ANNA JAQUES COMMUNITY HEALTH FOUNDATION: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- ANNA JAQUES COMMUNITY HEALTH FOUNDATION (EIN 04-3318952)
- Tax period
- 2012-10-01 to 2013-09-30
- Filed
- 2014-08-11
- IRS object ID
- 201412239349300926
- Schema version
- 2012v2.1
- 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) |
|---|---|---|
| Timestamp | 2014-08-11T10:12:07-05:00 | Timestamp |
| Tax Period End Date | 2013-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 346565596 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Ernst & Young | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 Clarendon St | AddressLine1 |
| City | Boston | City |
| State | MA | State |
| ZIP Code | 02116 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 043318952 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Anna Jaques Community Health Foundation | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | ANNA | NameControl |
| Phone | 9784631000 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 25 Highland Ave | AddressLine1 |
| City | Newburyport | City |
| State | MA | State |
| ZIP Code | 01950 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Mark Goldstein | Name |
| Title | Executive VP/CFO | Title |
| Phone | 9784631000 | Phone |
| Date Signed | 2014-08-11 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Jeanne Schuster | Name |
| PTIN | P00743154 | PTIN |
| Phone | 6172662000 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Delia O'Connor | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 25 Highland Ave | AddressLine1 |
| City | Newburyport | City |
| State | MA | State |
| ZIP Code | 01950 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 3185102 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.ajh.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1996 | YearFormation |
| State Legal Domicile | MA | StateLegalDomicile |
| Activity Or Mission Description | Anna Jaques Community Health Foundation provides support to Anna Jaques Hospital. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 23 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 19 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 18 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 1637611 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 1219449 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 0 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 0 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 1361399 | InvestmentIncomePriorYear |
| Investment Income Current Year | 1835778 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 15597 | OtherRevenuePriorYear |
| Other Revenue Current Year | 9578 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 3014607 | TotalRevenuePriorYear |
| Total Revenue Current Year | 3064805 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 1936478 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 4021540 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 258068 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 330161 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 42667 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 9700 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 409032 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 188637 | OtherExpensePriorYear |
| Other Expenses Current Year | 124003 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 2425850 | TotalExpensesPriorYear |
| Total Expenses Current Year | 4485404 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 588757 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -1420599 | RevenuesLessExpensesCY |
| Total Assets BOY | 22185938 | TotalAssetsBOY |
| Total Assets EOY | 21034231 | TotalAssetsEOY |
| Total Liabilities BOY | 1056900 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 1179435 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 21129038 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 19854796 | NetAssetsOrFundBalancesEOY |
| Mission Description | Anna Jaques Community Health Foundation provides support to Anna Jaques Hospital, a tax exempt hospital described in Section 170(b)(1)(A)(iii). | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 4021540 | Expense |
| Grants | 4021540 | Grants |
| Revenue | 1219449 | Revenue |
| Description | The mission of AJCHF is to provide support to Anna Jaques Hospital. The expenses represent donations which were released to the hospital either because they were unrestricted donations, or because they were restricted donations whose restrictions have been satisfied. | Description |
| Total Program Service Expense | 4021540 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 0 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 1 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 1 | NonDeductibleContributions |
| Non Deductible Disclosure | 1 | NonDeductibleDisclosure |
| Quid Pro Quo Contributions | 1 | QuidProQuoContributions |
| Quid Pro Quo Disclosure | 1 | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Excess Business Holdings | 0 | ExcessBusinessHoldings |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 23 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 19 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | MA | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Kirsten Arnold Director of Finance | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 9788348256 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 25 Highland Ave | AddressLine1 |
| City | Newburyport | City |
| State | MA | State |
| ZIP Code | 01950 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (23 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Average Hours Per Week RelatedAverageHoursPerWeekRelated | OfficerOfficer |
|---|---|---|---|---|---|---|---|
| Ginny Eramo | |||||||
| Chairperson, Board of Ttees | 5.00 | X | 0 | 0 | 0 | ||
| Donna Twombly | |||||||
| Ttee/Mgr Rad. | 5.00 | X | 0 | 89112 | 26564 | 40.00 | |
| Mark Goldstein | |||||||
| Treas, CHF Bd/EVP/CFO | 5.00 | X | 0 | 511574 | 119279 | 55.00 | X |
| Delia O'Connor | |||||||
| President/CEO | 5.00 | X | 0 | 671850 | 173591 | 55.00 | X |
| Todd Baltich | |||||||
| Trustee | 5.00 | X | 0 | 0 | 0 | ||
| Kari Bernard | |||||||
| Trustee | 5.00 | X | 0 | 0 | 0 | ||
| Cynthia Barry Rubenfeld | |||||||
| Trustee | 5.00 | X | 0 | 0 | 0 | ||
| Trey Byrnes | |||||||
| Trustee | 5.00 | X | 0 | 0 | 0 | ||
| Ralph Castagna | |||||||
| Trustee | 5.00 | X | 0 | 0 | 0 | ||
| Craig Childs | |||||||
| Trustee | 5.00 | X | 0 | 0 | 0 | ||
| Mary Anne Clancy | |||||||
| Trustee | 5.00 | X | 0 | 0 | 0 | ||
| Barbara Cullen | |||||||
| Secretary, Board of Ttees | 5.00 | X | 0 | 0 | 0 | ||
| Scott Eaton | |||||||
| Trustee | 5.00 | X | 0 | 0 | 0 | ||
| Cynthia Gompers | |||||||
| Trustee | 5.00 | X | 0 | 0 | 0 | ||
| Michael Jewell | |||||||
| Trustee | 5.00 | X | 0 | 0 | 0 | ||
| Leanne Martin | |||||||
| Trustee | 5.00 | X | 0 | 0 | 0 | ||
| Joan Miller | |||||||
| Trustee | 5.00 | X | 0 | 0 | 0 | ||
| Susan Kneeland Rumore | |||||||
| Trustee | 5.00 | X | 0 | 0 | 0 | ||
| Luis Fernandez | |||||||
| Trustee | 5.00 | X | 0 | 0 | 0 | ||
| Patricia Mansfield | |||||||
| Trustee | 5.00 | X | 0 | 0 | 0 | ||
| Jeffrey Nahas | |||||||
| Trustee | 5.00 | X | 0 | 0 | 0 | ||
| Charles Withee | |||||||
| Trustee | 5.00 | X | 0 | 0 | 0 | ||
| Sarah Gnerre | |||||||
| VP of Development | 5.00 | X | 157941 | 0 | 22201 | 50.00 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 157941 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1272536 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 341635 | TotalOtherCompensation |
| Number Individuals GT100 K | 1 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| Fundraising Events | 137428 | FundraisingEvents |
| All Other Contributions | 1082021 | AllOtherContributions |
| Total Contributions | 1219449 | TotalContributions |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 328907 | TotalRevenueColumn |
| Exclusion | $328,907 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 1583088 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 76217 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 1506871 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1506871 | TotalRevenueColumn |
| Exclusion | $1,506,871 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 53658 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 137428 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 44080 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 9578 | TotalRevenueColumn |
| Exclusion | $9,578 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 3064805 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $1,845,356 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4021540 | Total |
| Program Services | 4021540 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 157941 | Total |
| Management And General | 31588 | ManagementAndGeneral |
| Fundraising | 126353 | Fundraising |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 119447 | Total |
| Fundraising | 119447 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 44785 | Total |
| Management And General | 4440 | ManagementAndGeneral |
| Fundraising | 40345 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7988 | Total |
| Management And General | 2416 | ManagementAndGeneral |
| Fundraising | 5572 | Fundraising |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15000 | Total |
| Management And General | 15000 | ManagementAndGeneral |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9700 | Total |
| Fundraising | 9700 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 530 | Total |
| Fundraising | 530 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 93209 | Total |
| Fundraising | 93209 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13876 | Total |
| Fundraising | 13876 | Fundraising |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 978 | Total |
| Management And General | 978 | ManagementAndGeneral |
Other Expenses OtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | DUES | Description |
| Total | 410 | Total |
| Management And General | 410 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4485404 | Total |
| Program Services | 4021540 | ProgramServices |
| Management And General | 54832 | ManagementAndGeneral |
| Fundraising | 409032 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 365254 | BOY |
| EOY | 190258 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3651599 | BOY |
| EOY | 2533916 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4672 | BOY |
| EOY | 288 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18164413 | BOY |
| EOY | 18309769 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 22185938 | BOY |
| EOY | 21034231 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17560 | BOY |
| EOY | 15070 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1039340 | BOY |
| EOY | 1164365 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1056900 | BOY |
| EOY | 1179435 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4134561 | BOY |
| EOY | 4880323 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11702924 | BOY |
| EOY | 9518572 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5291553 | BOY |
| EOY | 5455901 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 21129038 | BOY |
| EOY | 19854796 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 22185938 | BOY |
| EOY | 21034231 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | -1420599 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 146357 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | X | SupportingOrganization509a3 |
| Supporting Org509a3 Type1 | X | SupportingOrg509a3Type1 |
| Written IRS Determination | X | WrittenIRSDetermination |
| Contrib By Controlling Individual | 0 | ContribByControllingIndividual |
| Contribution By Related Party | 0 | ContributionByRelatedParty |
| Contrib By35 Controlled Entity | 0 | ContribBy35ControlledEntity |
Supported Org Information SupportedOrgInformation
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Anna Jaques Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 042104338 | EIN |
| Type Of Organization | 3 | TypeOfOrganization |
| Listed In Governing Doc | 1 | ListedInGoverningDoc |
| Supported Organization Notified | 1 | SupportedOrganizationNotified |
| Organized In US | 1 | OrganizedInUS |
| Amount | $4,021,540 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Number Of Supported Orgs | 1 | TotalNumberOfSupportedOrgs |
| Sum Of Amounts | 4021540 | SumOfAmounts |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 8823165 | BeginningOfYearBalance |
| Contributions | 0 | Contributions |
| Investment Earnings Or Losses | 1231727 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 1341876 | GrantsOrScholarships |
| Other Expenditures | 0 | OtherExpenditures |
| Administrative Expenses | 18107 | AdministrativeExpenses |
| End Of Year Balance | 8694909 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 7645587 | BeginningOfYearBalance |
| Contributions | 0 | Contributions |
| Investment Earnings Or Losses | 1187609 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 0 | GrantsOrScholarships |
| Other Expenditures | 0 | OtherExpenditures |
| Administrative Expenses | 10031 | AdministrativeExpenses |
| End Of Year Balance | 8823165 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 8059246 | BeginningOfYearBalance |
| Investment Earnings Or Losses | -400480 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 0 | GrantsOrScholarships |
| Other Expenditures | 0 | OtherExpenditures |
| Administrative Expenses | 13179 | AdministrativeExpenses |
| End Of Year Balance | 7645587 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 6324578 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 1844069 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 99245 | GrantsOrScholarships |
| Administrative Expenses | 10145 | AdministrativeExpenses |
| End Of Year Balance | 8059257 | EndOfYearBalance |
Current Year Minus4 Years CurrentYearMinus4Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 6446549 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 65285 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 163961 | GrantsOrScholarships |
| Administrative Expenses | 23295 | AdministrativeExpenses |
| End Of Year Balance | 6324578 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Permanent Endowment EOY Balance | 0.22000 | PermanentEndowmentEOYBalance |
| Term Endowment EOY Balance | 0.78000 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
| Total Of Book Value Land Buildings | 0 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| Due to affiliates, net | $1,043,677 |
| Gift annuities payable | $120,688 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 1164365 | TotalOfAmounts |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Description of Intended Use of Endowment Funds: | Part V, Line 4: | CHF 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 pay for uninsured patients' care, to fund health care education for AJH employees or for scholarships to area high school students who wish to pursue a health care related degree program. The entities which use the endowment funds are the parent (SRHS), the hospital (AJH), the Foundation (CHF) and the physician group (SAGP). 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 Sections 501(a) of the Code. |
| Part X Line 2: There is no FIN 48 (ASC 740) footnote in the financial statements. |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | golf tournament | NameOfEvent1 |
| Gross Receipts Event1 | 191086 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 137428 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 53658 | GrossRevenueEvent1 |
| Cash Prizes Event1 | 0 | CashPrizesEvent1 |
| Non Cash Prizes Event1 | 0 | NonCashPrizesEvent1 |
| Rent Facility Costs Event1 | 33391 | RentFacilityCostsEvent1 |
| Food And Beverage Event1 | 9533 | FoodAndBeverageEvent1 |
| Other Direct Expenses Event1 | 1156 | OtherDirectExpensesEvent1 |
| Gross Receipts Total | 191086 | GrossReceiptsTotal |
| Charitable Contributions Total | 137428 | CharitableContributionsTotal |
| Gross Revenue Total Events | 53658 | GrossRevenueTotalEvents |
| Rent Facility Costs Total Events | 33391 | RentFacilityCostsTotalEvents |
| Food And Beverage Total Events | 9533 | FoodAndBeverageTotalEvents |
| Other Direct Expenses Total Events | 1156 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 44080 | DirectExpenseSummaryEvents |
| Net Income Summary | 9578 | NetIncomeSummary |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Anna Jaques Hospital | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 25 Highland Ave | AddressLine1 |
| City | Newburyport | City |
| State | MA | State |
| ZIP Code | 01950 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN Of Recipient | 042104338 | EINOfRecipient |
| IRC Section | 501c3 | IRCSection |
| Amount Of Cash Grant | 4021540 | AmountOfCashGrant |
| Method Of Valuation | FMV | MethodOfValuation |
| Purpose Of Grant | general assistance | PurposeOfGrant |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 1 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 0 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Procedure for Monitoring Grants in the U.S.: | Identifier |
| Return Reference | Part I, Line 2: | ReturnReference |
| Explanation | Schedule I, Part I, Line 2: 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 501c3 organization. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 1 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 1 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (3 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Mark Goldstein | ||||||||||||||
| Treas, CHF Bd/EVP/CFO | 0 | 430385 | 0 | 81189 | 0 | 0 | 0 | 96280 | 0 | 22999 | 0 | 630853 | 0 | 0 |
| Delia O'Connor | ||||||||||||||
| President/CEO | 0 | 574988 | 0 | 96862 | 0 | 0 | 0 | 158075 | 0 | 15516 | 0 | 845441 | 0 | 0 |
| Sarah Gnerre | ||||||||||||||
| VP of Development | 144416 | 0 | 13525 | 0 | 0 | 0 | 7264 | 0 | 14937 | 0 | 180142 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| 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 and Mark Goldstein participate in a supplemental non-qualified retirement plan, which is funded by split dollar life insurance policies. The premium applicable to Ms. O'Connor was $130,550 and to Mr. Goldstein was $70,560. In addition, Ms. O'Connor participated in a Rabbi Trust plan. No employer contribution was made to this plan in CY 2012. |
| Part I, Line 6 | Mark Goldstein's and Delia O'Connor's bonus payments were contingent on the organizations within the system meeting several targets, including the targeted earnings. The amounts were $96,862 and $81,189 respectively. |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| Form 990, Part VI, Section A, line 6 | Anna Jaques Hospital (AJH) is the sole member of AJHCHF. |
| Form 990, Part VI, Section A, line 7a | The AJH board elects the members of 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 corporations; 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
Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|
| Anna Jaques Hospital | |||||||||
| 25 Highland Ave | Newburyport | MA | 01950 | 042104338 | hospital | MA | 501c | hospital | 0 |
| Seacoast Regional Health Systems | |||||||||
| 25 Highland Ave | Newburyport | MA | 01950 | 222814214 | functionally integrated supporting org | MA | 501c | supporting org | 0 |
| Seacoast Affiliated Group Practices | |||||||||
| 25 Highland Ave | Newburyport | MA | 01950 | 043485648 | physician group | MA | 501c | Line 9 | 0 |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Greater Newburyport Management Services Org | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 25 Highland Ave | AddressLine1 |
| City | Newburyport | City |
| State | MA | State |
| ZIP Code | 01950 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 161744477 | EIN |
| Primary Activity | management services | PrimaryActivity |
| Legal Domicile State | MA | LegalDomicileState |
| Type Of Entity | C | TypeOfEntity |
| Controlled Org | 0 | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (4 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| Anna Jaques Hospital | ||
| B | 3908690 | funds distributed |
| Anna Jaques Hospital | ||
| L | 1273107 | revenues raised |
| Anna Jaques Hospital | ||
| P | 507943 | expenses paid |
| Seacoast Affiliated Group Practices | ||
| B | 112850 | funds distributed |
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