| FORM 990, PART III, Line 4D: |
OTHER PROGRAM SERVICE REVENUE PRIMARILY CONSISTS OF CAFETERIA RECEIPTS, INTERCOMPANY REIMBURSEMENTS, DSTI WAIVER FUNDS, DSRIP FUNDS, AND OCCUPATIONAL HEALTH CLINIC REVENUE. |
| FORM 990, PART VI, SECTION B, LINE 11: |
FORM 990 IS PREPARED AND REVIEWED BY THE ORGANIZATION'S EXTERNAL CONSULTANT AND SUBSEQUENTLY REVIEWED BY THE CONTROLLER AND ORGANIZATION'S CFO. ONCE COMPLETE, THE FORM AND ALL SCHEDULES ARE MADE AVAILABLE TO THE BOARD OF TRUSTEES VIA A SECURE INTERNET PORTAL FOR REVIEW. THE ORGANIZATION'S CFO AND EXECUTIVE VICE PRESIDENT ARE AVAILABLE TO FACILITATE THE REVIEW AS WELL AS ANSWER ANY QUESTIONS REGARDING THE FORM. |
| FORM 990, PART VI, SECTION B, LINE 12C: |
ON AN ANNUAL BASIS, THE HOSPITAL DISTRIBUTES A CONFLICT OF INTEREST POLICY TO THE BOARD OF TRUSTEES. THE TRUSTEES ARE REQURED TO DISCLOSE, IN WRITING, ANY POTENTIAL CONFLICT THAT THEY ARE AWARE OF. ALL KNOWN INTERESTS HAVE BEEN DISCLOSED IN SCHEDULE L. |
| FORM 990, PART VI, SECTION B, LINE 15: |
THE CEO'S ANNUAL COMPENSATION IS REVIEWED AND APPROVED BY AN EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES. THE COMPENSATION FOR THE CFO, EVP, AND SENIOR MANAGEMENT ARE DETERMINED BY THE CEO AND REVIEWED BY THE BOARD OF TRUSTEES. INDEPENDENT SURVEYS ARE ALSO PERFORMED TO DETERMINE SALARY RESONABLENESS. |
| FORM 990, PART VI, SECTION C, LINE 18: |
THE HOSPITAL MAKES THE FORM 990 AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST. |
| FORM 990, PART VI, SECTION C, LINE 19: |
THE HOSPITAL MAKES ALL DOCUMENTS, INCLUDING COPIES OF ITS BY-LAWS, CONFLICT-OF-INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST. |
| FORM 990, PART VII, BOARD OF DIRECTORS: |
SUBSEQUENT TO THE END OF FISCAL YEAR 2019 AND BEFORE THE FILING OF THE 2018 TAX RETURNS, DIANNE J. ANDERSON, PRESIDENT & CEO, LEFT THE ORGANIZATION IN NOVEMBER, 2019, AND DEBORAH J. WILSON, CORPORATION ASSISTANT TREASURER & EXECUTIVE VP, WAS PROMOTED TO PRESIDENT & CEO, AND WILL BE REPORTED AS SUCH ON THIS 2018 TAX FILING. |
| FORM 990, PART VIII, LINE 11A: |
ON OCTOBER 30, 2014, CMS APPROVED A FIVE-YEAR MASSACHUSETTS MEDICAID WAIVER EXTENSION FOR THE PERIOD OF OCTOBER 30, 2014 THROUGH JUNE 30, 2019 THAT INCLUDED DELIVERY SYSTEM TRANSFORMATION INITIATIVE (DSTI) POTENTIAL FUNDING OF $15,876,000 ANNUALLY FOR LGH, FOR EACH YEAR OF THE WAIVER. THE DSTI FUNDING IS DESIGNED AS INCENTIVE PAYMENTS TO SUPPORT INITIATIVES THAT FURTHER INVESTS IN HEALTHCARE DELIVERY SYSTEMS. THE AMOUNT IS REFLECTED AS OTHER OPERATING REVENUE IN OUR FINANCIAL STATEMENTS AND FORM 990. |
| FORM 990, PART XI LINE 9, RECONCILIATION OF NET ASSETS: |
CHANGE IN THE VALUE OF NET ASSETS HELD BY LGH CHARITABLE TRUST, INC. ($-1,223,422); NET ASSET TRANSFER TO COMMUNITY MEDICAL ASSOCIATES, INC. (-$3,049,000); NET ASSET TRANSFER FROM LGH CHARITABLE TRUST, INC. $179,000; OTHER $560 EQUALS: TOTAL OTHER CHANGES IN NET ASSETS ($-4,092,862). |
Attach to Form 990 or 990-EZ.