2018-08-14T14:36:52-05:00 2017-09-30 861065772 DELOITTE TAX LLP TWO JERICHO PLAZA JERICHO NY 11753 990 2016-10-01 043326928 CARL J SHAPIRO INSTITUTE FOR EDUCATION AND RESEARCH AT HARVARD MEDICAL SCHOOL CARL 6176670608 330 BROOKLINE AVENUE NO ES 2 BOSTON MA 022155400 RICHARD M SCHWARTZSTEIN MD PRESIDENT & EXECUTIVE DIRECTOR 6176670608 2018-08-03 1 CHRISTINE KAWECKI P00743140 5169187000 2018-08-03 2016 2022-09-23 18:48:47Z RICHARD SCHWARTZSTEIN MD 330 BROOKLINE AVENUE NO ES 2 BOSTON MA 022155400 694598 0 X WWW.BIDMC.ORG X 1996 MA SEE SCHEDULE O 15 4 0 4 -300 -6058 0 0 176677 673980 29177 20618 0 0 205854 694598 39229 94408 0 0 0 0 0 0 0 68309 445396 107538 539804 98316 154794 3166318 3467768 21553 45470 3144765 3422298 X SEE SCHEDULE O 0 0 44733 92936 SIMULATION AND SKILLS CENTER ("CENTER") - THE CENTER PROVIDES OPPORTUNITIES FOR TRAINEES TO PRACTICE SKILLS FOR LAPAROSCOPIC AND OTHER SURGICAL PROCEDURES, TO ENGAGE IN TEAM-BASED LEARNING, AND TO ENHANCE COMMUNICATION SKILLS. THE CENTER INCORPORATES REALISTIC OPERATING AND INTENSIVE CARE/EMERGENCY ROOMS WHICH ALLOW FOR TEAM TRAINING AND DISCIPLINE-SPECIFIC EDUCATIONAL EXPERIENCES. THE CENTER'S RESOURCES INCLUDE A WIDE RANGE OF TASK TRAINERS AND SIMULATORS, VIDEOCONFERENCE FACILITIES AND DEDICATED FACULTY AND STAFF TO SUPPORT THE EDUCATION OF STUDENTS, TRAINEES, AND PRACTITIONERS IN ALL OF THE HEALTH CARE PROFESSIONS. 105566 173445 CONTINUING MEDICAL EDUCATION COURSES - THE INSTITUTE HAS SPONSORED COURSES ON "MAXIMIZING YOUR TEACHING SKILLS: PRINCIPLES OF MEDICAL EDUCATION." THE COURSE CURRICULUM IS AN INTRODUCTION TO THE PRINCIPLES OF EFFECTIVE CLINICAL TEACHING FOR ADULT LEARNERS. THROUGH DIDACTIC AND INTERACTIVE SESSIONS, PARTICIPANTS LEARN MODELS OF CLINICAL INSTRUCTION AND HOW TO APPLY THESE EFFECTIVE TECHNIQUES TO THEIR OWN TEACHING. THE COURSE ALSO PROVIDES AN EXPLORATION OF CRITICAL THINKING, REFLECTION, ASSESSMENT, AND FEEDBACK. 144602 352084 THE INSTITUTE COLLABORATED WITH THE INTERNATIONAL EMERGENCY MANAGEMENT SOCIETY EMERGENCY MEDICAL COMMITTEE, TO DEVELOP PROGRAMS AND INITIATIVES WHICH PROMOTE THE INTERNATIONAL EXCHANGE OF MEDICAL STUDENTS AND SHARE MUTUAL MEDICAL EDUCATION INTERESTS. THE TWO PARTIES JOINTLY PROMOTED EDUCATION TO MAKE A SIGNIFICANT CONTRIBUTION TO THE DEVELOPMENT AND PROGRESS OF HUMAN HEALTH IN CHINA, INCLUDING AN EDUCATIONAL PROGRAM FOR CHINESE SENIOR HOSPITAL EXECUTIVES IN BOSTON. 189576 94408 55515 OTHER PROGRAM SERVICES 189576 94408 55515 484477 1 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 1 0 0 0 1 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 40 0 1 0 1 1 0 0 0 0 0 0 0 0 0 X 15 4 1 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 1 0 MA X CHRISTINE COUGHLIN 6176679120 330 BROOKLINE AVENUE EAST CAMPUS/ES BOSTON MA 02215 BRENNER-GATI MD LEONA TRUSTEE 1.00 0.00 X 0 0 0 CHAIKOF MD PHD ELLIOT L TRUSTEE 1.00 64.00 X 0 1038142 115728 EDELHEIT PHD LEWIS S TRUSTEE 1.00 0.00 X 0 0 0 GOLDBERG CAROL R TRUSTEE 1.00 0.00 X 0 0 0 HUNDERT MD EDWARD TRUSTEE 1.00 59.00 X 0 380489 58731 JICK DANIEL J TRUSTEE (EX-OFFICIO) 1.00 0.00 X 0 0 0 MEEKER MD DAVID TRUSTEE 1.00 0.00 X 0 0 0 RABKIN MD MITCHELL T TRUSTEE 1.00 0.00 X 0 0 0 RICCIOTTI MD HOPE A TRUSTEE 1.00 64.00 X 0 633980 81674 SAFFITZ MD PHD JEFFREY E TRUSTEE 1.00 64.00 X 1000 657972 53573 SCHWARTZSTEIN RICHARD M TRUSTEE (EX-OFF), EXEC DIRECTOR 12.00 53.00 X X 82256 316757 46473 STEVENSON MD PHD MARY ANN TRUSTEE 1.00 59.00 X 0 698508 84734 SUKHATME MD SCD VIKAS P TRUSTEE (EX-OFFICIO) 1.00 59.00 X 1250 639010 80986 TABB MD KEVIN TRUSTEE (EX-OFFICIO) & CO-CHAIR 1.00 64.00 X 0 1445730 170597 ZEIDEL MD MARK L TRUSTEE 1.00 64.00 X 0 767425 64397 COUGHLIN CHRISTINE M ASSOCIATE DIRECTOR, CLERK 2.00 18.00 X 7088 45745 5510 HUGHES CAROL A OPERATIONS MANAGER & CLERK 12.00 28.00 X 60478 117636 42373 WANG DIANA TREASURER & FINANCIAL ANALYST 8.00 12.00 X 38493 41838 25521 190565 6783232 830297 0 0 1 1 0 PROGRAM FEES 900099 673980 673980 673980 20178 -740 20918 440 0 440 440 440 694598 673980 -300 20918 94408 94408 19082 19082 11977 761 11216 2091 2091 309920 309920 24153 24153 TEACHING HONORARIUM 45642 45642 TEACHING EXPENSES 30791 30791 BANK FEES 876 876 DUES & MEMBERSHIP 864 864 539804 484477 55327 0 1293703 1466111 23315 51742 9142 223024 128147 116904 94877 1723254 1855038 3166318 3467768 21553 45470 21553 45470 X 1869581 2054592 377184 469706 898000 898000 3144765 3422298 3166318 3467768 X 154794 140623 -17884 X 0 1 X 1 0 X X X 2 BETH ISRAEL DEACONESS MEDICAL CENTER 042103881 3 1 242238 0 PRESIDENT & FELLOWS OF HARVARD COLLEGE 042103580 2 1 242238 0 2 484476 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FORM 990, SCHEDULE A, PART IV, SECTION A, LINE 6 AS PREVIOUSLY NOTED IN THIS FILING, THE INSTITUTE IS A SUPPORT ORGANIZATION OF BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC OR MEDICAL CENTER) AND THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE/HARVARD MEDICAL SCHOOL. IN ADDITION, HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER (HMFP) IS THE DEDICATED PHYSICIAN PRACTICE OF BIDMC AND AN ENTITY INTEGRALLY RELATED TO BIDMC. ALL OF THESE ENTITIES ARE PUBLIC CHARITIES EXEMPT FROM INCOME TAX UNDER SECTION 501(C) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED. DURING THE PERIOD COVERED BY THIS FILING AS REPORTED IN SCHEDULE I, GRANTS AND OTHER ASSISTANCE TO ORGANIZATIONS, GOVERNMENTS AND INDIVIDUALS IN THE UNITED STATES, THE SHAPIRO INSTITUTE MADE CASH GRANTS TO BIDMC IN FURTHERANCE OF BIDMC'S MISSIONS. FORM 990, SCHEDULE A, PART IV, SECTION B, LINE 1 FOR THE PERIOD COVERED BY THIS FILING, ALTHOUGH A MAJORITY OF THE INSTITUTE'S BOARD WAS NOT APPOINTED BY ITS SUPPORTED ORGANIZATIONS, PURSUANT TO THE SHAPIRO INSTITUTE'S BY-LAWS, A MAJORITY OF THE INSTITUTE'S OFFICERS WERE APPOINTED BY ITS SUPPORTED ORGANIZATIONS. IN ADDITION, AT ALL TIMES DURING THE YEAR THE INSTITUTE'S SUPPORTED ORGANIZATIONS MAINTAINED A CLOSE WORKING RELATIONSHIP WITH THE INSTITUTE. IN PARTICULAR, ALL OF THE INSTITUTE'S OFFICERS WERE INDIVIDUALS EMPLOYED BY AND/OR APPOINTED BY THE SUPPORTED ORGANIZATIONS. OF THESE, HALF OF THE OFFICER POSITIONS, THE TWO CO-CHAIRS AND THE EXECUTIVE DIRECTOR, WERE FILLED BY THE SUPPORTED ORGANIZATIONS. SPECIFICALLY THE TWO CO-CHAIRS WERE INDIVIDUALS WHO SERVED IN THOSE POSITIONS, EX-OFFICIO, BY VIRTUE OF OFFICES TO WHICH THEY WERE NAMED AT THE SUPPORTED ORGANIZATIONS BY THE SUPPORTED ORGANIZATIONS' BOARDS OR OFFICERS OF THE SUPPORTED ORGANIZATIONS ACTING IN THEIR OFFICIAL CAPACITIES, AND THE EXECUTIVE DIRECTOR WAS APPOINTED BY THE CO-CHAIRS ACTING ON BEHALF OF THE TWO SUPPORTED ORGANIZATIONS. 1723254 112110 20000 422996 1392368 1631810 400000 45924 30000 324480 1723254 1710961 14575 20000 73726 1631810 1658531 143793 20000 71363 1710961 1634038 165638 141145 1658531 0.00000 0.35000 0.65000 0 0 71661 34636 37025 96043 40197 55846 55320 53314 2006 94877 CAREGROUP INVESTMENT PARTNERSHIP 1792151 F POOLED FUNDS 62887 F 1855038 X 932169 140624 96947 237571 694598 0 694598 654636 114832 114832 539804 0 539804 PART X, LINE 2: THE INSTITUTE OPERATES AS A PUBLICLY SUPPORTED TAX-EXEMPT ORGANIZATION PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND, ACCORDINGLY, IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME. THE INSTITUTE IS ALSO EXEMPT FROM MASSACHUSETTS INCOME TAX UNDER MASSACHUSETTS GENERAL LAW CHAPTER 180. RETURNS FOR TAX YEARS BEGINNING WITH THOSE FILED FOR THE YEAR ENDED JUNE 30, 2013 ARE OPEN TO EXAMINATION. PART XI, LINE 2D - OTHER ADJUSTMENTS: IN KIND CONTRIBUTIONS 167,272. COST OF DIRECT BENEFITS -52,441. OTHER ADJUSTMENTS TO FUND BALANCES -17,884. PART XII, LINE 2D - OTHER ADJUSTMENTS: IN KIND CONTRIBUTIONS 167,272. COST OF DIRECT BENEFITS -52,440. 1 CENTRAL AMERICA & THE CARIBBEAN 0 0 INVESTMENTS 144454 EUROPE (INCLUDING ICELAND & GREENLAND) 0 0 INVESTMENTS 18127 NORTH AMERICA 0 0 INVESTMENTS 6230 0 0 0 0 0 0 168811 0 168811 1 0 1 1 1 0 FORM 990, SCHEDULE F, PART IV, LINE 1 ALTHOUGH THE CARL J SHAPIRO INSTITUTE FOR EDUCATION RESEARCH AT HARVARD MEDICAL SCHOOL WAS AN INDIRECT U.S. TRANSFEROR OF PROPERTY TO A FOREIGN CORPORATION DURING THE TAX YEAR, SUCH TRANSFERS DID NOT RESULT IN AN OBLIGATION TO FILE FORM 926, RETURN BY A U.S. TRANSFEROR OF PROPERTY TO A FOREIGN CORPORATION. FORM 990, SCHEDULE F, PART IV, LINE 3 ALTHOUGH THE CARL J SHAPIRO INSTITUTE FOR EDUCATION RESEARCH AT HARVARD MEDICAL SCHOOL HAD AN INDIRECT OWNERSHIP INTEREST IN A FOREIGN CORPORATION DURING THE TAX YEAR, IT DID NOT MEET ANY OF THE FIVE CATEGORIES OF REQUIRED FILER AND AS SUCH WAS NOT REQUIRED TO FILE FORM 5471, INFORMATION RETURN OF U.S. PERSONS WITH RESPECT TO CERTAIN FOREIGN CORPORATIONS. FORM 990, SCHEDULE F, PART IV, LINE 4 ALTHOUGH THE CARL J. SHAPIRO INSTITUTE FOR EDUCATION AND RESEARCH AT HARVARD MEDICAL SCHOOL AND BETH ISRAEL DEACONESS MEDICAL CENTER WAS AN INDIRECT SHAREHOLDER OF A PASSIVE FOREIGN INVESTMENT COMPANY OR A QUALIFIED ELECTING FUND DURING THE PERIOD COVERED BY THIS FILING, SUCH OWNERSHIP DID NOT RESULT IN AN OBLIGATION TO FILE FORM 8621, INFORMATION RETURN BY A SHAREHOLDER OF A PASSIVE FOREIGN INVESTMENT COMPANY OR QUALIFIED ELECTING FUND. FORM 990, SCHEDULE F, PART IV, LINE 5 ALTHOUGH THE CARL J SHAPIRO INSTITUTE FOR EDUCATION RESEARCH AT HARVARD MEDICAL SCHOOL HELD AN INDIRECT OWNERSHIP INTEREST IN A FOREIGN PARTNERSHIP DURING THE TAX YEAR, THE INTEREST DID NOT RESULT IN AN OBLIGATION TO FILE FORM 8865, RETURN OF U.S. PERSONS WITH RESPECT TO CERTAIN FOREIGN PARTNERSHIPS. 1 BETH ISRAEL DEACONESS MEDICAL CENTER 330 BROOKLINE AVE BOSTON MA 02215 042103881 501(C)(3) 94408 TO SUPPORT MEDICAL EDUCATION 1 0 FORM 990, SCHEDULE I, PART IV AS PREVIOUSLY NOTED IN THIS FILING, BIDMC IS AN ENTITY SUPPORTED BY THE SHAPIRO INSTITUTE. IN ADDITION, HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER (HMFP) IS THE DEDICATED PHYSICIAN PRACTICE OF BIDMC AND AN ENTITY INTEGRALLY RELATED TO BIDMC AND AN ENTITY THAT CONDUCTS RESEARCH AND TEACHING IN CONJUNCTION WITH BIDMC AND IN FURTHERANCE OF BIDMC'S MISSIONS. AS SUCH, ANY SUPPORT PROVIDED TO HMFP IS IN FURTHERANCE OF THE BIDMC PURPOSES AS WELL. X 0 1 0 0 0 0 0 0 0 CHAIKOF MD PHD ELLIOT L TRUSTEE 0 1022177 0 0 0 15965 0 78776 0 36952 0 1153870 0 0 HUNDERT MD EDWARD TRUSTEE 0 379341 0 0 0 1148 0 33825 0 24906 0 439220 0 0 RICCIOTTI MD HOPE A TRUSTEE 0 622582 0 0 0 11398 0 49688 0 31986 0 715654 0 0 SAFFITZ MD PHD JEFFREY E TRUSTEE 1000 640357 0 0 0 17615 0 34968 0 18605 1000 711545 0 0 SCHWARTZSTEIN RICHARD M TRUSTEE (EX-OFF), EXEC DIRECTOR 80267 307692 314 1433 1675 7632 5247 23903 3118 14205 90621 354865 0 0 STEVENSON MD PHD MARY ANN TRUSTEE 0 685960 0 0 0 12548 0 49688 0 35046 0 783242 0 0 SUKHATME MD SCD VIKAS P TRUSTEE (EX-OFFICIO) 1250 578034 0 10463 0 50513 0 42558 0 38428 1250 719996 0 0 TABB MD KEVIN TRUSTEE (EX-OFFICIO) & CO-CHAIR 0 1019207 0 405820 0 20703 0 127000 0 43597 0 1616327 0 0 ZEIDEL MD MARK L TRUSTEE 0 752771 0 0 0 14654 0 46448 0 17949 0 831822 0 0 HUGHES CAROL A OPERATIONS MANAGER & CLERK 60458 117556 0 0 20 80 2216 8863 6259 25035 68953 151534 0 0 PART I, LINE 4B AS REQUIRED BY THIS FORM 990, SCHEDULE J, COMPENSATION INFORMATION, THE COMPENSATION DETAIL INCLUDED IN THE INSTITUTE'S FORM 990 FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2017 IS CALENDAR YEAR 2016 DETAIL. AS PREVIOUSLY NOTED THROUGHOUT THIS FILING, BETH ISRAEL DEACONESS MEDICAL CENTER ("MEDICAL CENTER") IS AN ORGANIZATION SUPPORTED BY THE INSTITUTE. DURING THE 2016 CALENDAR YEAR, THE MEDICAL CENTER WAS A PARTICIPATING EMPLOYER IN THE BETH ISRAEL DEACONESS MEDICAL CENTER EXECUTIVE RETIREMENT PROGRAM AND THE BETH ISRAEL DEACONESS MEDICAL CENTER 457(B) PLAN. PURSUANT TO THESE PLANS, ELIGIBLE EMPLOYEES RECEIVE CERTAIN RETIREMENT BENEFITS AND/OR CAN DEFER PART OF THEIR COMPENSATION. UNDER THE DEFINITIONS TO THIS FORM 990, THESE PLANS ARE SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLANS. AMOUNTS DEFERRED BY PARTICIPANTS ARE INCLUDED IN FORM 990 SCHEDULE J, PART II, COLUMN B(III), OTHER REPORTABLE COMPENSATION AND/OR IN 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. FORM 990 SCHEDULE J ADDITIONAL EXPLANATORY FOOTNOTES: 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 NOT OTHERWISE SEPARATELY NOTED IN THIS RETURN BUT QUANTIFIED IN OTHER REPORTABLE COMPENSATION INCLUDE AMOUNTS FROM ONE OR MORE OF THE FOLLOWING ITEMS: AMOUNTS DEFERRED BY THE EMPLOYEE (PLUS EARNINGS) UNDER FULLY VESTED 457(B) PLAN; INCREASE/DECREASE IN VALUE OF NONQUALIFIED FULLY VESTED 457(B) PLAN; VESTED AMOUNTS UNDER 457(F) PLAN; TAXABLE EMPLOYER-SUBSIDIZED PARKING; TAXABLE MOVING EXPENSES; TAXABLE LIFE, DISABILITY, OR LONG-TERM CARE INSURANCE; AND 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, 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 THE 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, 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 CARL J. SHAPIRO INSTITUTE FOR EDUCATION AND RESEARCH AT HARVARD MEDICAL SCHOOL & BETH ISRAEL DEACONESS MEDICAL CENTER, INC. AND PRESIDENT AND FELLOWS OF HARVARD COLLEGE/HARVARD MEDICAL SCHOOL MAY BE REFERRED TO IN THESE EXPLANATORY NOTES TO FORM 990 PART VII AND FORM 990 SCHEDULE J AS SHAPIRO INSTITUTE AND PFHC/HMS RESPECTIVELY. HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER AND BETH ISRAEL DEACONESS MEDICAL CENTER MAY BE REFERRED TO IN THESE EXPLANATORY NOTES TO FORM 990 PART VII AND FORM 990 SCHEDULE J AS HMFP AND BIDMC RESPECTIVELY. BRENNER-GATI, M.D., LEONA TRUSTEE - SHAPIRO INSTITUTE DR. BRENNER-GATI DEVOTES, ON AVERAGE, 1 HOUR PER WEEK TO THE REPORTING ORGANIZATION. CHAIKOF, M.D., PHD, ELLIOT TRUSTEE - SHAPIRO INSTITUTE DIRECTOR (EX-OFFICIO) AND CHAIR (SURGERY) - HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER DIRECTOR (EX-OFFICIO) AND CHIEF (SURGERY) -BETH ISRAEL DEACONESS MEDICAL CENTER DIRECTOR (EX-OFFICIO) AND PRESIDENT - BETH ISRAEL DEACONESS DEPARTMENT OF SURGERY FOUNDATION JOHNSON & JOHNSON PROFESSOR OF SURGERY - HARVARD MEDICAL SCHOOL DR. CHAIKOF PERFORMS SERVICES FOR BOTH HMFP AND BIDMC AND DEVOTES, ON AVERAGE, A COMBINED 65 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE. AS REQUIRED BY THIS FORM 990, ALTHOUGH DR. CHAIKOF IS PAID DIRECTLY BY HMFP, THE PORTION OF DR. CHAIKOF'S COMPENSATION ATTRIBUTABLE TO EACH POSITION HAS BEEN SEPARATELY REPORTED ON THIS FORM 990, AS FURTHER OUTLINED BELOW. PAYMENTS REPORTED BY HMFP: BASE COMPENSATION: 511,089 INCENTIVE COMPENSATION: 0 OTHER REPORTABLE COMPENSATION: 7,983 DEFERRED COMPENSATION: 39,388 NON-TAXABLE BENEFITS: 18,476 PAYMENTS REPORTED BY BIDMC: BASE COMPENSATION: 511,089 INCENTIVE COMPENSATION: 0 OTHER REPORTABLE COMPENSATION: 7,983 DEFERRED COMPENSATION: 39,388 NON-TAXABLE BENEFITS: 18,476 AS REQUIRED IN THIS FORM 990, COMPENSATION REPORTED BY HMFP AND BIDMC FOR THE 2016 CALENDAR YEAR INCLUDES THE FOLLOWING PAYMENTS FROM THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE/HARVARD MEDICAL SCHOOL RELATED TO DR. CHAIKOF'S POSITIONS AS CHIEF OF SURGERY AT BIDMC, CHAIR OF THE HMFP DEPARTMENT OF SURGERY AND JOHNSON & JOHNSON PROFESSOR OF SURGERY, HARVARD MEDICAL SCHOOL: $230,605 BASE AND OTHER REPORTABLE COMPENSATION, $29,088 DEFERRED COMPENSATION AND $4,308 NON-TAXABLE BENEFITS. EDELHEIT, PHD., LEWIS S. TRUSTEE - SHAPIRO INSTITUTE DR. EDELHEIT DEVOTES, ON AVERAGE, 1 HOUR PER WEEK TO THE REPORTING ORGANIZATION. GOLDBERG, CAROL R. TRUSTEE - SHAPIRO INSTITUTE MS. GOLDBERG DEVOTES, ON AVERAGE, 1 HOUR PER WEEK TO THE REPORTING ORGANIZATION. HUNDERT, M.D., EDWARD TRUSTEE - SHAPIRO INSTITUTE DEAN FOR MEDICAL EDUCATION - HARVARD MEDICAL SCHOOL DR. HUNDERT DEVOTES, ON AVERAGE, 1 HOUR PER WEEK TO THE REPORTING ORGANIZATION. PAYMENTS REPORTED BY PFHC/HMS BASE COMPENSATION: 379,341 INCENTIVE COMPENSATION: 0 OTHER REPORTABLE COMPENSATION: 1,148 DEFERRED COMPENSATION: 33,825 NON-TAXABLE BENEFITS: 24,906 JICK, DANIEL J. TRUSTEE (EX-OFFICIO) - SHAPIRO INSTITUTE DIRECTOR (EX-OFFICIO) - CAREGROUP, INC. DIRECTOR AND BOARD CHAIR - BETH ISRAEL DEACONESS MEDICAL CENTER MR. JICK DEVOTES, ON AVERAGE, 12 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE. MEEKER, M.D., DAVID TRUSTEE - SHAPIRO INSTITUTE DR. MEEKER SERVED ON THE BOARD THROUGH APRIL 1, 2017 AND DEVOTED, ON AVERAGE, 1 HOUR PER WEEK TO THE REPORTING ORGANIZATION DURING THAT TIME. RABKIN, M.D., MITCHELL T. TRUSTEE, CO-FOUNDER AND DISTINGUISHED INSTITUTE SCHOLAR - SHAPIRO INSTITUTE DIRECTOR - BETH ISRAEL DEACONESS HOSPITAL - MILTON, INC. DIRECTOR - MILTON HOSPITAL FOUNDATION, INC. DIRECTOR - COMMUNITY PHYSICIANS ASSOCIATES PROFESSOR OF MEDICINE - HARVARD MEDICAL SCHOOL DR. RABKIN DEVOTES, ON AVERAGE, A COMBINED 3 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE. RICCIOTTI, M.D., HOPE TRUSTEE - SHAPIRO INSTITUTE DIRECTOR (EX-OFFICIO) AND CHAIR OF OBSTETRICS AND GYNECOLOGY - HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER CHIEF OF OBSTETRICS AND GYNECOLOGY - BETH ISRAEL DEACONESS MEDICAL CENTER PRESIDENT AND DIRECTOR - BETH ISRAEL DEACONESS MEDICAL CENTER OBSTETRICS AND GYNECOLOGY FOUNDATION ASSOCIATE PROFESSOR OF OBSTETRICS, GYNECOLOGY AND REPRODUCTIVE BIOLOGY - HARVARD MEDICAL SCHOOL DR. RICCIOTTI DEVOTES, ON AVERAGE, A COMBINED 65 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE. DR. RICCIOTTI PERFORMS SERVICES FOR BOTH BIDMC AND HMFP. AS REQUIRED BY THIS FORM 990, ALTHOUGH DR. RICCIOTTI IS PAID DIRECTLY BY HMFP, THE PORTION OF DR. RICCIOTTI'S COMPENSATION HAS BEEN SEPARATELY REPORTED ON THIS FORM 990, AS FURTHER OUTLINED BELOW. PAYMENTS REPORTED BY HMFP: BASE COMPENSATION: 311,291 INCENTIVE COMPENSATION: 0 OTHER REPORTABLE COMPENSATION: 5,699 DEFERRED COMPENSATION: 24,844 NON-TAXABLE BENEFITS: 15,993 PAYMENTS REPORTED BY BIDMC: BASE COMPENSATION: 311,291 INCENTIVE COMPENSATION: 0 OTHER REPORTABLE COMPENSATION: 5,699 DEFERRED COMPENSATION: 24,844 NON-TAXABLE BENEFITS: 15,993 AS REQUIRED BY THIS FORM 990, COMPENSATION REPORTED BY HMFP AND BIDMC FOR THE 2016 CALENDAR YEAR INCLUDES THE FOLLOWING PAYMENTS FROM THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE/HARVARD MEDICAL SCHOOL RELATED TO DR. RICCIOTTI'S POSITIONS AS CHIEF OF OBSTETRICS AND GYNECOLOGY AT BIDMC, CHAIR OF THE HMFP DEPARTMENT OF OBSTETRICS AND GYNECOLOGY AND ASSOCIATE PROFESSOR OF OBSTETRICS, GYNECOLOGY AND REPRODUCTIVE BIOLOGY, HARVARD MEDICAL SCHOOL: $ 1,800 BASE AND OTHER REPORTABLE COMPENSATION. FORM 990 SCHEDULE J ADDITIONAL EXPLANATORY FOOTNOTES (CONTINUED): SAFFITZ, M.D., PH.D., JEFFREY E. TRUSTEE - SHAPIRO INSTITUTE DIRECTOR (EX-OFFICIO) AND CHAIR OF PATHOLOGY - HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER CHIEF OF PATHOLOGY - BETH ISRAEL DEACONESS MEDICAL CENTER DIRECTOR (EX-OFFICIO) AND PRESIDENT - BIH PATHOLOGY FOUNDATION MALINCKRODT PROFESSOR OF PATHOLOGY - HARVARD MEDICAL SCHOOL DR. SAFFITZ PERFORMS SERVICES FOR BOTH HMFP AND BIDMC AND DEVOTES, ON AVERAGE, A COMBINED 65 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE. AS REQUIRED BY THIS FORM 990, ALTHOUGH DR. SAFFITZ IS PAID DIRECTLY BY HMFP, THE PORTION OF DR. SAFFITZ'S COMPENSATION ATTRIBUTABLE TO EACH POSITION HAS BEEN SEPARATELY REPORTED ON THIS FORM 990, AS FURTHER OUTLINED BELOW. PAYMENTS REPORTED BY SHAPIRO INSTITUTE: BASE COMPENSATION: 1,000 INCENTIVE COMPENSATION: 0 OTHER REPORTABLE COMPENSATION: 0 DEFERRED COMPENSATION: 0 NON-TAXABLE BENEFITS: 0 PAYMENTS REPORTED BY HMFP: BASE COMPENSATION: 320,179 INCENTIVE COMPENSATION: 0 OTHER REPORTABLE COMPENSATION: 8,808 DEFERRED COMPENSATION: 17,484 NON-TAXABLE BENEFITS: 9,303 PAYMENTS REPORTED BY BIDMC: BASE COMPENSATION: 320,179 INCENTIVE COMPENSATION: 0 OTHER REPORTABLE COMPENSATION: 8,808 DEFERRED COMPENSATION: 17,484 NON-TAXABLE BENEFITS: 9,303 AS REQUIRED IN THIS FORM 990, COMPENSATION REPORTED BY HMFP AND BIDMC FOR THE 2016 CALENDAR YEAR INCLUDES THE FOLLOWING PAYMENTS FROM THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE/HARVARD MEDICAL SCHOOL RELATED TO DR. SAFFITZ'S POSITIONS AS CHIEF OF PATHOLOGY AT BIDMC, CHAIR OF THE HMFP DEPARTMENT OF PATHOLOGY AND MALINCKRODT PROFESSOR OF PATHOLOGY, HARVARD MEDICAL SCHOOL: $15,836 BASE AND OTHER REPORTABLE COMPENSATION, $1.584 DEFERRED COMPENSATION AND $141 NON-TAXABLE BENEFITS. SCHWARTZSTEIN, M.D., RICHARD M. TRUSTEE (EX-OFFICIO), AND EXECUTIVE DIRECTOR - SHAPIRO INSTITUTE VICE PRESIDENT OF EDUCATION - BETH ISRAEL DEACONESS MEDICAL CENTER PHYSICIAN, PULMONARY AND CRITICAL CARE MEDICINE - HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER ELLEN AND MELVIN GORDON PROFESSOR OF MEDICAL EDUCATION - HARVARD MEDICAL SCHOOL DR. SCHWARTZSTEIN PERFORMS SERVICES FOR THE SHAPIRO INSTITUTE, BIDMC AND HMFP AND DEVOTES, ON AVERAGE, A COMBINED 65 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE. DR. SCHWARTZSTEIN RECEIVED PAYMENTS FROM BOTH THE SHAPIRO INSTITUTE AND HMFP FOR HIS SERVICES PROVIDED IN THESE ROLES. AS REQUIRED BY THIS FORM 990, ALTHOUGH DR. SCHWARTZSTEIN IS PAID DIRECTLY BY SHAPIRO INSTITUTE AND HMFP, THE PORTION OF DR. SCHWARTZSTEIN'S COMPENSATION ATTRIBUTABLE TO EACH POSITION HAS BEEN SEPARATELY REPORTED ON THIS FORM 990, AS FURTHER OUTLINED BELOW. PAYMENTS REPORTED BY SHAPIRO INSTITUTE: BASE COMPENSATION: 80,267 INCENTIVE COMPENSATION: 314 OTHER REPORTABLE COMPENSATION: 1,675 DEFERRED COMPENSATION: 5,247 NON-TAXABLE BENEFITS: 3,118 PAYMENTS REPORTED BY HMFP: BASE COMPENSATION: 75,047 INCENTIVE COMPENSATION: 350 OTHER REPORTABLE COMPENSATION: 1,862 DEFERRED COMPENSATION: 5,830 NON-TAXABLE BENEFITS: 3,465 PAYMENTS REPORTED BY BIDMC: BASE COMPENSATION: 232,645 INCENTIVE COMPENSATION: 1,083 OTHER REPORTABLE COMPENSATION: 5,770 DEFERRED COMPENSATION: 18,073 NON-TAXABLE BENEFITS: 10,740 AS REQUIRED IN THIS FORM 990, COMPENSATION REPORTED BY HMFP AND BIDMC FOR THE 2016 CALENDAR YEAR INCLUDES THE FOLLOWING PAYMENTS FROM THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE/HARVARD MEDICAL SCHOOL RELATED TO DR. SCHWARTZSTEIN'S POSITIONS AS BIDMC VICE PRESIDENT OF EDUCATION, HMFP PULMONARY AND CRITICAL CARE PHYSICIAN AND ELLEN AND MELVIN GORDON PROFESSOR OF MEDICAL EDUCATION, HARVARD MEDICAL SCHOOL: $1,750 BASE AND OTHER REPORTABLE COMPENSATION. STEVENSON, M.D., PHD, MARY ANN TRUSTEE - SHAPIRO INSTITUTE CHIEF, RADIATION ONCOLOGY -BETH ISRAEL DEACONESS MEDICAL CENTER DIRECTOR (EX-OFFICIO), SECRETARY, BOARD CHAIR AND CHAIR, RADIATION ONCOLOGY - HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER DIRECTOR (EX-OFFICIO) - LONGWOOD MEDICAL INTERNATIONAL FOUNDATION, INC. ASSOCIATE PROFESSOR OF RADIATION ONCOLOGY - HARVARD MEDICAL SCHOOL DR. STEVENSON PERFORMS SERVICES FOR BOTH HMFP AND BIDMC AND DEVOTES, ON AVERAGE, A COMBINED 60 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE. AS REQUIRED BY THIS FORM 990, ALTHOUGH DR. STEVENSON IS PAID DIRECTLY BY HMFP, THE PORTION OF DR. STEVENSON'S COMPENSATION ATTRIBUTABLE TO EACH POSITION HAS BEEN SEPARATELY REPORTED ON THIS FORM 990, AS FURTHER OUTLINED BELOW. PAYMENTS REPORTED BY HMFP: BASE COMPENSATION: 342,980 INCENTIVE COMPENSATION: 0 OTHER REPORTABLE COMPENSATION: 6,274 DEFERRED COMPENSATION: 24,844 NON-TAXABLE BENEFITS: 17,523 PAYMENTS REPORTED BY BIDMC: BASE COMPENSATION: 342,980 INCENTIVE COMPENSATION: 0 OTHER REPORTABLE COMPENSATION: 6,274 DEFERRED COMPENSATION: 24,844 NON-TAXABLE BENEFITS: 17,523 SUKHATME, M.D., SC.D, VIKAS P. TRUSTEE - SHAPIRO INSTITUTE CHIEF ACADEMIC OFFICER - BETH ISRAEL DEACONESS MEDICAL CENTER NEPHROLOGIST - HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER VICTOR J. ARESTY PROFESSOR OF MEDICINE- HARVARD MEDICAL SCHOOL DR. SUKHATME PERFORMS SERVICES FOR THE SHAPIRO INSTITUTE, BIDMC AND HMFP AND DEVOTES, ON AVERAGE, A COMBINED 60 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE. DR. SUKHATME RECEIVED PAYMENTS FROM BOTH THE SHAPIRO INSTITUTE AND BIDMC FOR HIS SERVICES PROVIDED IN THESE ROLES. AS REQUIRED BY THIS FORM 990, ALTHOUGH DR. SUKHATME IS PAID DIRECTLY BY SHAPIRO INSTITUTE AND BIDMC, THE PORTION OF DR. SUKHATME'S COMPENSATION ATTRIBUTABLE TO EACH POSITION HAS BEEN SEPARATELY REPORTED ON THIS FORM 990, AS FURTHER OUTLINED BELOW. PAYMENTS REPORTED BY SHAPIRO INSTITUTE: BASE COMPENSATION: 1,250 INCENTIVE COMPENSATION: 0 OTHER REPORTABLE COMPENSATION: 0 DEFERRED COMPENSATION: 0 NON-TAXABLE BENEFITS: 0 PAYMENTS REPORTED BY BIDMC BASE COMPENSATION: 578,034 INCENTIVE COMPENSATION: 10,463 OTHER REPORTABLE COMPENSATION: 50,513 DEFERRED COMPENSATION: 42,558 NON-TAXABLE BENEFITS: 38,428 AS REQUIRED BY THIS FORM 990, COMPENSATION REPORTED BY HMFP AND BIDMC FOR THE 2016 CALENDAR YEAR INCLUDES THE FOLLOWING PAYMENTS FROM THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE/HARVARD MEDICAL SCHOOL RELATED TO DR. SUKHATME'S POSITION AS VICTOR J. ARESTY PROFESSOR OF MEDICINE, HARVARD MEDICAL SCHOOL: $ 93,544 BASE AND OTHER REPORTABLE COMPENSATION, $9,354 DEFERRED COMPENSATION AND $141 NON-TAXABLE BENEFITS. TABB, M.D., KEVIN TRUSTEE (EX-OFFICIO) AND CO-CHAIR - SHAPIRO INSTITUTE DIRECTOR (EX-OFFICIO) AND CHIEF EXECUTIVE OFFICER - BETH ISRAEL DEACONESS MEDICAL CENTER DIRECTOR (EX-OFFICIO) - HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER DIRECTOR (EX-OFFICIO) - BETH ISRAEL DEACONESS DEPARTMENT OF MEDICINE FOUNDATION DIRECTOR (EX-OFFICIO) - BETH ISRAEL DEACONESS MEDICAL CENTER OBSTETRICS AND GYNECOLOGY FOUNDATION DIRECTOR (EX-OFFICIO) - BETH ISRAEL DEACONESS DEPARTMENT OF SURGERY FOUNDATION TRUSTEE (EX-OFFICIO) - BETH ISRAEL DEACONESS HOSPITAL - NEEDHAM DIRECTOR - BETH ISRAEL DEACONESS HOSPITAL - MILTON DIRECTOR - MILTON HOSPITAL FOUNDATION DIRECTOR - COMMUNITY PHYSICIANS ASSOCIATES DIRECTOR - BETH ISRAEL DEACONESS HOSPITAL -- PLYMOUTH DIRECTOR - JORDAN HEALTH SYSTEMS, INC. DIRECTOR AND PRESIDENT - BETH ISRAEL DEACONESS MEDICAL CENTER PHARMACY PROFESSOR OF MEDICINE - HARVARD MEDICAL SCHOOL DR. TABB DEVOTES, ON AVERAGE, A COMBINED 65 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE. PAYMENTS REPORTED BY BIDMC: BASE COMPENSATION: 1,019,207 INCENTIVE COMPENSATION: 405,820 OTHER REPORTABLE COMPENSATION: 20,703 DEFERRED COMPENSATION: 127,000 NON-TAXABLE BENEFITS: 43,597 OTHER REPORTABLE AND DEFERRED COMPENSATION FOR DR. TABB INCLUDES COMBINED PAYMENTS FROM NONQUALIFIED RETIREMENT PLANS IN THE AMOUNT OF $127,775. OF THIS AMOUNT, $109,775 IS BOTH UNFUNDED AND UNVESTED. FORM 990 SCHEDULE J ADDITIONAL EXPLANATORY FOOTNOTES (CONTINUED): ZEIDEL, M.D., MARK TRUSTEE - SHAPIRO INSTITUTE DIRECTOR (EX-OFFICIO) AND CHIEF (MEDICINE) - BETH ISRAEL DEACONESS MEDICAL CENTER DIRECTOR (EX-OFFICIO) AND CHAIR (MEDICINE) - HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER DIRECTOR - LONGWOOD MEDICAL INTERNATIONAL FOUNDATION DIRECTOR (EX-OFFICIO) - MEDICAL CARE OF BOSTON MANAGEMENT, CORP, D/B/A BETH ISRAEL DEACONESS HEALTHCARE A/K/A AFFILIATED PHYSICIANS GROUP PRESIDENT AND DIRECTOR (EX-OFFICIO) - BETH ISRAEL DEACONESS DEPARTMENT OF MEDICINE FOUNDATION, INC. HERMAN LUDWIG BLUMGART PROFESSOR OF MEDICINE - HARVARD MEDICAL SCHOOL DR. ZEIDEL PERFORMS SERVICES FOR BOTH HMFP AND BIDMC AND DEVOTES, ON AVERAGE, A COMBINED 65 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE. AS REQUIRED BY THIS FORM 990, ALTHOUGH DR. ZEIDEL IS PAID DIRECTLY BY HMFP, THE PORTION OF DR. ZEIDEL'S COMPENSATION ATTRIBUTABLE TO EACH POSITION HAS BEEN SEPARATELY REPORTED ON THIS FORM 990, AS FURTHER OUTLINED BELOW. PAYMENTS REPORTED BY BIDMC: BASE COMPENSATION: 376,386 INCENTIVE COMPENSATION: 0 OTHER REPORTABLE COMPENSATION: 7,327 DEFERRED COMPENSATION: 23,224 NON-TAXABLE BENEFITS: 8975 PAYMENTS REPORTED BY HMFP: BASE COMPENSATION: 376,386 INCENTIVE COMPENSATION: 0 OTHER REPORTABLE COMPENSATION: 7,327 DEFERRED COMPENSATION: 23,224 NON-TAXABLE BENEFITS: 8,975 AS REQUIRED IN THIS FORM 990, COMPENSATION REPORTED BY HMFP AND BIDMC FOR THE 2016 CALENDAR YEAR INCLUDES THE FOLLOWING PAYMENTS FROM THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE/HARVARD MEDICAL SCHOOL RELATED TO DR. ZEIDEL'S POSITION AS CHAIR OF MEDICINE AND HERMAN LUDWIG BLUMGART PROFESSOR OF MEDICINE, HARVARD MEDICAL SCHOOL: $155,902 BASE AND OTHER REPORTABLE COMPENSATION, $17,298 DEFERRED COMPENSATION AND $1,917 NON-TAXABLE BENEFITS. COUGHLIN, CHRISTINE, M. CLERK AND ASSOCIATE DIRECTOR - SHAPIRO INSTITUTE ADMINISTRATIVE DIRECTOR, CENTER FOR EDUCATION, ACADEMIC AFFAIRS - BETH ISRAEL DEACONESS MEDICAL CENTER MS. COUGHLIN PERFORMS SERVICES FOR BOTH THE SHAPIRO INSTITUTE AND BIDMC AND DEVOTES, ON AVERAGE, A COMBINED 20 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE. MS. COUGHLIN RECEIVED PAYMENTS FROM BOTH THE SHAPIRO INSTITUTE AND BIDMC FOR HER SERVICES PROVIDED IN THESE ROLES. THE PORTION OF MS. COUGHLIN'S COMPENSATION ATTRIBUTABLE TO EACH POSITION HAS BEEN SEPARATELY REPORTED ON THIS FORM 990, AS FURTHER OUTLINED BELOW. PAYMENTS REPORTED BY SHAPIRO INSTITUTE BASE COMPENSATION: 7,088 INCENTIVE COMPENSATION: 0 OTHER REPORTABLE COMPENSATION: 0 DEFERRED COMPENSATION: 590 NON-TAXABLE BENEFITS: 71 PAYMENTS REPORTED BY BIDMC: BASE COMPENSATION: 45,745 INCENTIVE COMPENSATION: 0 OTHER REPORTABLE COMPENSATION: 0 DEFERRED COMPENSATION: 4,327 NON-TAXABLE BENEFITS: 522 HUGHES, CAROL A. OPERATIONS MANAGER - SHAPIRO INSTITUTE OPERATIONS MANAGER, CENTER FOR EDUCATION, ACADEMIC AFFAIRS - BETH ISRAEL DEACONESS MEDICAL CENTER EXECUTIVE EDUCATION, HARVARD INSTITUTE OF MEDICINE - HARVARD MEDICAL SCHOOL MS. HUGHES PERFORMS SERVICES FOR BOTH THE SHAPIRO INSTITUTE, BIDMC AND HMS AND DEVOTES, ON AVERAGE, A COMBINED 40 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE. MS. HUGHES RECEIVED PAYMENTS FROM BOTH THE SHAPIRO INSTITUTE, BIDMC AND HMS FOR HER SERVICES PROVIDED IN THESE ROLES. THE PORTION OF MS. HUGHES' COMPENSATION ATTRIBUTABLE TO EACH POSITION HAS BEEN SEPARATELY REPORTED ON THIS FORM 990, AS FURTHER OUTLINED BELOW. PAYMENTS REPORTED BY SHAPIRO INSTITUTE BASE COMPENSATION: 60,458 INCENTIVE COMPENSATION: 0 OTHER REPORTABLE COMPENSATION: 20 DEFERRED COMPENSATION: 2,216 NON-TAXABLE BENEFITS: 6,259 PAYMENTS REPORTED BY BIDMC: BASE COMPENSATION: 83,431 INCENTIVE COMPENSATION: 0 OTHER REPORTABLE COMPENSATION: 80 DEFERRED COMPENSATION: 8,863 NON-TAXABLE BENEFITS: 25,035 PAYMENTS REPORTED BY PFHC/HMS BASE COMPENSATION: 34,125 INCENTIVE COMPENSATION: 0 OTHER REPORTABLE COMPENSATION: 0 DEFERRED COMPENSATION: 0 NON-TAXABLE BENEFITS: 0 WANG, DIANA TREASURER AND FINANCIAL ANALYST - SHAPIRO INSTITUTE FINANCIAL ANALYST - BETH ISRAEL DEACONESS MEDICAL CENTER MS. WANG PERFORMS SERVICES FOR BOTH THE SHAPIRO INSTITUTE AND BIDMC AND DEVOTES, ON AVERAGE, A COMBINED 20 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE. MS. WANG RECEIVED PAYMENTS FROM BOTH THE SHAPIRO INSTITUTE AND BIDMC FOR HER SERVICES PROVIDED IN THESE ROLES. THE PORTION OF MS. WANG'S COMPENSATION ATTRIBUTABLE TO EACH POSITION HAS BEEN SEPARATELY REPORTED ON THIS FORM 990, AS FURTHER OUTLINED BELOW. PAYMENTS REPORTED BY SHAPIRO INSTITUTE BASE COMPENSATION: 38,464 INCENTIVE COMPENSATION: 0 OTHER REPORTABLE COMPENSATION: 29 DEFERRED COMPENSATION: 2,104 NON-TAXABLE BENEFITS: 8,105 PAYMENTS REPORTED BY BIDMC: BASE COMPENSATION: 41,795 INCENTIVE COMPENSATION: 0 OTHER REPORTABLE COMPENSATION: 43 DEFERRED COMPENSATION: 3,155 NON-TAXABLE BENEFITS: 12,157 FORM 990, PART I, LINE 1 THE MISSION OF THE CARL J. SHAPIRO INSTITUTE FOR EDUCATION AND RESEARCH AT HARVARD MEDICAL SCHOOL AND BETH ISRAEL DEACONESS MEDICAL CENTER ("SHAPIRO INSTITUTE OR "INSTITUTE") IS TO SUPPORT, PROMOTE, AND DEVELOP INNOVATIVE PROGRAMS AND MODELS FOR THE DUAL ACTIVITIES OF TEACHING AND RESEARCH AT ACADEMIC MEDICAL CENTERS. THE INSTITUTE PROVIDES INTELLECTUAL LEADERSHIP, STATE-OF-THE-ART FACILITIES AND STAFF RESOURCES TO SUPPORT THE EDUCATION AND TRAINING OF MEDICAL STUDENTS, RESIDENTS AND FELLOWS. THE INSTITUTE SERVES AS A SUPPORT ORGANIZATION OF BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC) AND THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE/HARVARD MEDICAL SCHOOL (HMS). FORM 990, PART III, LINE 1: THE MISSION OF THE CARL J. SHAPIRO INSTITUTE FOR EDUCATION AND RESEARCH AT HARVARD MEDICAL SCHOOL AND BETH ISRAEL DEACONESS MEDICAL CENTER ("SHAPIRO INSTITUTE OR "INSTITUTE") IS TO SUPPORT, PROMOTE, AND DEVELOP INNOVATIVE PROGRAMS AND MODELS FOR THE DUAL ACTIVITIES OF TEACHING AND RESEARCH AT ACADEMIC MEDICAL CENTERS. THE INSTITUTE PROVIDES INTELLECTUAL LEADERSHIP, STATE-OF-THE-ART FACILITIES AND STAFF RESOURCES TO SUPPORT THE EDUCATION AND TRAINING OF MEDICAL STUDENTS, RESIDENTS AND FELLOWS. THE INSTITUTE SERVES AS A SUPPORT ORGANIZATION OF BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC) AND THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE/HARVARD MEDICAL SCHOOL (HMS). FORM 990, PART III, LINE 4A SIMULATION AND SKILLS CENTER ("CENTER") - THE CENTER PROVIDES OPPORTUNITIES FOR TRAINEES TO PRACTICE SKILLS FOR LAPAROSCOPIC AND OTHER SURGICAL PROCEDURES, TO ENGAGE IN TEAM-BASED LEARNING, AND TO ENHANCE COMMUNICATION SKILLS. THE CENTER INCORPORATES REALISTIC OPERATING AND INTENSIVE CARE/EMERGENCY ROOMS WHICH ALLOW FOR TEAM TRAINING AND DISCIPLINE-SPECIFIC EDUCATIONAL EXPERIENCES. THE CENTER'S RESOURCES INCLUDE A WIDE RANGE OF TASK TRAINERS AND SIMULATORS, VIDEOCONFERENCE FACILITIES AND DEDICATED FACULTY AND STAFF TO SUPPORT THE EDUCATION OF STUDENTS, TRAINEES, AND PRACTITIONERS IN ALL OF THE HEALTH CARE PROFESSIONS. FORM 990, PART III, LINE 4B CONTINUING MEDICAL EDUCATION COURSES - THE INSTITUTE HAS SPONSORED COURSES ON "MAXIMIZING YOUR TEACHING SKILLS: PRINCIPLES OF MEDICAL EDUCATION." THE COURSE CURRICULUM IS AN INTRODUCTION TO THE PRINCIPLES OF EFFECTIVE CLINICAL TEACHING FOR ADULT LEARNERS. THROUGH DIDACTIC AND INTERACTIVE SESSIONS, PARTICIPANTS LEARN MODELS OF CLINICAL INSTRUCTION AND HOW TO APPLY THESE EFFECTIVE TECHNIQUES TO THEIR OWN TEACHING. THE COURSE ALSO PROVIDES AN EXPLORATION OF CRITICAL THINKING, REFLECTION, ASSESSMENT, AND FEEDBACK. FORM 990, PART VI, SECTION A, LINE 2 THE SHAPIRO INSTITUTE IS NON-PROFIT CORPORATION EXEMPT FROM INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED AND SERVES AS A SUPPORT ORGANIZATION, PROVIDING MEDICAL TRAINING AND EDUCATION TO, BETH ISRAEL DEACONESS MEDICAL CENTER AND THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE/HARVARD MEDICAL SCHOOL. EACH OF THESE ENTITIES IS ALSO A NON-PROFIT CORPORATION EXEMPT FROM INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED. IN ADDITION, HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER (HMFP) IS THE DEDICATED PHYSICIAN PRACTICE OF BIDMC, AN ENTITY INTEGRALLY RELATED TO BIDMC AND ALSO A NON-PROFIT CORPORATION EXEMPT FROM INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED. 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 NOTED ABOVE. ADDITIONAL DETAIL RELATED TO EMPLOYMENT RELATIONSHIPS IS PROVIDED IN THE EXPLANATORY NOTES TO THIS FORM 990 SCHEDULE J. FORM 990, PART VI, SECTION A, LINE 8B MINUTES ARE DOCUMENTED FOR THE BOARD OF TRUSTEE MEETINGS. NO SUBCOMMITTEE HAS THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B THE INSTITUTE'S FORM 990 IS PREPARED IN CONJUNCTION WITH THE CAREGROUP TAX DEPARTMENT AND DELOITTE TAX, LLP. CAREGROUP IS THE SOLE MEMBER OF BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC) AND AS PREVIOUSLY NOTED IN THIS FILING, BIDMC IS AN ENTITY SUPPORTED BY THE INSTITUTE. BOTH CAREGROUP AND BIDMC ARE ENTITIES EXEMPT FROM INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED. PRIOR TO FILING THE FORM 990, RELATED SCHEDULES AND REQUIRED DISCLOSURES (RETURN), EACH MEMBER OF THE INSTITUTE'S GOVERNING BODY (BOARD OF TRUSTEES) RECEIVES A COPY OF THE RETURN FOR THEIR REVIEW. TIME IS THEN DEDICATED TO DISCUSS THE RETURN, INCLUDING ITS SCOPE AND CONTENTS, AT THE NEXT BOARD MEETING. FORM 990, PART VI, SECTION B, LINE 12C AS PREVIOUSLY NOTED IN THIS FILING, THE INSTITUTE IS A SUPPORT ORGANIZATION OF BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC OR MEDICAL CENTER) AND THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE/HARVARD MEDICAL SCHOOL. IN ADDITION, HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER (HMFP) IS THE DEDICATED PHYSICIAN PRACTICE OF BIDMC, AN ENTITY INTEGRALLY RELATED TO BIDMC AND ALSO A NON-PROFIT CORPORATION EXEMPT FROM INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED. AS NOTED IN THE SUPPLEMENTAL INFORMATION TO THIS FORM 990, PART VII AND SCHEDULE J, THERE IS SIGNIFICANT OVERLAP BETWEEN THE INSTITUTE'S TRUSTEES AND EMPLOYEES AND BIDMC. BIDMC HAS A WRITTEN, COMPREHENSIVE CONFLICT OF INTEREST POLICY THAT APPLIES TO ALL MEMBERS OF ITS WORKFORCE, INCLUDING EMPLOYEES, PROFESSIONAL STAFF, TRAINEES, CONSULTANTS, CONTRACTORS, AGENTS, AND VENDORS, AND TO THE MEMBERS OF THE BOARD OF DIRECTORS. IN ADDITION, HMFP ALSO HAS A COMPREHENSIVE CONFLICT OF INTEREST POLICY. PURSUANT TO THIS RELATIONSHIP, THE INSTITUTE HAS ADOPTED THE BIDMC CONFLICT OF INTEREST POLICY. CAREGROUP IS THE SOLE MEMBER OF THE MEDICAL CENTER. THE CAREGROUP TAX DEPARTMENT DISTRIBUTED A JOINT ANNUAL CONFLICT OF INTEREST DISCLOSURE AND TAX QUESTIONNAIRE TO ALL CURRENT AND FORMER MEMBERS OF THE INSTITUTE BOARD OF TRUSTEES AS WELL AS CURRENT AND FORMER INSTITUTE OFFICERS AND KEY EMPLOYEES. THE TAX QUESTIONNAIRE IS DESIGNED TO GATHER THE INFORMATION NECESSARY FOR THE INSTITUTE TO COMPLETELY AND ACCURATELY PROCESS AND COMPLETE FORM 990 SCHEDULE L, TRANSACTIONS WITH INTERESTED PERSONS AND FORM 990, PART VI, QUESTION 2, FAMILY AND BUSINESS RELATIONSHIPS BETWEEN OFFICERS, DIRECTORS/TRUSTEES AND KEY EMPLOYEES. FORM 990, PART VI, SECTION B, LINE 15 AS PREVIOUSLY NOTED IN THIS FILING, THE INSTITUTE IS A SUPPORT ORGANIZATION OF BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC OR MEDICAL CENTER) AND THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE/HARVARD MEDICAL SCHOOL. IN ADDITION, HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER (HMFP) IS THE DEDICATED PHYSICIAN PRACTICE OF BIDMC AND AN ENTITY INTEGRALLY RELATED TO BIDMC. AS NOTED IN THE SUPPLEMENTAL INFORMATION TO THIS FORM 990, PART VII AND SCHEDULE J, THE INSTITUTE'S EXECUTIVE DIRECTOR ALSO SERVES AS THE VICE PRESIDENT FOR MEDICAL EDUCATION AT BIDMC. THE MEDICAL CENTER HAS A COMPENSATION COMMITTEE THAT IS COMPOSED OF MEMBERS OF THE BOARD OF DIRECTORS. ALL MEMBERS ARE INDEPENDENT. THE MEDICAL CENTER'S COMPENSATION COMMITTEE ESTABLISHES THE POLICIES AND THE COMPENSATION STRUCTURE OF MEDICAL CENTER SENIOR MANAGEMENT INCLUDING VICE PRESIDENTS. THE COMPENSATION COMMITTEE IS RESPONSIBLE FOR ASSURING THAT THE TOTAL COMPENSATION PROVIDED TO THESE INDIVIDUALS IS FAIR AND REASONABLE USING CURRENT AND CREDIBLE MARKET PRACTICE INFORMATION AND THAT IT COMPLIES WITH APPLICABLE LEGAL AND REGULATORY GUIDELINES. IN SETTING COMPENSATION, THE COMPENSATION COMMITTEE RELIED UPON WRITTEN COMPENSATION SURVEYS AND STUDIES PRODUCED BY AN INDEPENDENT COMPENSATION CONSULTING FIRM THAT REGULARLY ASSESSES EXECUTIVE COMPENSATION AND BENEFITS OF SIMILAR ORGANIZATIONS. THE COMPENSATION COMMITTEE MET TO REVIEW THE COMPENSATION STRUCTURE OF THESE INDIVIDUALS AND AT THAT TIME REVIEWED THE COMPENSATION SURVEY PREPARED BY THE INDEPENDENT COMPENSATION CONSULTING FIRM. THE COMPENSATION COMMITTEE THEN VOTED TO APPROVE THE COMPENSATION ARRANGEMENTS. REGULAR COMPENSATION FOR OTHER BIDMC EMPLOYEES WHO ALSO SERVE AS INSTITUTE OFFICERS IS SET THROUGH THE ORDINARY BIDMC PROCEDURES WITH INPUT FROM THE BIDMC VICE PRESIDENT OF MEDICAL EDUCATION/INSTITUTE EXECUTIVE DIRECTOR. IN ADDITION TO THE COMPENSATION PROCESSES NOTED ABOVE, FROM TIME TO TIME THE INSTITUTE MAY ACKNOWLEDGE EFFORTS OF ITS EXECUTIVE DIRECTOR, OFFICERS OR OTHER EMPLOYEES WITH AN HONORARIUM. THE INSTITUTE'S BOARD OF TRUSTEES APPROVES ANY SUCH AMOUNTS FOR THE EXECUTIVE DIRECTOR AND INSTITUTE OFFICERS. FORM 990, PART VI, SECTION C, LINE 19 ALL APPLICABLE DOCUMENTS ARE AVAILABLE FROM THE ORGANIZATION UPON WRITTEN REQUEST. FORM 990, PART XI, LINE 9: OTHER ADJUSTMENTS TO FUND BALANCES -17,884. BETH ISRAEL DEACONESS MEDICAL CENTER 330 BROOKLINE AVE BOSTON MA 02215 042103881 HOSPITAL MA 501(C)(3) LINE 3 N/A 0 PRESIDENT & FELLOWS OF HARVARD COLLEGE 1563 MASSACHUSETTS AVE CAMBRIDGE MA 02138 042103580 HOSPITAL MA 501(C)(3) LINE 3 N/A 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1