2020-08-17T22:44:01-05:00 2019-09-30 861065772 DELOITTE TAX LLP TWO JERICHO PLAZA JERICHO NY 11753 990 2018-10-01 043318952 ANNA JAQUES COMMUNITY HEALTH FOUNDATION ANNA 9784631000 25 HIGHLAND AVE NEWBURYPORT MA 01950 KEVIN KILDAY VP/CFO 9784631000 2020-08-17 1 CHRISTINE KAWECKI P00743140 5169187000 2020-08-17 71.184.237.192 2020-08-17 22:29:46 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 99BB87E027D7BD763CC874A5F05ECE6A7EBF22DF 2018 2020-09-22 18:59:49Z MARK GOLDSTEIN 25 HIGHLAND AVE NEWBURYPORT MA 01950 3990191 0 X WWW.AJH.ORG X 1996 MA SEE SCHEDULE O 21 17 1 21 0 0 1610850 2972748 0 0 991121 897208 2900 6256 2604871 3876212 894927 1256919 0 0 382793 359614 0 0 0 128757 176642 1406477 1793175 1198394 2083037 22084523 23218782 16984 -96969 22067539 23315751 X SEE SCHEDULE O 0 0 1728295 1256919 0 SEE SCHEDULE O 1728295 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 1 0 0 0 0 0 1 1 0 0 1 0 1 0 0 0 0 0 0 0 1 1 0 0 0 0 1 1 1 0 0 1 0 0 1 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 X 21 17 1 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 MA X KEVIN KILDAY 9784631000 25 HIGHLAND AVE NEWBURYPORT MA 01950 ABBOTT MARY ANN TRUSTEE (EX-OFFICIO) 1.00 0.00 X 0 0 0 BAILEY MARK D TRUSTEE 1.00 0.00 X 0 0 0 BYRNES CHARLES TRUSTEE, CHAIR 1.00 0.00 X X 0 0 0 CANNON PATRICIA TRUSTEE 1.00 0.00 X 0 0 0 CARAS RONNA TRUSTEE 1.00 0.00 X 0 0 0 CONNORS KATHY TRUSTEE, SECRETARY 1.00 0.00 X X 0 0 0 ELIAS CLAUDE TRUSTEE 1.00 0.00 X 0 0 0 FERNANDEZ LUIS TRUSTEE 1.00 0.00 X 0 0 0 FOLEY MELISSA TRUSTEE 1.00 0.00 X 0 0 0 FOULKES KIM TRUSTEE 1.00 0.00 X 0 0 0 GANONG JULIE TRUSTEE, VICE CHAIR 1.00 0.00 X X 0 0 0 GASIOROWSKI KEVIN TRUSTEE 1.00 0.00 X 0 0 0 GOLDSTEIN MARK TRUSTEE (EX-OFFICIO), PRESIDENT & CEO 6.00 54.00 X X 84444 759997 66220 JOHNSTON CHRISTOPHER TRUSTEE 1.00 0.00 X 0 0 0 KELLY KATE TRUSTEE 1.00 0.00 X 0 0 0 KHATIB MATT TRUSTEE, CHAIR 1.00 0.00 X X 0 0 0 LAFLAMME DAVID TRUSTEE (EX-OFFICIO) 1.00 0.00 X 0 0 0 PURINTON LISA TRUSTEE 1.00 0.00 X 0 0 0 SULLIVAN CHRISTOPHER R TRUSTEE 1.00 0.00 X 0 0 0 SWIERZEWSKI DAVID TRUSTEE 0.00 60.00 X 0 559527 36429 TWOMBLY DONNA TRUSTEE, CLINICAL MGR 0.00 60.00 X 0 114664 25398 WILLIAMSON MARY TRUSTEE (EX-OFFICIO), EXEC DIR 0.00 60.00 X X 0 80476 16383 KILDAY KEVIN TREASURER 6.00 54.00 X 35133 316196 61809 GNERRE SARAH FORMER VP EXEC DIR 0.00 60.00 X 0 132149 20457 O'CONNOR DELIA FORMER CHIEF EXECUTIVE OFFICER 1.00 0.00 X 0 166584 0 SALVO STEPHEN FORMER VP HR 1.00 0.00 X 0 175788 39874 119577 2305381 266570 1 1 1 0 0 112540 2860208 70386 2972748 389604 389604 585829 78225 507604 507604 507604 42010 112540 35754 6256 6256 3876212 0 0 903464 1256919 1256919 119577 114794 4783 161890 152077 9813 56101 54101 2000 22046 20929 1117 15000 15000 31455 31455 55706 55706 55331 55331 17581 17581 712 712 857 857 1793175 1728295 64880 0 385040 221271 437215 1855321 276 47661 21261992 21094529 22084523 23218782 15475 34925 1509 -131894 16984 -96969 X 8676188 8669480 7673378 9030449 5717973 5615822 22067539 23315751 22084523 23218782 2083037 -834825 0 X X 0 1 X 1 0 X X X 1 ANNA JAQUES HOSPITAL 042104338 3 1 2216919 0 1 2216919 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 16236372 14698 333751 35697 15881622 15304864 1341021 386000 23513 16236372 13932112 15000 1792855 416628 18475 15304864 13706652 1029573 796286 7827 13932112 14520243 -477873 330000 5718 13706652 0.47700 0.12600 0.39700 0 0 0 DUE TO/(FROM) AFFILIATES -131894 -131894 X 3267670000 -406124 3267722606 3267316482 353518 3522694 3522694 3876212 3594794000 3593225349 3593225349 1568651 224524 224524 1793175 PART V, LINE 4: ANNA JAQUES COMMUNITY HEALTH FOUNDATION MAINTAINS MULTIPLE ENDOWMENTS WITH DIFFERENT PURPOSES. THE MAJORITY HAVE A PERMANENTLY RESTRICTED CORPUS, WITH THE INCOME AVAILABLE TO SUPPORT THE OPERATIONS OF ANNA JAQUES HOSPITAL. THE INCOME FROM OTHER ENDOWMENTS IS AVAILABLE TO FUND HEALTHCARE EDUCATION FOR AJH EMPLOYEES, OR FOR SCHOLARSHIPS TO AREA HIGH SCHOOL STUDENTS WHO WISH TO PURSUE A HEALTH CARE RELATED DEGREE PROGRAM. THE ENTITIES WHICH USE THE ENDOWMENT FUNDS ARE THE PARENT (SRHS), THE HOSPITAL (AJH), THE FOUNDATION (CHF), AND THE PHYSICIAN GROUP (SAGP). PART X, LINE 2: EACH ENTITY WITHIN THE BETH ISRAEL LAHEY HEALTH, INC. (BILH) SYSTEM RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. RECOGNIZED INCOME TAX POSITIONS ARE MEASURED AT THE LARGEST AMOUNT OF BENEFIT THAT IS GREATER THAN FIFTY PERCENT LIKELY TO BE REALIZED UPON SETTLEMENT. CHANGES IN MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN JUDGEMENT OCCURS. THE SYSTEM DID NOT RECOGNIZED THE EFFECT OF ANY INCOME TAX POSITIONS IN 2019. PART XI, LINE 2D - OTHER ADJUSTMENTS: NET ASSETS RELEASED FROM RESTRICTIONS 32,397. UNRESTRICTED NET ASSETS UPON ACQUISITION 8,449,210. CONSOLIDATED AFFILIATES NET OF ELIMINATIONS 3,259,240,999. PART XI, LINE 4B - OTHER ADJUSTMENTS: 5 MONTH REVENUE NOT IN FINANCIAL STATEMENTS 585,512. RESTRICTED CONTRIBUTIONS 2,477,317. RESTRICTED REVENUE 495,619. RENTAL/FUNDRAISING EXPENSE RECLASS -35,754. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL/ FUNDRAISING EXPENSE RECLASS 35,754. CONSOLIDATED AFFILIATES NET OF ELIMINATIONS 3,593,189,595. PART XII, LINE 4B - OTHER ADJUSTMENTS: 5 MONTH EXPENSES NOT IN FINANCIAL STATEMENTS 224,524. X X X X X X 0 GOLF TOURNAMENT 154550 112540 42010 5423 13500 12540 4291 154550 112540 42010 5423 13500 12540 4291 35754 6256 PART IV, QUESTION 2, 17, 18, 19 AND 29 AS NOTED IN THIS FILING, ANNA JAQUES COMMUNITY HEALTH FOUNDATION (AJCHF) IS A SISTER-ORGANIZATION TO ANNA JAQUES HOSPITAL (AJH, EIN: 04-2104338) AND SEACOAST AFFILIATED GROUP PRACTICES, INC. (SAGP EIN: 04-3485648). ALL THREE ENTITIES ARE EXEMPT FROM INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED. AJCHF PERFORMS FUNDRAISING ACTIVITIES ON BEHALF OF, AND IN THE NAME OF, ANNA JAQUES HOSPITAL, INCLUDING SPECIAL FUNDRAISING EVENTS AS WELL AS MAIL AND IN-PERSON SOLICITATIONS FROM INDIVIDUALS, CORPORATIONS AND FOUNDATIONS. DETAILED DISCLOSURES CAN BE FOUND IN THE FORM 990 AND SCHEDULE G, SUPPLEMENTAL INFORMATION REGARDING FUNDRAISING OR GAMING ACTIVITIES, FILED AS PART OF THE AJCHF FORM 990 FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2019. 1 ANNA JAQUES HOSPITAL 25 HIGHLAND AVE NEWBURYPORT MA 01950 042104338 501(C)(3) 1256919 0 FMV GENERAL SUPPORT 1 0 PART I, LINE 2: AS PREVIOUSLY NOTED IN THE FILING ANNA JAQUES COMMUNITY HEALTH FOUNDATION, MAINTAINS STRONG RELATIONSHIP WITH MANY PARTNERS AND ANNA JAQUES COMMUNITY HEALTH FOUNDATION WORKS WITH THOSE PARTNERS AS PART OF ITS COMMUNITY BENEFIT MISSION AND ACTIVITIES. PURSUANT TO THOSE RELATIONSHIPS, GRANTS MAY BE DISTRIBUTED TO THESE PARTNERS. ANNA JAQUES COMMUNITY HEALTH FOUNDATION ENSURES THAT FUNDS GRANTED ARE USED FOR THE INTENDED PURPOSES AS PART OF ITS ON-GOING AND CLOSE CONNECTIONS WITH THESE COMMUNITY PARTNERS. 0 1 0 0 0 1 1 1 0 GOLDSTEIN MARK TRUSTEE (EX-OFFICIO), PRESIDENT & CE 58444 525997 25000 225000 1000 9000 3175 28575 3447 31023 91066 819595 0 0 SWIERZEWSKI DAVID TRUSTEE 0 468016 0 91511 0 0 0 8250 0 28179 0 595956 0 0 KILDAY KEVIN TREASURER 33133 298196 2000 18000 0 0 2146 19312 4035 36316 41314 371824 0 0 GNERRE SARAH FORMER VP EXEC DIR 0 7409 0 0 0 124740 0 5850 0 14607 0 152606 0 0 O'CONNOR DELIA FORMER CHIEF EXECUTIVE OFFICER 0 0 0 0 0 166584 0 0 0 0 0 166584 0 0 SALVO STEPHEN FORMER VP HR 0 171888 0 0 0 3900 0 17680 0 22194 0 215662 0 0 PART I, LINE 4B AS REQUIRED BY THIS FORM 990, SCHEDULE J, COMPENSATION INFORMATION, THE COMPENSATION DETAIL INCLUDED IN ANNA JAQUES COMMUNITY HEALTH FOUNDATION'S FORM 990 FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2019 IS CALENDAR YEAR 2018 DETAIL. DURING THE 2018 CALENDAR YEAR, ANNA JAQUES COMMUNITY HEALTH FUNDATION WAS A PARTICIPATING EMPLOYER IN A NON-QUALIFIED DEFERRED COMPENSATION PLAN AND PURSUANT TO THE PLAN ELIGIBLE EMPLOYEES RECEIVE CERTAIN RETIREMENT BENEFITS. CONTRIBUTIONS RECEIVED BY PARTICIPANTS AND RELATED TO THESE PLANS ARE INCLUDED IN FORM 990 SCHEDULE J, PART II, COLUMN B(III), OTHER REPORTABLE COMPENSATION AND/OR FORM 990, SCHEDULE J, PART II, COLUMN C, DEFERRED COMPENSATION IN ACCORDANCE WITH THE INSTRUCTIONS TO THIS FORM 990. ADDITIONAL INFORMATION IS INCLUDED WITH THE EXPLANATORY NOTES TO SCHEDULE J BELOW. PART I, LINE 7 THE ANNA JAQUES COMMUNITY HEALTH FOUNDATION EXECUTIVE COMPENSATION PACKAGES AND CERTAIN EMPLOYEE COMPENSATION PACKAGES INCLUDED OPPORTUNITIES TO EARN INCENTIVE COMPENSATION BASED ON A COMBINATION OF MEETING OR EXCEEDING PRE-DETERMINED GOALS. FOR THE PERIOD COVERED BY THIS FILING, THE INCENTIVE COMPENSATION FOR EACH EXECUTIVE REPORTED IN THIS FORM 990 WAS REVIEWED AND APPROVED BY THE ANNA JAQUES HOSPITAL COMPENSATION COMMITTEE , WHICH AS PREVIOUSLY NOTED, WAS FULLY STAFFED BY INDEPENDENT MEMBERS. SCHEDULE J ADDITIONAL EXPLANATORY FOOTNOTES: THE FILING ORGANIZATION HAS PROVIDED DETAILED NARRATIVE DISCLOSURE FOR EACH INDIVIDUAL LISTED IN PART VII. NOTE, HOWEVER, THAT THE ORDER OF THE NARRATIVE DISCLOSURE INCLUDED BELOW MAY NOT COINCIDE WITH THE ORDER OF THE INDIVIDUALS LISTED IN PART VII. REPORTABLE COMPENSATION LISTED IN FORM 990 PART VII INCLUDES BASE COMPENSATION, INCENTIVE COMPENSATION AND OTHER REPORTABLE COMPENSATION AS REPORTED IN FORM 990 SCHEDULE J. OTHER COMPENSATION LISTED IN FORM 990 PART VII INCLUDES DEFERRED COMPENSATION AND NON-TAXABLE BENEFITS AS REPORTED IN FORM 990 SCHEDULE J. BASE COMPENSATION: AMOUNTS NOT OTHERWISE SEPARATELY NOTED IN THIS RETURN BUT QUANTIFIED IN BASE COMPENSATION INCLUDE AMOUNTS FROM ONE OR MORE OF THE FOLLOWING ITEMS: REGULAR WAGES, EMPLOYEE DEFERRALS TO A 401(K) AND/OR 403(B) PLAN OTHER REPORTABLE COMPENSATION: AMOUNTS QUANTIFIED IN OTHER REPORTABLE COMPENSATION WHICH MAY NOT BE SEPARATELY NOTED IN THIS FILING INCLUDE AMOUNTS FROM ONE OR MORE OF THE FOLLOWING ITEMS: TAXABLE EMPLOYER-SUBSIDIZED PARKING; TAXABLE MOVING EXPENSES; TAXABLE LIFE, DISABILITY, OR LONG-TERM CARE INSURANCE; AMOUNTS DEFERRED BY THE EMPLOYEE (PLUS EARNINGS) UNDER FULLY VESTED 457(B) PLAN; DISTRIBUTIONS FROM A 457(B) PLAN; AMOUNTS INCLUDIBLE IN INCOME UNDER A 457(F) PLAN; INCREASE/DECREASE IN VALUE OF NONQUALIFIED RETIREMENT BENEFITS; OTHER TAXABLE RETIREMENT BENEFITS DEFERRED COMPENSATION: AMOUNTS NOT OTHERWISE SEPARATELY NOTED BUT QUANTIFIED IN DEFERRED COMPENSATION INCLUDE AMOUNTS FROM ONE OR MORE OF THE FOLLOWING ITEMS: EMPLOYER CONTRIBUTIONS TO 401K RETIREMENT PLAN, EMPLOYER CONTRIBUTIONS TO 403B RETIREMENT PLAN, EMPLOYER CONTRIBUTION TO PENSION PLAN AND/OR THE CHANGE IN ACTUARIAL VALUE OF THE PENSION PLAN BENEFIT, UNFUNDED AND UNVESTED AMOUNTS DEFERRED UNDER 457(F) PLAN NON-TAXABLE BENEFITS: AMOUNTS NOT OTHERWISE SEPARATELY NOTED BUT QUANTIFIED IN NON-TAXABLE BENEFITS INCLUDE AMOUNTS FROM ONE OR MORE OF THESE NON-TAXABLE BENEFITS: EMPLOYEE CONTRIBUTIONS TO HEALTH INSURANCE, EMPLOYER CONTRIBUTIONS TO HEALTH INSURANCE, EMPLOYEE CONTRIBUTIONS TO FLEXIBLE SPENDING ACCOUNTS FOR DEPENDENT CARE AND/OR MEDICAL REIMBURSEMENT, ADOPTION ASSISTANCE, TUITION ASSISTANCE PURSUANT TO AN EMPLOYER PLAN, GROUP TERM LIFE INSURANCE, DISABILITY INSURANCE ALL DIRECTORS/TRUSTEES SERVE WITHOUT COMPENSATION OR BENEFITS. COMPENSATION PAID TO OFFICERS, DIRECTORS/TRUSTEES OR KEY EMPLOYEES WAS EARNED FOR WORK PERFORMED IN A CAPACITY OTHER THAN THAT OF DIRECTOR/TRUSTEE, AS DENOTED BY THE LISTED TITLES. ANNA JAQUES HOSPITAL, ANNA JAQUES COMMUNITY HEALTH FOUNDATION AND SEACOAST AFFILIATED GROUP PRACTICES, INC. MAY BE REFERRED TO IN THESE EXPLANATORY NOTES TO FORM 990 PART VII AND FORM 990 SCHEDULE J AS AJH, AJCHF, AND SAGP RESPECTIVELY. GOLDSTEIN, MARK TRUSTEE (EX-OFFICIO), PRESIDENT, CEO ANNA JAQUES HOSPITAL TRUSTEE (EX-OFFICIO) ANNA JAQUES COMMUNITY HEALTH FOUNDATION TRUSTEE (EX-OFFICIO), PRESIDENT SEACOAST AFFILIATED GROUP PRACTICES, INC. MR. GOLDSTEIN PERFORMS SERVICES FOR AJH, AJCHF, AND SAGP. ALTHOUGH MR. GOLDSTEIN IS PAID DIRECTLY BY AJH, THE PORTION OF MR. GOLDSTEIN'S COMPENSATION ATTRIBUTABLE TO EACH POSITION HAS BEEN SEPARATELY REPORTED ON THIS FORM 990, AS FURTHER OUTLINED BELOW. PAYMENTS REPORTED BY AJH: BASE COMPENSATION: 409,109 INCENTIVE COMPENSATION: 175,000 OTHER REPORTABLE COMPENSATION: 7,000 DEFERRED COMPENSATION: 22,225 NON-TAXABLE BENEFITS: 24,129 PAYMENTS REPORTED BY AJCHF: BASE COMPENSATION: 58,444 INCENTIVE COMPENSATION: 25,000 OTHER REPORTABLE COMPENSATION: 1,000 DEFERRED COMPENSATION: 3,175 NON-TAXABLE BENEFITS: 3,447 PAYMENTS REPORTED BY SAGP: BASE COMPENSATION: 116,888 INCENTIVE COMPENSATION: 50,000 OTHER REPORTABLE COMPENSATION: 2,000 DEFERRED COMPENSATION: 6,350 NON-TAXABLE BENEFITS: 6,894 OTHER REPORTABLE AND DEFERRED COMPENSATION FOR DR. GOLDSTEIN INCLUDES COMBINED PAYMENTS FROM NONQUALIFIED RETIREMENT PLANS IN THE AMOUNT OF $18,000. OF THIS AMOUNT, $18,000 IS BOTH UNFUNDED AND UNVESTED. KILDAY, KEVIN CHIEF FINANCIAL OFFICER ANNA JAQUES HOSPITAL TREASURER ANNA JAQUES COMMUNITY HEALTH FOUNDATION CHIEF FINANCIAL OFFICER SEACOAST AFFILIATED GROUP PRACTICES, INC. MR. KILDAY PERFORMS SERVICES FOR AJH, AJCHF, AND SAGP. ALTHOUGH MR. KILDAY IS PAID DIRECTLY BY AJH, THE PORTION OF MR. KILDAY 'S COMPENSATION ATTRIBUTABLE TO EACH POSITION HAS BEEN SEPARATELY REPORTED ON THIS FORM 990, AS FURTHER OUTLINED BELOW. PAYMENTS REPORTED BY AJH: BASE COMPENSATION: 198,797 INCENTIVE COMPENSATION: 12,000 OTHER REPORTABLE COMPENSATION: 0 DEFERRED COMPENSATION: 12,875 NON-TAXABLE BENEFITS: 24,211 PAYMENTS REPORTED BY AJCHF: BASE COMPENSATION: 33,133 INCENTIVE COMPENSATION: 2,000 OTHER REPORTABLE COMPENSATION: 0 DEFERRED COMPENSATION: 2,146 NON-TAXABLE BENEFITS: 4,035 PAYMENTS REPORTED BY SAGP: BASE COMPENSATION: 99,399 INCENTIVE COMPENSATION: 6,000 OTHER REPORTABLE COMPENSATION: 0 DEFERRED COMPENSATION: 6,437 NON-TAXABLE BENEFITS: 12,105 OTHER REPORTABLE AND DEFERRED COMPENSATION FOR DR. KILDAY INCLUDES COMBINED PAYMENTS FROM NONQUALIFIED RETIREMENT PLANS IN THE AMOUNT OF $10,458. OF THIS AMOUNT, $10,458 IS BOTH UNFUNDED AND UNVESTED. SCHEDULE J ADDITIONAL EXPLANATORY FOOTNOTES: O'CONNOR, DELIA FORMER CHIEF EXECUTIVE OFFICER ANNA JAQUES HOSPITAL FORMER CHIEF EXECUTIVE OFFICER ANNA JAQUES COMMUNITY HEALTH FOUNDATION FORMER CHIEF EXECUTIVE OFFICER SEACOAST AFFILIATED GROUP PRACTICES, INC. PAYMENTS REPORTED BY AJH: BASE COMPENSATION: 0 INCENTIVE COMPENSATION: 0 OTHER REPORTABLE COMPENSATION: 166,584 DEFERRED COMPENSATION: 0 NON-TAXABLE BENEFITS: 0 OTHER REPORTABLE AND DEFERRED COMPENSATION FOR DR. O'CONNOR INCLUDES COMBINED PAYMENTS FROM NONQUALIFIED RETIREMENT PLANS IN THE AMOUNT OF $105,312. WILLIAMSON, MARY TRUSTEE (EX-OFFICIO), EXECUTIVE DIRECTOR ANNA JAQUES COMMUNITY HEALTH FOUNDATION PAYMENTS REPORTED BY AJH: BASE COMPENSATION: 80,476 INCENTIVE COMPENSATION: 0 OTHER REPORTABLE COMPENSATION: 0 DEFERRED COMPENSATION: 0 NON-TAXABLE BENEFITS: 16,383 GNERRE, SARAH FORMER VP EXECUTIVE DIRECTOR ANNA JAQUES COMMUNITY HEALTH FOUNDATION PAYMENTS REPORTED BY AJH: BASE COMPENSATION: 7,409 INCENTIVE COMPENSATION: 0 OTHER REPORTABLE COMPENSATION: 124,740 DEFERRED COMPENSATION: 5,850 NON-TAXABLE BENEFITS: 14,607 SALVO, STEPHEN FORMER VP HR ANNA JAQUES HOSPITAL FORMER VP HR ANNA JAQUES COMMUNITY HEALTH FOUNDATION FORMER VP HR SEACOAST AFFILIATED GROUP PRACTICES, INC. PAYMENTS REPORTED BY AJH: BASE COMPENSATION: 171,888 INCENTIVE COMPENSATION: 0 OTHER REPORTABLE COMPENSATION: 3,900 DEFERRED COMPENSATION: 17,680 NON-TAXABLE BENEFITS: 22,194 OTHER REPORTABLE AND DEFERRED COMPENSATION FOR DR. SALVO INCLUDES COMBINED PAYMENTS FROM NONQUALIFIED RETIREMENT PLANS IN THE AMOUNT OF $17,971. OF THIS AMOUNT, $14,071 IS BOTH UNFUNDED AND UNVESTED. TWOMBLY, DONNA TRUSTEE, CLINICAL MANAGER ANNA JAQUES COMMUNITY HEALTH FOUNDATION PAYMENTS REPORTED BY AJH: BASE COMPENSATION: 105,946 INCENTIVE COMPENSATION: 8,718 OTHER REPORTABLE COMPENSATION: 0 DEFERRED COMPENSATION: 2,119 NON-TAXABLE BENEFITS: 23,279 BYRNES, CHARLES TRUSTEE, CHAIR ANNA JAQUES COMMUNITY HEALTH FOUNDATION JOHNSTON, CHRISTOPHER TRUSTEE ANNA JAQUES COMMUNITY HEALTH FOUNDATION SULLIVAN, CHRISTOPHER R. TRUSTEE ANNA JAQUES COMMUNITY HEALTH FOUNDATION ELIAS, CLAUDE TRUSTEE ANNA JAQUES COMMUNITY HEALTH FOUNDATION LAFLAMME, DAVID TRUSTEE (EX-OFFICIO) ANNA JAQUES COMMUNITY HEALTH FOUNDATION TRUSTEE, CHAIRMAN ANNA JAQUES HOSPITAL TRUSTEE, CHAIRMAN SEACOAST AFFILIATED GROUP PRACTICES, INC. SWIERZEWSKI, DAVID TRUSTEE ANNA JAQUES COMMUNITY HEALTH FOUNDATION TRUSTEE (EX-OFFICIO), PRESIDENT OF MEDICAL STAFF SEACOAST AFFILIATED GROUP PRACTICES, INC. TRUSTEE, PRESIDENT OF MEDICAL STAFF ANNA JAQUES HOSPITAL PAYMENTS REPORTED BY AJH: BASE COMPENSATION: 50,925 INCENTIVE COMPENSATION: 0 OTHER REPORTABLE COMPENSATION: 0 DEFERRED COMPENSATION: 0 NON-TAXABLE BENEFITS: 0 PAYMENTS REPORTED BY SAGP: BASE COMPENSATION: 417,091 INCENTIVE COMPENSATION: 91,511 OTHER REPORTABLE COMPENSATION: 0 DEFERRED COMPENSATION: 8,250 NON-TAXABLE BENEFITS: 28,179 GANONG, JULIE TRUSTEE, VICE CHAIR ANNA JAQUES COMMUNITY HEALTH FOUNDATION KELLY, KATE TRUSTEE ANNA JAQUES COMMUNITY HEALTH FOUNDATION CONNORS, KATHY TRUSTEE, SECRETARY ANNA JAQUES COMMUNITY HEALTH FOUNDATION GASIOROWSKI, KEVIN TRUSTEE ANNA JAQUES COMMUNITY HEALTH FOUNDATION FOULKES, KIM TRUSTEE ANNA JAQUES COMMUNITY HEALTH FOUNDATION PURINTON, LISA TRUSTEE ANNA JAQUES COMMUNITY HEALTH FOUNDATION FERNANDEZ, LUIS TRUSTEE ANNA JAQUES COMMUNITY HEALTH FOUNDATION MR. FERNANDEZ'S TERM ON THE ANNA JAQUES COMMUNITY HEALTH FOUNDATION BOARD ENDED ON APRIL 1, 2019. BAILEY, MARK D. TRUSTEE ANNA JAQUES COMMUNITY HEALTH FOUNDATION ABBOTT, MARY ANN TRUSTEE (EX-OFFICIO) ANNA JAQUES COMMUNITY HEALTH FOUNDATION KHATIB, MATT TRUSTEE, CHAIR ANNA JAQUES COMMUNITY HEALTH FOUNDATION TRUSTEE (EX-OFFICIO), CHAIR ANNA JAQUES HOSPITAL TRUSTEE (EX OFFICIO), CHAIR/PRESIDENT, FOUNDATION SEACOAST AFFILIATED GROUP PRACTICES, INC. FOLEY, MELISSA TRUSTEE ANNA JAQUES COMMUNITY HEALTH FOUNDATION CANNON, PATRICIA TRUSTEE ANNA JAQUES COMMUNITY HEALTH FOUNDATION CARAS, RONNA TRUSTEE ANNA JAQUES COMMUNITY HEALTH FOUNDATION SUBSTANTIAL CONTRIBUTOR #4 SUBSTANTIAL CONTRIBUTOR 26400 MARKETING PURCHASED SERVICES 0 SUBSTANTIAL CONTRIBUTOR #39 SUBSTANTIAL CONTRIBUTOR 212977 RENT PAYMENTS 0 SUBSTANTIAL CONTRIBUTOR #71 SUBSTANTIAL CONTRIBUTOR 3136 XRAY READS FOR EMPLOYEE HEALTH 0 SUBSTANTIAL CONTRIBUTOR #82 SUBSTANTIAL CONTRIBUTOR 96221 LEGAL FEES 0 SUBSTANTIAL CONTRIBUTOR #83 SUBSTANTIAL CONTRIBUTOR 991483 CONSTRUCTION/RENOVATION PROJECTS 0 SUBSTANTIAL CONTRIBUTOR #87 SUBSTANTIAL CONTRIBUTOR 320416 LANDSCAPING AND SNOW REMOVAL 0 SUBSTANTIAL CONTRIBUTOR #90 SUBSTANTIAL CONTRIBUTOR 416551 LABORATORY SEND-OUTS 0 X 4 70386 COST OR SELLING PRICE 0 0 0 0 FORM 990, PART I & III THE ANNA JAQUES COMMUNITY HEALTH FOUNDATION (FOUNDATION) WAS ESTABLISHED IN 1996 FOR THE PURPOSE OF CULTIVATING AND SOLICITING ON-GOING DONOR SUPPORT FOR THE GENERAL OPERATIONS, CRITICAL PROGRAMS AND CAPITAL EQUIPMENT NEEDS OF ANNA JAQUES HOSPITAL (AJH OR HOSPITAL), A HOSPITAL EXEMPT FROM INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED. THE FOUNDATION'S MISSION IS TO SUPPORT AJH AND TO FURTHER THE HOSPITAL'S ABILITY TO PROVIDE THE HIGHEST QUALITY MEDICAL CARE AND IMPROVE THE HEALTH OF OUR COMMUNITY. THE FOUNDATION ACCOMPLISHES ITS MISSION THROUGH COMMUNITY OUTREACH AND ENGAGEMENT AND BY SEEKING PHILANTHROPIC SUPPORT FROM GRATEFUL PATIENTS AND COMMUNITY MEMBERS, FOUNDATIONS, AND BUSINESSES. ON MARCH 1, 2019, THE LAHEY HEALTH SYSTEM INCLUDING THE LAHEY CLINIC AND LAHEY CLINIC HOSPITAL D/B/A LAHEY HOSPITAL AND MEDICAL CENTER, WINCHESTER HOSPITAL, NORTHEAST HOSPITAL CORPORATION D/B/A BEVERLY HOSPITAL, ADDISON GILBERT HOSPITAL AND BAYRIDGE HOSPITAL, THE BETH ISRAEL DEACONESS SYSTEM INCLUDING BETH ISRAEL DEACONESS MEDICAL CENTER, BETH ISRAEL DEACONESS MILTON, BETH ISRAEL DEACONESS NEEDHAM AND BETH ISRAEL DEACONESS PLYMOUTH, MOUNT AUBURN HOSPITAL, NEW ENGLAND BAPTIST HOSPITAL AND SEACOAST REGIONAL HEALTH SYSTEMS, INCLUDING ANNA JAQUES HOSPITAL AS WELL AS ENTITIES FOR WHICH THESE LISTED ORGANIZATIONS SERVE AS SOLE MEMBER AND ADDITIONAL AFFILIATES CAME TOGETHER TO FORM BETH ISRAEL LAHEY HEALTH (BILH). BILH IS AN INTEGRATED HEALTH CARE SYSTEM COMMITTED TO EXPANDING ACCESS TO EXTRAORDINARY PATIENT CARE ACROSS EASTERN MASSACHUSETTS AND ADVANCING THE SCIENCE AND PRACTICE OF MEDICINE THROUGH GROUNDBREAKING RESEARCH AND EDUCATION. THE BILH SYSTEM IS COMPRISED OF ACADEMIC AND TEACHING HOSPITALS, A PREMIER ORTHOPEDICS HOSPITAL, PRIMARY CARE AND SPECIALTY CARE PROVIDERS, AMBULATORY SURGERY CENTERS, URGENT CARE CENTERS, COMMUNITY HOSPITALS, HOMECARE SERVICES, OUTPATIENT BEHAVIORAL HEALTH CENTERS, ADDICTION TREATMENT PROGRAMS. BILH'S COMMUNITY OF CLINICIANS, CAREGIVERS AND STAFF INCLUDES APPROXIMATELY 4,000 PHYSICIANS AND 35,000 EMPLOYEES. FORM 990, PART IV, LINE 4A FUNDRAISING ACTIVITIES AS NOTED PREVIOUSLY IN THIS FILING, THE ANNA JAQUES COMMUNITY HEALTH FOUNDATION (FOUNDATION), IN FURTHERANCE OF ITS EXEMPT PURPOSES, ENGAGES IN DONOR CULTIVATION, SOLICITATION AND STEWARDSHIP TO EXCLUSIVELY SUPPORT ANNA JAQUES HOSPITAL (AJH). THE HOSPITAL, LOCATED IN NEWBURYPORT, MASSACHUSETTS HAS BEEN A VITAL PART OF THE COMMUNITY SINCE IT OPENED ITS DOORS IN 1884. . THROUGH THE DIRECT FUNDRAISING EFFORTS OF THE FOUNDATION, AJH SUPPORTERS ARE ENCOURAGED TO RENEW THEIR ANNUAL SUPPORT TO CREATE A RELIABLE STREAM OF CONTRIBUTED INCOME TO FUND THE HOSPITAL'S GREATEST NEEDS INCLUDING SPECIAL PROGRAMS, GENERAL OPERATIONS AND CAPITAL PRIORITIES. PROGRAMS SUPPORTED INCLUDE A TOP-RATED WOUND HEALING CENTER, THE AJH CANCER CENTER IN AFFILIATION WITH BETH ISRAEL DEACONESS MEDICAL CENTER, A WORLD REKNOWN TERTIARY CARE ACADEMIC MEDICAL CENTER ALSO EXEMPT FROM INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED, AND EFFECTIVE MARCH 1, 2019, A SISTER ENTITY TO AJH, THE GERRISH BREAST CARE CENTER, AND THE PERSIST PROGRAM SUPPORTING PREGNANT WOMEN WITH SUBSTANCE USE DISORDER AND THEIR NEWBORNS. DURING THE PERIOD COVERED BY THIS FILING, THE FOUNDATION'S PRINCIPAL FOCUS WAS TO GENERATE COMMUNITY SUPPORT FOR THE STEPPING FORWARD CAMPAIGN TO EXPAND SURGICAL SERVICES. THIS $3.5 MILLION CAMPAIGN WILL HELP AJH BUILD TWO NEW, STATE-OF-THE-ART OPERATING ROOMS TO HELP TO EXPAND AJH'S ORTHOPEDIC PROGRAM IN COLLABORATION WITH NEW ENGLAND BAPTIST HOSPITAL (NEBH),THE PREMIER REGIONAL PROVIDER FOR ORTHOPEDIC SURGERY AND THE TREATMENT OF MUSCULOSKELETAL DISEASES AND DISORDERS, ALSO EXEMPT FROM INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED, AND EFFECTIVE MARCH 1, 2019 A SISTER ENTITY TO AJH. IN ADDITION, THE FOUNDATION OPERATES TWO LARGE-SCALE FUNDRAISING EVENTS EACH YEAR THE FORE YOUR HEALTH GOLF TOURNAMENT AND CELEBRATING SURVIVORS, A BRUNCH AND FASHION SHOW FEATURING SURVIVORS OF CANCER CARE PROGRAMS AND THEIR CAREGIVERS. DURING THE FISCAL YEAR COVERED BY THIS FILING, THE FOUNDATION THROUGH ITS FUNDRAISING EFFORTS PROVIDED $1,256,919 OF SUPPORT TO ANNA JAQUES HOSPITAL TO SUPPORT THE HOSPITAL'S OPERATING AND CAPITAL NEEDS. FORM 990, PART IV, LINE 12 THE BOSTON, MA OFFICE OF KPMG ISSUED AN UNQUALIFIED OPINION ON THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF THE BETH ISRAEL LAHEY HEALTH, INC. AND AFFILIATES FOR FISCAL PERIOD ENDED SEPTEMBER 30, 2019. THESE STATEMENTS WERE PREPARED IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP) AND INCLUDED THE ACCOUNTS OF THE BETH ISRAEL LAHEY HEALTH, INC. (BILH), AND THE ENTITIES FOR WHICH BETH ISRAEL LAHEY HEALTH, INC. (BILH) SERVED AS SOLE MEMBER DURING THE FISCAL PERIOD COVERED BY THIS FILING, (BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC), MOUNT AUBURN HOSPITAL (MAH), NEW ENGLAND BAPTIST HOSPITAL (NEBH), BETH ISRAEL DEACONESS HOSPITAL MILTON, INC. (MILTON), BETH ISRAEL DEACONESS HOSPITAL NEEDHAM, INC. (NEEDHAM), BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH, INC. (PLYMOUTH), LAHEY CLINIC FOUNDATION, LAHEY HEALTH SHARED SERVICES, WINCHESTER HOSPITAL (WINCHESTER), NORTHEAST HOSPITAL CORPORATION (NHC), NORTHEAST BEHAVIORAL HEALTH CORPORATION (NBHC) AND ANNA JAQUES HOSPITAL). EACH OF THESE AFFILIATES MAY IN TURN SERVE AS MEMBER OF ADDITIONAL ENTITIES WITHIN THE NETWORK OF AFFILIATES, AND WHOSE ACCOUNTS ARE INCLUDED IN THE BILH AUDITED FINANCIAL STATEMENTS. THE FINANCIAL STATEMENTS ALSO INCLUDE THE ACCOUNTS OF HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER, INC. (HMFP), THE DEDICATED PHYSICIAN PRACTICE OF BETH ISRAEL DEACONESS MEDICAL CENTER AND AN ENTITY INTEGRALLY RELATED TO HELPING BIDMC ACCOMPLISH ITS CHARITABLE PURPOSES, AS WELL AS ALL ENTITIES FOR WHICH THESE ENTITIES SERVE AS MEMBER. FORM 990, PART V, LINE 7G ANNA JAQUES COMMUNITY HEALTH FOUNDATION DID NOT RECEIVE ANY CONTRIBUTIONS OF INTELLECTUAL PROPERTY AND AS SUCH, WAS NOT REQUIRED TO FILE FORM 8899. FORM 990, PART V, LINE 7H ANNA JAQUES COMMUNITY HEALTH FOUNDATION DID NOT RECEIVE ANY CONTRIBUTIONS OF CARS, BOATS, AIRPLANES OR OTHER VEHICLES AND AS SUCH, WAS NOT REQUIRED TO FILE FORM 1098-C. FORM 990, PART VI, SECTION A, LINE 2 FOR THE PERIOD COVERED BY THIS FILING, BETH ISRAEL LAHEY HEALTH, INC. SERVED AS THE SOLE MEMBER OF BETH ISRAEL DEACONESS MEDICAL CENTER, INC. (BIDMC), MOUNT AUBURN HOSPITAL (MAH), NEW ENGLAND BAPTIST HOSPITAL (NEBH), BETH ISRAEL DEACONESS HOSPITAL MILTON, INC. (MILTON), BETH ISRAEL DEACONESS HOSPITAL NEEDHAM, INC. (NEEDHAM), BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH, INC. (PLYMOUTH), LAHEY HEALTH SHARED SERVICES, LAHEY CLINIC FOUNDATION, WINCHESTER HOSPITAL (WINCHESTER), NORTHEAST HOSPITAL CORPORATION (NHC), NORTHEAST BEHAVIORAL CORPORATION (NBC), AND ANNA JAQUES HOSPITAL. THE LAHEY CLINIC FOUNDATION IN TURN SERVES AS SOLE MEMBER TO LAHEY CLINIC INC, AND LAHEY CLINIC HOSPITAL DBA LAHEY HOSPITAL AND MEDICAL CENTER (LHMC). ADDITIONAL ENTITIES LISTED HERE MAY ALSO IN TURN SERVE AS MEMBER TO OTHER NETWORK AFFILIATES. TWO OR MORE OF THE PERSONS LISTED IN THIS FORM 990 PART VII HAVE A BUSINESS RELATIONSHIP WITH EACH OTHER BY VIRTUE OF SITTING ON ONE OR MORE BOARDS OF DIRECTORS/TRUSTEES OR BY SERVING IN AN EMPLOYMENT RELATIONSHIP WITH ONE OR MORE ENTITIES WITHIN THE NETWORK OF AFFILIATED ORGANIZATIONS. ADDITIONAL DETAIL IS PROVIDED IN THE EXPLANATORY NOTES TO THIS FORM 990 SCHEDULE J. FORM 990, PART VI, SECTION A, LINE 4 ANNA JAQUES COMMUNITY HEALTH FOUNDATION MADE CHANGES TO ITS BYLAWS DURING THE FISCAL PERIOD ENDED SEPTEMBER 30, 2019 AS PART OF THE CREATION OF THE BETH ISRAEL LAHEY HEALTH (BILH), AN INTEGRATED HEALTH CARE SYSTEM PROVIDING PATIENT CARE INFORMED BY WORLD-CLASS RESEARCH AND EDUCATION. BETH ISRAEL LAHEY HEALTH, INC. BECAME THE SOLE MEMBER OF ANNA JAQUES COMMUNITY HEALTH FOUNDATION'S MEMBER. CHANGES TO THE BYLAWS AFFECT: - FREQUENCY OF MEETINGS - MINIMUM & MAXIMUM NUMBER OF TRUSTEES - EX-OFFICIO TRUSTEES - APPOINTMENT, REAPPOINTMENT AND REMOVAL OF TRUSTEES - COMMITTEES - OFFICERS - TERMS AND TERM LIMITS FORM 990, PART VI, SECTION A, LINE 6 EFFECTIVE MARCH 1, 2019, BETH ISRAEL LAHEY HEALTH, INC. (BILH) IS THE SOLE MEMBER OF ANNA JAQUES HOSPITAL, THE MEMBER OF ANNA JAQUES COMMUNITY HEALTH FOUNDATION. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBER HAS THE AUTHORITY TO ELECT SOME OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B THE MEMBER OF ANNA JAQUES COMMUNITY HEALTH FOUNDATION HAS THE FOLLOWING RIGHTS, AS DESIGNATED IN ANNA JAQUES COMMUNITY HEALTH FOUNDATION'S BYLAWS: - WITH RESPECT TO THE MANAGEMENT AND GOVERNANCE OF THE FOUNDATION, THE MEMBER SHALL HAVE ONLY SUCH POWERS AS PROVIDED BY LAW, THE ARTICLES OF ORGANIZATION, OR THESE BYLAWS. THE MEMBER MAY DELEGATE ANY OR ALL OF ITS POWERS PERTAINING TO THE MANAGEMENT AND GOVERNANCE OF THE FOUNDATION TO THE BOARD OF TRUSTEES OF THE FOUNDATION, AT ANY TIME, FROM TIME TO TIME. - IN THE EVENT THE MEMBER CEASES TO OPERATE AS A FULL-SERVICE, ACUTE CARE HOSPITAL, OR FOR ANY REASON CEASES TO QUALIFY AS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OR 509(A)(1), (2) OR (3) OF THE INTERNAL REVENUE CODE, THEN THE POWERS OF THE MEMBER PERTAINING TO THE MANAGEMENT AND GOVERNANCE OF THE FOUNDATION, OR AS OTHERWISE CONFERRED UPON MEMBER HEREUNDER, SHALL VEST WITH THE BOARD OF TRUSTEES OF THE FOUNDATION. THE MEMBER MAY NOT SELL, PLEDGE, ASSIGN OR OTHERWISE TRANSFER ANY PART OF ITS INTEREST IN THE ASSETS OF THE FOUNDATION, AND ANY ATTEMPTED PLEDGE, ASSIGNMENT OR OTHER TRANSFER OF THE FOUNDATION'S ASSETS BY THE MEMBER SHALL BE NULL AND VOID. THE ASSETS OF THE FOUNDATION SHALL NOT BE SUBJECT TO BEING ATTACHED OR TAKEN BY THE MEMBER'S CREDITORS BY ANY PROCESS WHATEVER. THE OFFICERS SHALL HAVE THE POWERS AND PERFORM THE DUTIES CUSTOMARILY BELONGING TO THEIR RESPECTIVE OFFICES, INCLUDING THE POWERS AND DUTIES LISTED BELOW: - THE CHAIRMAN SHALL PRESIDE AT ALL MEETINGS OF THE BOARD OF TRUSTEES AT WHICH HE OR SHE IS PRESENT AND SHALL HAVE SUCH DUTIES AND RESPONSIBILITIES AS MAY BE ASSIGNED FROM TIME TO TIME BY THE BOARD OF TRUSTEES. THE VICE CHAIRMAN SHALL PRESIDE IN THE ABSENCE OF THE CHAIRMAN. - THE EXECUTIVE DIRECTOR SHALL BE THE CHIEF EXECUTIVE OFFICER OF THE FOUNDATION, RESPONSIBLE TO THE BOARD FOR THE ADMINISTRATION OF THE FOUNDATION'S BUSINESS AND AFFAIRS. EXCEPT AS OTHERWISE PROVIDED BY THE BOARD OF TRUSTEES OR THESE BY-LAWS, THE EXECUTIVE DIRECTOR SHALL SIGN FOR THE FOUNDATION AL DEEDS, AGREEMENTS, AND OTHER FORMAL INSTRUMENTS. - THE SECRETARY SHALL KEEP RECORDS OF ALL MEETINGS OF THE BOARD OF TRUSTEES AND MAKE A REPORT THEREON AND SHALL ISSUE CALLS AND NOTICES OF MEETINGS. - THE TREASURER SHALL BE THE CHIEF FINANCIAL OFFICER OF THE FOUNDATION AND SHALL ENSURE THAT PROPER FINANCIAL RECORDS ARE KEPT AND THAT APPROPRIATE ARRANGEMENTS ARE MADE FOR THE INVESTMENT OF THE FOUNDATION'' FUNDS. HE OR SHE SHALL RENDER TO THE BOARD OF TRUSTEES AT THE ANNUAL MEETING AND WHENEVER ELSE IT SO REQUESTS AN ACCURATE ACCOUNT OF ALL SUMS RECEIVED AND DISBURSED DURING THE PRECEDING FISCAL YEAR AND OF ALL SUMS AND FUNDS WHICH ARE NOT EXPENDED. FORM 990, PART VI, SECTION B, LINE 11B AS NOTED IN VARIOUS DISCLOSURES THROUGHOUT THIS FILING, EFFECTIVE MARCH 1, 2019, BETH ISRAEL LAHEY HEALTH, INC. (BILH) BECAME THE SOLE MEMBER OF ANNA JAQUES HOSPITAL, INC., WHICH IS THE SOLE MEMBER OF ANNA JAQUES COMMUNITY HEALTH FOUNDATION. THIS FORM 990 IS REVIEWED BY THE CHIEF FINANCIAL OFFICER OF ANNA JAQUES HOSPITAL, INC., THE TAX DIRECTOR OF BILH AND DELOITTE TAX, LLP. A COPY OF THE COMPLETE RETURN IS THEN PROVIDED TO EACH MEMBER OF THE ANNA JAQUES COMMUNITY HEALTH FOUNDATION BOARD PRIOR TO SUBMISSION TO THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C EXPLANATION OF MONITORING AND ENFORCEMENT OF CONFLICTS ANNA JAQUES COMMUNITY HEALTH FOUNDATION (AJCHF) HAS A WRITTEN, CONFLICT OF INTEREST POLICY. TRUSTEES AND SENIOR EXECUTIVES REVIEW THE CONFLICT OF INTEREST POLICY ANNUALLY AND EACH IS ASKED TO COMPLETE AN ANNUAL CONFLICT OF INTEREST FORM TO DISCLOSE POSSIBLE CONFLICTS. RESPONSES ARE REVIEWED BY THE BOARD CHAIR TO DETERMINE IF ANY CONFLICT EXISTS. ANY INDIVIDUAL WITH A CONFLICT IS ASKED TO ABSTAIN FROM VOTING ON A RELATED MATTER. THE BOARD CHAIR AND/OR SECRETARY MONITOR SURVEYS TO ENSURE COMPLIANCE. FORM 990, PART VI, SECTION B, LINE 15 DESCRIPTION OF PROCESS TO DETERMINE COMPENSATION OF THE ORGANIZATION'S CEO AND OTHER OFFICERS AND KEY EMPLOYEES AS NOTED THROUGHOUT THIS FILING, ANNA JAQUES HOSPITAL AND ANNA JAQUES COMMUNITY HEALTH FOUNDATION (AJH AND AJCHF RESPECTIVELY) ALONG WITH THEIR OTHER RELATED ENTITIES BECAME MEMBERS OF THE BETH ISRAEL LAHEY HEALTH NETWORK OF AFFILIATES WITH BILH SERVING AS AJH'S SOLE MEMBER AND AJH, IN TURN SERVING AS AJCHF'S SOLE MEMBER, EFFECTIVE MARCH 1, 2019. PRIOR TO THAT DATE, ANNA JAQUES COMMUNITY HEALTH FOUNDATION,, .(AJCHF) WHICH WAS ALSO AN ENTITY EXEMPT FROM INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED, SERVED AS THE SOLE MEMBER OF BOTH AJH AND AJCHF AND MAINTAINED A COMPENSATION COMMITTEE THAT WAS COMPOSED OF MEMBERS OF THE BOARD OF TRUSTEES. ALL MEMBERS WERE INDEPENDENT. AS REQUIRED BY THIS FORM 990 FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2019, COMPENSATION REPORTED HEREIN IS CALENDAR YEAR 2018 COMPENSATION. AS SUCH, COMPENSATION REPORTED IN THIS FORM 990 FOR AJH AND AJCHF OFFICERS, TRUSTEES AND KEY EMPLOYEES WAS SET BY THE AJCHF COMPENSATION COMMITTEE AND GUIDED BY THE COMMITTEE'S PROCESS AS OUTLINED BELOW. THE COMPENSATION OF THE SENIOR EXECUTIVE TEAM WAS REVIEWED ANNUALLY BY AN INDEPENDENT COMMITTEE OF THE PARENT'S (AJCHF) BOARD. THE COMMITTEE USED DATA RECEIVED FROM AN INDEPENDENT COMPENSATION CONSULTING FIRM TO DETERMINE THE FAIRNESS AND OVERALL COMPARABILITY OF EACH EXECUTIVE'S COMPENSATION PACKAGE INCLUDING POTENTIAL INCENTIVE COMPENSATION. THE COMMITTEE RELIED ON THE SALARY SURVEY DATA TO INFORM WHETHER ANY CHANGES TO AN EXECUTIVE'S COMPENSATION WAS APPROPRIATE. IN ADDITION, THE COMMITTEE AGREED ON AND SET BENCHMARKS FOR EXECUTIVE INCENTIVE PAYMENTS AT THE START OF EACH YEAR, AND REVIEWED PROGRESS RELATED TO THOSE BENCHMARKS AT THE CONCLUSION OF THE YEAR TO DETERMINE WHETHER INCENTIVES WOULD BE PAID AND IF SO, AT WHAT LEVEL. FORM 990, PART VI, SECTION C, LINE 19 ANNA JAQUES COMMUNITY HEALTH FOUNDATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST AT THE FOLLOWING LOCATION: BETH ISRAEL LAHEY HEALTH TAX DEPARTMENT 109 BROOKLINE AVENUE, SUITE 300 BOSTON, MA 02215 FORM 990, PART XII, 2C ON MARCH 1, 2019, LAHEY HEALTH SYSTEM INCLUDING THE LAHEY CLINIC AND LAHEY CLINIC HOSPITAL D/B/A LAHEY HOSPITAL AND MEDICAL CENTER, WINCHESTER HOSPITAL, NORTHEAST HOSPITAL CORPORATION D/B/A BEVERLY HOSPITAL, ADDISON GILBERT HOSPITAL AND BAYRIDGE HOSPITAL, THE BETH ISRAEL DEACONESS SYSTEM INCLUDING BETH ISRAEL DEACONESS MEDICAL CENTER, BETH ISRAEL DEACONESS MILTON, BETH ISRAEL DEACONESS NEEDHAM AND BETH ISRAEL DEACONESS PLYMOUTH, MOUNT AUBURN HOSPITAL, NEW ENGLAND BAPTIST HOSPITAL, ANNA JAQUES HOSPITAL AS WELL AS ENTITIES FOR WHICH THESE LISTED ORGANIZATIONS SERVE AS SOLE MEMBER AND ADDITIONAL AFFILIATES CAME TOGETHER TO FORM BETH ISRAEL LAHEY HEALTH (BILH). AS A NEWLY CREATED HEALTHCARE SYSTEM, BILH ENGAGED KPMG TO PERFORM A FINANCIAL AUDIT OF THE SYSTEM. THE BOSTON, MA OFFICE OF KPMG ISSUED AN UNQUALIFIED OPINION ON THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF THE BETH ISRAEL LAHEY HEALTH, INC. AND AFFILIATES FOR FISCAL PERIOD ENDED SEPTEMBER 30, 2019. THESE STATEMENTS WERE PREPARED IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP) AND INCLUDED THE ACCOUNTS OF THE BETH ISRAEL LAHEY HEALTH, INC. AND ITS AFFILIATE SCHEDULE C NARRATIVE ANNA JAQUES COMMUNITY HEALTH FOUNDATION DOES NOT ENGAGE IN ANY DIRECT LOBBYING EFFORTS. HOWEVER, VARIOUS AFFILIATES OF ANNA JAQUES COMMUNITY HEALTH FOUNDATION, MAY HAVE ENGAGED IN SOME LOBBYING EFFORTS ON BEHALF OF THEMSELVES AND OTHER AFFILIATED NETWORK ENTITIES. TOTAL LOBBYING EXPENDITURES WERE MINIMAL AND NOT SUBSTANTIAL BASED ON REVENUES. ADDISON GILBERT SOCIETY INC 41 MALL ROAD BURLINGTON MA 01805 464371382 SUPPORT MA 501(C)(3) 7 LAHEY HEALTH SHARED SERVICES INC 1 ANNA JAQUES HOSPITAL INC 25 HIGHLAND AVE NEWBURYPORT MA 01950 042104338 HEALTHCARE MA 501(C)(3) 3 BETH ISRAEL LAHEY HEALTH INC 1 ASSOC PHYS HARVARD MED FAC PHY AT BIDMC 375 LONGWOOD AVE BOSTON MA 02215 320058309 TO PROVIDE EMERGENCY MEDICAL SERVICES MA 501(C)(3) 12A, I HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER 1 BAIM INSTITUTE OF CLINICAL RESEARCH INC FKA HCRI 930 COMMONWEALTH AVE BOSTON MA 02215 043521077 SCIENTIFIC & MEDICAL RESEARCH MA 501(C)(3) 7 N/A 1 BETH ISRAEL DEACONESS HOSPITAL - MILTON INC 199 REEDSDALE RD MILTON MA 02186 042103604 HOSPITAL FOR THE TREATMENT, CARE AND RELIEF OF SICK AND SUFFERING PERSONS. MA 501(C)(3) 3 BETH ISRAEL LAHEY HEALTH INC 1 BETH ISRAEL DEACONESS HOSPITAL - NEEDHAM INC 148 CHESTNUT ST NEEDHAM MA 02492 043229679 HOSPITAL FOR THE TREATMENT, CARE AND RELIEF OF SICK AND SUFFERING PERSONS. MA 501(C)(3) 3 BETH ISRAEL LAHEY HEALTH INC 1 BETH ISRAEL DEACONESS HOSPITAL - PLYMOUTH INC 275 SANDWICH ST PLYMOUTH MA 02360 222667354 HOSPITAL FOR THE TREATMENT, CARE AND RELIEF OF SICK AND SUFFERING PERSONS. MA 501(C)(3) 3 BETH ISRAEL LAHEY HEALTH INC 1 BETH ISRAEL DEACONESS MEDICAL CENTER 330 BROOKLINE AVE BOSTON MA 02215 042103881 THE OPERATION OF A WORLD CLASS ACADEMIC MEDICAL CENTER IN BOSTON, MA MA 501(C)(3) 3 BETH ISRAEL LAHEY HEALTH INC 1 BETH ISRAEL LAHEY HEALTH PRIMARY CARE FKA LPCO 41 MALL ROAD BURLINGTON MA 01805 472248298 HEALTHCARE MA 501(C)(3) 10 LAHEY HEALTH SHARED SERVICES INC 1 BETH ISRAEL LAHEY HEALTH INC 20 UNIVERSITY ROAD CAMBRIDGE MA 02138 832671600 SUPPORT MA 501(C)(3) 12A, I N/A 1 BI ANAESTHESIA FOUNDATION INC 330 BROOKLINE AVE BOSTON MA 02215 042997215 SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HFMP AND HMS MA 501(C)(3) 12A, I HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER 1 BI COMMUNITY FOUNDATION INC 330 BROOKLINE AVE STE 300 BOSTON MA 02215 042776678 INACTIVE CORPORATION MA 501(C)(3) 7 N/A 1 BI DEACONESS DEPARTMENT OF EMERGENCY MEDICINE FOUNDATION INC 330 BROOKLINE AVE W/CC-2 BOSTON MA 02215 364803234 SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HFMP AND HMS MA 501(C)(3) 12A, I HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER 1 BI DEACONESS DEPARTMENT OF MEDICINE FOUNDATION INC 330 BROOKLINE AVE BOSTON MA 02215 043079630 SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HFMP AND HMS MA 501(C)(3) 12A, I HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER 1 BI DEACONESS DEPARTMENT OF NEONATOLOGY FOUNDATION INC 330 BROOKLINE AVE BOSTON MA 02215 208253452 SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HFMP AND HMS MA 501(C)(3) 12A, I HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER 1 BI DEACONESS DEPARTMENT OF NEUROLOGY FOUNDATION INC 330 BROOKLINE AVE BOSTON MA 02215 043030397 SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HFMP AND HMS MA 501(C)(3) 12A, I HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER 1 BI DEACONESS DEPARTMENT OF ORTHOPAEDIC SURGERY FOUNDATION INC 330 BROOKLINE AVE BOSTON MA 02215 204974585 SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HFMP AND HMS MA 501(C)(3) 12A, I HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER 1 BI DEACONESS DEPARTMENT OF SURGERY FOUNDATION INC 330 BROOKLINE AVE BOSTON MA 02215 020671240 SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HFMP AND HMS MA 501(C)(3) 12A, I HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER 1 BI DERMATOLOGY FOUNDATION INC 330 BROOKLINE AVE BOSTON MA 02215 043117601 SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HFMP AND HMS MA 501(C)(3) 12A, I HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER 1 BIDMC AND CHILDREN'S HOSPITAL MEDICAL CARE CORP 482 BEDFORD STREET LEXINGTON MA 02420 043200113 SUPPORT MA 501(C)(3) 12A, I N/A 0 BIDMC OBSTETRICS AND GYNECOLOGY FOUNDATION INC 330 BROOKLINE AVE BOSTON MA 02215 042794855 SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HFMP AND HMS MA 501(C)(3) 12A, I HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER 1 BIDMC PHARMACY INC 330 BROOKLINE AVE BOSTON MA 02215 822526816 OPERATE A SPECIALTY PHARMACY MA 501(C)(3) 12A, I BETH ISRAEL DEACONESS MEDICAL CENTER 1 BID-MILTON PHYSICIAN ASSOCIATES INC FKA MHF 199 REEDSDALE RD MILTON MA 02186 222566792 PROMOTE HEALTHCARE MA 501(C)(3) 12A, I BETH ISRAEL DEACONESS HOSPITAL - MILTON 1 BIH PATHOLOGY FOUNDATION INC 330 BROOKLINE AVE BOSTON MA 02215 222548374 SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HFMP AND HMS MA 501(C)(3) 12A, I HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER 1 BIH RADIOLOGIC FOUNDATION INC 330 BROOKLINE AVE BOSTON MA 02215 042571853 SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HFMP AND HMS MA 501(C)(3) 12A, I HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER 1 CAB HEALTH AND RECOVERY 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HERRICK STREET BEVERLY MA 01915 042721511 PHYSICIAN OFFICE MA N/A C 1 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 ANNA JAQUES HOSPITAL INC B 1256919 FMV PART I - V: AS NOTED THROUGHOUT THIS FILING, ON MARCH 1, 2019, BETH ISRAEL LAHEY HEALTH (BILH) BECAME SOLE MEMBER OF BETH ISRAEL DEACONESS MEDICAL CENTER, INC. (BIDMC), MOUNT AUBURN HOSPITAL (MAH), NEW ENGLAND BAPTIST HOSPITAL (NEBH), BETH ISRAEL DEACONESS HOSPITAL MILTON, INC. (MILTON), BETH ISRAEL DEACONESS HOSPITAL NEEDHAM, INC. (NEEDHAM), BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH, INC. (PLYMOUTH), LAHEY HEALTH SHARED SERVICES, LAHEY CLINIC FOUNDATION, WINCHESTER HOSPITAL (WINCHESTER), NORTHEAST HOSPITAL CORPORATION (NHC), NORTHEAST BEHAVIORAL CORPORATION (NBC), AND ANNA JAQUES HOSPITAL. THE LAHEY CLINIC FOUNDATION IN TURN SERVES AS SOLE MEMBER TO LAHEY CLINIC INC, AND LAHEY CLINIC HOSPITAL DBA LAHEY HOSPITAL AND MEDICAL CENTER (LHMC). ADDITIONAL ENTITIES LISTED HERE MAY ALSO IN TURN SERVE AS MEMBER TO OTHER NETWORK AFFILIATES. BY-LAW CHANGES WERE MADE TO REFLECT THE CENTRALIZATION OF THE SYSTEM, AND AS SUCH, AFFILIATES WITHIN THE BILH SYSTEM ARE CONSIDERED CONTROLLED ENTITIES UNDER IRC SECTION 512(B)(13), AS EACH AFFILIATE IS UNDER COMMON GOVERNANCE CONTROL, AS DESCRIBED IN TREAS. REGS. 1.512(B)-1(L)(4). UNDER IRC SEC. 512, CONTROL MEANS THAT MORE THAN 50 PERCENT OF THE DIRECTORS OR TRUSTEES OF AN ORGANIZATION ARE EITHER REPRESENTATIVES OF, OR DIRECTLY OR INDIRECTLY CONTROLLED, BY AN EXEMPT ORGANIZATION. A TRUSTEE OR DIRECTOR IS A REPRESENTATIVE OF AN EXEMPT ORGANIZATION IF THEY ARE A TRUSTEE, DIRECTOR, AGENT, OR EMPLOYEE OF SUCH EXEMPT ORGANIZATION. UNDER THIS DEFINITION, HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER, INC. AND AFFILIATES ARE INCLUDED IN ANNA JAQUES COMMUNITY HEALTH FOUNDATION'S FORM 990, SCHEDULE R FOR THE CURRENT TAX YEAR.