2016-08-10T15:01:10-05:00 2015-09-30 135381590 BDO USA LLP 200 PORTLAND STREET BOSTON MA 02114 990 2014-10-01 320423203 LGH ADMINISTRATIVE SERVICES INC LGHA 9789468550 1 GENERAL ST LAWRENCE MA 01841 DEBORAH J WILSON CORP ASSISTANT TREASURER/CFO 9789468550 2016-07-29 1 JEFFREY T ROGERS P01074284 6177427788 2014 2016-12-15 16:53:06Z DIANNE J ANDERSON 1 GENERAL ST LAWRENCE MA 01841 18037 0 X WWW.LAWRENCEGENERAL.ORG X 2013 MA LGH ADMINISTRATIVE SERVICES, INC. IS A QUALIFIED ACTIVE LOW INCOME COMMUNITY BUSINESS ("QALICB") THAT IS EXPECTED TO COMPLETE A NEW MARKET TAX CREDIT TRANSACTION IN FY2015, WHICH WILL FUND CONSTRUCTION OF A SURGICAL BUILDING. 5 2 0 0 0 0 0 0 0 0 0 18037 0 0 0 18037 0 0 0 0 0 0 0 0 0 0 120443 0 120443 0 -102406 155000 21921921 0 20612252 155000 1309669 X LGH ADMINISTRATIVE SERVICES, INC. IS A QUALIFIED ACTIVE LOW INCOME COMMUNITY BUSINESS ("QALICB") THAT PROVIDES SERVICES TO, MANAGE FUNDS AND OTHER ASSETS FOR, AND OTHERWISE SUPPORT THE FUNCTIONS OF AND/OR TO CARRY OUT THE PURPOSES OF LAWRENCE GENERAL HOSPITAL, WHICH INCLUDES OWNING, ACQUIRING AND/OR MAINTAINING REAL ESTATE. 0 0 120443 18037 TO SUPPORT THE PURPOSE/MISSION OF LAWRENCE GENERAL HOSPITAL 120443 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 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 X 5 0 1 0 1 0 0 0 0 0 0 0 0 0 0 X 5 2 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X X FELIX MERCADO VICE PRESIDENT FINANCE 9786834000 1 GENERAL ST LAWRENCE MA 01841 ELLEN MURPHY MEEHAN PRESIDENT 1.00 0.00 X 0 0 0 DIANNE J ANDERSON VICE PRESIDENT/CEO 1.00 50.00 X X 0 776592 43694 PETER F QUINLAN TREASURER (DEC 14-FORWARD) 1.00 0.00 X 0 0 0 DEBORAH J WILSON ASST TREASURER/CFO 1.00 50.00 X X 0 441348 37421 MARK J COCOZZA SECRETARY/CLERK (DEC 14-FORWARD) 1.00 1.00 X 0 0 0 DENISE S PALUMBO SECRETARY/CLERK (OCT 14-DEC 14)/COO 1.00 50.00 X X 0 453348 28235 0 1671288 109350 0 0 1 0 BOND BROTHERS 145 SPRING STREET EVERETT MA 02129 GENERAL CONTRACTOR 5324720 MORRIS SWITZER 185 TALCOTT ROAD WILLISTON VT 05495 ARCHITECT 780915 LEGGAT MCCALL PROPERTIES 10 POST OFFICE SQUARE 13TH FLOOR BOSTON MA 02114 PROJECT MANAGER 127085 3 18037 18037 18037 18037 0 0 119931 119931 512 512 120443 120443 0 0 4623 12454099 0 155000 12454099 0 9463199 155000 21921921 126457 16816000 0 3669795 0 20612252 X 155000 1309669 155000 1309669 155000 21921921 X -102406 1257075 X 0 1 X 1 0 X X X 1 LGH CHARITABLE TRUST INC 222586814 7 1 1412074 0 1 1412074 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 12454099 12454099 12454099 FUNDS HELD BY TRUSTEE 9463199 9463199 CONSTRUCTION PAYABLE 3021245 RETAINAGE PAYABLE 643550 DUE TO AFFILIATE - LAWRENCE GENERAL HOSPITAL 5000 3669795 X 18037 0 18037 0 18037 120443 0 120443 0 120443 PART X, LINE 2: THE ORGANIZATION ANNUALLY EVALUATES ITS TAX STATUS AND TAX POSITIONS TAKEN WITH RESPECT TO ITS OPERATIONS AND FINANCIAL POSITION. 0 1 0 0 0 0 0 0 0 DIANNE J ANDERSON VICE PRESIDENT/CEO 0 555275 0 221317 0 0 0 19500 0 24194 0 820286 0 0 DEBORAH J WILSON ASST TREASURER/CFO 0 371026 0 70322 0 0 0 18500 0 18921 0 478769 0 0 DENISE S PALUMBO SECRETARY/CLERK (OCT 14-DEC 14)/COO 0 382677 0 70671 0 0 0 18500 0 9735 0 481583 0 0 PART I, LINE 4B AS PART OF ITS TOTAL COMPENSATION PACKAGE FOR EXECUTIVE-LEVEL EMPLOYEES, THE PARENT COMPANY OF LGH ADMINISTRATIVE SERVICES, INC., LAWRENCE GENERAL HOSPITAL, OFFERED 403(B), 457(B) AND 457(F) NON-QUALIFIED SUPPLEMENTAL RETIREMENT PLANS. FOR THE 2014 CALENDAR YEAR, LAWRENCE GENERAL HOSPITAL CONTRIBUTED THESE AMOUNTS TO THE FOLLOWING EMPLOYEES LISTED ON FORM 990, SCHEDULE J, PART II: DIANNE J. ANDERSON, 403B PLAN ($2,000), 457B PLAN ($17,500), 457F PLAN ($95,174); DENISE S. PALUMBO, 403B PLAN ($1,000), 457B PLAN ($17,500), 457F PLAN ($19,101); DEBORAH J. WILSON, 403B PLAN ($1,000), 457B PLAN ($17,500), 457F PLAN ($18,500). PART II PAYROLL RECORDS ARE FOR THE 01/01/2014 TO 12/31/2014 CALENDAR YEAR. PART I LINE 3 THE PRESIDENT OF LGH ADMINISTRATIVE SERVICES, INC. IS NOT COMPENSATED. FORM 990, PART VI, SECTION B, LINE 11 FORM 990 IS PREPARED BY THE ORGANIZATION'S ASSISTANT CONTROLLER AND REVIEWED BY THE VICE PRESIDENT OF FINANCE AND CFO. FORM 990 IS ALSO REVIEWED BY THE ORGANIZATION'S EXTERNAL ACCOUNTANT. ONCE COMPLETE, THE FORM AND ALL SCHEDULES ARE ARE MADE AVAILABLE TO THE BOARD OF TRUSTEES VIA A SECURE INTERNET PORTAL FOR REVIEW. THE ORGANIZATION'S VICE PRESIDENT OF FINANCE AND CFO ARE AVAILABLE TO FACILITATE THE REVIEW AS WELL AS ANSWER ANY QUESTIONS REGARDING THE FORM. FORM 990, PART VI, SECTION B, LINE 12C ON AN ANNUAL BASIS, THE PARENT COMPANY (LAWRENCE GENERAL HOSPITAL) OF LGH ADMINISTRATIVE SERVICES, INC. DISTRIBUTES A CONFLICT ON INTEREST POLICY TO THE BOARD OF TRUSTEES. THE MEMBERS ARE REQUIRED TO DISCLOSE IN WRITING ANY POTENTIAL CONFLICT THEY ARE AWARE OF. FORM 990, PART VI, SECTION B, LINE 15 THE PARENT COMPANY CEO'S COMPENSATION IS REVIEWED AND APPROVED BY AN EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES. THE COMPENSATION FOR THE CFO AND COO ARE DETERMINED BY THE CEO AND REVIEWED BY AN EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES. INDEPENDENT SURVEYS ARE ALSO PERFORMED TO DETERMINE SALARY REASONABLENESS. FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATION MAKES ALL DOCUMENTS AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST. THE FORM 990 IS ALSO AVAILABLE ON THE WEBSITE OF THE MASSACHUSETTS' ATTORNEY GENERAL AND THROUGH WWW.GUIDESTAR.ORG. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ALL DOCUMENTS AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: NET ASSET TRANSFER FROM LGH CHARITABLE TRUST, INC. 1,412,074. NET ASSET TRANSFER TO LAWRENCE GENERAL HOSPITAL -154,837. OTHER -162. LAWRENCE GENERAL HOSPITAL 1 GENERAL ST LAWRENCE MA 01841 042103586 HOSPITAL MA 501(C)3 3 0 LGH CHARITABLE TRUST INC 1 GENERAL ST LAWRENCE MA 01841 222586814 FUNDRAISING MA 501(C)3 7 LAWRENCE GENERAL HOSPITAL 0 COMMUNITY MEDICAL ASSOCIATES INC 1 GENERAL ST LAWRENCE MA 01841 272142635 MULTI-SPECIALTY PRACTICE MA 501(C)3 3 LAWRENCE GENERAL HOSPITAL 0 MERRIMACK VALLEY HEALTH SERVICES INC 600 FEDERAL ST ANDOVER MA 01810 222604915 MEDICAL IMAGING MA 501(C)3 9 LAWRENCE GENERAL HOSPITAL 0 LGH HEALTH ENTERPRISES INC 38 PROSPECT ST LAWRENCE MA 01842 042869696 HEALTHCARE MANAGEMENT MA LAWRENCE GENERAL HOSPITAL C 0 LGH PHYSICIAN ASSOCIATES PC 38 PROSPECT ST LAWRENCE MA 01842 043174041 HEALTHCARE MANAGEMENT MA LAWRENCE GENERAL HOSPITAL C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 LAWRENCE GENERAL HOSPITAL R -154837 REVIEW OF RECORDS LGH CHARITABLE TRUST INC S 1412074 REVIEW OF RECORDS