TY 2023 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/1099-NEC)
(1) RAYMOND ANSTISS JR...................................................................... CHAIR	1.00 ................. 1.00	X	X	0	0	0
(2) JOHN CARSON PH D...................................................................... BOARD MEMBER	1.00 ................. 1.00	X		0	0	0
(3) BRIAN CHAPMAN...................................................................... BOARD MEMBER	1.00 ................. 1.00	X		0	0	0
(4) JULIE CHEN PH D...................................................................... BOARD MEMBER	1.00 ................. 1.00	X		0	0	0
(5) JACK CLANCY...................................................................... BOARD MEMBER	1.00 ................. 1.00	X		0	0	0
(6) MARK S COCHRAN...................................................................... BOARD MEMBER (UNTIL 7/24)	1.00 ................. 1.00	X		0	0	0
(7) SHAMIN DAHOD MD...................................................................... BOARD MEMBER	1.00 ................. 1.00	X		0	0	0
(8) MICHAEL DANDORPH...................................................................... PRESIDENT & CEO - TUFTS MEDICINE	1.00 ................. 49.00	X	X	0	1,726,150	359,711
(9) MICHAEL DUBUQUE...................................................................... CLERK	1.00 ................. 3.00	X	X	0	0	0
(10) SUSAN WEST LAVINE...................................................................... BOARD MEMBER	1.00 ................. 1.00	X		0	0	0
(11) BOPHA MALONE...................................................................... BOARD MEMBER	1.00 ................. 1.00	X		0	0	0
(12) DANIEL J MANSUR ESQ...................................................................... BOARD MEMBER	1.00 ................. 3.00	X		0	0	0
(13) GEORGE MELTSAKOS MD...................................................................... BOARD MEMBER	1.00 ................. 1.00	X		0	0	0
(14) TUSHAR PATEL MD...................................................................... BOARD MEMBER	1.00 ................. 1.00	X		0	0	0
(15) NAOMI M PRENDERGAST...................................................................... VICE CHAIR	1.00 ................. 2.00	X	X	0	0	0
(16) BRUCE ROBINSON...................................................................... BOARD MEMBER	1.00 ................. 1.00	X		0	0	0
(17) AMY HOEY...................................................................... PRESIDENT	1.00 ................. 49.00		X	806,881	0	126,817

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) ZACHARY REDMOND ESQ........................................................................ SECRETARY	1.00 .......................49.00	X				0	599,263	70,149
(19) SUSAN GREEN........................................................................ TREASURER (UNTIL 12/23)	1.00 .......................49.00	X				0	1,047,084	38,808
(20) ANDREW DEVOE........................................................................ TREASURER/CFO	1.00 .......................49.00	X				0	0	0
(21) CECELIA LYNCH........................................................................ VP/PATIENT CARE SVCS, CNE	50.00 .......................0.00		X			520,486	0	30,132
(22) DIANE REGAN........................................................................ ASSOC CHIEF NURSING OFFICER	50.00 .......................0.00			X		271,037	0	20,868
(23) JASON PROULX........................................................................ CLINICAL ADMIN COORDINATOR	50.00 .......................0.00			X		237,300	0	21,065
(24) KATHLEEN GARLAND........................................................................ SR DIRECTOR CONTRACTING	50.00 .......................0.00			X		251,539	0	19,402
(25) TRACIE MCPADDEN........................................................................ ASSOCIATE CNO	50.00 .......................0.00			X		262,823	0	22,260
(26) YISHI REN........................................................................ CHIEF MEDICAL PHYSICIST	50.00 .......................0.00			X		306,967	0	18,819
(27) JOSEPH A WHITE........................................................................ FORMER PRESIDENT/CEO (UNTIL 9/23)	0.00 .......................50.00				X	0	1,117,468	23,483
(28) WILLIAM F WYMAN........................................................................ FORMER SR VP, OPS/TREAS/ASST CLERK	0.00 .......................50.00				X	0	499,190	60,460
(29) WILLIAM GALVIN III MD........................................................................ FORMER BOARD MEMBER/MED DIR.	50.00 .......................0.00				X	577,138	0	24,295

(A) Name and business address	(B) Description of services	(C) Compensation
MERRIMACK VALLEY EMERGENCY MEDICAL SERVI 1 HOSPITAL DR LOWELL,MA01852	PHYSICIAN SERVICES	8,697,284
SODEXO INC & AFFILIATES 9801 WASHINGTONIAN BLVD GAITHERSBURG,MD20878	FOOD & FACILITIES SERVICES	4,955,959
CERNER CORPORATION 2800 ROCKCREEK PARKWAY NORTH KANSAS CITY,MO64117	INFORMATION SYSTEMS PROVIDER	1,895,856
FRESENIUS MANAGEMENT SERVICES INC 920 WINTER STREET WALTHAM,MA02451	ADMINISTRATIVE SERVICES	1,816,747
SHIELDS HEALTH CARE GROUP INC 700 CONGRESS STREET 204 QUINCY,MA02169	MEDICAL SERVICES	1,303,040
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 29

- TIN:

SCHEDULE A
(Form 990)

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.
right arrow

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

OMB No. 1545-0047

2023

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).)

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 33 1/3% 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 33 1/3% 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 on 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) 2023

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2019	(b) 2020	(c) 2021	(d) 2022	(e) 2023	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..	35,087,144	12,022,244	28,717,039	56,579,860	16,318,725	148,725,012
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	35,087,144	12,022,244	28,717,039	56,579,860	16,318,725	148,725,012
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.						148,725,012

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2019	(b) 2020	(c) 2021	(d) 2022	(e) 2023	(f) Total
7	Amounts from line 4..	35,087,144	12,022,244	28,717,039	56,579,860	16,318,725	148,725,012
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...	3,939,580	2,067,759	887,348	725,064	1,859,874	9,479,625
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.)..	154,574	82,122	83,550	56,000	35,620	411,866
11	Total support. Add lines 7 through 10						158,616,503

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

2,578,430,608

First 5 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 2023 (line 6, column (f) divided by line 11, column (f)) .........

93.760 %

Public support percentage for 2022 Schedule A, Part II, line 14 ...............

91.310 %

16a

33 1/3% support test—2023. 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—2022. 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—2023. 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—2022. 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) 2023

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) 2019	(b) 2020	(c) 2021	(d) 2022	(e) 2023	(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) 2019	(b) 2020	(c) 2021	(d) 2022	(e) 2023	(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 on 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 5 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 2023 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2022 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2023 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2022 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests-2023. 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—2022. 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) 2023

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, 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 lines 3b and 3c 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 box 12a or 12b in Part I, answer lines 4b and 4c 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 lines 5b and 5c 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) .

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

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 on 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 on 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) 2023

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 on lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described on 11a above?

11b

A 35% controlled entity of a person described on line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, 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 line 2 above, 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 lines 2a and 2b 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 on line 2a, above 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 lines 3a and 3b 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?If "Yes" or "No", 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) 2023

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 0.015 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 0.035	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) 2023

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	1
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity	2
3 Administrative expenses paid to accomplish exempt purposes of supported organizations	3
4 Amounts paid to acquire exempt-use assets	4
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI)	5
6 Other distributions (describe in Part VI). See instructions	6
7Total annual distributions. Add lines 1 through 6.	7
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions	8
9 Distributable amount for 2023 from Section C, line 6	9
10 Line 8 amount divided by Line 9 amount	10

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2023	(iii) Distributable Amount for 2023
1 Distributable amount for 2023 from Section C, line 6
2 Underdistributions, if any, for years prior to 2023 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2023:
a From 2018.......
b From 2019.......
c From 2020.......
d From 2021.......
e From 2022.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2023 distributable amount
i Carryover from 2018 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2023 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2023 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2023, 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 2023. 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 2024. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2019.....
b Excess from 2020.....
c Excess from 2021.....
d Excess from 2022.....
e Excess from 2023.....

Schedule A (Form 990) (2023)

Schedule A (Form 990) 2023

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, PART II, LINE 10, EXPLANATION OF OTHER INCOME:	FUNDRAISING EVENT INCOME - 2019 AMOUNT: $ 154,574. 2020 AMOUNT: $ 82,122. 2021 AMOUNT: $ 83,550. 2022 AMOUNT: $ 56,000. 2023 AMOUNT: $ 35,620.

Schedule A (Form 990) 2023

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990)

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

2023

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) (2023)

Schedule B (Form 990) (2023) Page 2

Name of organization THE LOWELL GENERAL HOSPITAL

Part I Contributors	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) (2023)

Schedule B (Form 990) (2023)

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) (2023)

Schedule B (Form 990) (2023)

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) (2023)

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.
right arrow

Attach to Form 990.
right arrow

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

OMB No. 1545-0047

2022

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 July 25, 2006, 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 right arrow

Number of states where property subject to conservation easement is located right arrow

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
right arrow

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
right arrow

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 FASB 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 FASB 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 ......................... right arrow

(ii)

Assets included in Form 990, Part X ............................... right arrow

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 FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... right arrow

Assets included in Form 990, Part X ............................... right arrow

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

Cat. No. 52283D

Schedule D (Form 990) 2022

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 ....	4,356,562	28,407,899	101,547,015	85,601,158	78,726,366
b	Contributions ...					10,000
c	Net investment earnings, gains, and losses	509,543	950,343	-11,136,207	15,956,346	6,864,792
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...	11,837	25,001,680	62,002,909	10,489
f	Administrative expenses ....
g	End of year balance ......	4,854,268	4,356,562	28,407,899	101,547,015	85,601,158

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

Board designated or quasi-endowment right arrow

20.710 %

Permanent endowment right arrow

79.290 %

Term endowment right arrow

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 ....	317,411,903	182,580,760	134,831,143
c	Leasehold improvements	8,252,922	7,673,954	578,968
d	Equipment ....	146,452,950	123,551,255	22,901,695
e	Other .....	126,239,446	72,203,971	54,035,475
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				217,725,045

Schedule D (Form 990) 2022

Page 3

Part VII

Investments - Other 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) MUTUAL FUNDS	24,021,623	F
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	24,021,623

Part VIII

Investments - Program 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				9,222,280
(2)DUE FROM AFFILIATES				12,856,582
(3)RIGHT OF USE ASSETS				3,029,796
(4)ESTIMATED 3RD PARTY - CURRENT				1,146,609
(5)ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS				25,622,322
(6)DEFERRED COMPENSATION AND OTHER				9,214
(7)INVESTMENTS IN UNCONSOLIDATED AFFILIATES				19,001,452
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				70,888,255

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	5,499,648
ACCRUED PENSION EXPENSE	19,394,983
OTHER LONG-TERM LIABILITIES	6,402,193
DUE TO AFFILIATES	4,750,642
RIGHT OF USE LIABILITIES	3,328,249
SELF-INSURANCE RESERVES	5,757,364
ESTIMATED THIRD PARTY SETTLEMENTS	1,809,237


Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	46,942,316
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) 2022

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	682,131,536
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a	-243,486
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ...........	2d	114,995,490
e	Add lines 2a through 2d .....................			2e	114,752,004
3	Subtract line 2e from line 1..................			3	567,379,532
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	8,997
b	Other (Describe in Part XIII.) ...........	4b	37,866,389
c	Add lines 4a and 4b....................			4c	37,875,386
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	605,254,918

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	590,225,600
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	1,261,485
e	Add lines 2a through 2d....................			2e	1,261,485
3	Subtract line 2e from line 1...................			3	588,964,115
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	8,997
b	Other (Describe in Part XIII.) ...........	4b	37,866,389
c	Add lines 4a and 4b.....................			4c	37,875,386
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	626,839,501

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:	NET ASSET TRANSFERS 105,187,473. RENTAL EXPENSE 1,731,713. SPECIAL EVENTS EXPENSE -470,228. PENSION RELATED ADJUSTMENTS 8,546,532.
PART XI, LINE 4B - OTHER ADJUSTMENTS:	OTHER COMPONENTS OF NET PERIODIC PENSION COSTS 2,048,728. PROVISION FOR UNCOLLECTIBLE ACCOUNTS 35,817,661.
PART XII, LINE 2D - OTHER ADJUSTMENTS:	RENTAL EXPENSES 1,731,713. SPECIAL EVENTS EXPENSE -470,228.
PART XII, LINE 4B - OTHER ADJUSTMENTS:	OTHER COMPONENTS OF NET PERIODIC PENSION COSTS 2,048,728. PROVISION FOR UNCOLLECTIBLE ACCOUNTS 35,817,661.

Schedule D (Form 990) 2022

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE G (Form 990)

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

2023

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 10 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) 2023

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 TEAMWALK FOR CANCER (event type)	(b) Event #2 LGH BALL (event type)	(c) Other events 2 (total number)	(d) Total events (add col. (a) through col. (c))
1	Gross receipts . . . . .	650,752	618,417	240,400	1,509,569
2	Less: Contributions . . . .	615,132	618,417	240,400	1,473,949
3	Gross income (line 1 minus line 2) . . . . . .	35,620			35,620

4	Cash prizes . . . . .	0	0	0
5	Noncash prizes . . . .	771	5,363	400	6,534
6	Rent/facility costs . . . .	25,789	79,955	14,211	119,955
7	Food and beverages . . .	5,059	470	0	5,529
8	Entertainment . . . .	61,744	72,592	3,985	138,321
9	Other direct expenses . . .	168,943	23,926	7,020	199,889
10	Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . .				470,228
11	Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . .				-434,608

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) 2023

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) 2023

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 20a.
Medium right arrow

Attach to Form 990.
Medium right arrow

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

OMB No. 1545-0047

2023

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) . . .	9,557,737	3,502,859	6,054,878	0.970 %
b	Medicaid (from Worksheet 3, column a) . . . . .	7,032,244		7,032,244	1.120 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .	18,642,978		18,642,978	2.970 %
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	35,232,959	3,502,859	31,730,100	5.060 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	3,910,175	540	3,909,635	0.620 %
f	Health professions education (from Worksheet 5) . . .	804,542	207,078	597,464	0.100 %
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .	480,634	27,770	452,864	0.070 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	44,181		44,181	0.010 %
j	Total. Other Benefits . .	5,239,532	235,388	5,004,144	0.800 %
k	Total. Add lines 7d and 7j .	40,472,491	3,738,247	36,734,244	5.860 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2023

Schedule H (Form 990) 2023

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.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare 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. ......

13,128,394

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. ......

787,704

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).....

108,186,037

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

141,006,563

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

-32,820,526

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) 2023

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) 2023

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 22

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.TUFTSMEDICINE.ORG/GET-CARE/OUR-LOCATIONS/ABOUT-LOWELL-GENERAL-HOSPITAL/

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 22

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

Yes

If "Yes" (list url): WWW.TUFTSMEDICINE.ORG/GET-CARE/OUR-LOCATIONS/ABOUT-LOWELL-GENERAL-HOSPITAL/

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) 2023

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.TUFTSMEDICINE.ORG/GET-CARE/OUR-LOCATIONS/ABOUT-LOWELL-GENERAL-HOSPITAL/

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.TUFTSMEDICINE.ORG/GET-CARE/OUR-LOCATIONS/ABOUT-LOWELL-GENERAL-HOSPITAL/

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) 2023

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 (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

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) 2023

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) 2023

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, 20a, 20b, 20c, 20d, 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 (CHNA) EVERY THREE YEARS, WITH THE MOST RECENT BEING COMPLETED IN 2022. INFORMATION FOR THE NEEDS ASSESSMENT WAS COLLECTED IN THE FOLLOWING WAYS: (1) COMMUNITY SURVEYS, (2) LISTENING SESSIONS, (3) A REVIEW OF PUBLIC HEALTH DEMOGRAPHIC DATA, AND (4) KEY INFORMANT INTERVIEWS. THE CHNA IS CONDUCTED IN PARTNERSHIP WITH THE GREATER LOWELL HEALTH ALLIANCE (GLHA), AND THE UNIVERSITY OF MASSACHUSETTS-LOWELL.
THE LOWELL GENERAL HOSPITAL PART V, SECTION B, LINE 5:	AS PART OF THE ASSESSMENT, THERE WERE 2,055 SURVEYS COMPLETED, 26 FOCUSED LISTENING SESSIONS COMPLETED, AND 30 KEY INFORMANT INTERVIEWS COMPLETED. SURVEYS WERE TRANSLATED INTO 6 LANGUAGES (SPANISH, PORTUGUESE, KHMER, ARABIC, FRENCH AND SWAHILI, AND COULD BE COMPLETED ON-LINE OR ON PAPER. THE LISTENING SESSIONS WERE CONDUCTED BY RESEARCH STUDENTS FROM THE UNIVERSITY OF MASSACHUSETTS-LOWELL AND HAD OVER 230 PARTICIPANTS. THE LISTENING SESSIONS WERE HELD WITH POPULATION GROUPS OF PARTICULAR INTEREST, INCLUDING SPANISH AND KHMER SPEAKING COMMUNITY MEMBERS, THE ELDERLY, RECENT IMMIGRANTS, AND COMMUNITY MEMBERS IN RECOVERY. MULTIPLE PUBLIC HEALTH DEMOGRAPHIC DATA SOURCES WERE REVIEWED FROM THE MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH POPULATION HEALTH INFORMATION TOOL (PHIT). LASTLY, 30 KEY COMMUNITY MEMBERS WERE INTERVIEWED, INCLUDING PHYSICIANS, COMMUNITY LEADERS, AND FIRST RESPONDERS. THE TOP HEALTH PRIORITIES IDENTIFIED IN THIS COMPREHENSIVE ARE 1) MENTAL HEALTH, 2) CHRONIC HEALTH AND WELLNESS (INCLUDING HEART HEALTH AND NUTRITION), 3) SUBSTANCE AND ALCOHOL USE, 4) COVID-19 AND OTHER INFECTIOUS DISEASES, AND 5) REPRODUCTIVE, SEXUAL AND PREGNANCY HEALTH. IN ADDITION, THE ASSESSMENT IDENTIFIED THE TOP SOCIOECONOMIC FACTORS INCLUDING HOUSING COSTS, THE COST OF INSURANCE AND LOW WAGES AS BARRIERS TO THE ABILITY TO ACCESS HEALTH SERVICES.THE TOP RESOURCES IDENTIFIED WERE 1) A ROBUST AND ACCESSIBLE HEALTHCARE SERVICE INFRASTRUCTURE, 2) SUBSTANCE USE PREVENTION AND TREATMENT SERVICES, 3) NUTRITION AND FOOD SECURITY, 4) AFFORDABLE, SAFE HOUSING, AND 5) SERVICES FOR CHILDREN AND YOUTH.RECOMMENDATIONS FROM THE SURVEYS, LISTENING SESSIONS, AND KEY INFORMANT INTERVIEWS INCLUDED INCREASING THE ACCESSIBILITY OF EXISTING HEALTHCARE SERVICES, ENGAGING WITH LOCAL AND STATE OFFICIALS TO REDUCE THE COST OF LIVING, AND IMPROVEMENTS IN COMMUNICATION TO THE COMMUNITY BY INCREASING THE NUMBER OF TRANSLATED PRINTED AND ON-LINE HEALTHCARE RELATED INFORMATION.
THE LOWELL GENERAL HOSPITAL PART V, SECTION B, LINE 6B:	LOWELL GENERAL HOSPITAL CONDUCTED THE 2022 COMMUNITY HEALTH ALLIANCE WITH THE GREATER LOWELL HEALTH ALLIANCE (GLHA) AND THE UNIVERSITY OF MASSACHUSETTS-LOWELL.
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, CHRONIC HEALTH ISSUES (HEART DISEASE, HYPERTENSION, ETC.), SUBSTANCE AND ALCOHOL DISORDER, COVID-19 AND OTHER INFECTIOUS DISEASES, AND REPRODUCTIVE AND SEXUAL HEALTH. 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 SOCIAL ISSUES IDENTIFIED IN THE 2022 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, AND BARRIERS TO ACCESS SERVICES DUE TO TRANSPORTATION, CULTURAL CONCERNS AND LIMITED ACCESS TO PRIMARY CARE PHYSICIANS.LOWELL GENERAL HOSPITAL WORKS CLOSELY WITH THE GREATER LOWELL HEALTH ALLIANCE TO WORK WITH THE COMMUNITY TO FORM A COMMUNITY HEALTH IMPROVEMENT PLAN(CHIP) TO ADDRESS THESE ISSUES AND WORK COLLABORATIVELY TO ASSIST OUR COMMUNITY. THIS CHIP PROVIDES A GUIDE FOR COMMUNITY AGENCIES TO FOCUS RESOURCES AND PROGRAMMING TO RESPOND TO THE NEEDS OF OUR PATIENTS AND COMMUNITY MEMBERS.
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) 2023

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?18
Name and address		Type of Facility (describe)
1	1 - LGH - OFFICE SPACE OFF-SITE 10 RESEARCH PLACE CHELMSFORD,MA01824	SURGICAL DAY CARE, OCCUPATIONAL MEDICINE, LAB & X-RAY
2	2 - LGH - OFFICE SPACE OFF-SITE 2-4 MEETINGHOUSE RD 17 18 CHELMSFORD,MA01824	PATIENT AMBASSADOR & LAB OFFICE SPACE
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 2337 VILLAGE SQUARE CHELMSFORD,MA01854	PROVIDE BLOOD DRAWING SERVICES
7	7 - LGH - OFFICE SPACE OFF-SITE 600 CLARK RD TEWKSBURY,MA01876	PROVIDE BLOOD DRAWING & RADIOLOGY SERVICES
8	8 - LGH - OFFICE SPACE OFF-SITE 161 JACKSON ST LOWELL,MA01852	LAB OFFICE SPACE
9	9 - LGH - OFFICE SPACE OFF-SITE 10 ADAMS ST CHELMSFORD,MA01824	LAB OFFICE SPACE
10	10 - LGH - OFFICE SPACE OFF-SITE 43 VILLAGE SQUARE CHELMSFORD,MA01824	REHABILITATION SERVICES
11	11 - LGH - OFFICE SPACE OFF-SITE 1595 BRIDGE ST DRACUT,MA01826	PATIENT SERVICE CENTER
12	12 - LGH - OFFICE SPACE OFF-SITE 1574 MAIN ST TEWKSBURY,MA01876	URGENT CARE & PATIENT SERVICE CENTER
13	13 - LGH - OFFICE SPACE OFF-SITE 198 LITTLETON ROAD WESTFORD,MA01886	URGENT CARE & PATIENT SERVICE CENTER
14	14 - LGH - OFFICE SPACE OFF-SITE 33 BARTLETT ST LOWELL,MA01852	CIRCLE CARE BEHAVIORLAL HEALTH
15	15 - LGH - OFFICE SPACE OFF-SITE 199 BOSTON ROAD NO BILLERICA,MA01821	URGENT CARE & PATIENT SERVICE CENTER
16	16 - LGH - OFFICE SPACE OFF-SITE 9 LOON HILL ROAD DRACUT,MA01850	URGENT CARE & PATIENT SERVICE CENTER
17	17 - LGH - OFFICE SPACE OFF-SITE 847 ROGERS ST LOWELL,MA01852	PROVIDE DIALYSIS SERVICES
18	18 - LGH - OFFICE SPACE OFF-SITE 49 ATWOOD ROAD PELHAM,NH03076	PATIENT SERVICE CENTER, LAB AND X-RAY, AND PEDIATRICS

Schedule H (Form 990) 2023

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 FY2024 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:	LOWELL GENERAL HOSPITAL COMPLETES A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) EVERY THREE YEARS, WITH THE MOST RECENT BEING COMPLETED IN 2022. INFORMATION FOR THE NEEDS ASSESSMENT WAS COLLECTED IN THE FOLLOWING WAYS: (1) COMMUNITY SURVEYS, (2) LISTENING SESSIONS, (3) A REVIEW OF PUBLIC HEALTH DEMOGRAPHIC DATA, AND (4) KEY INFORMANT INTERVIEWS. THE CHNA IS CONDUCTED IN PARTNERSHIP WITH THE GREATER LOWELL HEALTH ALLIANCE (GLHA), AND THE UNIVERSITY OF MASSACHUSETTS-LOWELLTHE 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. 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 13 AND 14 OF THE AUDITED FINANCIAL STATEMENTS ATTACHED. THE FOLLOWING IS EXCERPTED FROM THAT FOOTNOTE:GENERALLY, PATIENTS WHO ARE COVERED BY THIRD-PARTY PAYORS ARE RESPONSIBLE FOR RELATED DEDUCTIBLES AND COINSURANCE, WHICH VARY IN AMOUNT. THE SYSTEM ALSO PROVIDES SERVICES TO UNINSURED PATIENTS, AND OFFERS THOSE UNINSURED PATIENTS A DISCOUNT, EITHER BY POLICY OR LAW, FROM STANDARD CHARGES. THE SYSTEM ESTIMATES THE TRANSACTION PRICE FOR PATIENTS WITH DEDUCTIBLES AND COINSURANCE AND FROM THOSE WHO ARE UNINSURED BASED ON HISTORICAL EXPERIENCE AND CURRENT MARKET CONDITIONS. THE INITIAL ESTIMATE OF THE TRANSACTION PRICE IS DETERMINED BY REDUCING THE STANDARD CHARGE BY ANY CONTRACTUAL ADJUSTMENTS, DISCOUNTS, AND IMPLICIT PRICE CONCESSIONS. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE GENERALLY RECORDED AS ADJUSTMENTS TO PATIENT SERVICE REVENUE IN THE PERIOD OF THE CHANGE. FOR THE YEARS ENDED SEPTEMBER 30, 2024 AND 2023, ADDITIONAL REVENUE OF $28,686,000 AND $28,812,000, RESPECTIVELY, WAS RECOGNIZED DUE TO CHANGES IN ITS ESTIMATES OF IMPLICIT PRICE CONCESSIONS, DISCOUNTS, AND CONTRACTUAL ADJUSTMENTS FOR PERFORMANCE OBLIGATIONS SATISFIED IN PRIOR YEARS. SUBSEQUENT CHANGES THAT ARE DETERMINED TO BE THE RESULT OF AN ADVERSE CHANGE IN THE PATIENT'S ABILITY TO PAY ARE RECORDED AS BAD DEBT EXPENSE.THE FOLLOWING IS FROM THE TUFTS MEDICINE, INC. AND CONSOLIDATED AFFILIATES (THE SYSTEM) AUDITED FINANCIAL STATEMENTS, OF WHICH THE LOWELL GENERAL HOSPITAL IS INCLUDED, RELATING TO CHARITY CARE AND BAD DEBT EXPENSE:CHARITY CARE AND COMMUNITY BENEFITS FOOTNOTECHARITY CARE - THE SYSTEM'S COMMITMENT TO COMMUNITY SERVICE IS EVIDENCED BY SERVICES PROVIDED TO THE POOR AND BENEFITS PROVIDED TO THE PATIENTS THAT IT SERVES. THE SYSTEM PROVIDES HEALTH CARE SERVICES TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY. THESE PATIENTS MAY RECEIVE FULL ASSISTANCE OR MAY BE SUBJECT TO PARTIAL LIABILITY BASED ON INCOME AND FAMILY SIZE. BECAUSE THE SYSTEM DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, SUCH AMOUNTS ARE NOT REPORTED AS NET PATIENT SERVICE REVENUE.THE SYSTEM PROVIDED CHARITY CARE, BASED ON ESTIMATED COST OF THE CHARITY CARE PROVIDED, OF $10,919,000 AND $3,237,000 FOR THE YEAR ENDED SEPTEMBER 30, 2024 AND 2023, RESPECTIVELY. THE ESTIMATED COST OF CHARITY CARE IS BASED ON THE RELATIONSHIP OF PATIENT CARE SERVICE CHARGES TO THE RELATED COSTS APPLIED TO CHARITY CARE CHARGES RECOGNIZED DURING THE YEARS ENDED SEPTEMBER 30, 2024 AND 2023. THE SYSTEM HAS NOT CHANGED ITS CHARITY CARE OR UNINSURED DISCOUNT POLICIES DURING 2024.THE SYSTEM DOES NOT MAINTAIN A MATERIAL ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS FROM THIRD-PARTY PAYERS, NOR DID IT HAVE SIGNIFICANT BAD DEBT WRITE-OFFS FROM THIRD-PARTY PAYERS.HEALTH SAFETY NET FUND (HSN) - THE COMMONWEALTH OF MASSACHUSETTS (THE "COMMONWEALTH") OPERATES THE HSN, WHICH WAS CREATED BY THE COMMONWEALTH'S HEALTH CARE REFORM ACT TO REPLACE THE STATE'S UNCOMPENSATED CARE POOL. THE HSN ALLOCATES THE COST OF UNCOMPENSATED CARE AMONG THE HOSPITALS IN THE COMMONWEALTH. HOSPITALS HAVE BEEN ASSESSED A UNIFORM ALLOWANCE BASED ON ESTIMATES OF THE STATEWIDE COST OF UNCOMPENSATED CARE AND REIMBURSED FOR A PORTION OF THE COST OF UNCOMPENSATED CARE, SUBJECT TO CERTAIN LIMITATIONS. REIMBURSABLE UNCOMPENSATED CARE INCLUDES NET CHARITY CARE AND CERTAIN UNCOLLECTIBLE ACCOUNTS RELATED TO EMERGENCY SERVICES. HOSPITALS' RECOVERIES FROM THE HSN ARE BASED ON A CLAIMS-BASED PAYMENT METHOD THAT USES MEDICARE PRINCIPLES. REIMBURSEMENT FROM THE HSN FOR UNCOMPENSATED CARE IS RECORDED IN NET PATIENT SERVICE REVENUE IN THE CONSOLIDATED STATEMENT OF OPERATIONS. THE COMMONWEALTH HAS DETERMINED FINAL SETTLEMENTS WITH RESPECT TO THE HSN FOR ALL YEARS PRIOR TO 2021.COMMUNITY BENEFIT - IN FURTHERING ITS CHARITABLE PURPOSE, THE SYSTEM PROVIDES A WIDE VARIETY OF HEALTH CARE SERVICES TO THE COMMUNITY IN ORDER TO PROVIDE ACCESS TO APPROPRIATE CARE FOR POPULATIONS IN NEED. THE SYSTEM HAS DEVELOPED A FORMAL COMMUNITY BENEFIT PLAN THAT RESPONDS TO THE COMPREHENSIVE ASSESSMENT OF HEALTH CARE NEEDS IN THE COMMUNITY. THE COMMUNITY BENEFIT PLAN SUPPORTS SERVICES THAT TARGET NOT ONLY THE GENERAL POPULATION IN THE SYSTEM'S SERVICE AREA, BUT ALSO PARTICULAR POPULATIONS WITH SPECIAL HEALTH CARE NEEDS, INCLUDING THE POOR, ELDERLY, CHILDREN, AND MINORITY POPULATIONS. SUPPORTED SERVICES INCLUDE VARIOUS CLINICS, HEALTH SCREENING PROGRAMS, HEALTH EDUCATION PROGRAMS, AND SUPPORT GROUPS OPERATED IN THE SYSTEM'S SERVICE AREA. ADDITIONALLY, CERTAIN PATIENT SERVICES ARE PROVIDED WITHOUT COMPENSATION. THE SYSTEM WORKS ACTIVELY WITH OTHER AREA SERVICE PROVIDERS TO FACILITATE THE DEVELOPMENT OF AN EFFECTIVE COMMUNITY HEALTH NETWORK. THE SYSTEM ALSO PARTICIPATES IN ACTIVITIES DESIGNED TO FOSTER AND ENHANCE THE ECONOMIC AND CIVIC ENVIRONMENT OF ITS SERVICE AREAS.
PART III, LINE 8:	THERE WAS A DECLINE IN MEDICARE VOLUME FOR BOTH INPATIENT AND OUTPATIENT COMPARING FISCAL YEARS.
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.LOWELL GENERAL HOSPITAL COMPLETES A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) EVERY THREE YEARS, WITH THE MOST RECENT BEING COMPLETED IN 2022. INFORMATION FOR THE NEEDS ASSESSMENT WAS COLLECTED IN THE FOLLOWING WAYS: (1) COMMUNITY SURVEYS, (2) LISTENING SESSIONS, (3) A REVIEW OF PUBLIC HEALTH DEMOGRAPHIC DATA, AND (4) KEY INFORMANT INTERVIEWS. THE CHNA IS CONDUCTED IN PARTNERSHIP WITH THE GREATER LOWELL HEALTH ALLIANCE (GLHA), AND THE UNIVERSITY OF MASSACHUSETTS-LOWELL. THE GREATER LOWELL REGION INCLUDES EIGHT COMMUNITIES: BILLERICA, CHELMSFORD, DRACUT, DUNSTABLE, LOWELL, TEWKSBURY, TYNGSBORO, AND WESTFORD. THERE IS SIGNIFICANT SOCIO-ECONOMIC VARIATION IN GREATER LOWELL. APPROXIMATELY 9.6% OF RESIDENTS LIVE BELOW THE FEDERAL POVERTY LINE, BUT THE MEDIAN INCOME RANGES FROM A HIGH OF $158,523 IN DUNSTABLE TO A LOW OF $62,196 IN LOWELL. THE PREMATURE MORTALITY RATE (PMR) IS A MEASURE OF DEATHS THAT OCCUR BEFORE AGE 75, CALCULATED AS A RATE PER 100,000 RESIDENTS. THE PMR OF GREATER LOWELL (295.7 PER 100,000) IS HIGHER THAN THE STATE RATE OF (272.8 PER 100,000). THE GREATER LOWELL REGION ALSO IDENTIFIED MENTAL HEALTH AS THE TOP HEALTH PRIORITY IN THE 2022 CHNA.
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 SEPTEMBER 2022 INDICATES A 4.2% UNEMPLOYMENT RATE COMPARED TO 3.7% FOR THE STATE OF MASSACHUSETTS. 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 2020, THE GREATER LOWELL AREA, AS DEFINED HEREIN, HAD A POPULATION OF 310,000 RESIDENTS, INCLUDING AN ESTIMATED 113,000 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 HOMELESSNESS TASK FORCE, THE HOUSING AND BUILT ENVIRONMENT TASK FORCE, LOWELL'S EARLY CHILDHOOD ADVISORY COUNCIL, AND THE HEALTH EQUITY TASK FORCE. OUR LEADERSHIP ROLE IN THESE INITIATIVES ENABLES US TO INCREASE COMMUNITY BUILDING AND CAPACITY, BROADENING THE IMPACT OF OUR REACH. 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 TO SIX (SUBSTANCE USE & PREVENTION, MENTAL HEALTH, CULTURAL COMPETENCE, HEALTHY EATING & LIVING, HOUSING AND BUILT ENVIRONMENT, 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", TO RAISE AWARENESS AND FUNDS FOR COMMUNITY OUTREACH AND EDUCATION. THE BALL EVENT DID NOT OCCUR BETWEEN 2020 AND 2022 DUE TO COVID. IN THE FIVE YEARS BEFORE THAT, LOWELL GENERAL HOSPITAL RAISED MORE THAN $1.7 MILLION 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. 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 2014, 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 TUFTS MEDICINE 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) 2023

Additional Data

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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

2023

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) D'YOUVILLE SENIOR CARE 981 VARNUM AVE LOWELL,MA01854	91-2055004	501(C)(3)	9,000	SPONSORSHIP
(2) NASHOBA VALLEY SKI AREA 79 POWERS RD WESTORD,MA01886	04-2349619		25,000	SPONSORSHIP
(3) UNIVERSITY OF MASSACHUSETTS LOWELL 225 FRANKLIN ST FL 33 BOSTON,MA02110	04-3167352	GOV'T ENTITY	16,250	DONATION/SPONSOR VARIOUS EVENTS

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) 2023

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) 2023

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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
medium right arrow graphic

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
medium right arrow graphic

Attach to Form 990.
medium right arrow graphic

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

OMB No. 1545-0047

2023

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 on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .....

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

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) 2023

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, 1099-MISC compensation, and/or 1099-NEC			(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)
1MICHAEL DANDORPH PRESIDENT & CEO - TUFTS MEDICINE	(i) (ii)	0 ------------- 1,330,398	0 ------------- 381,250	0 ------------- 14,502	0 ------------- 335,493	0 ------------- 24,218	0 ------------- 2,085,861	0 ------------- 0
2JOSEPH A WHITE FORMER PRESIDENT/CEO (UNTIL 9/23)	(i) (ii)	0 ------------- 650,140	0 ------------- 0	0 ------------- 467,328	0 ------------- 10,825	0 ------------- 12,658	0 ------------- 1,140,951	0 ------------- 261,092
3SUSAN GREEN TREASURER (UNTIL 12/23)	(i) (ii)	0 ------------- 793,432	0 ------------- 123,750	0 ------------- 129,902	0 ------------- 14,707	0 ------------- 24,101	0 ------------- 1,085,892	0 ------------- 116,452
4AMY HOEY PRESIDENT	(i) (ii)	667,948 ------------- 0	103,275 ------------- 0	35,658 ------------- 0	102,784 ------------- 0	24,033 ------------- 0	933,698 ------------- 0	22,819 ------------- 0
5ZACHARY REDMOND ESQ SECRETARY	(i) (ii)	0 ------------- 458,977	0 ------------- 88,250	0 ------------- 52,036	0 ------------- 46,240	0 ------------- 23,909	0 ------------- 669,412	0 ------------- 41,693
6WILLIAM GALVIN III MD FORMER BOARD MEMBER/MED DIR.	(i) (ii)	497,639 ------------- 0	77,882 ------------- 0	1,617 ------------- 0	10,087 ------------- 0	14,208 ------------- 0	601,433 ------------- 0	0 ------------- 0
7WILLIAM F WYMAN FORMER SR VP, OPS/TREAS/ASST CLERK	(i) (ii)	0 ------------- 393,702	0 ------------- 50,787	0 ------------- 54,701	0 ------------- 44,218	0 ------------- 16,242	0 ------------- 559,650	0 ------------- 54,070
8CECELIA LYNCH VP/PATIENT CARE SVCS, CNE	(i) (ii)	379,178 ------------- 0	139,556 ------------- 0	1,752 ------------- 0	6,265 ------------- 0	23,867 ------------- 0	550,618 ------------- 0	0 ------------- 0
9YISHI REN CHIEF MEDICAL PHYSICIST	(i) (ii)	291,686 ------------- 0	0 ------------- 0	15,281 ------------- 0	8,953 ------------- 0	9,866 ------------- 0	325,786 ------------- 0	0 ------------- 0
10DIANE REGAN ASSOC CHIEF NURSING OFFICER	(i) (ii)	247,253 ------------- 0	13,028 ------------- 0	10,756 ------------- 0	6,514 ------------- 0	14,354 ------------- 0	291,905 ------------- 0	0 ------------- 0
11TRACIE MCPADDEN ASSOCIATE CNO	(i) (ii)	239,961 ------------- 0	12,793 ------------- 0	10,069 ------------- 0	7,873 ------------- 0	14,387 ------------- 0	285,083 ------------- 0	0 ------------- 0
12KATHLEEN GARLAND SR DIRECTOR CONTRACTING	(i) (ii)	216,601 ------------- 0	34,442 ------------- 0	496 ------------- 0	5,026 ------------- 0	14,376 ------------- 0	270,941 ------------- 0	0 ------------- 0
13JASON PROULX CLINICAL ADMIN COORDINATOR	(i) (ii)	228,690 ------------- 0	3,843 ------------- 0	4,767 ------------- 0	6,734 ------------- 0	14,331 ------------- 0	258,365 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2023

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, LINES 4A-B	JOSEPH WHITE RECEIVED $196,823 OF SEVERANCE IN CALENDAR YEAR 2023. SECTION 457(F) RETIREMENT PLAN EMPLOYER DEFERRALS: MICHAEL DANDORPH - $321,300 AMY HOEY - $87,784 ZACHARY REDMOND - $39,447 WILLIAM F. WYMAN - $34,318
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) 2023

Additional Data

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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.
Attach to Form 990.
Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2023

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	MASSACHUSETTS 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

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	65,689,334
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............
6 Proceeds in refunding escrows ...............
7 Issuance costs from proceeds ...............	1,009,853
8 Credit enhancement from proceeds .............
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............	15,585,808
11 Other spent proceeds .............	49,093,673
12 Other unspent proceeds .............
13 Year of substantial completion .............	2013
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue of tax-exempt bonds (or, if issued prior to 2020, a current refunding issue)? ........	X
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2020, an advance refunding issue)? ........		X
16 Has the final allocation of proceeds been made? ..........	X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X

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

Cat. No. 50193E

Schedule K (Form 990) 2023

Page 2

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
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............	X
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............	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
c Are there any research agreements that may result in private business use of bond-financed property? .............		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 ....	2.150 %
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 %
6 Total of lines 4 and 5 .............	2.150 %
7 Does the bond issue meet the private security or payment test? ...		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
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

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
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X
b Exception to rebate? ........		X
c No rebate due? .........	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

Schedule K (Form 990) 2023

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X
b Name of provider ..........
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		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
7 Has the organization established written procedures to monitor the requirements of section 148? ...	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

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: MASSACHUSETTS DEVELOPMENT FINANCE AGENCY SERIES G DATE THE REBATE COMPUTATION WAS PERFORMED: 04/30/2021

PART II:

MASS. DEVELOPMENT FINANCE AGENCY SERIES G, LINE 3B: TOTAL PROCEEDS OF ISSUE CONSISTS OF $65,688,217 ORGINAL PROCEEDS PLUS INVESTMENT INCOME OF $1,117 FOR TOTAL OF $65,689,334. THE LOWELL GENERAL HOSPITAL HAS HISTORICALLY DISCLOSED ON FORM 990, SCHEDULE K, ITS ALLOCATED SHARE OF SERIES A (2019) AND SERIES C (2020) BONDS OF THE OBLIGATED GROUP, WHICH INCLUDES TUFTS MEDICAL CENTER, INC. AND MELROSEWAKEFIELD HEALTHCARE, INC. FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2024, TUFTS MEDICAL CENTER, INC. HAS REPORTED ON ITS FORM 990, THE FULL AMOUNT OF THE SERIES A (2019) AND SERIES C (2020) BONDS, CONSISTENT WITH THE INTERNAL ACCOUNTING FOR THE INDEBTEDNESS AMONGST THE MEMBERS OF THE OBLIGATED GROUP AS OF SEPTEMBER 30, 2024. AS SUCH, THE LOWELL GENERAL HOSPITAL NO LONGER REPORTS THOSE ISSUES ON ITS FORM 990, SCHEDULE K.

Schedule K (Form 990) 2023

Additional Data

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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

2023

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 .
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	83	80,413	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 isn't 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 didn't 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) (2023)

Page 2

Part IISupplemental 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) (2023)

Additional Data

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SCHEDULE O
(Form 990)

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

OMB No. 1545-0047

2023

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. TUFTS MEDICINE, INC. IS THE SOLE CORPORATE MEMBER OF CIRCLE HEALTH, INC.
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 ADVISORS, 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 20% INTEREST IN YANKEE ALLIANCE, LLC AND A 50% INTEREST IN SHIELDS IMAGING OF LOWELL GENERAL HOSPITAL, 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:	PENSION RELATED ADJUSTMENTS 8,546,532. NET ASSET TRANSFERS 105,187,473. OTHER ADJUSTMENTS 183.

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

Cat. No. 51056K

Schedule O (Form 990) 2023

Additional Data

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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.
Attach to Form 990.
Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2023

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) CIRCLE HEALTH OBGYN 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) TUFTS MEDICINE PARTNERSHIP ACO LLC 800 DISTRICT AVE BURLINGTON,MA01803 00-1274839	ACO	MA	TUFTS MEDICINE INTEGRATED NETWORK INC
(9) TUFTS MEDICINE PHARMACY LLC 800 DISTRICT AVE BURLINGTON,MA01803 00-1530181	PHARMACY	MA	TUFTS MEDICINE INC
(10) WELLFORCE ACO LLC 800 DISTRICT AVE BURLINGTON,MA01803 00-1071236	ACO	MA	TUFTS MEDICINE INTEGRATED NETWORK 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 PROPERTIES 170 GOVERNORS AVE MEDFORD,MA02155 22-2580542	PROPERTY	MA	501(C)(3)	LINE 12B, II	MELROSEWAKEFIELD HEALTHCARE PARENT CORPORATION	Yes
(6)MELROSEWAKEFIELD HEALTHCARE PARENT CORPORATION 170 GOVERNORS AVE MEDFORD,MA02155 04-2103587	PARENT	MA	501(C)(3)	LINE 12A, I	TUFTS MEDICINE INC	Yes
(7)THE LOWELL GENERAL HOSPITAL 295 VARNUM AVENUE LOWELL,MA01854 04-2103590	HEALTH CARE	MA	501(C)(3)	LINE 3	CIRCLE HEALTH INC	Yes
(8)CIRCLE HEALTH PHYSICIANS INC 295 VARNUM AVENUE LOWELL,MA01854 27-3902914	MEDICAL SERVICES	MA	501(C)(3)	LINE 10	CIRCLE HEALTH INC	Yes
(9)LGH PHYSICIAN ASSOCIATES INC 295 VARNUM AVENUE LOWELL,MA01854 04-3190747	MEDICAL SERVICES	MA	501(C)(3)	PF	CIRCLE HEALTH PHYSICIANS INC	Yes
(10)CIRCLE HEALTH INC 295 VARNUM AVENUE LOWELL,MA01854 22-2579798	PARENT/SUPPORTING ORGANIZATION	MA	501(C)(3)	LINE 12B, II	TUFTS MEDICINE INC	Yes
(11)TUFTS MEDICINE INC 800 DISTRICT AVENUE BURLINGTON,MA01803 45-2250732	PARENT/SUPPORTING ORGANIZATION	MA	501(C)(3)	LINE 12A, I	N/A		No
(12)TUFTS MEDICINE INTEGRATED NETWORK INC 800 DISTRICT AVENUE BURLINGTON,MA01803 87-1600172	HEALTH CARE	MA	501(C)(3)	LINE 10	TUFTS MEDICINE INC	Yes
(13)CNS NURSING HOME CARE INC 360 MERRIMACK STREET BUILDING 9 LAWRENCE,MA01843 37-1836433	HOME CARE SERVICES	MA	501(C)(3)	LINE 10	CIRCLE HOME INC	Yes
(14)TUFTS MEDICAL CENTER PARENT INC 800 WASHINGTON STREET BOSTON,MA02111 04-2810022	FUNDRAISING, ADMIN. PLANNING & OTHER ACTIVITIES	MA	501(C)(3)	LINE 12B, II	TUFTS MEDICINE INC	Yes
(15)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
(16)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
(17)NEW ENGLAND QUALITY CARE ALLIANCE INC 800 WASHINGTON STREET BOSTON,MA02111 04-3040427	MEDICAL PROGRAMS & SERVICES	MA	501(C)(3)	LINE 10	TUFTS MEDICINE INTEGRATED NETWORK INC	Yes
(18)NEQCA ACCOUNTABLE CARE INC 325 WOOD RD SUITE 210 BRAINTREE,MA02184 80-0824142	ACO	MA	501(C)(3)	LINE 10	TUFTS MEDICINE INTEGRATED NETWORK INC	Yes
(19)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 PHYSICIANS ORG INC	Yes
(20)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
(21)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
(22)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
(23)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
(24)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
(25)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
(26)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
(27)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
(28)PRATT OTOLARYNGOLOGY 800 WASHINGTON STREET BOSTON,MA02111 04-3148381	MEDICAL SERVICES	MA	501(C)(3)	LINE 10	TUFTS MEDICAL CENTER PHYSICIANS ORG INC	Yes
(29)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
(30)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
(31)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
(32)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
(33)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
(34)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
(35)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
(36)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
(37)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
(38)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
(39)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
(40)LOWELL GENERAL HOSPITAL AUXILIARY 295 VARNUM AVENUE LOWELL,MA01854 22-3459303	SUPPORTING ORGANIZATION	MA	501(C)(3)	LINE 12A, I	N/A		No
(41)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
(42)TIFTS MEDICINE CARE AT HOME PARENT INC 360 MERRIMACK STREET BUILDING 9 LAWRENCE,MA01843 22-2587225	MANAGEMENT SERVICES	MA	501(C)(3)	LINE 12B, II	TUFTS MEDICINE INC	Yes
(43)HOME HEALTH VNA INC 360 MERRIMACK STREET BUILDING 9 LAWRENCE,MA01843 04-2435675	HOME HEALTH CARE	MA	501(C)(3)	LINE 10	TIFTS MEDICINE CARE AT HOME PARENT INC	Yes
(44)TUFTS MEDICINE CARE AT HOME INC 360 MERRIMACK STREET BUILDING 9 LAWRENCE,MA01843 04-3024278	HOSPICE SERVICES	MA	501(C)(3)	LINE 10	TIFTS MEDICINE CARE AT HOME PARENT INC	Yes
(45)HOME CARE INC 360 MERRIMACK STREET BUILDING 9 LAWRENCE,MA01843 04-2854358	HOME HEALTH SUPPORTIVE SERIVCES	MA	501(C)(3)	LINE 10	TIFTS MEDICINE CARE AT HOME PARENT INC	Yes

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

Cat. No. 50135Y

Schedule R (Form 990) 2023

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?		(k) Percentage ownership
(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	(k) Percentage ownership
(1) MONTVALE PETCT LLC 100 BAYVIEW CIRCLE SUITE 400 NEWPORT BEACH,CA92660 27-0325022	CAT SCAN	DE	MELROSEWAKEFIELD HEALTHCARE INC	RELATED				No			No
(2) 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

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	(h) Percentage ownership	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) LAWRENCE MELROSE MEDICAL ELECTRONICS RECORD INC 170 GOVERNORS AVE MEDFORD,MA02155 42-1685777	ELECTRONIC MEDICAL RECORDS	MA	MELROSEWAKEFIELD HEALTHCARE INC	C					No
(7) HALLMARK HEALTH PHO INC 170 GOVERNORS AVE MEDFORD,MA02155 46-1134759	PHYSICIAN HOSPITAL ORGANIZATION	MA	MELROSEWAKEFIELD HEALTHCARE INC	C					No
(8) TUFTS MEDICINE INDEMNITY COMPANY LTD 800 WASHINGTON STREET BOSTON,MA02111 98-0444573	CAPTIVE INSURANCE	CJ	TUFTS MEDICINE INC	C				Yes
(9) TMIN SERVICES INC 800 DISTRICT AVENUE BURLINGTON,MA01803 92-2005219	HEALTH CARE	MA	TUFTS MEDICINE INTEGRATED NETWORK INC	C				Yes

Schedule R (Form 990) 2023

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

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

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

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

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

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

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

Yes

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

Yes

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) CIRCLE HEALTH PHYSICIANS INC	E	4,462,247	BOOK VALUE
(2) TUFTS MEDICINE INC	D	4,665,749	BOOK VALUE
(3) TUFTS MEDICINE INDEMNITY COMPANY LTD	D	7,902,437	BOOK VALUE
(4) MELROSEWAKEFIELD HEALTHCARE INC	R	4,528,445	BOOK VALUE
(5) TUFTS MEDICAL CENTER INC	S	84,298,921	BOOK VALUE
(6) TUFTS MEDICINE INC	S	79,534,170	BOOK VALUE
(7) LGH MEDICAL BUILDING SERVICE INC	R	2,452,673	BOOK VALUE
(8) CIRCLE HEALTH PHYSICIANS INC	R	67,314,846	BOOK VALUE
(9) TUFTS MEDICINE INTEGRATED NETWORK INC	R	599,557	BOOK VALUE
(10) TUFTS MEDICINE CARE AT HOME INC	R	341,383	BOOK VALUE
(11) CIRCLE HEALTH INC	S	7,386,833	BOOK VALUE
(12) HALLMARK HEALTH MEDICAL ASSOCIATES	S	350,000	BOOK VALUE
(13) TUFTS MEDICAL CENTER PHYSICIANS ORG INC	S	8,583,593	BOOK VALUE

Schedule R (Form 990) 2023

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?		(k) Percentage ownership
(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	(k) Percentage ownership

Schedule R (Form 990) 2023

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) 2023

Additional Data

Software ID:
Software Version:

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	56,579,860	16,318,725
9	Program service revenue (Part VIII, line 2g) .........	522,242,458	560,961,261
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	55,120,766	1,839,451
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	23,179,363	26,135,481
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	657,122,447	605,254,918
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	187,967	78,924
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)	296,518,278	299,728,121
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 772,051
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	293,603,102	327,032,456
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	590,309,347	626,839,501
19	Revenue less expenses. Subtract line 18 from line 12.......	66,813,100	-21,584,583
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	481,194,403	399,882,241
21	Total liabilities (Part X, line 26).............	390,206,460	216,988,179
22	Net assets or fund balances. Subtract line 21 from line 20.....	90,987,943	182,894,062

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 337,640,091 including grants of $ 78,924 ) (Revenue $ 301,787,671 )
	LOWELL GENERAL HOSPITAL'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.

4b	(Code: ) (Expenses $ 181,499,480 including grants of $ ) (Revenue $ 286,285,209 )
	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).

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












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses519,139,571

1b	Sub-Total..............
c	Total from continuation sheets to Part VII, Section A..
d	Total (add lines 1b and 1c).........	3,234,171	4,989,155	836,269

		Business Code
2a	PATIENT SERVICE REVENUE	621500	560,961,261	560,961,261
b
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		560,961,261

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	15
5	Total number of individuals employed in calendar year 2023 (Part V, line 2a) ......	5	4,574
6	Total number of volunteers (estimate if necessary) .............	6	345
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	936,993
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	0

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c	1,473,949
d	Related organizations		1d
e	Government grants (contributions)		1e	14,794,457

f	All other contributions, gifts, grants, and similar amounts not included above		1f	50,319

g	Noncash contributions included in lines 1a - 1f:$		1g	80,413

h Total. Add lines 1a-1f.......		16,318,725

3 Investment income (including dividends, interest, and othersimilar amounts) ......			1,606,684		936,993	669,691
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
			(i) Real	(ii) Personal
6a	Gross rents	6a	1,190,183
b	Less: rental expenses	6b	1,731,713
c	Rental income or (loss)	6c	-541,530
d	Net rental income or (loss).......			-541,530			-541,530
			(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	7a	232,767
b	Less: cost or other basis and sales expenses	7b	0
c	Gain or (loss)	7c	232,767
d	Net gain or (loss).........			232,767			232,767
8a	Gross income from fundraising events (not including $ 1,473,949of contributions reported on line 1c). See Part IV, line 18 ....
			8a	35,620
b	Less: direct expenses ...		8b	470,228
c	Net income or (loss) from fundraising events..			-434,608			-434,608
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..

Business Code
11a	OTHER REVENUE		621500	27,111,619	27,111,619
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			27,111,619
12	Total revenue. See instructions.....			605,254,918	588,072,880	936,993	-73,680

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	78,924	78,924
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, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	2,564,077		2,564,077
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........	243,738,804	204,282,426	39,041,717	414,661
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	6,964,114	5,836,766	1,115,500	11,848
9	Other employee benefits .......	29,948,985	25,100,851	4,797,183	50,951
10	Payroll taxes ...........	16,512,141	13,839,160	2,644,890	28,091
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	1,369,436		1,369,436
c	Accounting ...........	450,000		450,000
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	8,997		8,997
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	61,296,083	45,970,340	15,199,389	126,354
12	Advertising and promotion ....	25,135		16,515	8,620
13	Office expenses .......	148,152,624	129,601,942	18,511,504	39,178
14	Information technology ......	20,281,715	17,279,212	2,951,406	51,097
15	Royalties ..
16	Occupancy ...........	9,957,117	6,201,103	3,751,629	4,385
17	Travel ............	166,742	156,096	10,634	12
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	1,037,890	827,207	210,655	28
20	Interest ...........	10,401,152	2,401	10,398,751
21	Payments to affiliates .......	121	105	16
22	Depreciation, depletion, and amortization ..	23,249,268	20,543,855	2,688,036	17,377
23	Insurance ...	902,655	11,585	891,070
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	PROVISION FOR BAD DEBTS	35,817,661	35,817,661
b	PHYSICIAN FEES	12,115,729	12,029,735	85,994
c	TEMP RESTRICTED MISC EX	1,140,187	1,140,187
d
e	All other expenses	659,944	420,015	220,480	19,449
25	Total functional expenses. Add lines 1 through 24e	626,839,501	519,139,571	106,927,879	772,051
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 ........			48,303,067	1	14,217,284
2	Savings and temporary cash investments .........				2
3	Pledges and grants receivable, net ......			1,067,805	3	2,372,677
4	Accounts receivable, net .............			77,477,298	4	61,837,928
5	Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........				7
8	Inventories for sale or use ............			6,076,154	8	6,280,479
9	Prepaid expenses and deferred charges ......			2,070,964	9	2,538,950
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	603,734,985
b	Less: accumulated depreciation	10b	386,009,940	232,541,782	10c	217,725,045
11	Investments—publicly traded securities .				11
12	Investments—other securities. See Part IV, line 11 .....			11,120,044	12	24,021,623
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			102,537,289	15	70,888,255
16	Total assets. Add lines 1 through 15 (must equal line 33)...			481,194,403	16	399,882,241

17	Accounts payable and accrued expenses .....	109,028,457	17	98,982,971
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........	191,141,246	20	71,062,892
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..	16,587,290	23	0
24	Unsecured notes and loans payable to unrelated third parties ..		24
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	73,449,467	25	46,942,316
26	Total liabilities. Add lines 17 through 25..	390,206,460	26	216,988,179

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	82,334,745	27	174,209,144
28	Net assets with donor restrictions ...........	8,653,198	28	8,684,918
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	90,987,943	32	182,894,062
33	Total liabilities and net assets/fund balances ........	481,194,403	33	399,882,241