS COLLECTED FROM MULTIPLE SOURCES, IN THREE DIFFERENT WAYS: (1) FOCUS GROUPS, (2) KEY INFORMANT INTERVIEWS, AND (3) A REVIEW OF PUBLICLY COLLECTED HEALTH AND DEMOGRAPHIC STATISTICS FROM THE MASS CHIP DATABASE. THERE WERE 16 FOCUS GROUPS WITH A TOTAL OF 167 PARTICIPANTS. THE FOCUS GROUPS WERE CONDUCTED IN ENGLISH, KHMER, SPANISH, PORTUGUESE AND OTHER LANGUAGES, AS NEEDED. THE UNIVERSITY OF MASSACHUSETTS LOWELL CONDUCTED THREE KEY INFORMANT INTERVIEWS.
THE LOWELL GENERAL HOSPITAL PART V, SECTION B, LINE 5:	INFORMATION FOR THE NEEDS ASSESSMENT WAS COLLECTED FROM MULTIPLE SOURCES, IN THREE DIFFERENT WAYS: (1) FOCUS GROUPS, (2) KEY INFORMANT INTERVIEWS, AND (3) A REVIEW OF PUBLICLY COLLECTED HEALTH AND DEMOGRAPHIC STATISTICS FROM THE MASSCHIP DATABASE. THERE WERE 16 FOCUS GROUPS WITH A TOTAL OF 167 PARTICIPANTS. THE FOCUS GROUPS WERE CONDUCTED IN ENGLISH, KHMER, SPANISH, PORTUGUESE AND OTHER LANGUAGES, AS NEEDED. THE UNIVERSITY OF MASSACHUSETTS LOWELL CONDUCTED THREE KEY INFORMANT INTERVIEWS.ALL PARTICIPANTS IN THE FOCUS GROUPS AND KEY INFORMANT INTERVIEWS INDICATED THAT PROVIDERS AND AGENCIES IN LOWELL COLLABORATE WELL, ESPECIALLY LOWELL GENERAL HOSPITAL AND LOWELL COMMUNITY HEALTH CENTER. THEY ALSO ACKNOWLEDGED STRONG COLLABORATION BETWEEN COMMUNITIES, AGENCIES AND PROVIDERS. SOME FELT THAT LOWELL AND LOWELL AREA SERVICES HAVE A "GOOD PUBLIC HEALTH APPROACH." THE COMMUNITY FOCUS GROUPS ALSO FELT THAT GOOD ATTENTION TO DIVERSE COMMUNITIES, OUTREACH AT COMMUNITY EVENTS, GOOD PREVENTION PROGRAMS, AND STRONG SERVICES FOR IMMIGRANTS, REFUGEES, AND THE HOMELESS AT LCHC WERE ALL STRENGTHS OF THE HEALTHCARE SYSTEM.MORE THAN 50 GREATER LOWELL PROFESSIONALS PARTICIPATED IN THE FOCUS GROUPS AND PERSONAL INTERVIEWS - INCLUDING SCHOOL NURSES, HOSPITAL EXECUTIVES, TOWN MANAGERS AND LOCAL HEALTH DEPARTMENT DIRECTORS, AS WELL AS INDIVIDUALS REPRESENTING THE COUNCILS OF AGING, SKILLED NURSING FACILITIES AND VARIOUS COMMUNITY-BASED ORGANIZATIONS. THESE INDIVIDUALS WERE ASKED TO SPEAK TO THE STRENGTHS AND WEAKNESSES OF THE AREA'S HEALTH SYSTEM AND SUGGEST CHANGES TO IMPROVE IT.THE HEALTH AND DEMOGRAPHIC DATA AVAILABLE WITHIN THE GREATER LOWELL AREA WAS THOROUGHLY INVESTIGATED, FOCUSING SUBSTANTIALLY ON THE ISSUES OR PROBLEMS INDICATED FROM THE PERSONAL AND FOCUS GROUP INTERVIEWS, AS WELL AS THE PUBLIC HEALTH DATA AND STATISTICS. THESE DATA INDICATED THAT THE GREATER LOWELL AREA SAW A DOUBLING OF THE RATE OF MENTAL HEALTH HOSPITALIZATIONS BETWEEN 1989 AND 2006. IN ADDITION, LOWELL HAS SEEN INCREASES IN PROBLEMATIC ALCOHOL CONSUMPTION AND OPIATE-RELATED MORTALITY. THE EXPERIENCE IN THE LOWELL AREA WAS ALSO COMPARED, AS APPROPRIATE, WITH THE STATEWIDE EXPERIENCE. IN SO DOING, WE FOUND THAT THE USE OF EMERGENCY DEPARTMENT SERVICES IN LOWELL IS 39% HIGHER THAN THE STATE AVERAGE IN MOST RECENT DATA AVAILABLE, 2002 THROUGH 2005. WHEN RELIABLE INFORMATION WAS AVAILABLE, WE ADDITIONALLY EXAMINED THE COMPARATIVE EXPERIENCE OF DIFFERENT DEMOGRAPHIC SUBGROUPS. THE MORTALITY RATE AMONG ASIAN-AMERICANS IN THE GREATER LOWELL AREA, FOR EXAMPLE, WAS NEARLY TWICE AS HIGH AS THE MASSACHUSETTS AVERAGE FOR THIS GROUP. IN ADDITION TO PROVIDING SUPPLEMENTAL INFORMATION ON HEALTHCARE CONCERNS VOICED BY VARIOUS STUDY RESPONDENTS, THE DATA ANALYSIS ALSO INDICATED OTHER IMPORTANT FINDINGS, MOST IMPORTANTLY, THAT THE PROPORTION OF INDIVIDUALS IN LOWELL WITHOUT HEALTH INSURANCE INCREASED SUBSTANTIALLY BETWEEN 2000 AND 2008.
THE LOWELL GENERAL HOSPITAL PART V, SECTION B, LINE 6B:	LOWELL GENERAL HOSPITAL CONDUCTED THE LAST COMMUNITY HEALTH NEEDS ASSESSMENT WITH RESEARCHERS AND STUDENTS OF UNIVERSITY OF MASSACHUSETTS LOWELL (UML) AND THE GREATER LOWELL HEALTH ALLIANCE (GLHA).
THE LOWELL GENERAL HOSPITAL PART V, SECTION B, LINE 11:	THE TOP HEALTH PROBLEMS THAT WERE IDENTIFIED IN THE FOCUS GROUPS AND INTERVIEWS AND SUPPORTED BY PUBLIC HEALTH DATA INCLUDE MENTAL HEALTH, DIABETES, SUBSTANCE ABUSE AND ADDICTION, HYPERTENSION, OBESITY, AND ASTHMA AND RESPIRATORY DISEASE. THE HOSPITAL IS ADDRESSING THE SIGNIFICANT NEEDS IDENTIFIED IN THE LATEST COMMUNITY HEALTH NEEDS ASSESSMENT BY INCORPORATING THESE INTO THE ORGANIZATION'S ANNUAL COMMUNITY BENEFIT PLAN. THE COMMUNITY BENEFIT PLAN IS AN ACTION PLAN DEVELOPED ANNUALLY BY HOSPITAL LEADERS TO ADDRESS PRIORITY HEALTH NEEDS WITHIN THE GREATER LOWELL REGION. LOWELL GENERAL HOSPITAL AND THE GREATER LOWELL HEALTH ALLIANCE ARE COMMITTED TO A COLLABORATIVE APPROACH INVOLVING OTHER COMMUNITY STAKEHOLDERS WITH THE GOAL TO IDENTIFY TOP PRIORITIES AND FORMULATE ACTION STEPS THAT WILL IMPROVE THE AREA HEALTHCARE SYSTEM AND OVERALL COMMUNITY HEALTH.THE MAJOR WEAKNESSES IDENTIFIED IN THE 2016 COMMUNITY HEALTH NEEDS ASSESSMENT INCLUDE MENTAL AND BEHAVIORAL HEALTH NEEDS THAT ARE NOT BEING MET, LACK OF SUBSTANCE ABUSE RESOURCES, DIFFICULT AND/OR LACK OF ACCESS TO CARE FOR MANY LOWELL AND GREATER LOWELL RESIDENTS, NEED FOR ADDITIONAL INTERPRETATION AND TRANSLATION SERVICES, LACK OF CASE MANAGEMENT SERVICES AND HEALTH NAVIGATORS, LACK OF COMMUNICATION BETWEEN EMERGENCY CARE AND PCPS, PERCEPTION OF FRAGMENTED CARE, LACK OF OUTREACH TO VULNERABLE POPULATIONS, AND LACK OF HEALTH EDUCATION.
THE LOWELL GENERAL HOSPITAL PART V, SECTION B, LINE 13B:	PATIENTS WHOSE HOUSEHOLD INCOME EXCEEDS 400% OF THE FEDERAL POVERTY GUIDELINES AND WHO MEET HEALTH SAFETY NET INCOME CRITERIA FOR MEDICAL HARDSHIP AND HAVE BALANCES (AFTER FREE CARE) OF $10,000 OR MORE. SPECIFICALLY, THESE PATIENTS MAY (1) BE ELIGIBLE FOR MEDICAL HARDSHIP ASSISTANCE UNDER THE HEALTH SAFETY NET BUT HAVE PATIENT CONTRIBUTION REQUIREMENTS GREATER THAN $10,000 OR (2) MEET THE MEDICAL HARDSHIP INCOME CRITERIA, BUT ARE INELIGIBLE FOR FREE CARE BECAUSE THE SERVICES RECEIVED ARE NOT HOSPITAL-LICENSED SERVICES. IN SUCH CIRCUMSTANCES:(I)FINANCIAL ASSISTANCE WILL BE DETERMINED AFTER A REVIEW OF ALL FINANCIAL INFORMATION AND CIRCUMSTANCES.(II)FINANCIAL ASSISTANCE WILL GENERALLY REDUCE AN OUTSTANDING BALANCE TO 15% OF ANNUAL INCOME ABSENT SIGNIFICANT ASSETS.(III)FINANCIAL ASSISTANCE UP TO 100% WILL BE CONSIDERED BASED ON THE PATIENT'S PARTICULAR MEDICAL AND FINANCIAL CIRCUMSTANCES AND MUST BE APPROVED BY THE LOWELL GENERAL HOSPITAL VICE PRESIDENT OF REVENUE OR VP FINANCE/CFO OR HIS/HER DESIGNEE.

Schedule H (Form 990) 2018

Page 9

Part VFacility Information (continued)

Section D. 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?17
Name and address		Type of Facility (describe)
1	1 - LGH - OFFICE SPACE OFF-SITE 10 RESEARCH PLACE CHELMSFORD,MA01824	SURGICAL DAY CARE, MD OFFICES, LAB & X-RAY
2	2 - LGH - OFFICE SPACE OFF-SITE 4 MEETINGHOUSE RD 13 CHELMSFORD,MA01824	XRAY PROCEDURES
3	3 - LGH - OFFICE SPACE OFF-SITE 20 RESEARCH PLACE STE 100 CHELMSFORD,MA01824	PATIENT AMBASSADOR & LAB OFFICE SPACE
4	4 - LGH - OFFICE SPACE OFF-SITE 20 RESEARCH PLACE 310 CHELMSFORD,MA01824	PATIENT AMBASSADOR & LAB OFFICE SPACE
5	5 - LGH - OFFICE SPACE OFF-SITE 14 RESEARCH PLACE CHELMSFORD,MA01824	ORTHOPAEDIC SURGICAL ASSOCIATES
6	6 - LGH - OFFICE SPACE OFF-SITE 203 TURNPIKE RD NORTH ANDOVER,MA01845	EMPLOYED PHYSICIAN PRACTICE
7	7 - LGH - OFFICE SPACE OFF-SITE 2337 VILLAGE SQUARE CHELMSFORD,MA01854	PROVIDE BLOOD DRAWING SERVICES
8	8 - LGH - OFFICE SPACE OFF-SITE 600 CLARK RD TEWKSBURY,MA01876	PROVIDE BLOOD DRAWING AND RADIOLOGY SERVICES.
9	9 - LGH - OFFICE SPACE OFF-SITE 161 JACKSON ST LOWELL,MA01852	LAB OFFICE SPACE
10	10 - LGH - OFFICE SPACE OFF-SITE 10 ADAMS ST CHELMSFORD,MA01824	LAB OFFICE SPACE
11	11 - LGH - OFFICE SPACE OFF-SITE 43 VILLAGE SQUARE CHELMSFORD,MA01824	REHABILITATION SERVICES
12	12 - LGH - OFFICE SPACE OFF-SITE 1595 BRIDGE ST DRACUT,MA01826	PHYSICIAN PRACTICE
13	13 - LGH - OFFICE SPACE OFF-SITE 1656 MAIN ST TEWKSBURY,MA01876	PHYSICIAN PRACTICE
14	14 - LGH - OFFICE SPACE OFF-SITE 198 LITTLETON ROAD WESTFORD,MA01886	URGENT CARE AND PATIENT SERVICE CENTER
15	15 - LGH - OFFICE SPACE OFF-SITE 33 BARTLETT ST LOWELL,MA01852	CIRCLE CARE BEHAVIORLAL HEALTH
16	16 - LGH - OFFICE SPACE OFF-SITE 199 BOSTON ROAD NO BILLERICA,MA01821	URGENT CARE AND PATIENT SERVICE CENTER
17	17 - LGH - OFFICE SPACE OFF-SITE 9 LOON HILL ROAD DRACUT,MA01850	URGENT CARE AND PATEINT SERVICE CENTER

Schedule H (Form 990) 2018

Page 10

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs 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.

Form and Line Reference	Explanation
SCHEDULE H-PART I	PART I, LINE 6A & B: THE ORGANIZATION PREPARES A COMMUNITY BENEFIT REPORT EVERY YEAR. THE COMMUNITY BENEFIT ANNUAL REPORT IS AVAILABLE TO THE PUBLIC ON THE ORGANIZATION'S WEBSITE OR UPON REQUEST.PART I, LINE 7: THE COST ALLOCATION IS BASED OFF THE FY2019 TOTAL PATIENT CARE EXPERIENCE (NOT INCLUDING BAD DEBT AND LESS THE MEDICAID PROVIDER TAX) DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS PERCENTAGE IS APPLIED TO THE SPECIFIC LINE ITEMS TO REFLECT THE MOST ACCURATE COST CALCULATION.
PART II, COMMUNITY BUILDING ACTIVITIES:	INFORMATION FOR THE NEEDS ASSESSMENT WAS COLLECTED FROM MULTIPLE SOURCES, IN THREE DIFFERENT WAYS: (1) FOCUS GROUPS, (2) KEY INFORMANT INTERVIEWS, AND (3) A REVIEW OF PUBLICLY COLLECTED HEALTH AND DEMOGRAPHIC STATISTICS FROM THE MASSCHIP DATABASE. THERE WERE 16 FOCUS GROUPS WITH A TOTAL OF 167 PARTICIPANTS. THE FOCUS GROUPS WERE CONDUCTED IN ENGLISH, KHMER, SPANISH, PORTUGUESE AND OTHER LANGUAGES, AS NEEDED. THE UNIVERSITY OF MASSACHUSETTS LOWELL CONDUCTED THREE KEY INFORMANT INTERVIEWS.THE LOWELL GENERAL HOSPITAL HAS A CLOSE WORKING RELATIONSHIP THAT INCLUDES FINANCIAL SUPPORT TO LOWELL COMMUNITY HEALTH CENTER (LCHC) WHICH SERVES THE LOW-INCOME, MEDICALLY UNDERSERVED POPULATION, MANY OF WHOM HAVE NO OTHER ACCESS TO HEALTHCARE SERVICES. THE MAJORITY OF PATIENTS SERVED BY LCHC HAVE MASSHEALTH, ANOTHER 10% HAVE PRIVATE HEALTH INSURANCE OR HMO COVERAGE, 7% HAVE MEDICARE, AND 20% ARE UNINSURED; AND 95% LIVE AT OR BELOW THE POVERTY LEVEL. ALMOST HALF OF LCHC'S PATIENT POPULATION IS UNDER 18 YEARS OF AGE, AND THE MAJORITY OF WOMEN ARE IN THEIR CHILDBEARING YEARS. IN 2007, 37% OF PATIENTS WERE WHITE/NON-HISPANIC; 28% WERE LATINO; 27% WERE ASIAN (PRIMARILY CAMBODIANS) AND 8% WERE AFRICAN IMMIGRANTS. ALMOST 60% OF PATIENTS WERE BEST SERVED IN A LANGUAGE OTHER THAN ENGLISH. SOME OF THE MAJOR SERVICES THAT LCHC PROVIDES ARE - CARINO, WHICH PROVIDES SPECIAL CARE FOR PATIENTS WITH HIV/AIDS; PROMOTORAS PROGRAMS, WHICH ARE TRAINED COMMUNITY HEALTH WORKERS AND VOLUNTEERS WHO SPEAK SPANISH AND/OR PORTUGUESE AND GO THROUGH AN INTENSIVE TRAINING WITH LCHC STAFF ON SPECIFIC HEALTH TOPICS TO EDUCATE THE COMMUNITY; LCHC TEEN COALITION AND ADOLESCENT HEALTH PROGRAM, WHICH COVERS EVERYTHING FROM MENTAL HEALTH AND SELF-ESTEEM ISSUES AMONG GIRLS TO EDUCATING AND INVOLVING YOUTH IN SUBSTANCE ABUSE PREVENTION AND A JOURNEY TO HEALING PROGRAM FOR REFUGEE CHILDREN AND CHILDREN OF REFUGEES. WITHOUT THE LOWELL GENERAL'S FINANCIAL SUPPORT TO LCHC'S PENSION AND WORKER'S COMPENSATION PROGRAM, MANY OF THESE PROGRAMS WOULD NOT HAVE ADEQUATE FUNDING. THE HEALTH AND DEMOGRAPHIC DATA AVAILABLE WITHIN THE GREATER LOWELL AREA WAS THOROUGHLY INVESTIGATED, FOCUSING SUBSTANTIALLY ON THE ISSUES OR PROBLEMS INDICATED FROM THE PERSONAL AND FOCUS GROUP INTERVIEWS, AS WELL AS THE PUBLIC HEALTH DATA AND STATISTICS.
PART III, LINE 2:	THE BAD DEBT EXPENSE AMOUNT DETAILED ON LINE 2 IS BASED ON THE COST TO CHARGE RATIO CALCULATED FROM THE MEDICARE COST REPORT. REGARDING THE RATIONALE FOR INCLUDING THE AMOUNT ON LINE 3 AS CHARITY CARE, THE HOSPITAL PROVIDES AN ESTIMATE OF HOW MUCH IS ATTRIBUTABLE TO PERSONS WHO WOULD NORMALLY QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S CHARITY CARE POLICIES, BUT HAVE NOT TAKEN ADVANTAGE OF THE FINANCIAL ASSISTANCE THAT IS AVAILABLE TO THEM. CURRENTLY THROUGH MANUAL PROCESSES IT IS IMPOSSIBLE TO SCREEN EVERY PATIENT TO MAKE AN INCOME STATUS DETERMINATION FOR QUALIFICATION TO THE HOSPITAL'S CHARITY PROGRAM UNDER A PRESUMPTIVE CHARITY POLICY. THESE INDIVIDUALS THAT DO NOT SEEK OUT CHARITY PROGRAMS ARE OFTEN UNDERINSURED OR LOW INCOME AND DO NOT NECESSARILY CONSIDER THE BENEFIT OF THE PROCESS OF SUBMITTING AN APPLICATION TO THE HOSPITAL. THE HOSPITAL CONTINUES TO PROVIDE CARE TO THOSE INDIVIDUALS THAT HAVE A HISTORY OF POOR CREDIT WITH THE FACILITY AND NEED MEDICALLY NECESSARY SERVICES AS WE UNDERSTAND THAT THE ABILITY FOR THE COMMUNITY TO SEEK OUT QUALITY MEDICAL SERVICES IS OF THE UTMOST IMPORTANCE AND EXTENDS OUR CHARITABLE BENEFIT TO THE COMMUNITY. WE BELIEVE THAT HAD THE QUALIFICATION PROCESS TAKEN PLACE THIS BAD DEBT WOULD BE CLASSIFIED IN THE CHARITY CARE OF THE HOSPITAL. SINCE THE QUALIFICATION PROCESS HAS NOT BEEN PERFORMED WE PROPERLY REPORT THIS AS BAD DEBT AS THE ACTUAL COST TO OUR HOSPITAL.
PART III, LINE 3:	THE BAD DEBT EXPENSE AMOUNT DETAILED ON LINE 2 IS BASED ON THE COST TO CHARGE RATIO CALCULATED FROM THE MEDICARE COST REPORT. REGARDING THE RATIONALE FOR INCLUDING THE AMOUNT ON LINE 3 AS CHARITY CARE, THE HOSPITAL PROVIDES AN ESTIMATE OF HOW MUCH IS ATTRIBUTABLE TO PERSONS WHO WOULD NORMALLY QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S CHARITY CARE POLICIES, BUT HAVE NOT TAKEN ADVANTAGE OF THE FINANCIAL ASSISTANCE THAT IS AVAILABLE TO THEM. CURRENTLY THROUGH MANUAL PROCESSES IT IS IMPOSSIBLE TO SCREEN EVERY PATIENT TO MAKE AN INCOME STATUS DETERMINATION FOR QUALIFICATION TO THE HOSPITAL'S CHARITY PROGRAM UNDER A PRESUMPTIVE CHARITY POLICY. THESE INDIVIDUALS THAT DO NOT SEEK OUT CHARITY PROGRAMS ARE OFTEN UNDERINSURED OR LOW INCOME AND DO NOT NECESSARILY CONSIDER THE BENEFIT OF THE PROCESS OF SUBMITTING AN APPLICATION TO THE HOSPITAL. THE HOSPITAL CONTINUES TO PROVIDE CARE TO THOSE INDIVIDUALS THAT HAVE A HISTORY OF POOR CREDIT WITH THE FACILITY AND NEED MEDICALLY NECESSARY SERVICES AS WE UNDERSTAND THAT THE ABILITY FOR THE COMMUNITY TO SEEK OUT QUALITY MEDICAL SERVICES IS OF THE UTMOST IMPORTANCE AND EXTENDS OUR CHARITABLE BENEFIT TO THE COMMUNITY. WE BELIEVE THAT HAD THE QUALIFICATION PROCESS TAKEN PLACE THIS BAD DEBT WOULD BE CLASSIFIED IN THE CHARITY CARE OF THE HOSPITAL. SINCE THE QUALIFICATION PROCESS HAS NOT BEEN PERFORMED WE PROPERLY REPORT THIS AS BAD DEBT AS THE ACTUAL COST TO OUR HOSPITAL.
PART III, LINE 4:	THE ORGANIZATION'S PROVISION FOR UNCOLLECTIBLE ACCOUNTS IS DESCRIBED ON PAGE 18 OF THE AUDITED FINANCIAL STATEMENTS ATTACHED. THE FOLLOWING IS EXCERPTED FROM THAT FOOTNOTE:ACCOUNTS RECEIVABLE ARE STATED AT ESTIMATED NET REALIZABLE AMOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE SYSTEM ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE PROVISION FOR UNCOLLECTIBLE ACCOUNTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE SYSTEM ANALYZES CONTRACTUALLY DUE AMOUNTS AND HISTORIC PAYMENT TRENDS AND RECORDS ESTIMATED CONTRACTUAL ALLOWANCES. THE SYSTEM RECORDS A SIGNFICANT PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICTATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILLS FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES AND THE AMOUNTS ACTUALLY COVERED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS.THE SYSTEM'S ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS FOR ALL PATIENTS WAS 21% OF ACCOUNTS RECEIVABLE AS OF SEPTEMBER 30, 2018. IN ADDITION, THE SYSTEM'S WRITE-OFFS, NET OF RECOVERIES, WERE $44,846,000 AND $39,165,000, RESPECTIVELY, FOR THE YEAR ENDED SEPTEMBER 30, 2019 AND 2018. THE CHANGES WERE A RESULT OF MANAGEMENT'S REVIEW OF HISTORICAL TRENDS IN UNCOLLECTIBLE ACCOUNTS AND DETERMINATION OF RESERVES, INCLUDING THE IMPACT OF THE PROVISIONS OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT. THE SYSTEM HAS NOT CHANGED ITS CHARITY CARE OR UNINSURED DISCOUNT POLICIES DURING 2019. THE SYSTEM DOES NOT MAINTAIN A MATERIAL ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS FROM THIRD-PARTY PAYORS, NOR DID IT HAVE SIGNIFICANT BAD DEBT WRITE-OFFS FROM THIRD PARTY PAYORS.
PART III, LINE 8:	THERE WAS A DECLINE IN MEDICARE VOLUME FOR BOTH INPATIENT AND OUTPATIENT COMPARING FISCAL YEARS. ALSO CONTRIBUTING WAS A DECREASE IN THE MEDICARE INPATIENT BASE RATE WHICH WOULD EXPLAIN THE LOWER REVENUE IN FY'19.
PART III, LINE 9B:	THERE ARE TWO DISTINCTIONS THAT ARE MADE FOR PATIENTS THAT ARE CONSIDERED EITHER LOW INCOME BY DEFINITION OF THE STATE OF MASSACHUSETTS ELIGIBILITY PROGRAM OR UNDER THE HOSPITAL'S INTERNAL FINANCIAL ASSISTANCE PROGRAM FOR CHARITY CARE. IF THE PATIENT IS DEEMED TO BE LOW INCOME BY THE STATE OF MASSACHUSETTS, ALL COLLECTION EFFORTS ARE CEASED ON PRIOR AND CURRENT BALANCE ACCOUNTS. WHERE APPROPRIATE, ACCOUNTS WILL BE WRITTEN OFF TO HOSPITAL CHARITY FOR THOSE ACCOUNTS THAT EXCEED THE RETROACTIVE LOOK BACK PERIOD. FOR PATIENTS WHO QUALIFY FOR THE HOSPITAL'S INTERNAL FINANCIAL ASSISTANCE PROGRAM, THE PROGRAM WILL QUALIFY THE PATIENT FOR MEDICALLY NECESSARY SERVICES FOR THE PERIOD OF ONE YEAR IN WHICH THE ACCOUNT ACTIVITY OF THE PATIENT WILL BE WRITTEN OFF TO THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM AND REPORTED AS CHARITY CARE. ALL COLLECTION ACTIVITIES ON PRIOR BALANCE ACCOUNTS CEASES AT THE POINT OF THIS QUALIFICATION. FINANCIAL COUNSELORS WORK CLOSELY WITH PATIENTS TO MONITOR THEIR CURRENT FINANCIAL STATUS TO DETERMINE ANY CHANGES IN QUALIFICATIONS FOR BOTH THE STATE AND HOSPITAL PROGRAMS.
PART VI, LINE 2:	ON BEHALF OF LOWELL GENERAL HOSPITAL, UNIVERSITY OF MASSACHUSETTS LOWELL (UML) AND THE GREATER LOWELL HEALTH ALLIANCE (GLHA), A TEAM OF UMASS LOWELL RESEARCHERS AND STUDENTS CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT STUDY TO DISTINGUISH THE UNMET MEDICAL AND PUBLIC HEALTH NEEDS WITHIN THE GREATER LOWELL COMMUNITY. THE GEOGRAPHIC AREA ASSESSED INCLUDED THE COMMUNITIES OF LOWELL, BILLERICA, CHELMSFORD, DRACUT, DUNSTABLE, TEWKSBURY, TYNGSBOROUGH AND WESTFORD. THE STUDY HAD SEVERAL OBJECTIVES, WHICH WERE TO: ASSESS THE OVERALL HEALTH OF AREA RESIDENTS, IDENTIFY THE STRENGTHS AND WEAKNESSES OF THE LOCAL HEALTHCARE SYSTEM, DETERMINE THE TOP HEALTH PROBLEMS FACING AREA RESIDENTS AND THE POPULATIONS AT GREATEST RISK, INVOLVE A BROAD SPECTRUM OF PROFESSIONALS AND RESIDENTS, INCLUDING NEWER IMMIGRANT COMMUNITIES, PROVIDE RECOMMENDATIONS TO IMPROVE THE HEALTHCARE SYSTEM AND ADDRESS UNMET HEALTH NEEDS, AND INFORM THE PROCESS TO IDENTIFY PRIORITY HEALTH NEEDS AND DEVELOP ACTION PLANS TO ADDRESS THESE PRIORITY NEEDS.INFORMATION FOR THE NEEDS ASSESSMENT WAS COLLECTED FROM MULTIPLE SOURCES, IN THREE DIFFERENT WAYS: (1) FOCUS GROUPS, (2) KEY INFORMANT INTERVIEWS, AND (3) A REVIEW OF PUBLICLY COLLECTED HEALTH AND DEMOGRAPHIC STATISTICS FROM THE MASSCHIP DATABASE. THERE WERE 14 FOCUS GROUPS WITH A TOTAL OF 113 PARTICIPANTS-MAJORITY WERE CONDUCTED IN ENGLISH, BUT CAMBODIAN COMMUNITY GROUP WAS CONDUCTED IN KHMER AND THE LATINO GROUP IN SPANISH. THE UNIVERSITY OF MASSACHUSETTS LOWELL CONDUCTED SIX KEY INFORMANT INTERVIEWS.MORE THAN 50 GREATER LOWELL PROFESSIONALS PARTICIPATED IN THE FOCUS GROUPS AND PERSONAL INTERVIEWS - INCLUDING SCHOOL NURSES, HOSPITAL EXECUTIVES, TOWN MANAGERS AND LOCAL HEALTH DEPARTMENT DIRECTORS, AS WELL AS INDIVIDUALS REPRESENTING THE COUNCILS OF AGING, SKILLED NURSING FACILITIES AND VARIOUS COMMUNITY-BASED ORGANIZATIONS. THESE INDIVIDUALS WERE ASKED TO SPEAK TO THE STRENGTHS AND WEAKNESSES OF THE AREA'S HEALTH SYSTEM AND SUGGEST CHANGES TO IMPROVE IT.THE HEALTH AND DEMOGRAPHIC DATA AVAILABLE WITHIN THE GREATER LOWELL AREA WAS THOROUGHLY INVESTIGATED, FOCUSING SUBSTANTIALLY ON THE ISSUES OR PROBLEMS INDICATED FROM THE PERSONAL AND FOCUS GROUP INTERVIEWS, AS WELL AS THE PUBLIC HEALTH DATA AND STATISTICS. THESE DATA INDICATED THAT THE GREATER LOWELL AREA SAW A DOUBLING OF THE RATE OF MENTAL HEALTH HOSPITALIZATIONS BETWEEN 1989 AND 2006. IN ADDITION, LOWELL HAS SEEN INCREASES IN PROBLEMATIC ALCOHOL CONSUMPTION AND OPIATE-RELATED MORTALITY. THE EXPERIENCE IN THE LOWELL AREA WAS ALSO COMPARED, AS APPROPRIATE, WITH THE STATEWIDE EXPERIENCE. IN SO DOING, WE FOUND THAT THE USE OF EMERGENCY DEPARTMENT SERVICES IN LOWELL IS 39% HIGHER THAN THE STATE AVERAGE IN MOST RECENT DATA AVAILABLE, 2002 THROUGH 2005. WHEN RELIABLE INFORMATION WAS AVAILABLE, WE ADDITIONALLY EXAMINED THE COMPARATIVE EXPERIENCE OF DIFFERENT DEMOGRAPHIC SUBGROUPS. THE MORTALITY RATE AMONG ASIAN-AMERICANS IN THE GREATER LOWELL AREA, FOR EXAMPLE, WAS NEARLY TWICE AS HIGH AS THE MASSACHUSETTS AVERAGE FOR THIS GROUP. IN ADDITION TO PROVIDING SUPPLEMENTAL INFORMATION ON HEALTHCARE CONCERNS VOICED BY VARIOUS STUDY RESPONDENTS, THE DATA ANALYSIS ALSO INDICATED OTHER IMPORTANT FINDINGS, MOST IMPORTANTLY, THAT THE PROPORTION OF INDIVIDUALS IN LOWELL WITHOUT HEALTH INSURANCE INCREASED SUBSTANTIALLY BETWEEN 2000 AND 2008. THE NEXT COMMUNITY HEALTH NEEDS ASSESSMENT WILL BE COMPLETED IN 2019.
PART VI, LINE 3:	FOR THOSE PATIENTS WHO ARE UNINSURED OR UNDERINSURED, THE HOSPITAL WORKS WITH THEM TO ASSIST WITH APPLYING FOR AVAILABLE FINANCIAL ASSISTANCE PROGRAMS THAT MAY COVER SOME OR ALL OF THEIR UNPAID HOSPITAL BILLS. IN ORDER TO HELP UNINSURED AND UNDERINSURED PATIENTS FIND AVAILABLE AND APPROPRIATE FINANCIAL ASSISTANCE PROGRAMS, THE HOSPITAL PROVIDES ALL PATIENTS WITH A GENERAL NOTICE OF THE AVAILABILITY OF PROGRAMS IN BOTH THE BILLS THAT ARE SENT TO PATIENTS AS WELL AS IN GENERAL NOTICES THAT ARE POSTED THROUGHOUT THE HOSPITAL. IN ADDITION TO GENERAL NOTICES, THERE ARE INFORMATIONAL BROCHURES AVAILABLE IN ACCESS AREAS AND DURING THE PROCESS OF REGISTRATION ANYONE THAT INDICATES THEY ARE HAVING TROUBLE PAYING THEIR BILLS OR WHO ARE UNINSURED ARE PROVIDED WITH A BUSINESS CARD THAT IDENTIFIES HOW TO CONTACT A PATIENT FINANCIAL COUNSELOR. ALL SIGNS AND NOTICES ARE TRANSLATED INTO LANGUAGES OTHER THAN ENGLISH IF SUCH LANGUAGE IS SPOKEN BY 10% OR MORE OF THE POPULATION RESIDING IN THE HOSPITAL SERVICE AREA. CURRENTLY, THE HOSPITAL TRANSLATES THE NOTICES INTO THE FOLLOWING LANGUAGES - SPANISH, PORTUGUESE, AND KHMER.THE HOSPITAL TRIES TO IDENTIFY AVAILABLE COVERAGE OPTIONS FOR PATIENTS WHO MAY BE UNINSURED OR UNDERINSURED WITH THEIR CURRENT INSURANCE PROGRAM WHEN THE PATIENT IS SCHEDULING THEIR SERVICES, WHILE THE PATIENT IS IN THE HOSPITAL, UPON DISCHARGE, AND FOR A REASONABLE TIME FOLLOWING DISCHARGE FROM THE HOSPITAL. THE HOSPITAL PATIENT ACCESS STAFF DIRECTS ALL PATIENTS SEEKING AVAILABLE COVERAGE OPTIONS OR FINANCIAL ASSISTANCE TO THE HOSPITAL'S PATIENT FINANCIAL COUNSELING OFFICE TO DETERMINE IF THEY ARE ELIGIBLE AND THEN TO SCREEN FOR ELIGIBILITY IN AN APPROPRIATE COVERAGE OPTION. THE HOSPITAL ASSISTS THE PATIENT IN APPLYING FOR THE APPROPRIATE COVERAGE OPTIONS THAT ARE AVAILABLE OR NOTIFY THEM OF THE AVAILABILITY OF FINANCIAL ASSISTANCE THROUGH THE HOSPITAL'S OWN INTERNAL FINANCIAL ASSISTANCE PROGRAM.
PART VI, LINE 4:	THE CITY OF LOWELL WAS FOUNDED IN 1820 AS A PLANNED INDUSTRIAL COMMUNITY ALONG THE BANKS OF THE MERRIMACK RIVER WHOSE ECONOMY WAS BASED ON TEXTILE MANUFACTURING. BY THE 1850'S, IT HAD BECOME THE LARGEST INDUSTRIAL CENTER IN THE UNITED STATES AND THE SECOND LARGEST CITY IN NEW ENGLAND. MUCH OF THE POPULATION GROWTH IN LOWELL WAS ATTRIBUTABLE TO IMMIGRATION, WHICH NEW RESIDENTS COMING FROM MANY PARTS OF EUROPE AND FRENCH-SPEAKING CANADA, CREATING AN ETHNICALLY DIVERSE COMMUNITY. DURING THIS PERIOD, LOWELL SERVED AS A REGIONAL ECONOMIC ENGINE, PROVIDING GOODS AND SERVICES TO THE SURROUNDING COMMUNITIES, WHICH RETAINED A LARGELY AGRICULTURAL ECONOMY INTO THE EARLY 1900'S. BY THE 1920'S, HOWEVER, LOWELL HAD GONE INTO ECONOMIC DECLINE AS THE U.S. TEXTILE INDUSTRY MOVED SOUTH, AND BY THE END OF THE 1950'S ALL OF THE TEXTILE MILLS HAD CLOSED. IN THE 1970'S, WANG LABORATORIES LOCATED ITS HEADQUARTERS IN THE CITY AND SPURRED A TEMPORARY ECONOMIC REVIVAL, WHICH COLLAPSED WHEN THE COMPANY FILED FOR BANKRUPTCY IN 1992. WHILE THE URBAN CORE HAS BEEN REDEVELOPED AS A RESIDENTIAL COMMUNITY, WITH FORMER TEXTILE MILLS BEING REHABILITATED AS CONDOMINIUMS AND APARTMENTS, LOWELL LACKS A STRONG INDUSTRIAL BASE. IN A LARGE MEASURE, THE EMERGENCE OF A HIGH TECHNOLOGY AND BIOMEDICAL ECONOMIC BASE IN EASTERN MASSACHUSETTS COINCIDED WITH A DECENTRALIZATION OF DEVELOPMENT AND URBAN PLANNING, WITH MANY NEW BUSINESSES LOCATING OUTSIDE CITY CENTERS, ALONG TRANSPORTATION CORRIDORS (E.G., ROUTES 128 AND 495). WHILE LOWELL STILL PROVIDES REGIONAL SERVICES NOT AVAILABLE IN THE SMALLER COMMUNITIES - HEALTHCARE, EDUCATION AND ENTERTAINMENT - MUCH OF THE AREA'S RECENT JOB GROWTH HAS COME FROM THE HIGH TECHNOLOGY SECTOR IN NEARBY TOWNS SUCH AS BILLERICA, CHELMSFORD, TEWKSBURY AND WESTFORD.IN THE 1980'S, THE CITY OF LOWELL WAS DESIGNATED AS A REFUGEE AND RESETTLEMENT AREA FOR CAMBODIANS IN THE WAKE OF THE ATROCITIES COMMITTED BY THE KHMER ROUGE REGIME. TODAY, LOWELL IS HOME TO THE SECOND LARGEST CAMBODIAN POPULATION WITHIN THE U.S. IN ADDITION, MANY OF THE AMENITIES THAT HAD SERVED PREVIOUS GENERATIONS OF LOWELL IMMIGRANTS, SUCH AS PLENTIFUL RENTAL HOUSING AND A HIGH GEOGRAPHIC DENSITY OF RETAIL BUSINESSES AND SERVICES CONTINUE TO ATTRACT IMMIGRANTS. IN THE 2000 CENSUS, MORE THAN ONE IN FIVE LOWELL RESIDENTS WAS FOREIGN BORN. CONTRASTED WITH THE PREDOMINANTLY NORTHERN AND WESTERN EUROPEAN IMMIGRATION DURING THE CITY'S MANUFACTURING HEYDAY, RECENT FIGURES SHOW THAT THE FOREIGN BORN IN LOWELL TODAY HAVE MORE DIVERSE ORIGINS. IN 2000, APPROXIMATELY HALF OF ALL LOWELL IMMIGRANTS WERE ASIAN, NEARLY A QUARTER FROM LATIN AMERICA, 16 PERCENT FROM EUROPE (WITH MANY ARRIVING FROM PORTUGAL), AND APPROXIMATELY SIX PERCENT FROM AFRICA. WITH THEIR ARRIVAL, THESE IMMIGRANTS HAVE ALSO ALTERED THE SERVICE ENVIRONMENT, WITH SOME HEALTHCARE FACILITIES, NOTABLY THE LOWELL COMMUNITY HEALTH CENTER, ADAPTING THEIR SERVICES TO ACCOMMODATE INDIVIDUALS WITH IDIOSYNCRATIC CULTURAL AND HEALTH NEEDS, AS WELL AS PROVIDING SERVICES IN AN INCREASING NUMBER OF LANGUAGES.IMMIGRANTS ARRIVING IN LOWELL TODAY ARE GREETED WITH A STARKLY DIFFERENT ECONOMIC REALITY THAN THOSE ARRIVING DURING THE INDUSTRIAL REVOLUTION. THERE ARE ESSENTIALLY NO MANUFACTURING JOBS REMAINING IN LOWELL, AND THE MAJORITY OF JOBS IN THE NEW HIGH TECHNOLOGY SECTOR REQUIRE A COLLEGE EDUCATION. AS A RESULT, MOST JOBS AVAILABLE TO NEW IMMIGRANTS WITHOUT AN ADVANCED EDUCATION ARE SERVICE JOBS, MANY OF WHICH DO NOT PAY A LIVING WAGE. GREATER LOWELL'S DEMOGRAPHIC PROFILE FROM THE MASSACHUSETTS EXECUTIVE OFFICE OF LABOR AND WORKFORCE DEVELOPMENT, AS OF DECEMBER 2016 INDICATES A 4.2% UNEMPLOYMENT RATE COMPARED TO 3.8% FOR THE STATE OF MASSACHUSETTS. HOWEVER, IT IS WORTH NOTING THAT LOWELL, MASSACHUSETTS, WHICH REPRESENTS APPROXIMATELY 39% OF THE POPULATION IN LOWELL GENERAL HOSPITAL'S SERVICE AREA, HAS 19% OF THE POPULATION LIVING BELOW POVERTY AND AN EMPLOYMENT RATE THAT HAS BEEN AT OR ABOVE 8% FOR THE PAST 12 MONTHS. THE COMMUNITIES SURROUNDING LOWELL HAVE ATTRACTED FAR FEWER IMMIGRANTS, WITH IMMIGRANTS ACCOUNTING FOR JUST THREE TO SEVEN PERCENT OF THEIR POPULATIONS. OF THE SUBURBAN COMMUNITIES IN THE GREATER LOWELL AREA, ONLY WESTFORD HAS A HIGHER PROPORTION FOREIGN BORN (12.6%), BUT THESE IMMIGRANTS ARE PREDOMINANTLY WELL EDUCATED AND DRAWN TO THE TOWN'S HIGH TECHNOLOGY JOBS.WHILE LOWELL IS NO LONGER THE ECONOMIC CENTER THAT IT ONCE WAS, LOWELL IS STILL A CULTURAL AND INSTITUTIONAL CENTER FOR THE REGION. IT IS HOME TO THE UNIVERSITY OF MASSACHUSETTS LOWELL, MIDDLESEX COMMUNITY COLLEGE AND THE LOWELL NATIONAL HISTORICAL PARK, AS WELL AS LOWELL GENERAL HOSPITAL, SUPERIOR AND DISTRICT COURTS, THE MERRIMACK REPERTORY THEATER, THE LOWELL MEMORIAL AUDITORIUM, THE TSONGAS CENTER AND LALACHEUR STADIUM.IN 2010, THE GREATER LOWELL AREA, AS DEFINED HEREIN, HAD A POPULATION OF 275,000 RESIDENTS, INCLUDING AN ESTIMATED 106,000 PEOPLE IN THE CITY OF LOWELL ALONE. THUS, THE CITY OF LOWELL ITSELF ACCOUNTS FOR LESS THAN 50 PERCENT OF THE AREA'S POPULATION. FOUR OTHER COMMUNITIES - BILLERICA, CHELMSFORD, DRACUT AND TEWKSBURY - EACH HAVE A POPULATION OF NEARLY 30,000 OR MORE. WE ALSO SEE THAT THE CITY OF LOWELL DIFFERS FROM ITS SUBURBAN NEIGHBORS IN IMPORTANT RESPECTS - A GREATER PERCENTAGE NON-HISPANIC WHITE, A GREATER PERCENTAGE FOREIGN BORN AND A HIGHER POVERTY RATE.LOWELL GENERAL HOSPITAL'S PRIMARY SERVICE AREA (PSA) IS COMPRISED OF APPROXIMATELY 300,000 RESIDENTS FROM THE FOLLOWING NINE COMMUNITIES: BILLERICA, CHELMSFORD, DRACUT, DUNSTABLE, LOWELL, TEWKSBURY, TYNGSBOROUGH, WESTFORD, AND PELHAM, NEW HAMPSHIRE. THE HOSPITAL'S SECONDARY SERVICE AREA (SSA) HAS A POPULATION OF APPROXIMATELY 371,000 AND INCLUDES THE SURROUNDING TOWNS OF ANDOVER, CARLISLE, GROTON, LAWRENCE, LITTLETON, METHUEN, NORTH ANDOVER, PEPPERELL, WILMINGTON, AND HOLLIS, HUDSON AND NASHUA, NEW HAMPSHIRE.
PART VI, LINE 5:	LOWELL GENERAL HOSPITAL PARTICIPATES IN COMMUNITY BUILDING ACTIVITIES IN MANY WAYS. TO HELP IMPROVE THE HEALTH STATUS OF OUR COMMUNITY WE RECOGNIZE THE IMPORTANCE OF ACCESS TO CARE. TO HELP MEET THIS NEED, LOWELL GENERAL HOSPITAL EVALUATES THE AVAILABILITY OF PRIMARY CARE AND SPECIALISTS TO OUR COMMUNITY MEMBERS AND ACTIVELY RECRUITS PHYSICIANS TO FILL GAPS. THESE GAPS OFTEN INCLUDE RECRUITMENT OF MULTI-LINGUAL PHYSICIANS AND THOSE WHO HAVE SPECIALTIES IN IDENTIFIED HEALTH NEEDS FOR OUR COMMUNITY. LOWELL GENERAL PROVIDES BOTH FINANCIAL AND PRACTICE MANAGEMENT SUPPORT TO THESE PHYSICIANS. THIS ENHANCES THE COMMUNITIES' ABILITY TO ACCESS EXCELLENT PRIMARY AND SPECIALTY CARE IN A LOCAL SETTING.LOWELL GENERAL HOSPITAL HAS A CLOSE WORKING RELATIONSHIP THAT INCLUDES FINANCIAL SUPPORT TO LOWELL COMMUNITY HEALTH CENTER (LCHC) WHICH SERVES THE LOW-INCOME, MEDICALLY UNDERSERVED POPULATION, MANY OF WHOM HAVE NO OTHER ACCESS TO HEALTHCARE SERVICES. THE MAJORITY OF PATIENTS SERVED BY LCHC HAVE MASSHEALTH, ANOTHER 10% HAVE PRIVATE HEALTH INSURANCE OR HMO COVERAGE, 7% HAVE MEDICARE, AND 20% ARE UNINSURED; AND 95% LIVE AT OR BELOW THE POVERTY LEVEL. ALMOST HALF OF LCHC'S PATIENT POPULATION IS UNDER 18 YEARS OF AGE, AND THE MAJORITY OF WOMEN ARE IN THEIR CHILDBEARING YEARS. IN 2007, 37% OF PATIENTS WERE WHITE/NON-HISPANIC; 28% WERE LATINO; 27% WERE ASIAN (PRIMARILY CAMBODIANS) AND 8% WERE AFRICAN IMMIGRANTS. ALMOST 60% OF PATIENTS WERE BEST SERVED IN A LANGUAGE OTHER THAN ENGLISH. SOME OF THE MAJOR SERVICES THAT LCHC PROVIDES ARE - CARINO, WHICH PROVIDES SPECIAL CARE FOR PATIENTS WITH HIV/AIDS; PROMOTORAS PROGRAMS, WHICH ARE TRAINED COMMUNITY HEALTH WORKERS AND VOLUNTEERS WHO SPEAK SPANISH AND/OR PORTUGUESE AND GO THROUGH AN INTENSIVE TRAINING WITH LCHC STAFF ON SPECIFIC HEALTH TOPICS TO EDUCATE THE COMMUNITY; LCHC TEEN COALITION AND ADOLESCENT HEALTH PROGRAM, WHICH COVERS EVERYTHING FROM MENTAL HEALTH AND SELF-ESTEEM ISSUES AMONG GIRLS TO EDUCATING AND INVOLVING YOUTH IN SUBSTANCE ABUSE PREVENTION AND A JOURNEY TO HEALING PROGRAM FOR REFUGEE CHILDREN AND CHILDREN OF REFUGEES. WITHOUT LOWELL GENERAL'S FINANCIAL SUPPORT TO LCHC'S PENSION AND WORKER'S COMPENSATION PROGRAM, MANY OF THESE PROGRAMS WOULD NOT HAVE ADEQUATE FUNDING.THE HOSPITAL DEDICATES EXTENSIVE RESOURCES THROUGHOUT THE ORGANIZATION IN ITS COMMITMENT TO THE COMMUNITY BENEFIT PROGRAM. THE BOARD OF DIRECTORS, IN PARTNERSHIP WITH THE SENIOR MANAGEMENT TEAM AND THE PLANNING AND RESEARCH DEPARTMENT, CREATED A FORMAL STRUCTURE TO SUPPORT THE HOSPITAL'S OUTREACH INTO THE COMMUNITY, DEDICATING RESOURCES AND INVESTING IN A THREE-PRONGED APPROACH THROUGH THE CREATION OF THREE MAJOR INITIATIVES: THE CENTER FOR COMMUNITY HEALTH & WELLNESS, THE GREATER LOWELL HEALTH ALLIANCE, AND THE LGH BALL FOR COMMUNITY HEALTH INITIATIVES, WHICH IS NOW KNOWN AS THE CIRCLE HEALTH BALL FOR COMMUNITY HEALTH INITIATIVES. CENTER FOR COMMUNITY HEALTH & WELLNESSTHE CENTER FOR COMMUNITY HEALTH & WELLNESS (CCHW) WAS CREATED IN 2006 TO MEET THE EVER-CHANGING HEALTHCARE NEEDS THROUGHOUT GREATER LOWELL. PROGRAMS AND EVENTS ARE CREATED BY THE STAFF TO ADDRESS UNMET PUBLIC HEALTH NEEDS INCLUDING, PHYSICAL ACTIVITY, NUTRITION, MENTAL HEALTH, PREVENTION, AND OVERALL HEALTH AND WELLNESS. MANY OF THESE PROGRAMS TARGET OUR COMMUNITY'S UNDERSERVED AND VULNERABLE POPULATIONS, INCLUDING CHILDREN, ELDERLY, AND IMMIGRANTS.TODAY, OUR CENTER FOR COMMUNITY HEALTH AND WELLNESS PLANS AND SUPPORTS MORE THAN 50 EVENTS ANNUALLY, INCLUDING HEALTH FAIRS AND COMMUNITY SCREENINGS, AND PROVIDES MORE THAN 15 SUPPORT GROUPS. IN ADDITION, WE PARTICIPATE IN 15-20 COMMITTEES AND COALITIONS IN THE GREATER LOWELL AREA, SUCH AS THE ASTHMA COALITION OF GREATER LOWELL, CITY MANAGER'S DOMESTIC VIOLENCE TASK FORCE, THE SUBSTANCE USE AND PREVENTION TASK FORCE, LOWELL'S EARLY CHILDHOOD ADVISORY COUNCIL, AND THE MENTAL HEALTH TASK FORCE. OUR LEADERSHIP ROLE IN THESE INITIATIVES ENABLES US TO INCREASE COMMUNITY BUILDING AND CAPACITY, BROADENING THE IMPACT OF OUR REACH. RESPONDING TO THE NEEDS AND FEEDBACK OF OUR COMMUNITY, WE ALSO IMPLEMENTED A CORPORATE WELLNESS PROGRAM, WHICH PROVIDES OUTSIDE CORPORATIONS WITH SCREENINGS, INNOVATIVE PROGRAMS AND HEALTH INFORMATION TO IMPROVE THEIR EMPLOYEES' HEALTH AND WELLBEING.IN 2008, THE HOSPITAL'S CHILDBIRTH EDUCATION DEPARTMENT MOVED UNDER THE LEADERSHIP OF THE CENTER FOR COMMUNITY HEALTH & WELLNESS, CENTRALIZING ALL PREVENTION AND WELLNESS PROGRAMMING FOR THE COMMUNITY. UNDER THE DIRECTION OF CCHW, THE CHILDBIRTH EDUCATION DEPARTMENT HAS GROWN IN NUMBER OF ATTENDEES AND PROGRAMS OFFERED. GREATER LOWELL HEALTH ALLIANCEAS THE CENTER FOR COMMUNITY HEALTH & WELLNESS THRIVED, OUR RESEARCH INDICATED THAT THE SCOPE OF THE REGION'S HEALTHCARE NEEDS REQUIRED RESOURCES AND COLLABORATION BEYOND THOSE THAT COULD BE PROVIDED BY A SINGLE INSTITUTION. THIS FINDING LED LOWELL GENERAL HOSPITAL TO CREATE THE GREATER LOWELL HEALTH ALLIANCE (GLHA), AN INDEPENDENT NON-PROFIT ALLIANCE WITH A MISSION TO SUSTAIN A STRATEGIC ALLIANCE OF COMMUNITY ORGANIZATIONS THAT IMPROVES THE OVERALL HEALTH AND WELLNESS OF THOSE LIVING IN THE GREATER LOWELL REGION. BY RAISING AWARENESS AND PROVIDING RESOURCES FOR OUR HEALTH CARE PROVIDERS, COMMUNITIES, SCHOOLS AND CIVIC AND BUSINESS LEADERS, WE EMPOWER THEM TO MAKE DECISIONS AND TAKE ACTIONS THAT WILL LEAD TO AN IMPROVEMENT IN THE OVERALL HEALTH OF OUR COMMUNITIES.A MAJOR GOAL OF THE GLHA IS TO REDUCE DUPLICATION OF EFFORTS. THEREFORE, IN 2008 GLHA MERGED WITH THE COMMUNITY HEALTH NETWORK AREA (CHNA) 10, A COALITION OF PUBLIC, NON-PROFIT AND PRIVATE SECTORS CREATED BY THE DEPARTMENT OF PUBLIC HEALTH IN 1992. THE UNIFICATION OF THE TWO ORGANIZATIONS STRENGTHENED OUR ABILITY TO WORK WITH OTHERS TO ENRICH THE GREATER LOWELL COMMUNITY; NETWORK AND SHARE IDEAS WITH PEOPLE OF SIMILAR INTEREST IN BUILDING A HEALTHIER GREATER LOWELL COMMUNITY; GAIN MORE KNOWLEDGE ABOUT HEALTH-RELATED ISSUES AND TOPICS; AND INCREASE CULTURAL COMPETENCY OF THE SERVICES PROVIDED TO THE COMMUNITY. SINCE 2006, GLHA HAS GROWN FROM 13 PARTICIPATING ORGANIZATIONS TO MORE THAN 100, AND FROM ONE TASK FORCE (HEALTHY WEIGHT) TO FIVE (SUBSTANCE USE & PREVENTION, MENTAL HEALTH, CULTURAL COMPETENCE, HEALTHY EATING & LIVING, AND MATERNAL CHILD HEALTH). LOWELL GENERAL HOSPITAL CONTINUES TO PROVIDE LEADERSHIP AND FINANCIAL SUPPORT TO THE GLHA.CIRCLE HEALTH BALL FOR COMMUNITY HEALTH INITIATIVESWITH THE GROWING NEED FOR COMMUNITY HEALTH PROGRAMS AND SUPPORT CAME THE NEED FOR ADDITIONAL FUNDING TO SUPPORT THEM. LOWELL GENERAL HOSPITAL DEVELOPED THE ANNUAL "LGH BALL FOR COMMUNITY HEALTH INITIATIVES", NOW KNOWN AS THE CIRCLE HEALTH BALL, TO RAISE AWARENESS AND FUNDS FOR COMMUNITY OUTREACH AND EDUCATION. IN THE PAST SEVEN YEARS, LOWELL GENERAL HOSPITAL HAS RAISED MORE THAN $600,000 FOR COMMUNITY INITIATIVES, INCLUDING THE HEALTHY BABIES INITIATIVE, A BREASTFEEDING EDUCATION AND SUPPORT PROGRAMS FOR NEW MOMS; THE "BEDS FOR KIDS" PROGRAM OF THE LOWELL WISH PROJECT, WHICH PROVIDES NEW BEDS AND BEDDING FOR AT-RISK CHILDREN IN THE CITY; A PUBLIC SERVICE CAMPAIGN TO PROMOTE MENTAL HEALTH AWARENESS AND RESOURCES; THE "HEART AND SOLES" MALL WALKING PROGRAM; AN OUTDOOR RIVER PATH WALKING PROGRAM; A CHILDREN'S LITERACY PROGRAM; A SMOKING PREVENTION PROGRAM IN THE LOWELL PUBLIC SCHOOLS; AND A COMPREHENSIVE HEALTH RISK ASSESSMENT PROGRAM.IN 2017, THE CIRCLE HEALTH BALL RAISED MORE THAN $97,000 TO HELP FUND VITAL HEALTH AND WELLNESS PROGRAMS WHICH BENEFIT RESIDENTS OF THE GREATER LOWELL COMMUNITY. FIVE LOCAL NON-PROFITS WERE AWARDED COMMUNITY HEALTH INITIATIVE GRANTS FOR 2017. THEY WERE THE LOWELL TRANSITIONAL LIVING CENTER, PHEASANT LANE WALKING POGRAM, UNITED TEAM EQUALITY CENTER, HABITAT FOR HUMANITY AND THE INTERNATIONAL INSTITUTE OF BOSTON.LOWELL GENERAL HOSPITAL IS DEDICATED TO THE PROMOTION OF THE HEALTH IN THE COMMUNITY BY PROVIDING EDUCATIONAL OPPORTUNITIES FOR LOCAL SENIOR CENTERS, HOSTING QUARTERLY BLOOD DRIVES IN PARTNERSHIP WITH THE AMERICAN RED CROSS, RUNNING ANNUAL FOOD DRIVES TO BENEFIT THE LOCAL FOOD BANKS, AND PARTICIPATING IN COUNTLESS HEALTH FAIRS WHERE WE PROVIDE VALUABLE HEALTH PROMOTION INFORMATION AND OFTEN PROVIDE FREE HEALTH SCREENINGS.
PART VI, LINE 6:	MEMBERS AND OFFICERS OF LOWELL GENERAL HOSPITAL ARE ACTIVELY SERVING ON THE BOARDS OF MANY LOCAL COMMUNITY AREA AGENCIES AND AS HEADS OF THE GREATER LOWELL HEALTH ALLIANCE. IN 2012, LOWELL GENERAL HOSPITAL OFFICIALLY BECAME A MEMBER OF CIRCLE HEALTH. CIRCLE HEALTH IS A PROGRESSIVE COLLABORATION OF PHYSICIANS, HOSPITALS, OTHER HEALTH PROVIDERS, AND OTHER COMMUNITY-BASED ORGANIZATIONS WITH A SHARED VISION FOR EMPOWERING PEOPLE AND COMMUNITIES TO BE THE HEALTHIEST THEY CAN BE. WITH OUR INNOVATIVE PROGRAMS AND APPROACH TO CARE MANAGEMENT, OUR PROMISE TO YOU IS AN EXPERIENCE OF COMPLETE CONNECTED CARESM. CIRCLE HEALTH IS ABOUT SUPPORTING COMMUNITIES WITH A COMPREHENSIVE RANGE OF SERVICES SO THAT INDIVIDUALS HAVE EASY ACCESS TO THE EXPERTISE AND RESOURCES THEY NEED IN ORDER TO ACHIEVE THE BEST POSSIBLE HEALTH THROUGHOUT THEIR LIVES.CIRCLE HEALTH IS A MASSACHUSETTS NONPROFIT CORPORATION AND MEMBER OF THE WELLFORCE SYSTEM THAT OVERSEES AND COORDINATES A SERIES OF AFFILIATED CORPORATIONS THAT PROVIDE A BROAD RANGE OF HEALTH CARE AND RELATED SERVICES IN LOWELL, MASSACHUSETTS. THE CONSOLIDATED AFFILIATED ENTITIES OF CIRCLE HEALTH INCLUDE THE LOWELL GENERAL HOSPITAL, A NONPROFIT GENERAL ACUTE CARE HOSPITAL; LGH SERVICES, INC. AND CONSOLIDATED AFFILIATES, A FOR-PROFIT ENTITY AND SOLE SHAREHOLDER OF LGH MANAGEMENT SERVICE, INC., LGH MEDICAL BUILDING SERVICES ("LGH MEDICAL BUILDING"), AND LGH MEDICAL SERVICES, INC.; CIRCLE HEALTH PHYSICIANS, A NONPROFIT ENTITY AND SOLE SHAREHOLDER OF A NUMBER OF PHYSICIAN PRACTICES AND CIRCLE HEALTH PHARMACY LLC; AND CIRCLE HEALTH ALLIANCE, LLC ("ALLIANCE"), AN ACCOUNTABLE CARE ORGANIZATION.
PART VI, LINE 7, REPORTS FILED WITH STATES	MA

Schedule H (Form 990) 2018

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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," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization
THE LOWELL GENERAL HOSPITAL

Employer identification number
04-2103590

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 Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on 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 section (if applicable)	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) BOYS & GIRLS CLUB OF GREATER LOWELL INC 657 MIDDLESEX STREET LOWELL,MA01851	04-2014396	501(C)(3)	9,500	SPONSOR VARIOUS EVENTS
(2) CHELMSFORD POP WARNER FOOTBALL INC PO BOX 101 NO CHELMSFORD,MA01863	52-1656310	501(C)(3)	5,000	DONATION
(3) CHINMAYA MISSION BOSTON 1 UNION STREET ANDOVER,MA01810	04-3491406	501(C)(3)	5,000	SPONSOR VARIOUS EVENTS
(4) CIRCLE HOME INC 847 ROGERS STREET LOWELL,MA01852	04-2103812	501(C)(3)	5,000	SPONSORSHIP
(5) CITY OF LOWELL 375 MERRIMACK STREET LOWELL,MA01852	04-6001396	GOV'T ENTITY	8,800	DONATION
(6) D'YOUVILLE SENIOR CARE 981 VARNUM AVENUE LOWELL,MA01854	91-2055004	501(C)(3)	12,700	SPONSORSHIP
(7) FRESH START FOOD GARDENS LLC 41 WEST STREET WESTFORD,MA01886	81-1481646		9,000	DONATION
(8) GIRLS INCORPORATED 220 WORTHERN STREET LOWELL,MA01852	04-2104401	501(C)(3)	5,750	SPONSOR VARIOUS EVENTS
(9) GREATER LOWELL COMMUNITY FOUNDATION 100 MERRIMACK STREET LOWELL,MA01852	04-3401997	501(C)(3)	7,100	SPONSOR VARIOUS EVENTS
(10) GREATER LOWELL YMCA 35 YMCA DRIVE LOWELL,MA01852	04-2104398	501(C)(3)	16,015	DONATION/SPONSOR VARIOUS EVENTS
(11) GREATER MERRIMACK VALLEY CONVENTION & VISITORS BUREAU 40 FRENCH STREET 2ND FL LOWELL,MA01852	04-3158302	501(C)(6)	7,500	SPONSORSHIP
(12) IMMACULATE CONCEPTION CHURCH 3 FAYETTE STREET LOWELL,MA01852	04-2106189	501(C)(3)	5,200	SPONSOR VARIOUS EVENTS
(13) LOWELL FESTIVAL FOUNDATION PO BOX 217 LOWELL,MA01852	04-2578293	501(C)(3)	6,000	DONATION
(14) LOWELL HOUSE INC 555 MERRIMACK STREET WESTFORD,MA01854	23-7110106	501(C)(3)	10,900	DONATION/SPONSOR VARIOUS EVENTS
(15) LOWELL SUMMER MUSIC SERIES 67 KIRK STREET LOWELL,MA01852	04-2578293	501(C)(3)	25,000	SPONSORSHIP
(16) LOWELL COMMUNITY HEALTH CENTER 161 JACKSON STREET LOWELL,MA01852	04-2881348	501(C)(3)	5,000	SPONSORSHIP
(17) MASSACHUSETTS MEDICAL SOCIETY 860 WINTER STREET WALTHAM,MA02451	04-2050773	501(C)(3)	5,000	SPONSORSHIP
(18) MERRIMACK REPERTORY THEATRE 132 WARREN STREET LOWELL,MA01852	04-2664784	501(C)(3)	26,481	DONATION/SPONSOR VARIOUS EVENTS
(19) MERRIMACK VALLEY FOOD BANK INC 735 BROADWAY STREET LOWELL,MA01854	22-3241609	501(C)(3)	5,000	SPONSORSHIP
(20) MIDDLESEX COMMUNITY COLLEGE FOUNDATION PO BOX 716 BEDFORD,MA01730	04-2973384	501(C)(3)	6,500	SPONSORSHIP
(21) THE LOWELL PLAN 600 SUFFOLK STREET SUITE 120 LOWELL,MA01854	04-2693109	501(C)(3)	10,500	DONATION/SPONSOR VARIOUS EVENTS
(22) THE MEGAN HOUSE FOUNDATION 31 KIRK STREET LOWELL,MA01852	47-3503719	501(C)(3)	10,000	SPONSOR VARIOUS EVENTS
(23) TOWN OF TYNGSBOROUGH 25 BRYANT LANE TYNGSBOROUGH,MA01879	04-6001328	GOV'T ENTITY	12,500	DONATION
(24) UNIVERSITY OF MASSACHUSETTS LOWELL 225 FRANKLIN STREET FL 33 BOSTON,MA02110	04-3167352	501(C)(3)	39,000	DONATION/SPONSOR VARIOUS EVENTS
(25) UNITED TEEN EQUALITY CENTER INC 35 WARREN STREET LOWELL,MA01852	38-3669532	501(C)(3)	10,000	DONATION
(26) WILLIAM JAMES COLLEGE INC FREEDMAN CENTER NEWTON,MA02459	04-2620216	501(C)(3)	5,000	DONATION

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) 2018

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on 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 noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference	Explanation
PART I, LINE 2:	THE LOWELL GENERAL HOSPITAL RESPONDS TO SPECIFIC REQUESTS FOR FUNDING TO LOCAL AGENCIES AND ORGANIZATIONS RELATED TO COMMUNITY BENEFIT EVENTS AND NEEDS. THE HOSPITAL REQUIRES THAT THE ORGANIZATION STATE THE NATURE OF THEIR NEED PRIOR TO THEM MAKING THE CONTRIBUTION AND, IN THE CASE OF MAJOR DONATIONS AN ANNUAL REPORT IS REQUESTED WHICH DETAILS HOW SUCH DONATED FUNDS WERE SPENT.

Schedule I (Form 990) 2018

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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" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

THE LOWELL GENERAL HOSPITAL

Employer identification number

04-2103590

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 on 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 .........

Yes

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including 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 on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

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

Yes

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

Yes

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

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

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on 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," on line 5a or 5b, describe in Part III.

For persons listed on 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," on line 6a or 6b, describe in Part III.

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

Yes

Were any amounts reported on 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" on 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) 2018

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 on 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 in column (B) reported as deferred on 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)
1JOSEPH WHITE PRESIDENT	(i) (ii)	679,599 ------------- 0	157,248 ------------- 0	487,914 ------------- 0	8,250 ------------- 0	12,671 ------------- 0	1,345,682 ------------- 0	0 ------------- 0
2WILLIAM WYMAN SR. VP OF FINANCE/TREAS./ASST. CLERK	(i) (ii)	317,072 ------------- 0	46,365 ------------- 0	3,158 ------------- 0	6,320 ------------- 0	13,670 ------------- 0	386,585 ------------- 0	0 ------------- 0
3SABRINA GRANVILLE CHO	(i) (ii)	87,142 ------------- 261,425	26,042 ------------- 78,125	6,802 ------------- 20,406	2,063 ------------- 6,188	4,817 ------------- 14,451	126,866 ------------- 380,595	0 ------------- 0
4AMY HOEY CHIEF OPERATING OFFICER	(i) (ii)	424,449 ------------- 0	117,212 ------------- 0	217,797 ------------- 0	8,250 ------------- 0	18,164 ------------- 0	785,872 ------------- 0	0 ------------- 0
5CECELIA LYNCH CNO	(i) (ii)	342,989 ------------- 0	59,098 ------------- 0	7,024 ------------- 0	8,250 ------------- 0	18,664 ------------- 0	436,025 ------------- 0	0 ------------- 0
6ARTHUR LAURETANO CMO	(i) (ii)	367,616 ------------- 0	32,334 ------------- 0	976 ------------- 0	0 ------------- 0	1,122 ------------- 0	402,048 ------------- 0	0 ------------- 0
7MICHELLE DAVIS VP EXTERNAL AFFAIRS	(i) (ii)	233,000 ------------- 0	0 ------------- 0	198 ------------- 0	2,581 ------------- 0	18,928 ------------- 0	254,707 ------------- 0	0 ------------- 0
8WENDY MITCHELL MEDICAL DIR. COMMUNITY HOME	(i) (ii)	284,411 ------------- 0	26,780 ------------- 0	1,022 ------------- 0	0 ------------- 0	24,520 ------------- 0	336,733 ------------- 0	0 ------------- 0
9EMILY YOUNG DIRECTOR OF HEALTHCARE OPS	(i) (ii)	218,312 ------------- 0	41,867 ------------- 0	876 ------------- 0	0 ------------- 0	22,469 ------------- 0	283,524 ------------- 0	0 ------------- 0
10YISHIS REN CHIEF MEDICAL PHYSICIST	(i) (ii)	248,530 ------------- 0	0 ------------- 0	3,741 ------------- 0	0 ------------- 0	20,706 ------------- 0	272,977 ------------- 0	0 ------------- 0
11RAMYA PRABHAKAR PHYSICIAN	(i) (ii)	272,204 ------------- 0	0 ------------- 0	743 ------------- 0	0 ------------- 0	25,755 ------------- 0	298,702 ------------- 0	0 ------------- 0
12JAMES WOOLMAN DIRECTOR ACO PERFORMANCE MGMT	(i) (ii)	212,922 ------------- 0	48,038 ------------- 0	572 ------------- 0	0 ------------- 0	23,383 ------------- 0	284,915 ------------- 0	0 ------------- 0
13WILLIAM GALVIN III MD BOARD MEMBER/MEDICAL DIRECTOR	(i) (ii)	432,780 ------------- 0	88,666 ------------- 0	2,094 ------------- 0	8,250 ------------- 0	18,163 ------------- 0	549,953 ------------- 0	0 ------------- 0
14SUSAN GREEN FMR. SENIOR VP & CFO & TREAS. - THE	(i) (ii)	0 ------------- 540,301	0 ------------- 155,461	0 ------------- 35,325	0 ------------- 8,250	0 ------------- 19,217	0 ------------- 758,554	0 ------------- 0
15NORMAND DESCHENE FMR. PRES. OF BOARD & CEO	(i) (ii)	0 ------------- 1,092,300	0 ------------- 366,053	0 ------------- 197,871	0 ------------- 8,250	0 ------------- 12,671	0 ------------- 1,677,145	0 ------------- 0

Schedule J (Form 990) 2018

Page 3

Part III

Supplemental Information

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.

Return Reference	Explanation
PART I, LINE 1A	THE HOSPITAL HAS ENTERED INTO RESTRICTIVE ENDORSEMENT BONUS ARRANGEMENTS ("REBA'S") WITH THE FOLLOWING EMPLOYEES AS PART OF A RETIREMENT RETENTION PROGRAM: JOSEPH WHITE - PRESIDENT - THE LOWELL GENERAL HOSPITAL AMY HOEY - CHIEF OPERATING OFFICER - THE LOWELL GENERAL HOSPITAL AMOUNTS PAID BY THE HOSPITAL UNDER THE ARRANGEMENT ARE REQUIRED TO BE REPAID TO THE HOSPITAL IF LENGTH OF SERVICE REQUIREMENTS ARE NOT MET. AMOUNTS PAID UNDER THE REBA ARRANGEMENTS ARE TREATED AS TAXABLE COMPENSATION IN THE YEAR PAID BY THE HOSPITAL. THIS ARRANGEMENT WAS APPROVED BY THE HOSPITAL'S COMPENSATION COMMITTEE AS DOCUMENTED IN THE COMMITTEE MINUTES. THE W-2 COMPENSATION REPORTED FOR MR. WHITE - PRESIDENT - THE LOWELL GENERAL HOSPITAL ON FORM 990, SCHEDULE J, PART II, COLUMN B(III) INCLUDES $426,404 PAID IN 2018 IN CONNECTION WITH THE REBA ARRANGEMENT. THE W-2 COMPENSATION REPORTED FOR MS. HOEY - CHIEF OPERATING OFFICER - THE LOWELL GENERAL HOSPITAL ON FORM 990, SCHEDULE J, PART II, COLUMN B(III) INCLUDES $180,018 PAID IN 2018 IN CONNECTION WITH THE REBA ARRANGEMENT. SOCIAL CLUB DUES ARE PROVIDED TO JOSEPH WHITE AND AMY HOEY. SOCIAL CLUB DUES ARE TREATED AS TAXABLE COMPENSATION TO THE EXTENT CONSIDERED PERSONAL USEAGE.
PART I, LINES 4A-B	THE HOSPITAL HAS ENTERED INTO A SPLIT-DOLLAR LIFE INSURANCE AGREEMENT WITH NORMAND DESCHENE - FMR. PRESIDENT OF BOARD & CEO - THE LOWELL GENERAL HOSPITAL. PREMIUMS PAID IN CALENDAR 2018 WERE $125,648. ALL PREMIUMS WILL BE REPAID TO THE HOSPITAL.
PART I, LINE 7	BONUSES ARE PAID AS INDICATED ON SCHEDULE J, PART II. BONUS PAID TO OFFICERS ARE APPROVED BY THE BOARD OF TRUSTEES. OTHER BONUSES ARE APPROVED BY THE OFFICERS OF THE HOSPITAL.

Schedule J (Form 990) 2018

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Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization
THE LOWELL GENERAL HOSPITAL

Employer identification number
04-2103590

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	MASS HEALTH AND ED FACILITIES AUTHORITY SERIES C	04-2456011	57586EXB2	09-29-2010	109,152,040	CONSTRUCTION OF NEW BUILDING, EQUIP. ACQUISITIONS, PAY OFF COMMERCIAL DEBT		X		X		X
B	MASS DEVELOPMENT FINANCE AGENCY SERIES G	04-3431814	57583UVQ8	05-01-2013	65,688,217	NEW CAPITAL PROJECTS AND EQUIPMENT COSTS AND REFUND/TERMINATE SERIES D BONDS		X		X		X
C	MASSACHUSETTS DEVELOPMENT FINANCE AGENCY SERIES A	04-3431814	57583UBK3	02-20-2019	23,765,000	SEE SUPPLEMENTAL INFORMATION		X		X	X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	12,525,000				24,730,490
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	109,975,336		65,689,334		25,565,023
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............	7,292,496
6 Proceeds in refunding escrows ...............
7 Issuance costs from proceeds ...............	1,755,029		1,009,853		250,000
8 Credit enhancement from proceeds .............	92,469
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............	74,150,946		15,585,808
11 Other spent proceeds .............	26,684,396		49,093,673		25,315,023
12 Other unspent proceeds .............
13 Year of substantial completion .............	2013		2013		2019
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? ....		X	X		X
15 Were the bonds issued as part of an advance refunding issue? .....		X		X		X
16 Has the final allocation of proceeds been made? ..........	X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............	X		X		X

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

Cat. No. 50193E

Schedule K (Form 990) 2018

Page 2

Part Ⅲ

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............	X		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?	X		X		X
c Are there any research agreements that may result in private business use of bond-financed property? .............		X		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	2.530 %		2.190 %		2.600 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........	0 %		0 %		0 %
6 Total of lines 4 and 5 .............	2.530 %		2.190 %		2.600 %
7 Does the bond issue meet the private security or payment test? ...		X		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X		X		X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X	X		X
b Exception to rebate? ........		X		X		X
c No rebate due? .........	X			X		X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....		X	X			X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X		X
b Name of provider ..........
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........

Schedule K (Form 990) 2018

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X		X
b Name of provider ..........
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X		X

Part Ⅴ

Procedures To Undertake Corrective Action

---------------------------------------------------------------------------------------------------------------	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X		X		X

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).

Return Reference

Explanation

DATE REBATE COMPUTATION PERFORMED

ISSUER NAME: MASS. HEALTH AND ED. FACILITIES AUTHORITY SERIES C DATE THE REBATE COMPUTATION WAS PERFORMED: 09/30/2017

PART II:

MASS. HEALTH AND ED. FACILITIES AUTHORITY SERIES C LINE 3A: TOTAL PROCEEDS OF ISSUE CONSISTS OF $109,152,040 ORIGINAL PROCEEDS PLUS INVESTMENT INCOME OF $823,296 FOR TOTAL OF $109,975,336. LINE 5A: CAPITALIZED INTEREST FROM PROCEEDS TOTALED $7,292,496. LINE 11A: OTHER SPENT PROCEEDS CONSISTING OF REPAYMENT OF PRIOR BONDS SERIES B BONDS OF $11,042,852 PLUS $10,357,512 OF CAPITALIZED INTEREST AND VARIOUS LOANS PAID OFF OF $5,284,032 FOR TOTAL AMOUNT OF $26,684,396. MASS. DEVELOPMENT FINANCE AGENCY SERIES G LINE 3C: TOTAL PROCEEDS OF ISSUE CONSISTS OF $65,688,217 ORGINAL PROCEEDS PLUS INVESTMENT INCOME OF $1,117 FOR TOTAL OF $65,689,334. MASS. DEVELOPMENT FINANCE AGENCY SERIES A DESCRIPTION OF BOND PURPOSE: A. THE ISSUANCE OF BONDS AND THE LOAN OF THE PROCEEDS THEREOF IS TO (1) REFINANCE CERTAIN OUTSTANDING INDEBTEDNESS OF OR ISSUED FOR THE BENEFIT OF THE INSTITUTION, AS FUTHER IDENTIFIED BELOW, (2) FINANCE CONSTRUCTION, RENOVATION AND IMPROVEMENTS AT AND ACQUISTIONS AND EQUIPMENT FOR THE ACUTE CARE HOSPITAL AND RELATED FACILITIES OWNED AND/OR OPERATED BY TUFTS MEDICAL CENTER, (3) FUND A DEBT SERVICE RESERVE FUND, AND (4) PAY CERTAIN COSTS OF ISSUANCE OF THE BONDS. FURTHER IDENTIFICATION OF BOND PURPOSE - REFINANCINGS: SERIES E & F BONDS ISSUED 9/27/12 SERIES A BONDS WERE ISSUED FOR THE WELLFORCE OBLIGATED GROUP, WHICH INCLUDES TUFTS MEDICAL CENTER, INC., THE LOWELL GENERAL HOSPITAL, AND MELROSEWAKEFIELD HEALTHCARE.

Schedule K (Form 990) 2018

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SCHEDULE M
(Form 990)

Department of the Treasury

Internal Revenue Service

Noncash Contributions

Complete if the organizations answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image

Attach to Form 990.
Right pointing arrow large image

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

THE LOWELL GENERAL HOSPITAL

Employer identification number

04-2103590

Part I

Types of Property

	(a) Check if applicable	(b) Number of contributions or items contributed	(c) Noncash contribution amounts reported on Form 990, Part VIII, line 1g	(d) Method of determining noncash contribution amounts
1 Art—Works of art ....
2 Art—Historical treasures .
3 Art—Fractional interests ..
4 Books and publications ..
5 Clothing and household goods .......
6 Cars and other vehicles ..
7 Boats and planes ....
8 Intellectual property ...
9 Securities—Publicly traded .	X	1	10,166	FMV
10 Securities—Closely held stock .
11 Securities—Partnership, LLC, or trust interests ....
12 Securities—Miscellaneous ..
13 Qualified conservation contribution—Historic structures .....
14 Qualified conservation contribution—Other ...
15 Real estate—Residential .
16 Real estate—Commercial ..
17 Real estate—Other ...
18 Collectibles .....
19 Food inventory ...
20 Drugs and medical supplies .
21 Taxidermy ......
22 Historical artifacts ....
23 Scientific specimens ..
24 Archeological artifacts ...
25 Other ( FUNDRAISING EVENT ITEMS )	X	397	187,501	FMV
26 Other ( )
27 Other ( )
28 Other ( )

Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement

Yes

30a

During the year, did the organization receive by contribution any property reported in Part I, lines 1 through 28, that it must hold for at least three years from the date of the initial contribution, and which is not required to be used for exempt purposes for the entire holding period? ...................

30a

If "Yes," describe the arrangement in Part II.

Does the organization have a gift acceptance policy that requires the review of any nonstandard contributions?

Yes

32a

Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash

contributions? ..........................

32a

If "Yes," describe in Part II.

If the organization did not report an amount in column (c) for a type of property for which column (a) is checked,

describe in Part II.

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

Cat. No. 51227J

Schedule M (Form 990) (2018)

Page 2

Part II

Supplemental Information. Provide the information required by Part I, lines 30b, 32b, and 33, and whether the organization is reporting in Part I, column (b), the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information.

Return Reference	Explanation
PART I, COLUMN (B):	THE AMOUNT IN COLUMN (B) REPRESENTS THE NUMBER OF CONTRIBUTIONS.

Schedule M (Form 990) (2018)

Additional Data

Software ID:
Software Version:

- 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 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization

THE LOWELL GENERAL HOSPITAL

Employer identification number

04-2103590

Return Reference	Explanation
FORM 990, PART VI, SECTION A, LINE 6	THE SOLE MEMBER OF THE LOWELL GENERAL HOSPITAL IS CIRCLE HEALTH, INC.
FORM 990, PART VI, SECTION A, LINE 7A	CIRCLE HEALTH, INC., AS SOLE MEMBER OF THE LOWELL GENERAL HOSPITAL, ELECTS THE MEMBERS OF THE HOSPITAL'S BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 7B	CIRCLE HEALTH, INC. APPROVES BUDGETS FOR THE LOWELL GENERAL HOSPITAL. CIRCLE HEALTH, INC. ALSO DETERMINES THE NUMBER OF LOWELL GENERAL HOSPITAL TRUSTEES AT AN ANNUAL MEETING. CIRCLE HEALTH, INC. MAY ALSO ELECT NEW TRUSTEES OR REMOVE TRUSTEES TO ACHIEVE THE NUMBER OF TRUSTEES SO FIXED.
FORM 990, PART VI, SECTION B, LINE 11B	CBIZ MHM, LLC A PROFESSIONAL ACCOUNTING/TAX FIRM, WILL PREPARE THE ANNUAL FORM 990 IN ASSOCIATION WITH THE FINANCE DEPARTMENT OF THE LOWELL GENERAL HOSPITAL WHO WILL SUPPLY RELEVANT INFORMATION. THE BOARD OF DIRECTORS WILL BE PROVIDED WITH A COMPLETED DRAFT OF THE FORM 990 PRIOR TO ITS FILING. ALL MEMBERS OF THE BOARD OF DIRECTORS WILL BE INVITED TO REVIEW THE COMPLETED 990 IN ADVANCE OF THE FILING DEADLINE. COPIES OF THE DRAFT FORM 990 WILL BE MADE AVAILABLE TO ALL MEMBERS OF THE BOARD OF DIRECTORS, AS NEEDED, AND IN AN APPROPRIATE FORMAT (ELECTRONIC OR PAPER.) THE BOARD OF DIRECTORS WILL RECEIVE THE FINANCE COMMITTEE REPORT AND ITS RECOMMENDATIONS FOR THE 990 AND WILL VOTE TO APPROVE IT FOR FILING. THE FINALIZED FORM, AFTER COORRECTIONS AND MODIFICATIONS, IF ANY, WILL THEN BE SIGNED BY EITHER THE CEO OR CFO AND FILED AS REQUIRED.
FORM 990, PART VI, SECTION B, LINE 12C	ALL OFFICERS, BOARD MEMBERS, AND KEY EMPLOYEES ARE SUBJECT TO THE CONFLICT OF INTEREST POLICY. ANY ACTUAL OR POTENTIAL CONFLICTS ARE FORWARDED TO THE COMPLIANCE COMMITTEE FOR CONSIDERATION. IN THE EVENT OF AN ACTUAL OR POTENTIAL CONFLICT, THE CONFLICTED INDIVIDUAL IS PROHIBITED FROM PARTICIPATING IN DELIBERATIONS OR DECISIONS RELATING TO THE MATTER. A COMPLIANCE COMMITTEE MEETING IS HELD EVERY OTHER MONTH TO ADDRESS CONCERNS.
FORM 990, PART VI, SECTION B, LINE 15	A THIRD PARTY CONSULTANT IS HIRED FOR AN INDEPENDENT ASSESSMENT OF APPROPRIATE SALARY RANGES FOR THE OFFICERS OF THE ORGANIZATION SUCH AS THE CEO, PRESIDENT, COO, AND CFO. THIS ASSESSMENT IS REVIEWED BY THE COMPENSATION COMMITTEE AND A RECOMMENDATION IS GIVEN TO THE BOARD OF TRUSTEES ON SALARY INCREASES AND BONUSES.
FORM 990, PART VI, SECTION C, LINE 19	GOVERNING DOCUMENTS ARE PROVIDED TO AND MADE AVAILABLE ON THE SECRETARY OF STATE WEBSITE AND MADE AVAILABLE UPON REQUEST ALONG WITH CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS.
FORM 990, PART VI, SECTION B., LINE 16A:	THE LOWELL GENERAL HOSPITAL OWNS 16.67% INTEREST IN YANKEE ALLIANCE, LLC.
FORM 990, PART VI, SECTION B., LINE 16B:	THE ORGANIZATION ROUTINELY CONSULTS WITH INTERNAL AND OUTSIDE COUNSEL PRIOR TO ENTERING INTO JOINT VENTURE ARRANGEMENTS. THE ORGANIZATION IS CURRENTLY CONSIDERING IMPLEMENTATION OF WRITTEN POLICIES AND PROCEDURES TO EVALUATE PARTICIPATION OF JOINT VENTURE ARRANGEMENTS TO SAFEGUARD THE ORGANIZATION'S EXEMPT STATUS WITH RESPECT TO SUCH ARRANGEMENTS.
FORM 990, PART XI, LINE 9:	PROVISION FOR UNCOLLECTIBLE ACCOUNTS -12,984,894. CHANGE IN BENEFICIAL INTEREST IN PERPETUAL TRUSTS -21,137. TRANSFERS TO AFFILIATES -24,616,222. PENSION RELATED ADJUSTMENTS -11,814,222. ROUNDING -3.

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2018

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

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

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

THE LOWELL GENERAL HOSPITAL

Employer identification number

04-2103590

Part I

Identification of Disregarded Entities Complete if the organization answered "Yes" on 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)	(f) Direct controlling entity
(1) LGH MEDICAL GROUP LLC 295 VARNUM AVE LOWELL,MA01854 20-5671277	MEDICAL SERVICES	MA	CIRCLE HEALTH PHYSICIANS INC
(2) LGH CANCERCARE ASSOCIATES LLC 295 VARNUM AVE LOWELL,MA01854 04-3483462	MEDICAL SERVICES	MA	CIRCLE HEALTH PHYSICIANS INC
(3) LGH WOMANHEALTH LLC 295 VARNUM AVE LOWELL,MA01854 26-2057970	MEDICAL SERVICES	MA	CIRCLE HEALTH PHYSICIANS INC
(4) LGH MERRIMACK VALLEY CARDIOLOGY ASSOCIATES LLC 295 VARNUM AVE LOWELL,MA01854 45-2014433	MEDICAL SERVICES	MA	CIRCLE HEALTH PHYSICIANS INC
(5) CIRCLE HEALTH URGENT CARE LLC 295 VARNUM AVE LOWELL,MA01854 47-1122896	MEDICAL SERVICES	MA	CIRCLE HEALTH PHYSICIANS INC
(6) CIRCLE HEALTH PHARMACY LLC 295 VARNUM AVE LOWELL,MA01854 00-1352934	MEDICAL SERVICES	MA	CIRCLE HEALTH PHYSICIANS INC
(7) LGH PROFESSIONAL SERVICES LLC 295 VARNUM AVE LOWELL,MA01854 61-1844933	MEDICAL SERVICES	MA	CIRCLE HEALTH PHYSICIANS INC
(8) WELLFORCE CARE PLAN LLC 800 DISTRICT AVE BURLINGTON,MA01803 00-1274839	ACO	MA	WELLFORCE INC

Part II

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled 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)MELROSEWAKEFIELD HEALTHCARE INC 170 GOVERNORS AVE MEDFORD,MA02155 04-2767880	HOSPITAL	MA	501(C)(3)	LINE 3	MELROSEWAKEFIELD HEALTHCARE PARENT CORPORATION	Yes
(2)HALLMARK HEALTH MEDICAL ASSOCIATES INC 170 GOVERNORS AVE MEDFORD,MA02155 04-3140938	MD OFFICES	MA	501(C)(3)	LINE 10	MELROSEWAKEFIELD HEALTHCARE PARENT CORPORATION	Yes
(3)LM LONG TERM CARE SERVICES INC 170 GOVERNORS AVE MEDFORD,MA02155 04-2938772	LONG-TERM CARE	MA	501(C)(3)	LINE 12B, II	MELROSEWAKEFIELD HEALTHCARE PARENT CORPORATION	Yes
(4)SAVIN LONG TERM CARE CORPORATION 170 GOVERNORS AVE MEDFORD,MA02155 04-3012616	LONG-TERM CARE	MA	501(C)(3)	LINE 10	MELROSEWAKEFIELD HEALTHCARE PARENT CORPORATION	Yes
(5)HALLMARK HEALTH VISITING NURSE ASSOCIATION AND HOSPICE INC 178 SAVIN ST SUITE 300 MALDEN,MA02148 04-2437064	VISITING NURSE	MA	501(C)(3)	LINE 10	HOME HEALTH FOUNDATION INC	Yes
(6)HALLMARK HEALTH PROPERTIES 170 GOVERNORS AVE MEDFORD,MA02155 22-2580542	PROPERTY	MA	501(C)(3)	LINE 12B, II	MELROSEWAKEFIELD HEALTHCARE PARENT CORPORATION	Yes
(7)MELROSEWAKEFIELD HEALTHCARE PARENT CORPORATION 170 GOVERNORS AVE MEDFORD,MA02155 04-2103587	PARENT	MA	501(C)(3)	LINE 12A, I	WELLFORCE INC	Yes
(8)THE LOWELL GENERAL HOSPITAL 295 VARNUM AVENUE LOWELL,MA01854 04-2103590	HEALTH CARE	MA	501(C)(3)	LINE 3	CIRCLE HEALTH INC	Yes
(9)CIRCLE HEALTH PHYSICIANS INC 295 VARNUM AVENUE LOWELL,MA01854 27-3902914	MEDICAL SERVICES	MA	501(C)(3)	LINE 10	CIRCLE HEALTH INC	Yes
(10)LGH PHYSICIAN ASSOCIATES INC ONE HOSPITAL DRIVE LOWELL,MA01852 04-3190747	MEDICAL SERVICES	MA	501(C)(3)	LINE 10	CIRCLE HEALTH PHYSICIANS INC	Yes
(11)CIRCLE HEALTH INC 295 VARNUM AVENUE LOWELL,MA01854 22-2579798	PARENT/SUPPORTING ORGANIZATION	MA	501(C)(3)	LINE 12B, II	WELLFORCE INC	Yes
(12)WELLFORCE INC 1600 DISTRICT AVE SUITE 125 BURLINGTON,MA01803 45-2250732	PARENT/SUPPORTING ORGANIZATION	MA	501(C)(3)	LINE 12A, I	N/A		No
(13)CNS NURSING HOME CARE INC 847 ROGERS STREET SUITE 201 LOWELL,MA01852 37-1836433	HOME CARE SERVICES	MA	501(C)(3)	LINE 10	CIRCLE HOME INC	Yes
(14)CIRCLE HOME INC 847 ROGERS STREET SUITE 201 LOWELL,MA01852 04-2103812	HOME CARE SERVICES	MA	501(C)(3)	LINE 10	HOME HEALTH FOUNDATION INC	Yes
(15)TUFTS MEDICAL CENTER PARENT INC 800 WASHINGTON STREET BOSTON,MA02111 04-2810022	FUNDRAISING, ADMIN. PLANNING & OTHER ACTIVITIES	MA	501(C)(3)	LINE 12B, II	WELLFORCE INC	Yes
(16)TUFTS MEDICAL CENTER INC 800 WASHINGTON STREET BOSTON,MA02111 04-3400617	HOSPITAL SERVICES	MA	501(C)(3)	LINE 3	TUFTS MEDICAL CENTER PARENT INC	Yes
(17)TUFTS MEDICAL CENTER REAL ESTATE COMPANY INC 800 WASHINGTON STREET BOSTON,MA02111 04-2772654	ACQUIRING REAL PROPERTY	MA	501(C)(3)	LINE 12B, II	TUFTS MEDICAL CENTER PARENT INC	Yes
(18)NEW ENGLAND LONG-TERM CARE INC 800 WASHINGTON STREET BOSTON,MA02111 04-2912578	PEDIATRIC LONG-TERM CARE FACILITY	MA	501(C)(3)	LINE 3	TUFTS MEDICAL CENTER PARENT INC	Yes
(19)NEW ENGLAND QUALITY CARE ALLIANCE INC 800 WASHINGTON STREET BOSTON,MA02111 04-3040427	MEDICAL PROGRAMS & SERVICES	MA	501(C)(3)	LINE 12B, II	TUFTS MEDICAL CENTER PARENT INC	Yes
(20)NEQCA ACCOUNTABLE CARE INC 325 WOOD RD SUITE 210 BRAINTREE,MA02184 80-0824142	ACO	MA	501(C)(3)	LINE 7	NEW ENGLAND QUALITY CARE ALLIANCE INC	Yes
(21)TUFTS MEDICAL CENTER COMMUNITY CARE INC 325 WOOD RD SUITE 210 BRAINTREE,MA02184 47-3046563	MEDICAL SERVICES	MA	501(C)(3)	LINE 10	TUFTS MEDICAL CENTER PARENT INC	Yes
(22)THE CAMERON M NEELY FOUNDATION 800 WASHINGTON STREET BOSTON,MA02111 04-3265628	CHARITABLE	MA	501(C)(3)	LINE 7	TUFTS MEDICAL CENTER PARENT INC	Yes
(23)HEART CENTER OF METROWEST INC 99 LINCOLN STREET FRAMINGHAM,MA01702 03-0390670	MEDICAL SERVICES	MA	501(C)(3)	LINE 10	TUFTS MEDICAL CENTER PHYSICIANS ORG INC	Yes
(24)PRATT ANESTHESIOLOGY ASSOCIATES INC 800 WASHINGTON STREET BOSTON,MA02111 04-3418395	MEDICAL SERVICES	MA	501(C)(3)	LINE 10	TUFTS MEDICAL CENTER PHYSICIANS ORG INC	Yes
(25)PRATT MEDICAL AND SURGICAL ASSOCIATES INC 800 WASHINGTON STREET BOSTON,MA02111 04-3148397	MEDICAL SERVICES	MA	501(C)(3)	LINE 10	TUFTS MEDICAL CENTER PHYSICIANS ORG INC	Yes
(26)PRATT NEUROLOGY ASSOICATES INC 800 WASHINGTON STREET BOSTON,MA02111 04-3148384	MEDICAL SERVICES	MA	501(C)(3)	LINE 10	TUFTS MEDICAL CENTER PHYSICIANS ORG INC	Yes
(27)PRATT OBGYN ASSOCIATES INC 800 WASHINGTON STREET BOSTON,MA02111 04-3148385	MEDICAL SERVICES	MA	501(C)(3)	LINE 10	TUFTS MEDICAL CENTER PHYSICIANS ORG INC	Yes
(28)PRATT OPHTHALMOLOGY ASSOCIATES INC 800 WASHINGTON STREET BOSTON,MA02111 04-3148392	MEDICAL SERVICES	MA	501(C)(3)	LINE 10	TUFTS MEDICAL CENTER PHYSICIANS ORG INC	Yes
(29)PRATT ORTHOPEDIC ASSOCIATES INC 800 WASHINGTON STREET BOSTON,MA02111 20-5129051	MEDICAL SERVICES	MA	501(C)(3)	LINE 10	TUFTS MEDICAL CENTER PHYSICIANS ORG INC	Yes
(30)PRATT OTOLARYNGOLOGY 800 WASHINGTON STREET BOSTON,MA02111 04-3148381	MEDICAL SERVICES	MA	501(C)(3)	LINE 10	TUFTS MEDICAL CENTER PHYSICIANS ORG INC	Yes
(31)PRATT PATHOLOGY ASSOCIATES INC 800 WASHINGTON STREET BOSTON,MA02111 04-3148393	MEDICAL SERVICES	MA	501(C)(3)	LINE 10	TUFTS MEDICAL CENTER PHYSICIANS ORG INC	Yes
(32)PRATT PEDIATRIC ASSOCIATES INC 800 WASHINGTON STREET BOSTON,MA02111 04-3148394	MEDICAL SERVICES	MA	501(C)(3)	LINE 10	TUFTS MEDICAL CENTER PHYSICIANS ORG INC	Yes
(33)PRATT PSYCHIATRIC ASSOCIATES INC 800 WASHINGTON STREET BOSTON,MA02111 04-3148387	MEDICAL SERVICES	MA	501(C)(3)	LINE 10	TUFTS MEDICAL CENTER PHYSICIANS ORG INC	Yes
(34)PRATT RADIOLOGY ASSOCIATES INC 800 WASHINGTON STREET BOSTON,MA02111 04-3148388	MEDICAL SERVICES	MA	501(C)(3)	LINE 10	TUFTS MEDICAL CENTER PHYSICIANS ORG INC	Yes
(35)PRATT RADIATION ONCOLOGY ASSOCIATES INC 800 WASHINGTON STREET BOSTON,MA02111 04-3148389	MEDICAL SERVICES	MA	501(C)(3)	LINE 10	TUFTS MEDICAL CENTER PHYSICIANS ORG INC	Yes
(36)PRATT REHABILITATION MEDICINCE 800 WASHINGTON STREET BOSTON,MA02111 04-3148378	MEDICAL SERVICES	MA	501(C)(3)	LINE 10	TUFTS MEDICAL CENTER PHYSICIANS ORG INC	Yes
(37)PRATT SURGICAL ASSOCIATES INC 800 WASHINGTON STREET BOSTON,MA02111 04-3148376	MEDICAL SERVICES	MA	501(C)(3)	LINE 10	TUFTS MEDICAL CENTER PHYSICIANS ORG INC	Yes
(38)PRATT UROLOGY ASSOCIATES INC 800 WASHINGTON STREET BOSTON,MA02111 04-3148379	MEDICAL SERVICES	MA	501(C)(3)	LINE 10	TUFTS MEDICAL CENTER PHYSICIANS ORG INC	Yes
(39)NEW ENGLAND MEDICAL CENTER 800 WASHINGTON STREET BOSTON,MA02111 04-3096445	MEDICAL SERVICES	MA	501(C)(3)	LINE 10	TUFTS MEDICAL CENTER PHYSICIANS ORG INC	Yes
(40)PRATT MEDICAL GROUP INC 800 WASHINGTON STREET BOSTON,MA02111 04-2743894	MEDICAL SERVICES	MA	501(C)(3)	LINE 10	TUFTS MEDICAL CENTER PHYSICIANS ORG INC	Yes
(41)TUFTS MEDICAL CENTER PHYSICIANS ORG INC 800 WASHINGTON STREET BOSTON,MA02111 04-3044706	ADMIN.	MA	501(C)(3)	LINE 12B, II	TUFTS MEDICAL CENTER PARENT INC	Yes
(42)LOWELL GENERAL HOSPITAL AUXILIARY 295 VARNUM AVENUE LOWELL,MA01854 22-3459303	SUPPORTING ORGANIZATION	MA	501(C)(3)	LINE 12A, I	N/A		No
(43)CARDIOVASCULAR CENTER AT TUFTS MEDICAL CENTER INC 800 WASHINGTON STREET BOSTON,MA02111 82-3315703	MEDICAL SERVICES	MA	501(C)(3)	LINE 10	TUFTS MEDICAL CENTER PHYSICIANS ORG INC	Yes
(44)HOME HEALTH FOUNDATION INC 360 MERRMIACK STREET LAWRENCE,MA01843 22-2587225	MANAGEMENT SERVICES	MA	501(C)(3)	LINE 12B, II	WELLFORCE INC	Yes
(45)HOME HEALTH VNA INC 360 MERRMIACK STREET LAWRENCE,MA01843 04-2435675	HOME HEALTH CARE	MA	501(C)(3)	LINE 10	HOME HEALTH FOUNDATION INC	Yes
(46)MERRIMACK VALLEY HOSPICE INC 360 MERRMIACK STREET LAWRENCE,MA01843 04-3024278	HOSPICE SERVICES	MA	501(C)(3)	LINE 10	HOME HEALTH FOUNDATION INC	Yes
(47)HOME CARE INC 360 MERRMIACK STREET LAWRENCE,MA01843 04-2854358	HOME HEALTH SUPPORTIVE SERIVCES	MA	501(C)(3)	LINE 10	HOME HEALTH FOUNDATION INC	Yes

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

Cat. No. 50135Y

Schedule R (Form 990) 2018

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(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 V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) HALLMARK HEALTH INVESTMENTS LLC 170 GOVERNORS AVE MEDFORD,MA02155 02-0657666	INVESTMENT	MA	MELROSEWAKEFIELD HEALTHCARE INC	EXCLUDED				No			No
(2) MONTVALE PETCT LLC 100 BAYVIEW CIRCLE SUITE 400 NEWPORT BEACH,CA92660 27-0325022	CAT SCAN	DE	MELROSEWAKEFIELD HEALTHCARE INC	RELATED				No			No
(3) CIRCLE HEALTH ALLIANCE LLC 295 VARNUM AVE LOWELL,MA01854 80-0782682	ACCOUNTABLE CARE ORGANIZATION	MA	CIRCLE HEALTH INC	RELATED				No			No
(4) SHIELDS-TUFTS MEDICAL CENTER IMAGING MANAGEMENT LLC 800 WASHINGTON STREET BOSTON,MA02111 32-0558307	MEDICAL SERVICES (MRI)	MA	TUFTS MEDICAL CENTER INC	RELATED				No			No
(5) MEDFORD LAWRENCE REAL ESTATE LLC 55 CHRISTYS DRIVE BROCKTON,MA02301 32-0553759	MEDICAL OFFICE BUILDING	MA	MELROSEWAKEFIELD HEALTHCARE INC	RELATED				No			No

Part IV

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(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) LGH MEDICAL SERVICES INC 295 VARNUM AVENUE LOWELL,MA01854 26-1889904	MEDICAL SERVICES	MA	LGH SERVICES INC	C				Yes
(2) LGH SERVICES INC 295 VARNUM AVENUE LOWELL,MA01854 04-2854673	MEDICAL SERVICES	MA	CIRCLE HEALTH INC	C				Yes
(3) LGH MANAGEMENT SERVICES INC 295 VARNUM AVENUE LOWELL,MA01854 04-2919244	MEDICAL SERVICES	MA	LGH SERVICES INC	C				Yes
(4) LGH MEDICAL BUILDING SERVICES INC 295 VARNUM AVENUE LOWELL,MA01854 04-3058954	MEDICAL OFFICE BUILDING	MA	LGH SERVICES INC	C				Yes
(5) CHARITABLE REMAINDER TRUSTS (5)	INVESTMENTS	MA	THE LOWELL GENERAL HOSPITAL	T			100.000 %	Yes
(6) HALLMARK HEALTH ENTERPRISES INC 585 LEBANON STREET MELROSE,MA02176 04-2475660	OTHER HEALTH SERVICES	MA	MELROSEWAKEFIELD HEALTHCARE PARENT CORPORATION	C				Yes
(7) LAWRENCE MELROSE MEDICAL ELECTRONICS RECORD INC 170 GOVERNORS AVE MEDFORD,MA02155 42-1685777	ELECTRONIC MEDICAL RECORDS	MA	MELROSEWAKEFIELD HEALTHCARE INC	C					No
(8) HALLMARK HEALTH PHO INC 170 GOVERNORS AVE MEDFORD,MA02155 46-1134759	PHYSICIAN HOSPITAL ORGANIZATION	MA	MELROSEWAKEFIELD HEALTHCARE INC	C					No
(9) WELLFORCE INDEMNITY COMPANY LTD 800 WASHINGTON STREET BOSTON,MA02111 98-0444573	CAPTIVE INSURANCE	CJ	TUFTS MEDICAL CENTER INC	C				Yes

Schedule R (Form 990) 2018

Page 3

Part V

Transactions With Related Organizations Complete if the organization answered "Yes" on 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) ............................

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

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

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

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 related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) LGH MEDICAL BUILDING SERVICE INC	J	1,122,450	BOOK VALUE
(2) LGH MEDICAL GROUP INC	K	3,376,069	BOOK VALUE
(3) CIRCLE HEALTH PHYSICIANS INC	E	2,646,129	BOOK VALUE
(4) CIRCLE HEALTH PHYSICIANS INC	D	6,160,962	BOOK VALUE
(5) LGH MEDICAL BUILDING SERVICE INC	D	53,619	BOOK VALUE
(6) CIRCLE HEALTH INC	D	81,203	BOOK VALUE
(7) TUFTS MEDICAL CENTER PHYSICIANS ORG	D	143,373	BOOK VALUE
(8) TUFTS MEDICAL CENTER PHYSICIANS ORG	E	395,982	BOOK VALUE
(9) MELROSEWAKEFIELD HEALTHCARE	D	436,696	BOOK VALUE
(10) WELLFORCE CARE PLAN LLC	D	302,547	BOOK VALUE
(11) TUFTS MEDICAL CENTER INC	D	6,246,226	BOOK VALUE
(12) CIRCLE HEALTH ALLIANCE LLC	D	729,040	BOOK VALUE
(13) WELLFORCE INC	E	2,506,129	BOOK VALUE
(14) CIRCLE HOME INC	D	192,250	BOOK VALUE
(15) CIRCLE HEALTH INC	R	443,085	BOOK VALUE
(16) CIRCLE HOME INC	Q	1,992,873	BOOK VALUE
(17) CNS NURSING HOME CARE INC	Q	450,342	BOOK VALUE

Schedule R (Form 990) 2018

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(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 V-UBI 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 V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2018

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2018

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: TO MEET THE HEALTHCARE NEEDS OF COMMUNITIES SERVED THROUGH THE PROVISION OF INPATIENT AND OUTPATIENT MEDICAL SERVICES. TO PROVIDE SERVICES, PROGRAMS AND INITIATIVES TO IMPROVE THE HEALTH AND QUALITY OF LIFE OF THE CITIZENS IN THE AREA, WITH A PARTICULAR FOCUS ON PEOPLE WHO ARE MEDICALLY UNDERSERVED, AT RISK, OR FINANCIALLY DISADVANTAGED.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	16
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	14
5	Total number of individuals employed in calendar year 2018 (Part V, line 2a) ......	5	4,442
6	Total number of volunteers (estimate if necessary) .............	6	300
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	-1,223,888
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) .........	3,162,248	3,877,996
9	Program service revenue (Part VIII, line 2g) .........	470,427,050	466,976,860
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	9,172,790	2,409,315
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	13,986,355	11,887,407
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	496,748,443	485,151,578
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	458,789	503,974
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)	229,017,093	230,929,189
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 963,360
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	226,604,404	227,187,999
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	456,080,286	458,621,162
19	Revenue less expenses. Subtract line 18 from line 12.......	40,668,157	26,530,416
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	488,997,334	455,209,859
21	Total liabilities (Part X, line 26).............	328,005,960	317,420,782
22	Net assets or fund balances. Subtract line 21 from line 20.....	160,991,374	137,789,077

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 147,508,264 including grants of $ 503,974 ) (Revenue $ 216,280,792 )
	LGH'S OUTPATIENT AND ANCILLARY SERVICES INCLUDE EMERGENCY DEPARTMENT (LEVEL III TRAUMA SERVICES), IMAGING/RADIOLOGY (INCLUDING MRI, CT, ULTRASOUND, MAMMOGRAPHY), LABORATORY, CARDIAC TESTING AND CATHETERIZATION, ENDOSCOPY, SURGERY, REHABILITATION THERAPIES, RADIATION ONCOLOGY AND CHEMOTHERAPY, AND A NUMBER OF OTHER SERVICES NEEDED TO SUPPORT INPATIENT AND OUTPATIENT CARE.OUTPATIENT STATISTICSEMERGENCY ROOM VISITS: 98,714OUTPATIENT VISITS: 406,799OUTPATIENT SURGERIES: 8,222RADIATION TREATMENTS: 12,199

4b	(Code: ) (Expenses $ 201,304,441 including grants of $ ) (Revenue $ 263,732,149 )
	THE LOWELL GENERAL HOSPITAL'S PRIMARY SERVICE AREA ("PSA") IS COMPRISED OF THE FOLLOWING NINE COMMUNITIES: BILLERICA, CHELMSFORD, DRACUT, DUNSTABLE, LOWELL, TEWKSBURY, TYNGSBORO AND WESTFORD, MASSACHUSETTS, AND PELHAM, NEW HAMPSHIRE, WITH A TOTAL OF APPROXIMATELY 291,000 RESIDENTS. THE HOSPITAL'S SECONDARY SERVICE AREA ("SSA") HAS A POPULATION OF ALMOST 340,000 AND INCLUDES THE SURROUNDING MUNICIPALITIES OF ANDOVER, CARLISLE, GROTON, LAWRENCE, LITTLETON, METHUEN, NORTH ANDOVER, PEPPERELL AND WILMINGTON, MASSACHUSETTS, AND HOLLIS, HUDSON AND NASHUA, NEW HAMPSHIRE. THE HOSPITAL OFFERS THE LATEST TECHNOLOGY AND A FULL RANGE OF MEDICAL, SURGICAL AND CRITICAL CARE SERVICES FOR PATIENTS, FROM NEWBORNS TO SENIORS. IT IS CURRENTLY LICENSED BY THE MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH TO OPERATE A TOTAL OF 434 ACUTE CARE BEDS (301 ADULT MEDICAL/SURGICAL, 29 INTENSIVE CARE, 40 PEDIATRIC, 26 OBSTETRICAL, 10 LEVEL IIB SPECIAL CARE NURSERY BASSINETS AND 28 WELL-NEWBORN BASSINETS).INPATIENT STATISTICSINPATIENT ADMISSIONS: 18,460 DELIVERIES: 2,230OBSERVATION STAYS: 4,696PATIENT DAYS: 76,980SURGERIES: 2,412

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












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses348,812,705

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	5,497,593	2,747,267	336,023

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c	300,000
d	Related organizations		1d	61,800
e	Government grants (contributions)		1e	237,298

f	All other contributions, gifts, grants, and similar amounts not included above		1f	3,278,898

g	Noncash contributions included in lines 1a - 1f:$ 197,667
h Total. Add lines 1a-1f.......		3,877,996

		Business Code
2a	PATIENT SVC. REVENUE	621500	466,976,860	468,662,277	-1,685,417
b
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f ....		466,976,860

3 Investment income (including dividends, interest, and othersimilar amounts) ......			2,065,890		478,502	1,587,388
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		2,016,725
b	Less: rental expenses		2,049,640
c	Rental income or (loss)		-32,915
d	Net rental income or (loss)......			-32,915		-16,973	-15,942
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		82,786,493
b	Less: cost or other basis and sales expenses	1,109,417	81,333,651
c	Gain or (loss)	-1,109,417	1,452,842
d	Net gain or (loss).....			343,425			343,425
8a	Gross income from fundraising events (not including $ 300,000of contributions reported on line 1c). See Part IV, line 18 ....
	a		1,356,545
b	Less: direct expenses ...b		786,887
c	Net income or (loss) from fundraising events..			569,658			569,658
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	OTHER REVENUE		621500	11,350,664	11,350,664
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			11,350,664
12	Total revenue. See Instructions......			485,151,578	480,012,941	-1,223,888	2,484,529

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	503,974	503,974
2	Grants and other assistance to domestic individuals. See Part IV, line 22
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, line 15 and 16.
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....
7	Other salaries and wages	189,254,218	142,115,635	46,957,104	181,479
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	4,469,592	3,356,326	1,108,980	4,286
9	Other employee benefits .......	23,785,016	17,859,634	5,902,572	22,810
10	Payroll taxes ...........	13,420,363	10,077,680	3,329,814	12,869
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	275,073		275,073
c	Accounting ...........	271,482		271,482
d	Lobbying ...........	120,000		120,000
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	342,295		342,295
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	32,113,975	21,121,932	10,978,207	13,836
12	Advertising and promotion ....	600,910	1,583	596,866	2,461
13	Office expenses .......	95,521,877	91,163,832	4,316,727	41,318
14	Information technology ......	23,566,905	19,255,055	4,199,082	112,768
15	Royalties ..
16	Occupancy ...........	9,453,432	5,755,066	3,694,990	3,376
17	Travel ............	430,281	188,305	241,948	28
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	834,954	497,614	337,301	39
20	Interest ...........	7,643,095		7,643,095
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	20,541,733	17,580,625	2,946,159	14,949
23	Insurance ...	1,938,506	5,865	1,932,641
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	PHYSICIAN FEES	18,989,274	10,601,399	8,387,875
b	UNCOMPENSATED CARE POOL	7,876,192	7,876,192
c	PROVISION FOR BAD DEBTS	4,730,546		4,730,546
d	TEMP RESTRICTED MISC EX	1,097,536	565,196	532,340
e	All other expenses	839,933	286,792		553,141
25	Total functional expenses. Add lines 1 through 24e	458,621,162	348,812,705	108,845,097	963,360
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).

1	Cash–non-interest-bearing ........			46,085,184	1	21,460,271
2	Savings and temporary cash investments .........			19,086,979	2
3	Pledges and grants receivable, net ......			2,009,974	3	1,607,095
4	Accounts receivable, net .............			66,149,741	4	63,918,912
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L .............
					5
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 ..............
					6
7	Notes and loans receivable, net ....				7
8	Inventories for sale or use ........			7,913,066	8	7,633,603
9	Prepaid expenses and deferred charges ......			2,536,133	9	3,646,230
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	483,296,049
b	Less: accumulated depreciation	10b	267,791,319	226,867,670	10c	215,504,730
11	Investments—publicly traded securities .				11
12	Investments—other securities. See Part IV, line 11 .....			76,984,000	12	93,581,882
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			41,364,587	15	47,857,136
16	Total assets. Add lines 1 through 15 (must equal line 34)...			488,997,334	16	455,209,859

17	Accounts payable and accrued expenses .....	92,059,339	17	79,048,146
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........	142,581,101	20	138,696,956
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
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..		22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ..	16,540,077	24	14,089,077
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	76,825,443	25	85,586,603
26	Total liabilities. Add lines 17 through 25..	328,005,960	26	317,420,782

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	151,081,636	27	128,519,297
28	Temporarily restricted net assets ...........	5,040,949	28	4,351,581
29	Permanently restricted net assets	4,868,789	29	4,918,199
	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 ...........	160,991,374	33	137,789,077
34	Total liabilities and net assets/fund balances ........	488,997,334	34	455,209,859