ANNA JAQUES COMMUNITY HEALTH FOUNDATION: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- ANNA JAQUES COMMUNITY HEALTH FOUNDATION (EIN 04-3318952)
- Tax period
- 2017-10-01 to 2018-09-30
- Filed
- 2019-08-14
- IRS object ID
- 201942279349300109
- Schema version
- 2017v2.3
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule I
- Schedule J
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2019-08-14T13:26:15-05:00 | ReturnTs |
| Tax Period End | 2018-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BDO USA LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | ONE INTERNATIONAL PLACE | AddressLine1Txt |
| City | BOSTON | CityNm |
| State Abbreviation | MA | StateAbbreviationCd |
| ZIP | 02110 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 043318952 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Anna Jaques Community Health Foundation | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % THE ORGANIZATION | InCareOfNm |
| Business Name Control | ANNA | BusinessNameControlTxt |
| Phone | 9784631000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 25 Highland Ave | AddressLine1Txt |
| City | Newburyport | CityNm |
| State Abbreviation | MA | StateAbbreviationCd |
| ZIP | 01950 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KEVIN KILDAY | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 9784631000 | PhoneNum |
| Signature | 2019-08-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Brian Vigneault | PreparerPersonNm |
| PTIN | P00540650 | PTIN |
| Phone | 6174220700 | PhoneNum |
| Preparation | 2019-08-15 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 4.14.180.58 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Federal Original Submission Id | 04123920192265000023 | FederalOriginalSubmissionId |
| Federal Original Submission Id | 2019-08-14 | FederalOriginalSubmissionIdDt |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 84A374456F6A769E03C52DF251DDEE56EDBBAFB5 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 7D1FA132861768FAAA6F7850C73535C89C74ABDC | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2019-02-21 02:37:17Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Mark Goldstein CEO | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 25 Highland Ave | AddressLine1Txt |
| City | Newburyport | CityNm |
| State Abbreviation | MA | StateAbbreviationCd |
| ZIP | 01950 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $2,706,681 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.ajh.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1996 | FormationYr |
| Legal Domicile State | MA | LegalDomicileStateCd |
| Activity Or Mission | To provide support to Anna Jaques Hospital. | ActivityOrMissionDesc |
| Voting Members Governing Body | 24 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 22 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 21 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $1,634,156 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,610,850 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,509,000 | PYInvestmentIncomeAmt |
| CY Investment Income | $991,121 | CYInvestmentIncomeAmt |
| PY Other Revenue | $3,616 | PYOtherRevenueAmt |
| CY Other Revenue | $2,900 | CYOtherRevenueAmt |
| PY Total Revenue | $3,146,772 | PYTotalRevenueAmt |
| CY Total Revenue | $2,604,871 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $1,820,809 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $894,927 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $361,674 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $382,793 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $475,431 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $110,107 | PYOtherExpensesAmt |
| CY Other Expenses | $128,757 | CYOtherExpensesAmt |
| PY Total Expenses | $2,292,590 | PYTotalExpensesAmt |
| CY Total Expenses | $1,406,477 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $854,182 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,198,394 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $20,905,297 | TotalAssetsBOYAmt |
| Total Assets EOY | $22,084,523 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $662,419 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $16,984 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $20,242,878 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $22,067,539 | NetAssetsOrFundBalancesEOYAmt |
| Mission | ANNA JAQUES COMMUNITY HEALTH FOUNDATION PROVIDES SUPPORT TO ANNA JAQUES HOSPITAL, A TAX EXEMPT HOSPITAL. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $894,927 | ExpenseAmt |
| Grant | $894,927 | GrantAmt |
| Revenue | $2,604,871 | RevenueAmt |
| Desc | The mission of AJCHF is to provide support to Anna Jaques Hospital. The grants represent donations which were released to the hospital, either because they were unrestricted donations, or because they were restricted donations for which the donors' restrictions had been satisfied. | Desc |
| Total Program Service Expenses | $894,927 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (true) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | false | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (true) | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | Yes (true) | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | Yes (true) | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | Yes (true) | NondeductibleContributionsInd |
| Nondeductible Contri Discl | Yes (true) | NondeductibleContriDisclInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 24 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 22 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | MA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | THE ORGANIZATION | PersonNm |
| Phone | 9784631100 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 25 HIGHLAND AVE | AddressLine1Txt |
| City | NEWBURYPORT | CityNm |
| State Abbreviation | MA | StateAbbreviationCd |
| ZIP | 01950 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (26 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|
| Ralph Castagna | ||||||||
| Director | 5.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| Jessica Amorosino MD | ||||||||
| Director | 5.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| Todd Baltich | ||||||||
| Director | 5.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| Kathy Bechtel | ||||||||
| Director | 5.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| Kari Bernard | ||||||||
| Director | 5.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| Kathy Connors | ||||||||
| Director | 5.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| Luis Fernandez | ||||||||
| Director | 5.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| Melissa Foley | ||||||||
| Director | 5.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| Kim Foulkes | ||||||||
| Director | 5.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| Julie Ganong | ||||||||
| Director | 5.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| Kevin Gasiorowski | ||||||||
| Director | 5.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| Matt Khatib | ||||||||
| Director | 5.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| Jeffrey Nahas | ||||||||
| Director | 5.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| Vania O'Connor | ||||||||
| Director | 5.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| Mary Williamson | ||||||||
| Director;VP/Exec Dir 5/21/18 | 40.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| Kevin Kilday | ||||||||
| VP/CFO | 5.0 | 55.0 | Yes (X) | $0 | $339,365 | $59,077 | Yes (X) | |
| Mark Goldstein | ||||||||
| President/CEO | 5.0 | 55.0 | Yes (X) | $0 | $618,849 | $149,904 | Yes (X) | |
| Claude Elias | ||||||||
| Director | 5.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| Ronna Caras | ||||||||
| Director | 5.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| Kate Kelly | ||||||||
| Director | 5.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| Jay Iannini | ||||||||
| Director | 5.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| Christopher Johnston | ||||||||
| Director | 5.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| Lisa Purinton | ||||||||
| Director | 5.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| Charles Byrnes | ||||||||
| Director | 5.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| Sarah Gnerre | ||||||||
| VP/Exec Director thru 1/5/18 | 5.0 | 50.0 | $0 | $179,454 | $39,549 | Yes (X) | ||
| Delia O'Connor | ||||||||
| President/CEO thru 12/31/14 | 0.0 | 0.0 | $0 | $157,472 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,295,140 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $248,530 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (true) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $118,880 | FundraisingAmt |
| All Other Contributions | $1,491,970 | AllOtherContributionsAmt |
| Noncash Contributions | $50,141 | NoncashContributionsAmt |
| Total Contributions | $1,610,850 | TotalContributionsAmt |
| Total Program Service Revenue | $0 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $344,782 | TotalRevenueColumnAmt |
| Exclusion | $344,782 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $714,329 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $67,990 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $646,339 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $646,339 | TotalRevenueColumnAmt |
| Exclusion | $646,339 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $36,720 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $118,880 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $33,820 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,900 | TotalRevenueColumnAmt |
| Exclusion | $2,900 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gaming Gross Income | $0 | GamingGrossIncomeAmt |
| Gaming Direct Expenses | $0 | GamingDirectExpensesAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $0 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $0 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $0 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,604,871 | TotalRevenueColumnAmt |
| Exclusion | $994,021 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $894,927 | TotalAmt |
| Program Services | $894,927 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $144,592 | TotalAmt |
| Management And General | $13,119 | ManagementAndGeneralAmt |
| Fundraising | $131,473 | FundraisingAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $164,249 | TotalAmt |
| Fundraising | $164,249 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $55,644 | TotalAmt |
| Management And General | $7,000 | ManagementAndGeneralAmt |
| Fundraising | $48,644 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,308 | TotalAmt |
| Management And General | $1,000 | ManagementAndGeneralAmt |
| Fundraising | $17,308 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,000 | TotalAmt |
| Management And General | $15,000 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $62,356 | TotalAmt |
| Fundraising | $62,356 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $33,594 | TotalAmt |
| Fundraising | $33,594 | FundraisingAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,852 | TotalAmt |
| Fundraising | $16,852 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $955 | TotalAmt |
| Fundraising | $955 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Expenses OtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | SERVICE CONTRACTS | Desc |
| Total | $0 | TotalAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,406,477 | TotalAmt |
| Program Services | $894,927 | ProgramServicesAmt |
| Management And General | $36,119 | ManagementAndGeneralAmt |
| Fundraising | $475,431 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $141,135 | BOYAmt |
| EOY | $385,040 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $794,678 | BOYAmt |
| EOY | $437,215 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,861 | BOYAmt |
| EOY | $276 | EOYAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,951,623 | BOYAmt |
| EOY | $21,261,992 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,905,297 | BOYAmt |
| EOY | $22,084,523 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,875 | BOYAmt |
| EOY | $15,475 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $656,544 | BOYAmt |
| EOY | $1,509 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $662,419 | BOYAmt |
| EOY | $16,984 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,118,107 | BOYAmt |
| EOY | $8,676,188 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,367,499 | BOYAmt |
| EOY | $7,673,378 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,757,272 | BOYAmt |
| EOY | $5,717,973 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,242,878 | BOYAmt |
| EOY | $22,067,539 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,905,297 | BOYAmt |
| EOY | $22,084,523 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $1,198,394 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $626,267 | NetUnrlzdGainsLossesInvstAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type1 | Yes (X) | SupportingOrgType1Ind |
| Supported Organizations | 1 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp
Supported Organization Name SupportedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ANNA JAQUES HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 042104338 | EIN |
| Organization Type | 3 | OrganizationTypeCd |
| Governing Document Listed | Yes (true) | GoverningDocumentListedInd |
| Support | $894,927 | SupportAmt |
| Other Support | $0 | OtherSupportAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 1 | SupportedOrganizationsTotalCnt |
| Support Sum | $894,927 | SupportSumAmt |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | Yes (true) | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | false | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | false | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | false | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | false | OrganizationChangeSuprtOrgInd |
| Support Non Supported Org | false | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | false | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | false | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | false | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | false | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | false | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | false | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | false | ContributionControllerInd |
| Contribution Family | false | ContributionFamilyInd |
| Contribution35 Controlled | false | Contribution35ControlledInd |
Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Power Appoint Majority Dir Trst | Yes (true) | PowerAppointMajorityDirTrstInd |
| Operate Benefit Non Suprt Org | false | OperateBenefitNonSuprtOrgInd |
Schedule B IRS990ScheduleB
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp |
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $15,304,864 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $1,341,021 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $386,000 | GrantsOrScholarshipsAmt |
| Administrative Expenses | $23,513 | AdministrativeExpensesAmt |
| End Year Balance | $16,236,372 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $13,932,112 | BeginningYearBalanceAmt |
| Contributions | $15,000 | ContributionsAmt |
| Investment Earnings Or Losses | $1,792,855 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $416,628 | GrantsOrScholarshipsAmt |
| Administrative Expenses | $18,475 | AdministrativeExpensesAmt |
| End Year Balance | $15,304,864 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $13,706,652 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $1,029,573 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $796,286 | GrantsOrScholarshipsAmt |
| Administrative Expenses | $7,827 | AdministrativeExpensesAmt |
| End Year Balance | $13,932,112 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $14,520,243 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$477,873 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $330,000 | GrantsOrScholarshipsAmt |
| Administrative Expenses | $5,718 | AdministrativeExpensesAmt |
| End Year Balance | $13,706,652 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $13,990,828 | BeginningYearBalanceAmt |
| Contributions | $87,359 | ContributionsAmt |
| Investment Earnings Or Losses | $1,163,509 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $701,569 | GrantsOrScholarshipsAmt |
| Administrative Expenses | $19,884 | AdministrativeExpensesAmt |
| End Year Balance | $14,520,243 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.47000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.12000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.41000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | false | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | false | EndowmentsHeldRelatedOrgInd |
| Land | LandGrp | |
| Buildings | BuildingsGrp | |
| Leasehold Improvements | LeaseholdImprovementsGrp | |
| Equipment | EquipmentGrp | |
| Other Land Buildings | OtherLandBuildingsGrp | |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO AFFILIATES | Desc |
| Amt | $1,509 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,509 | TotalLiabilityAmt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part V, Question 4: | AJCHF 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: | There is no FIN48 (ASC 740) footnote in the consolidated audited financial statements. |
Schedule G IRS990ScheduleG
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed States | MA | LicensedStatesCd |
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | GOLF TOURNAMENT | Event1Nm |
| Gross Receipts Event1 | $155,600 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $118,880 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $36,720 | GrossRevenueEvent1Amt |
| Non Cash Prizes Event1 | $5,793 | NonCashPrizesEvent1Amt |
| Rent Facility Costs Event1 | $26,586 | RentFacilityCostsEvent1Amt |
| Other Direct Expenses Event1 | $1,441 | OtherDirectExpensesEvent1Amt |
| Other Events Total | 0 | OtherEventsTotalCnt |
| Gross Receipts Total | $155,600 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $118,880 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $36,720 | GrossRevenueTotalEventsAmt |
| Non Cash Prizes Total Events | $5,793 | NonCashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $26,586 | RentFcltyCostsTotalEventsAmt |
| Oth Direct Expnss Total Events | $1,441 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $33,820 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $2,900 | NetIncomeSummaryAmt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (true) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Anna Jaques Hospital | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 25 Highland Ave | AddressLine1Txt |
| City | Newburyport | CityNm |
| State Abbreviation | MA | StateAbbreviationCd |
| ZIP | 01950 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 042104338 | RecipientEIN |
| IRC Section | 501C(3) | IRCSectionDesc |
| Cash Grant | $894,927 | CashGrantAmt |
| Valuation Method Used | FMV | ValuationMethodUsedDesc |
| Purpose Of Grant | general assistance | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I Description of Procedure for Monitoring Use of Funds | FormAndLineReferenceDesc |
| Explanation | Donations are tracked by donor restriction (for example, a donation to fund tYe purchase of a particular piece of capital equipment). Donations are not released to the hospital until the specific restriction has been met. Unrestricted donations are transferred periodically to assist with general support. All grants are made to Anna Jaques Hospital, CHF's sole member, a related 501c(3) organization. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | Yes (true) | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | Yes (true) | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (4 entries)
| TitleTitleTxt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|
| Kevin Kilday | ||||||
| VP/CFO | $282,255 | $57,110 | $24,450 | $34,627 | $398,442 | |
| Sarah Gnerre | ||||||
| VP/Exec Director thru 1/5/18 | $174,745 | $4,709 | $16,955 | $22,594 | $219,003 | |
| Mark Goldstein | ||||||
| President/CEO | $496,180 | $122,669 | $116,350 | $33,554 | $768,753 | |
| Delia O'Connor | ||||||
| President/CEO thru 12/31/14 | $157,472 | $157,472 | $157,472 | |||
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, SCHEDULE J, PART 1, QUESTION 3 | This organization does not establish compensation for the CEO and other executives. The board of the parent (SRHS) performs that function and does use a compensation committee, independent consultant, and compensation surveys to establish compensation levels and does require approval by the compensation committee before payments are made. |
| FORM 990, SCHEDULE J, PART 1, QUESTION 4B | DELIA O'CONNOR, CEO THROUGH 12/31/14, IS NOW RETIRED AND RECEIVED DISTRIBUTIONS IN CALENDAR 2017 FROM THE NON-QUALIFIED RETIREMENT PLANS SHE PARTICIPATED IN WHILE EMPLOYED. THE TOTAL OF THE PAYMENTS WAS $157,472. MARK GOLDSTEIN PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN FUNDED BY A SPLIT DOLLAR LIFE INSURANCE POLICY. THE PREMIUM PAID WAS $85,000. |
| FORM 990, SCHEDULE J, PART 1, QUESTION 5B | MARK GOLDSTEIN'S, KEVIN KILDAY'S BONUS PAYMENTS WERE CONTINGENT UPON THE ORGANIZATIONS IN THE SYSTEM MEETING CERTAIN TARGETS, INCLUDING THE TARGETED EARNINGS OF THE ORGANIZATIONS. THE AMOUNTS PAID WERE $122,669 AND $57,110 RESPECTIVELY. |
Schedule M IRS990ScheduleM
| Field | Value | IRS element (for citing) |
|---|---|---|
| Works Of Art | WorksOfArtGrp | |
| Art Historical Treasures | ArtHistoricalTreasuresGrp | |
| Art Fractional Interest | ArtFractionalInterestGrp | |
| Books And Publications | BooksAndPublicationsGrp | |
| Clothing And Household Goods | ClothingAndHouseholdGoodsGrp | |
| Cars And Other Vehicles | CarsAndOtherVehiclesGrp | |
| Boats And Planes | BoatsAndPlanesGrp | |
| Intellectual Property | IntellectualPropertyGrp |
Securities Publicly Traded SecuritiesPubliclyTradedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 575 | ContributionCnt |
| Noncash Contributions Rpt F990 | $50,141 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities Closely Held Stock | SecuritiesCloselyHeldStockGrp | |
| Secur Prtnrshp Trust Intrsts | SecurPrtnrshpTrustIntrstsGrp | |
| Securities Miscellaneous | SecuritiesMiscellaneousGrp | |
| Qualified Contrib Hist Struct | QualifiedContribHistStructGrp | |
| Qualified Contrib Other | QualifiedContribOtherGrp | |
| Real Estate Residential | RealEstateResidentialGrp | |
| Real Estate Commercial | RealEstateCommercialGrp | |
| Real Estate Other | RealEstateOtherGrp | |
| Collectibles | CollectiblesGrp | |
| Food Inventory | FoodInventoryGrp | |
| Drugs And Medical Supplies | DrugsAndMedicalSuppliesGrp | |
| Taxidermy | TaxidermyGrp | |
| Historical Artifacts | HistoricalArtifactsGrp | |
| Scientific Specimens | ScientificSpecimensGrp | |
| Archaeological Artifacts | ArchaeologicalArtifactsGrp | |
| Any Property That Must Be Held | false | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | false | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | false | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Question 6: | Anna Jaques Hospital is the sole member of AJCHF. |
| Form 990, Part VI, Question 7a: | The AJH board elects the AJCHF board. |
| Form 990, Part VI, Question 7b: | Approval by the AJH board is required for the adoption of annual operating and capital budgets: for the merger or consolidation of the organization with any other corporation: for the formation or dissolution of the subsidiaries of the corporation: and for a decision to conduct any fundraising activities. |
| Form 990, Part VI, Question 11b: | The Form 990 is prepared and reviewed by an outside accounting firm. Subsequently, the Form 990 is provided to the CEO and CFO for review and approval. Once approved, a copy of the 990 is made available to the board for review prior to filing. |
| Form 990, Part VI, Questoin 12c: | The board of trustees and senior executives review the conflict of interest policy annually and complete a survey about possible conflicts of interest. Their answers are reviewed by the chairperson to determine if conflicts exist. If there is a conflict of interest on a particular issue, the chairperson requires that the individual abstain from voting at that time. The chairperson or secretary monitors surveys to ensure compliance. |
| Form 990, Part VI, Question 15a: | Total compensation of the senior executive team is reviewed annually by an independent committee of the parent's board. The committee uses data received from an independent compensation consulting firm to determine the fairness and comparability of the compensation, and decides whether any changes are to be made. In addition, the committee agrees on benchmarks for executive bonuses at the start of each year, and reviews progress at the conclusion of the year to determine what bonuses are payable. Bonuses are included in total compensation during the salary review mentioned above. |
| Form 990, Part VI, Question 19: | Governing documents, the conflict of interest policy, and financial statements are available to the public upon request. |
| Form 990, Part III - Program Service, Line 4a | As noted in various disclsoures throughout this filing, Seacoast Regional Health System (SRHS) served as the sole member of Anna Jaques Community Health Foundation for the period covered by this filing, October 1, 2017 to September 30, 2018 (fiscal year ended September 30, 2018). Effective March 1, 2019, pursuant to a plan of statutory merger, SRHS merged into Anna Jaques Community Health Foundation and Beth Israel Lahey Health, Inc. (BILH) became the sole Member of Anna Jaques Community Health Foundation. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Anna Jaques Hospital | |||||||||||
| 25 Highland Ave | Newburyport | MA | 01950 | 042104338 | hospital | MA | 501c(3) | line 3 | SRHS | false | |
| Seacoast Regional Health Systems | |||||||||||
| 25 Highland Ave | Newburyport | MA | 01950 | 222814214 | supprtg org | MA | 501c(3) | LINE 12, II | false | N/A | |
| Seacoast Affiliated Group Practice | |||||||||||
| 25 Highland Ave | Newburyport | MA | 01950 | 043485648 | physician | MA | 501c(3) | LINE 10 | SRHS | false | |
| Seacoast Regional MRI | |||||||||||
| 25 Highland Ave | Newburyport | MA | 01950 | 320443663 | health svc | MA | 501c(3) | LINE 10 | SRHS | false | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Greater Newburyport Management Serv | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 25 Highland Ave | AddressLine1Txt |
| City | Newburyport | CityNm |
| State Abbreviation | MA | StateAbbreviationCd |
| ZIP | 01950 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 161744477 | EIN |
| Primary Activities | management | PrimaryActivitiesTxt |
| Legal Domicile State | MA | LegalDomicileStateCd |
| Entity Type | C Corp | EntityTypeTxt |
| Share Of Total Income | $0 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $0 | ShareOfEOYAssetsAmt |
| Ownership | 0.00000 | OwnershipPct |
| Controlled Organization | false | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (true) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (true) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (3 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| Anna Jaques Hospital | ||
| B | $894,927 | FMV |
| Anna Jaques Hospital | ||
| L | $1,647,480 | FMV |
| Anna Jaques Hospital | ||
| P | $545,370 | FMV |
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