2016-08-03T13:05:06-05:00 2015-09-30 135381590 BDO USA LLP 200 PORTLAND STREET BOSTON MA 02114 990 2014-10-01 043485648 SEACOAST AFFILIATED GROUP PRACTICES INC SEAC 9784631000 25 HIGHLAND AVE NEWBURYPORT MA 01950 KEVIN KILDAY VP/CFO 9784631000 2016-08-02 1 JEFFREY T ROGERS P01074284 6177427788 2014 2016-12-15 16:53:06Z KEVIN KILDAY 25 HIGHLAND AVE NEWBURYPORT MA 01950 16801852 0 X WWW.AJH.ORG X 1999 MA SAGP IS A MULTI-SPECIALTY MEDICAL GROUP PRACTICE THAT PROVIDES PROFESSIONAL MEDICAL CARE IN THE COMMUNITY SERVED BY ANNA JAQUS HOSPITAL. PHYSICIANS TREAT ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY AND ADHERE TO THE HOSPITAL'S CHARITY CARE POLICY. 4 2 173 2 0 0 305879 150000 16384319 16615450 190 94 19384 36308 16709772 16801852 0 0 0 0 14234469 14465856 0 0 0 3257894 3888301 17492363 18354157 -782591 -1552305 3769444 4268591 3447469 5498923 321975 -1230332 X SAGP IS A MULTI-SPECIALTY MEDICAL GROUP PRACTICE THAT PROVIDES PROFESSIONAL MEDICAL CARE IN THE COMMUNITY SERVED BY ANNA JAQUS HOSPITAL. PHYSICIANS TREAT ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY AND ADHERE TO THE HOSPITAL'S CHARITY CARE POLICY. 0 0 5149775 0 5629301 WOMEN'S HEALTH CARE IS THE LARGEST OF THE SAGP PRACTICES, SERVING THE WOMEN OF GREATER NEWBURYPORT, THE CITY WHERE AJH IS LOCATED. DURING FISCAL YEAR 2015, THE PHYSICIANS, NURSES, AND MIDWIVES ASSISTED AT 720 DELIVERIES, AS WELL AS PERFORMING SURGERY AND SEEING PATIENTS FOR OFFICE VISITS. THEY OFFER CHILDBIRTH CLASSES AND BREASTFEEDING CLASSES TO THEIR PATIENTS. THERE ARE NO OTHER OBSTETRIC PRACTICES IN THE SERVICE AREA, SO WOMEN'S HEALTH CARE IS CENTRAL TO THE SUCCESS OF ANNA JAQUES HOSPITAL. 3083936 0 3389680 NORTH SHORE INTERNAL MEDICINE IS A LARGE PRIMARY CARE PRACTICE BASED IN NEWBURYPORT, THE CITY WHERE AJH IS LOCATED. THE PHYSICIANS AND NURSE PRACTITIONERS FROM NSIM SAW THEIR PATIENTS FOR A TOTAL OF 32,055 VISITS IN FISCAL 2015, INCLUDING VISITS WITH 652 NEW PATIENTS. 2040062 0 2331533 THE HOSPITALIST PROGRAM EMPLOYS PHYSICIANS WHO CARE FOR ANNA JAQUES HOSPITAL INPATIENTS. DURING FISCAL 2015, THESE DOCTORS CARED FOR 3228 PATIENTS, OR 71 PERCENT OF ALL HOSPITAL MEDICAL/SURGICAL INPATIENTS. 6972983 0 5295512 PRACTICE REVENUE PROGRAM EXPENSEATLANTIC SURGICAL ASSOC $1,237,030 $1,210,816COASTAL MEDICAL ASSOC 1,444,750 1,560,781BREAST CARE CENTER 425,227 774,187NE ENDOCRINOLOGY 635,839 726,645NEWBORN CARE 365,016 578,589GI ASSOCIATES 346,134 522,392SLOCUM FAMILY PRACTICE 342,731 394,944HIGHLAND PRIMARY CARE 143,060 163,278COASTAL EXTENDED CARE/OTHER 355,725 1,041,351 6972983 0 5295512 17246756 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 23 0 1 173 1 0 0 0 0 0 0 0 0 X 4 2 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X THE ORGANIZATION 9784631000 25 HIGHLAND AVE NEWBURYPORT MA 01950 DAVID LAFLAMME DIRECTOR 5.00 10.00 X 0 0 0 ANN LAGASSE DIRECTOR 5.00 X 0 0 0 MARK GOLDSTEIN PRESIDENT/CEO 5.00 55.00 X X 0 544922 126200 KEVIN KILDAY VP/CFO 5.00 55.00 X X 0 92574 10063 DELIA O'CONNOR PRES/CEO THRU 12/31/14 5.00 55.00 X X 0 761064 47484 SAIRA NASEER-GHIASUDDIN PHYSICIAN 50.00 10.00 X 904437 0 35360 DAVID SWIERZEWSKI PHYSICIAN 50.00 5.00 X 758423 50000 25820 KIMBERLY KERSTEN PHYSICIAN 50.00 X 454039 0 15957 PETER HARTMANN PHYSICIAN 50.00 X 379428 0 28678 KAY FICHT PHYSICIAN 50.00 X 319547 0 33535 2815874 1448560 323097 31 0 1 0 MEDICUS HOSPITALISTS LLC 22 ROULSTON RD WINDHAM NH 03087 LOCUM PHYSICIAN COVERAGE 147911 NEWBURYPORT GASTROENTEROLOGY LLC 255 LOW ST SUITE 201 NEWBURYPORT MA 01950 OVERHEAD FOR EMPLOYED PHYSICIAN 107086 2 150000 150000 NET PATIENT SERVICE REVENUE 621110 16615450 16615450 0 16615450 94 94 5732 0 5732 5732 5732 PHYSICIAN DIRECTOR FEE 621110 18408 18408 BILLING FEES 621110 11008 11008 REBATES/DISCOUNTS 621110 1160 1160 30576 16801852 16646026 0 5826 12417297 11720606 696691 161778 152817 8961 1192914 1127015 65899 693867 655333 38534 33000 33000 1011888 895028 116860 11930 11930 475358 475358 821027 821027 69791 1415 68376 6069 6069 127545 127545 697306 697306 UTILITIES 284350 284350 0 0 DUES 256500 256500 0 0 RECRUITING 50000 0 50000 0 COLLECTIONS 29080 0 29080 0 14457 14457 18354157 17246756 1107401 0 0 2 502393 481774 0 0 2050401 2424395 0 0 0 0 0 0 0 0 516697 790012 1678878 1106470 699953 572408 0 0 0 0 0 0 0 0 0 0 3769444 4268591 1546875 1818634 0 0 1900594 3680289 3447469 5498923 X 321975 -1230332 0 0 0 0 321975 -1230332 3769444 4268591 -1552305 0 X 0 1 X 1 0 X 112850 305879 150000 568729 12842872 14253315 15467386 16397288 16646025 75606886 12842872 14253315 15580236 16703167 16796025 76175615 0 0 0 76175615 7457 6876 6045 6605 5826 32809 7457 6876 6045 6605 5826 32809 12850329 14260191 15586281 16709772 16801851 76208424 0.99960 0.99950 0.00040 0.00050 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 460818 349958 110860 1218060 756512 461548 572408 DUE TO AFFILIATES 3657001 DEFERRED RENT 23288 3680289 PART X, LINE 2 THERE IS NO FIN 48(ASC 740) FOOTNOTE IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS. 0 1 0 1 0 1 1 0 0 MARK GOLDSTEIN PRESIDENT/CEO 0 462706 0 82216 0 0 0 98627 0 27573 0 671122 0 0 DELIA O'CONNOR PRES/CEO THRU 12/31/14 0 628907 0 132157 0 0 0 29075 0 18409 0 808548 0 0 SAIRA NASEER-GHIASUDDIN PHYSICIAN 450056 0 454381 0 0 0 7800 0 27560 0 939797 0 0 0 DAVID SWIERZEWSKI PHYSICIAN 541992 50000 216431 0 0 0 7800 0 18020 0 784243 50000 0 0 KIMBERLY KERSTEN PHYSICIAN 354860 0 99179 0 0 0 7800 0 8157 0 469996 0 0 0 PETER HARTMANN PHYSICIAN 379428 0 0 0 0 0 3625 0 25053 0 408106 0 0 0 KAY FICHT PHYSICIAN 319547 0 0 0 0 0 5975 0 27560 0 353082 0 0 0 PART I, LINE 3 COMPENSATION FOR THE CEO AND CFO IS NOT SET BY THE SAGP BOARD, BUT BY THE BOARD OF THE PARENT, SRHS. THE SRHS BOARD DOES UTILIZE A COMPENSATION COMMITTEE, INDEPENDENT CONSULTANT, AND COMPENSATION STUDIES/SURVEYS TO SET THE EXECUTIVES' SALARIES. THE EXECUTIVE COMMITTEE OF THE SRHS BOARD APPROVES PAYMENTS BEFORE THEY ARE MADE. PART I, LINE 4B DELIA O'CONNOR, CEO THROUGH 12/31/14, PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN. SHE IS 100% VESTED IN THIS PLAN AND IS ENTITLED TO RECEIVE DISTRIBUTIONS UPON THE TERMINATION OF HER EMPLOYMENT. NO EMPLOYER CONTRIBUTION WAS MADE TO THIS PLAN IN CY 2014. IN ADDITION, MS. O'CONNOR AND MARK GOLDSTEIN PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN FUNDED BY A SPLIT DOLLAR LIFE INSURANCE POLICY. NO PREMIUM PAYMENT WAS MADE FOR MS. O'CONNOR'S POLICY IN CY 2014. MR. GOLDSTEIN'S PREMIUM WAS $70,560. PART I, LINE 5 DRS. SAIRA NASEER-GHIASUDDIN AND KIMBERLY KERSTEN WERE PAID BONUSES BASED ON THE PERFORMANCE OF NORTH SHORE INTERNAL MEDICINE, A DIVISION OF SAGP. THE AMOUNTS WERE $454,381 AND $99,179 RESPECTIVELY. DR. DAVID SWIERZEWSKI WAS PAID A BONUS OF $216,431 BASED ON THE PERFORMANCE OF ATLANTIC SURGICAL ASSOCIATES, A DIVISION OF SAGP. PART I, LINE 6 DELIA O'CONNOR'S AND MARK GOLDSTEIN'S BONUS PAYMENTS WERE CONTINGENT ON THE ORGANIZATIONS WITHIN THE SYSTEM MEETING SEVERAL TARGETS, INCLUDING THE TARGETED EARNINGS OF THE ORGANIZATIONS. THE AMOUNTS PAID WERE $132,157 AND $82,216 RESPECTIVELY. FORM 990, PART VI, SECTION A, LINE 6 SEACOAST REGIONAL HEALTH SYSTEMS, INC (SRHS), THE PARENT OF THE SYSTEM, IS THE SOLE MEMBER OF SAGP. FORM 990, PART VI, SECTION A, LINE 7A THE SRHS BOARD ELECTS THE MEMBERS OF THE SAGP BOARD. FORM 990, PART VI, SECTION A, LINE 7B APPROVAL BY THE STHS BOARD IS REQUIRED FOR THE ADOPTION OF ANNUAL OPERATING AND CAPITAL BUDGETS; FOR THE MERGER OR CONSOLIDATION OF THE ORGANIZATION WITH ANY OTHER CORPORATION; AND FOR THE 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 THE 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 BOARD MEMBER 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 FOR THE SENIOR EXECUTIVE TEAM IS REVIEWED ANNUALLY BY AN INDEPENDENT COMMITTEE OF THE SRHS BOARD (THE PARENT). THE COMMITTEE USES DATA RECEIVED FROM AN INDEPENDENT COMPENSATION CONSULTING FIRM TO DETERMINE FAIRNESS AND COMPARABILITY OF THE SALARIES, 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 REVIEW PROCESS 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. 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 ANNA JAQUES COMMUNITY HEALTH FOUNDATION 25 HIGHLAND AVE NEWBURYPORT MA 01950 043318952 FUNDRAISING ORGANIZATION MA 501(C)(3) LINE 11A, I 0 SEACOAST REGIONAL MRI 25 HIGHLAND AVE NEWBURYPORT MA 01950 320443663 PHYSICIAN PRACTICES MA 501(C)(3) LINE 9 0 GREATER NEWBURYPORT MANAGEMENT SERVICES ORG 25 HIGHLAND AVE NEWBURYPORT MA 01950 161744477 MANAGEMENT SERVICES MA C 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 ANNA JAQUES HOSPITAL C 150000 FMV ANNA JAQUES HOSPITAL J 3600 FMV ANNA JAQUES HOSPITAL K 147217 FMV