ANNA JAQUES COMMUNITY HEALTH FOUNDATION: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- ANNA JAQUES COMMUNITY HEALTH FOUNDATION (EIN 04-3318952)
- Tax period
- 2015-10-01 to 2016-09-30
- Filed
- 2017-08-09
- IRS object ID
- 201732219349300603
- Schema version
- 2015v3.0
- 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 O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-08-09T07:43:05-05:00 | ReturnTs |
| Tax Period End | 2016-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 135381590 | PreparerFirmEIN |
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 | TWO INTERNATIONAL PLACE | AddressLine1Txt |
| City | BOSTON | CityNm |
| State Abbreviation | MA | StateAbbreviationCd |
| ZIP | 02210 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-10-01 | 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) |
|---|---|---|
| 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 | VP/CFO | PersonTitleTxt |
| Phone | 9784631000 | PhoneNum |
| Signature | 2017-07-20 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JEFFREY T ROGERS | PreparerPersonNm |
| PTIN | P01074284 | PTIN |
| Phone | 6177427788 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | MARK GOLDSTEIN | 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 | $1,950,753 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | 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 | ANNA JAQUES COMMUNITY HEALTH FOUNDATION PROVIDES SUPPORT TO ANNA JAQUES HOSPITAL, A TAX EXEMPT HOSPITAL DESCRIBED IN SECTION 170(B)(1)(A)(III). | ActivityOrMissionDesc |
| Voting Members Governing Body | 26 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 23 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 23 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,980,446 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,209,823 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $958,616 | PYInvestmentIncomeAmt |
| CY Investment Income | $651,077 | CYInvestmentIncomeAmt |
| PY Other Revenue | -$9,091 | PYOtherRevenueAmt |
| CY Other Revenue | $1,676 | CYOtherRevenueAmt |
| PY Total Revenue | $2,929,971 | PYTotalRevenueAmt |
| CY Total Revenue | $1,862,576 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $1,859,192 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $2,054,458 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $348,441 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $428,557 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $475,037 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $109,400 | PYOtherExpensesAmt |
| CY Other Expenses | $125,776 | CYOtherExpensesAmt |
| PY Total Expenses | $2,317,033 | PYTotalExpensesAmt |
| CY Total Expenses | $2,608,791 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $612,938 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$746,215 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $19,657,160 | TotalAssetsBOYAmt |
| Total Assets EOY | $19,481,317 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $943,485 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $808,426 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $18,713,675 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $18,672,891 | NetAssetsOrFundBalancesEOYAmt |
| Mission | ANNA JAQUES COMMUNITY HEALTH FOUNDATION PROVIDES SUPPORT TO ANNA JAQUES HOSPITAL, A TAX EXEMPT HOSPITAL. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $2,054,458 | ExpenseAmt |
| Grant | $2,054,458 | GrantAmt |
| 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 | $2,054,458 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | Yes (1) | NondeductibleContributionsInd |
| Nondeductible Contri Discl | Yes (1) | NondeductibleContriDisclInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 26 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 23 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | MA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE ORGANIZATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 |
Form990 Part VII Section A Form990PartVIISectionAGrp (27 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|
| MARK GOLDSTEIN | ||||||||
| PRESIDENT/CEO | 5.00 | 55.00 | Yes (X) | Yes (X) | $0 | $610,294 | $143,933 | |
| KEVIN KILDAY | ||||||||
| VP/CFO | 5.00 | 55.00 | Yes (X) | Yes (X) | $0 | $313,946 | $38,305 | |
| SARAH GNERRE | ||||||||
| VP/EXECUTIVE DIRECTOR | 50.00 | Yes (X) | Yes (X) | $0 | $175,083 | $32,123 | ||
| TREY BYRNES | ||||||||
| DIRECTOR | 5.00 | Yes (X) | $0 | $0 | $0 | |||
| RALPH CASTAGNA | ||||||||
| DIRECTOR | 5.00 | Yes (X) | $0 | $0 | $0 | |||
| PATRICIA MANSFIELD | ||||||||
| DIRECTOR | 5.00 | Yes (X) | $0 | $0 | $0 | |||
| KARI BERNARD | ||||||||
| DIRECTOR | 5.00 | Yes (X) | $0 | $0 | $0 | |||
| LUIS FERNANDEZ | ||||||||
| DIRECTOR | 5.00 | Yes (X) | $0 | $0 | $0 | |||
| JESSICA AMOROSINO MD | ||||||||
| DIRECTOR | 5.00 | Yes (X) | $0 | $0 | $0 | |||
| KATHY CONNORS | ||||||||
| DIRECTOR | 5.00 | Yes (X) | $0 | $0 | $0 | |||
| JEFFREY NAHAS | ||||||||
| DIRECTOR | 5.00 | Yes (X) | $0 | $0 | $0 | |||
| JOAN MILLER | ||||||||
| DIRECTOR | 5.00 | Yes (X) | $0 | $0 | $0 | |||
| KEVIN GASIOROWSKI | ||||||||
| DIRECTOR | 5.00 | Yes (X) | $0 | $0 | $0 | |||
| MATT KHATIB | ||||||||
| DIRECTOR | 5.00 | Yes (X) | $0 | $0 | $0 | |||
| VANIA O'CONNOR | ||||||||
| DIRECTOR | 5.00 | Yes (X) | $0 | $0 | $0 | |||
| CHRIS SULLIVAN | ||||||||
| DIRECTOR | 5.00 | Yes (X) | $0 | $0 | $0 | |||
| KRISTIN TALLMAN OD | ||||||||
| DIRECTOR | 5.00 | Yes (X) | $0 | $0 | $0 | |||
| MARY WILLIAMSON | ||||||||
| DIRECTOR | 5.00 | Yes (X) | $0 | $0 | $0 | |||
| JAY IANNINI | ||||||||
| DIRECTOR | 5.00 | Yes (X) | $0 | $0 | $0 | |||
| CHRISTOPHER JOHNSTON | ||||||||
| DIRECTOR | 5.00 | Yes (X) | $0 | $0 | $0 | |||
| LISA PURINTON | ||||||||
| DIRECTOR | 5.00 | Yes (X) | $0 | $0 | $0 | |||
| TODD BALTICH | ||||||||
| DIRECTOR | 5.00 | Yes (X) | $0 | $0 | $0 | |||
| KATHY BECHTEL | ||||||||
| DIRECTOR | 5.00 | Yes (X) | $0 | $0 | $0 | |||
| MELISSA FOLEY | ||||||||
| DIRECTOR | 5.00 | Yes (X) | $0 | $0 | $0 | |||
| KIM FOULKES | ||||||||
| DIRECTOR | 5.00 | Yes (X) | $0 | $0 | $0 | |||
| JULIE GANONG | ||||||||
| DIRECTOR | 5.00 | Yes (X) | $0 | $0 | $0 | |||
| DELIA O'CONNOR | ||||||||
| PRESIDENT/CEO THROUGH 12/31/14 | 0.00 | $0 | $180,673 | $500 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,279,996 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $214,861 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $135,873 | FundraisingAmt |
| All Other Contributions | $1,073,950 | AllOtherContributionsAmt |
| Total Contributions | $1,209,823 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $363,482 | TotalRevenueColumnAmt |
| Exclusion | $363,482 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $336,713 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $49,118 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $287,595 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $287,595 | TotalRevenueColumnAmt |
| Exclusion | $287,595 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $40,735 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $135,873 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $39,059 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,676 | TotalRevenueColumnAmt |
| Exclusion | $1,676 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,862,576 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $652,753 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,054,458 | TotalAmt |
| Program Services | $2,054,458 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $175,083 | TotalAmt |
| Management And General | $47,272 | ManagementAndGeneralAmt |
| Fundraising | $127,811 | FundraisingAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $167,876 | TotalAmt |
| Fundraising | $167,876 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $64,046 | TotalAmt |
| Management And General | $11,893 | ManagementAndGeneralAmt |
| Fundraising | $52,153 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,552 | TotalAmt |
| Management And General | $3,521 | ManagementAndGeneralAmt |
| Fundraising | $18,031 | 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 Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,749 | TotalAmt |
| Fundraising | $17,749 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $80,214 | TotalAmt |
| Fundraising | $80,214 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,203 | TotalAmt |
| Fundraising | $11,203 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,360 | TotalAmt |
| Management And General | $1,360 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUES | Desc |
| Total | $250 | TotalAmt |
| Management And General | $250 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,608,791 | TotalAmt |
| Program Services | $2,054,458 | ProgramServicesAmt |
| Management And General | $79,296 | ManagementAndGeneralAmt |
| Fundraising | $475,037 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $75,727 | BOYAmt |
| EOY | $181,717 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,169,531 | BOYAmt |
| EOY | $750,381 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,827 | BOYAmt |
| EOY | $16,304 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,395,075 | BOYAmt |
| EOY | $18,532,915 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,657,160 | BOYAmt |
| EOY | $19,481,317 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,284 | BOYAmt |
| EOY | $21,357 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $917,201 | BOYAmt |
| EOY | $787,069 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $943,485 | BOYAmt |
| EOY | $808,426 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,598,711 | BOYAmt |
| EOY | $6,138,522 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,808,454 | BOYAmt |
| EOY | $7,071,640 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,306,510 | BOYAmt |
| EOY | $5,462,729 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,713,675 | BOYAmt |
| EOY | $18,672,891 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,657,160 | BOYAmt |
| EOY | $19,481,317 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$746,215 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $705,431 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | 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 (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | 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 (1) | GoverningDocumentListedInd |
| Support | $2,054,458 | SupportAmt |
| Other Support | $0 | OtherSupportAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 1 | SupportedOrganizationsTotalCnt |
| Support Sum | $2,054,458 | SupportSumAmt |
| Other Support Sum | $0 | OtherSupportSumAmt |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | Yes (1) | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | 0 | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | 0 | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | 0 | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | 0 | OrganizationChangeSuprtOrgInd |
| Support Non Supported Org | 0 | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | 0 | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | 0 | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | 0 | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | 0 | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | 0 | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | 0 | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | 0 | ContributionControllerInd |
| Contribution Family | 0 | ContributionFamilyInd |
| Contribution35 Controlled | 0 | Contribution35ControlledInd |
Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Power Appoint Majority Dir Trst | Yes (1) | PowerAppointMajorityDirTrstInd |
| Operate Benefit Non Suprt Org | 0 | OperateBenefitNonSuprtOrgInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| 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 Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| 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 Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| 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 |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $13,644,734 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $1,721,740 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $1,348,884 | GrantsOrScholarshipsAmt |
| Administrative Expenses | $26,762 | AdministrativeExpensesAmt |
| End Year Balance | $13,990,828 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $11,817,347 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $1,829,717 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $2,330 | AdministrativeExpensesAmt |
| End Year Balance | $13,644,734 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.44000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.14200 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.41800 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO AFFILIATES | Desc |
| Amt | $787,069 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $787,069 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | THE AMOUNTS IN PART V, COLUMN (B) ARE NOT THE SAME VALUES AS THE SEPTEMBER 30, 2015 TAX RETURN AS THE AMOUNTS ON THE FILED RETURN WERE INCORRECT. THE VALUES HAVE BEEN REVISED TO THE CORRECT AMOUNTS FOR THE SEPTEMBER 30, 2016 TAX RETURN. |
| PART X, LINE 2: | THERE IS NO FIN48 (ASC 740) FOOTNOTE IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS. |
| PART V LINE 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 (AJCHF) AND THE PHYSICIAN GROUP (SAGP). THEY ARE TAX EXEMPT ORGANIZATIONS UNDER SECTION 501(C)(3) OF THE IRS CODE AND, ACCORDINGLY, ARE EXEMPT FROM FEDERAL AND STATE CORPORATE INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | GOLF TOURNAMENT | Event1Nm |
| Gross Receipts Event1 | $176,608 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $135,873 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $40,735 | GrossRevenueEvent1Amt |
| Cash Prizes Event1 | $9,215 | CashPrizesEvent1Amt |
| Rent Facility Costs Event1 | $26,500 | RentFacilityCostsEvent1Amt |
| Other Direct Expenses Event1 | $3,344 | OtherDirectExpensesEvent1Amt |
| Gross Receipts Total | $176,608 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $135,873 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $40,735 | GrossRevenueTotalEventsAmt |
| Cash Prizes Total Events | $9,215 | CashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $26,500 | RentFcltyCostsTotalEventsAmt |
| Oth Direct Expnss Total Events | $3,344 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $39,059 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $1,676 | NetIncomeSummaryAmt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | 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 | 501C3 | IRCSectionDesc |
| Cash Grant | $2,054,458 | CashGrantAmt |
| Valuation Method Used | FMV | ValuationMethodUsedDesc |
| Purpose Of Grant | GENERAL ASSISTANCE | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | DONATIONS ARE TRACKED BY DONOR RESTRICTION (FOR EXAMPLE, A DONATION TO FUND THE 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 501(C)(3) ORGANIZATION. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | Yes (1) | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | Yes (1) | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (4 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MARK GOLDSTEIN | ||||||||||||||
| PRESIDENT/CEO | $0 | $518,749 | $0 | $91,545 | $0 | $0 | $0 | $113,090 | $0 | $30,843 | $0 | $754,227 | $0 | $0 |
| KEVIN KILDAY | ||||||||||||||
| VP/CFO | $0 | $267,388 | $0 | $46,558 | $0 | $0 | $0 | $7,135 | $0 | $31,170 | $0 | $352,251 | $0 | $0 |
| SARAH GNERRE | ||||||||||||||
| VP/EXECUTIVE DIRECTOR | $0 | $160,144 | $0 | $14,939 | $0 | $0 | $0 | $11,928 | $0 | $20,195 | $0 | $207,206 | $0 | $0 |
| DELIA O'CONNOR | ||||||||||||||
| PRESIDENT/CEO THROUGH 12/31/14 | $0 | $180,673 | $0 | $0 | $0 | $0 | $0 | $100 | $0 | $400 | $0 | $181,173 | $0 | $154,072 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3 | THIS ORGANIZATION DOES NOT ESTABLISH COMPENSATION FOR THE CEO AND OTHER SENIOR 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. |
| PART I, LINE 4B | DELIA O'CONNOR RETIRED AS CEO EFFECTIVE DECEMBER 31, 2014 AND IS NOW RECEIVING RETIREMENT DISTRIBUTIONS FROM SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLANS. IN CALENDAR YEAR 2015 THE AMOUNT OF THESE PAYMENTS WAS $173,918. MARK GOLDSTEIN PARTICIPATES IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN FUNDED BY A SPLIT DOLLAR LIFE INSURANCE POLICY. THE 2015 PREMIUM FOR THIS PLAN WAS $85,000. |
| PART I, LINE 6 | MARK GOLDSTEIN, KEVIN KILDAY AND SARAH GNERRE'S BONUS PAYMENTS WERE CONTINGENT ON THE ORGANIZATIONS IN THE SYSTEM MEETING SEVERAL TARGETS, INCLUDING THE TARGETED EARNINGS OF THE ORGANIZATIONS. THE AMOUNTS PAID WERE $91,545, $46,558 AND $14,939 RESPECTIVELY. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | ANNA JAQUES HOSPITAL IS THE SOLE MEMBER OF AJCHF. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE AJH BOARD ELECTS THE AJCHF BOARD. |
| FORM 990, PART VI, SECTION A, LINE 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 FUND-RAISING ACTIVITIES. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE FORM 990 IS PREPARED BY STAFF, REVIEWED BY AN OUTSIDE ACCOUNTING FIRM AND BY THE CEO AND CFO. ONCE APPROVED, A COPY OF THE 990 IS AVAILABLE TO THE BOARD FOR REVIEW PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 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 REQUESTS THAT THE INDIVIDUAL ABSTAIN FROM VOTING AT THAT TIME. THE CHAIRPERSON OR SECRETARY MONITORS SURVEYS TO ENSURE COMPLIANCE. |
| FORM 990, PART VI, SECTION B, LINE 15 | TOTAL COMPENSATION OF THE SENIOR EXECUTIVE TEAM IS REVIEWED ANNUALLY BY AN INDEPENDENT COMMITTEE OF THE PARENT'S (SRHS) 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, SECTION C, LINE 19 | GOVERNING DOCUMENTS, THE CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. |
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 | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| ANNA JAQUES HOSPITAL | |||||||||
| 25 HIGHLAND AVE | NEWBURYPORT | MA | 01950 | 042104338 | HOSPITAL | MA | 501(C)(3) | LINE 3 | 0 |
| SEACOAST REGIONAL HEALTH SYSTEMS | |||||||||
| 25 HIGHLAND AVE | NEWBURYPORT | MA | 01950 | 222814214 | FUNCTIONALLY INTEGRATED SUPPORTING ORG | MA | 501(C)(3) | LINE 11B, II | 0 |
| SEACOAST AFFILIATED GROUP PRACTICE | |||||||||
| 25 HIGHLAND AVE | NEWBURYPORT | MA | 01950 | 043485648 | PHYSICIAN GROUP | MA | 501(C)(3) | LINE 9 | 0 |
| SEACOAST REGIONAL MRI | |||||||||
| 25 HIGHLAND AVE | NEWBURYPORT | MA | 01950 | 320443663 | HEALTHCARE SERVICES | MA | 501(C)(3) | LINE 9 | 0 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GREATER NEWBURYPORT MANAGEMENT SERVICES ORG | 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 SERVICES | PrimaryActivitiesTxt |
| Legal Domicile State | MA | LegalDomicileStateCd |
| Entity Type | C | EntityTypeTxt |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (3 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| ANNA JAQUES HOSPITAL | ||
| B | $2,054,458 | FMV |
| ANNA JAQUES HOSPITAL | ||
| L | $1,211,499 | FMV |
| ANNA JAQUES HOSPITAL | ||
| P | $554,334 | FMV |
Comments