| FORM 990, PART III, LINE 1 - ORGANIZATION'S MISSION |
TO OPERATE AND MAINTAIN AN ACUTE CARE GENERAL HOSPITAL. PROVIDE APPROPRIATE HOSPITAL AND OTHER RELATED HEALTH SERVICES TO ALL PATIENTS REGARDLESS OF RACE, COLOR, CREED OR NATIONAL ORIGIN. PROVIDE ACCESS TO MEDICALLY NECESSARY SERVICES FOR AREA RESIDENTS REGARDLESS OF ABILITY TO PAY. ASSURE THE ONGOING PROCESS OF CONTINUOUSLY IMPROVING PATIENT CARE QUALITY. |
| 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 SENIOR 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 VIII, LINE 11A: |
DURING THE HOSPITAL'S FISCAL YEAR 2022 LAWRENCE GENERAL HOSPITAL AND THE COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF HEALTH AND HUMAN AGREEMENT CALLS FOR PAYMENT OF THE FOLLOWING AMOUNTS TO THE HOSPITAL: A $12,515,000 SFY 2019; $11,360,000 FOR SFY 2020; $11,090,000 FOR SFY 2021; AND $10,420,000 FOR SFY 2022. PAYMENT OF THESE AMOUNTS IS SUBJECT TO DETERMINATION BY EOHHS THAT THE HOSPITAL MEANINGFULLY PARTICIPATES IN MASSHEALTH'S ACO PROGRAM; DETERMINATION BY EOHHS THAT THE HOSPITAL MEANINGFULLY PARTICIPATES IN MASSHEALTH'S MANAGED CARE NETWORKS BY ACCEPTING APPROPRIATE CONTRACTING RATES TO THE EXTENT SUCH ARRANGEMENTS HAVE BEEN OFFERED BY ANY MASSHEALTH MANAGED CARE ORGANIZATIONS; (C) SATISFACTION OF ALL OTHER REQUIREMENTS AS SET FORTH BY MASSHEALTH; APPROPRIATION TO, AND AVAILABILITY OF FUNDS IN, THE SAFETY NET PROVIDER TRUST FUND ESTABLISHED UNDER M.G.L.C. 29, 2AAAAA (SAFETY NET PROVIDER TRUST FUND); ALL OTHER NECESSARY STATE APPROVALS; AND FEDERAL APPROVAL AND THE AVAILABILITY OF FULL FEDERAL FINANCIAL PARTICIPATION. IN ALL YEARS COVERED IN THE AGREEMENT, THESE AMOUNTS ARE REFLECTED IN "OTHER OPERATING REVENUE" ON THE HOSPITAL'S FINANCIAL STATEMENTS AND IRS FORM 990. |
| FORM 990, PART XI LINE 9: |
NET ASSET TRANSFER TO LGH CHARITABLE TRUST, INC. $351,000 CAPITAL GRANT TO LGHCT $200,000 OTHER CHANGES $ 60 NET ASSET TRANSFER TO COMMUNITY MEDICAL ASSOCIATES, INC. ($6,993,000) LOSS ON RETIREMENT OF LONG-TERM DEBT ($6,835,000) CHANGE IN THE VALUE OF NET ASSETS HELD BY LGH CHARITABLE TRUST, INC. ($3,862,940) CONTRIBUTION MADE ($ 80,000) TOTAL ($17,219,880) |
Attach to Form 990 or 990-EZ.