2014-08-13T15:24:40-05:00 2013-09-30 042684828 FEELEY & DRISCOLL PC 200 PORTLAND STREET BOSTON MA 02114 990 2012-10-01 222586814 LGH CHARITABLE TRUST INC LGHC 9786834000 1 GENERAL STREET LAWRENCE MA 01841 DEBORAH J WILSON 9786834000 2014-08-12 1 JEFFREY T ROGERS P01074284 6177427788 2012 2015-11-30 17:44:51Z DIANNE J ANDERSON 1 GENERAL STREET LAWRENCE MA 01841 3209039 0 X WWW.LAWRENCEGENERAL.ORG X 1984 MA TO PROMOTE AND ENCOURAGE PHILANTHROPIC SUPPORT FOR THE DELIVERY OF COMPREHENSIVE HEALTH CARE TO PATIENTS ACROSS THE MERRIMACK VALLEY REGION BY ENSURING ACCESS TO HIGH-QUALITY CARE, THE LATEST TECHNOLOGIES AND CARING, PERSONALIZED TREATMENT. 7 4 0 0 0 0 551820 685993 0 0 39849 779434 0 0 591669 1465427 0 0 0 0 0 0 0 0 427572 372816 427772 372816 427772 218853 1037655 23988071 24866517 142385 1563 23845686 24864954 TO PROMOTE AND ENCOURAGE PHILANTHROPIC SUPPORT FOR THE DELIVERY OF COMPREHENSIVE HEALTH CARE TO PATIENTS ACROSS THE MERRIMACK VALLEY REGION BY ENSURING ACCESS TO HIGH-QUALITY CARE, THE LATEST TECHNOLOGIES AND CARING, PERSONALIZED TREATMENT. 0 0 TO PROMOTE AND ENCOURAGE PHILANTHROPIC SUPPORT FOR THE DELIVERY OF COMPREHENSIVE HEALTH CARE TO PATIENTS ACROSS THE MERRIMACK VALLEY REGION BY ENSURING ACCESS TO HIGH-QUALITY CARE, THE LATEST TECHNOLOGIES AND CARING, PERSONALIZED TREATMENT. 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 7 4 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 STREET LAWRENCE MA 01841 BELISARIO ROSAS 1.00 1.00 X 0 0 0 DIANNE J ANDERSON 1.00 50.00 X X 0 617169 127680 RONALD J POLLINA 1.00 1.00 X 0 0 0 DEBRA RAHMIN SILBERSTEIN ESQ 1.00 1.00 X 0 0 0 DENISE S PALUMBO 1.00 50.00 X X 0 392373 45003 DEBORAH J WILSON 1.00 50.00 X X 0 378144 51892 RICHARD SANTAGATI 1.00 1.00 X 0 0 0 MAURICE BALBONI 1.00 1.00 X 0 0 0 0 1387686 224575 0 0 1 0 LAWRENCE GENERAL HOSPITAL 1 GENERAL STREET LAWRENCE MA 01841 MANAGEMENT SERVICES 603158 1 685993 27130 685993 198573 198573 2324473 1743612 580861 580861 580861 1465427 0 0 779434 324515 324515 84868 84868 18189 18189 200 200 427772 0 200 427572 1506252 1421972 328573 299866 5250 4150 1300 1100 10831051 11749739 11320895 11393840 23988071 24866517 142385 1563 142385 1563 X 23589204 24555244 256482 309710 23845686 24864954 23988071 24866517 X 1037655 268298 -286685 X X 0 1 X 1 0 X 1095596 405370 743264 551820 633283 3429333 1095596 405370 743264 551820 633283 3429333 3429333 201502 188318 233739 217679 198573 1039811 4469144 0.76730 0.77140 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 5250 4150 1100 1100 INVESTMENT IN AFFILIATE (LGH HEALTH ENTERPRISES, INC.) 11315797 OTHER CURRENT ASSETS 10000 DUE FROM AFFILIATES 10576 TEMPORARILY RESTRICTED CASH 57467 11393840 DUE TO AFFILIATE (LAWRENCE GENERAL HOSPITAL) 1563 1563 1733725 268298 268298 1465427 0 1465427 427772 0 427772 0 427772 0 1 0 0 0 0 0 0 0 DIANNE J ANDERSON 0 524169 0 93000 0 0 0 52600 0 75080 0 744849 0 0 DENISE S PALUMBO 0 347373 0 45000 0 0 0 34500 0 10503 0 437376 0 0 DEBORAH J WILSON 0 328644 0 49500 0 0 0 33500 0 18392 0 430036 0 0 PART I, LINE 3 THE CEO OF LGH CHARITABLE TRUST, INC. IS 100% PAID THROUGH ITS PARENT COMPANY, LAWRENCE GENERAL HOSPITAL. THE CEO'S COMPENSATION IS ESTABLISHED BY THE FOLLOWING METHODS: (A) COMPENSATION COMMITTEE, (B) INDEPENDENT COMPENSATION CONSULTANT, (C) FORM 990 OF OTHER ORGANIZATIONS, (D) WRITTEN EMPLOYMENT CONTRACT, (E) COMPENSATION SURVEY AND (F) APPROVAL BY AN EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES. PART I, LINE 4B AS PART OF ITS TOTAL COMPENSATION PACKAGE, THE PARENT COMPANY OF LGH CHARITABLE TRUST, INC., LAWRENCE GENERAL HOSPITAL, OFFERS 457(B) AND 457(F) NON-QUALIFIED SUPPLEMENTAL RETIREMENT PLANS. FOR THE 2012 CALENDAR YEAR, LAWRENCE GENERAL HOSPITAL CONTRIBUTED THESE AMOUNTS TO THE FOLLOWING EMPLOYEES LISTED ON FORM 990, SCHEDULE J, PART II: DIANNE J. ANDERSON, 457B PLAN ($17,000), 457F PLAN ($34,600); DENISE S. PALUMBO, 457B PLAN ($17,000), 457F PLAN ($17,500); DEBORAH J. WILSON 457B PLAN ($17,000), 457F PLAN ($16,500). SUPPLEMENTAL INFORMATION PART III PAYROLL RECORDS ARE FOR THE 01/01/2012 TO 12/31/2012 CALENDAR YEAR. X 16984 FAIR MARKET VALUE X 2 10146 FAIR MARKET VALUE 0 1 0 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 CHARITABLE TRUST, INC. DISTRIBUTES A CONFLICT OF INTEREST POLICY TO THE BOARD OF TRUSTEES. THE MEMBERS ARE REQUIRED TO DISCLOSE, IN WRITING, ANY POTENTIAL CONFLICT THAT 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, COO, AND SENIOR MANAGEMENT IS 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'S FORM 990 IS MADE AVAILABLE TO THE PUBLIC UPON REQUEST. THE FORM 990 IS ALSO AVAILABLE ON THE WEBSITE OF THE MASSACHUSETTS' ATTORNEY GENERAL AND GUIDESTAR.ORG. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ALL DOCUMENTS AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CHANGE IN TEMPORARILY RESTRICTED NET ASSETS -287,000. OTHER 315. FORM 990, PART XI, LINE 2C: THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS THAT IS PERFORMED BY OUR EXTERNAL AUDITORS. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. LAWRENCE GENERAL HOSPITAL 1 GENERAL STREET LAWRENCE MA 01841 042103586 HOSPITAL MA 501(C)(3) HOSPITAL N/A 0 COMMUNITY MEDICAL ASSOCIATES INC 1 GENERAL STREET LAWRENCE MA 01841 272142635 PRIMARY CARE MA 501(C)(3) PRIMARY CARE LAWRENCE GENERAL HOSPITAL 0 LGH HEALTH ENTERPRISES INC 38 PROSPECT STREET LAWRENCE MA 01842 042869696 HEALTH CARE MANAGEMENT MA LAWRENCE GENERAL HOSPITAL C 0 LGH PHYSICIAN ASSOCIATES PC 38 PROSPECT STREET LAWRENCE MA 01842 043174041 PHYSICIAN GROUP MA LAWRENCE GENERAL HOSPITAL C 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 0