2014-05-15T08:33:50-05:00 2013-06-30 861065772 DELOITTE TAX LLP TWO JERICHO PLAZA JERICHO NY 11753 990 2012-07-01 043326928 CARL J SHAPIRO INSTITUTE FOR EDUCATION RESEARCH AT HARVARD MEDICAL SCHOOL CARL 6176670608 330 BROOKLINE AVENUE NO ES 2 BOSTON MA 022155400 RICHARD SCHWARTZSTEIN 6176670608 2014-05-15 0 P00743140 5169187000 2012 2015-11-30 17:44:51Z RICHARD SCHWARTZSTEIN MD 330 BROOKLINE AVENUE NO ES 2 BOSTON MA 022155400 603040 0 X SEE SCHEDULE O X 1996 MA SEE SCHEDULE O. 14 2 0 0 237 0 55500 18622 945473 523354 39403 46567 0 0 1040376 588543 0 104690 0 0 0 0 0 0 0 608402 534128 608402 638818 431974 -50275 2863784 2864660 126382 49407 2737402 2815253 X SEE SCHEDULE O 0 0 10658 27763 SIMULATION AND SKILLS CENTER - THE CENTER PROVIDES TRAINEES WITH PRACTICE OPPORTUNITIES FOR LAPAROSCOPIC AND OTHER SURGICAL PROCEDURES AND REALISTIC OPERATING AND INTENSIVE CARE/EMERGENCY ROOM SIMULATIONS WHICH ALLOW FOR TEAM TRAINING AND DISCIPLINE-SPECIFIC EDUCATIONAL EXPERIENCES. THE CENTER'S RESOURCES INCLUDE A WIDE RANGE OF TASK TRAINERS AND SIMULATORS, VIDEOCONFERENCE FACILITIES AND DEDICATED FACULTY AND STAFF TO SUPPORT THE EDUCATION OF STUDENTS, TRAINEES, AND PRACTITIONERS IN ALL OF THE HEALTH CARE PROFESSIONS. 72629 114970 CONTINUING MEDICAL EDUCATION COURSES - THE INSTITUTE SPONSORS CONTINUING MEDICAL EDUCATION COURSES. FOR EXAMPLE "MAXIMIZING YOUR TEACHING SKILLS: PRINCIPLES OF MEDICAL EDUCATION" IS AN INTRODUCTION TO THE PRINCIPLES OF EFFECTIVE CLINICAL TEACHING FOR ADULT LEARNERS. THROUGH DIDACTIC AND INTERACTIVE SESSIONS, PARTICIPANTS LEARN MODELS OF CLINICAL INSTRUCTION AND HOW TO APPLY THESE EFFECTIVE TECHNIQUES TO THEIR OWN TEACHING ACTIVITIES. THE COURSE ALSO PROVIDES AN EXPLORATION OF CRITICAL THINKING, REFLECTION, ASSESSMENT, AND FEEDBACK. THE INSTITUTE HELPS TO FURTHER THE IMPACT OF CUTTING EDGE SIMULATION AND SKILLS CENTER FOR EDUCATION THROUGH A COURSE IN "ESTABLISHING A SIMULATION & SKILLS TRAINING CENTER" THAT HELPS PARTICIPANTS PLAN, IMPLEMENT, AND MANAGE NEW SIMULATION AND SKILLS CENTERS IN THE PARTICIPANTS' RESPECTIVE MEDICAL EDUCATION INSTITUTIONS. 282403 365961 THE SHAPIRO INSTITUTE WORKS IN COLLABORATION WITH OTHERS TO ENHANCE THE PROFESSIONAL TEACHING ABILITIES OF THEIR MEDICAL FACULTY BY PROVIDING EDUCATIONAL PROGRAMS FOR INDIVIDUALS AND GROUPS. IN THESE PROGRAMS, SHAPIRO INSTITUTE FACULTY TEACH DOCTORS THE SKILLS NECESSARY TO BE MEDICAL EDUCATORS. THESE PROGRAMS ARE DESIGNED TO IMPROVE THE EDUCATIONAL KNOWLEDGE AND ABILITIES OF FACULTY RESPONSIBLE FOR TEACHING MEDICAL TRAINEES AND OTHER HEALTH PROFESSIONALS WHO PROVIDE PATIENT CARE. THROUGH THESE EFFORTS, THE INSTITUTE HOPES TO ULTIMATELY IMPROVE THE QUALITY OF HEALTH CARE MORE BROADLY. 212677 104690 14660 THE SHAPIRO INSTITUTE'S MEDICAL EDUCATION TRAINING EXTENDS BEYOND TRADITION MEDICAL SURGICAL SKILLS TRAINING. "THE FAMILY MEETING PROJECT" PROVIDES RESIDENTS WITH TRAINING RELATED TO COMMUNICATING AND INTERACTING WITH PATIENTS' FAMILY MEMBERS IN A SIMULATED INTENSIVE CARE UNIT (ICU) AND CRITICAL CARE ENVIRONMENT. THE SHAPIRO INSTITUTE ALSO PROVIDES SUPPORT FOR A RESIDENT TO CONDUCT MEDICAL EDUCATION RESEARCH RELATED TO THE IMPACT OF EDUCATIONAL INTERVENTIONS ON PROVIDING SAFE AND EFFECTIVE PATIENT CARE. 212677 104690 14660 578367 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 1 1 0 0 0 1 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 X 35 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 14 2 1 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 1 0 MA X CHRISTINE COUGHLIN 6176679120 330 BROOKLINE AVE EAST CAMPUS/ES-20 BOSTON MA 02215 CHAIKOF MD PHD ELLIOT L 1.00 64.00 X 0 908734 110681 EDELHEIT PHD LEWIS S 1.00 X 0 0 0 FLIER MD JEFFREY S 1.00 59.00 X X 0 582243 51850 GOLDBERG CAROL R 1.00 1.00 X 0 0 0 GRAY PHD MARTHA 1.00 X 0 0 0 KAY STEPHEN 1.00 2.00 X 0 0 0 RABKIN MD MITCHELL T 1.00 2.00 X 0 0 0 ROSENBERG MD STUART A 1.00 64.00 X 0 766137 466881 SCHWARTZSTEIN MD RICHARD M 14.00 64.00 X X 114681 383931 50599 STEVENSON MD PHD MARY ANN 1.00 59.00 X 0 601275 72473 SUKHATME MD PHD VIKAS P 1.00 59.00 X 0 623519 49475 TABB MD KEVIN 1.00 64.00 X X 0 1331765 48187 ZEIDEL MD MARK L 1.00 64.00 X 0 710613 56575 ZINNER MD STEPHEN 1.00 0.50 X 0 0 0 HUGHES CAROL M 12.00 48.00 X 52600 98029 26751 COUGHLIN CHRISTINE 2.00 18.00 X 3000 48050 2760 WANG DIANA 12.00 8.00 X 19594 13063 1447 BUEHRENS ERIC 0.00 0.00 X 0 706584 33190 LEVY MD PAUL F 0.00 0.00 X 0 777205 9474 189875 7551148 980343 1 1 1 0 0 18622 18622 PROGRAM FEES 900099 523354 523354 523354 5012 192 4820 56052 14497 41555 41555 45 41510 588543 523354 237 46330 X 100436 100436 4254 4254 34229 19729 14500 2968 2968 131330 111069 20261 11573 10902 671 1645 1645 9230 8438 792 110594 110054 540 10009 10009 TEACHING HONORARIUM 143400 143400 0 0 MISCELLANEOUS 12154 2283 9871 0 COPYRIGHT PERMISSION 6467 6467 0 0 DUES & SUBSCRIPTIONS 4508 3669 839 0 56021 56021 638818 578367 60451 0 969151 512759 200981 118495 152780 81131 79614 71649 1284445 1897330 329593 264427 2863784 2864660 22456 24980 13333 90593 24427 126382 49407 X 1103364 1156723 736038 760531 898000 898000 2737402 2815253 2863784 2864660 -50275 128126 0 X 0 1 X 0 0 X X X X 0 0 0 BETH ISRAEL DEACONESS MEDICAL CENTER 042103881 3 1 1 1 319409 PRESIDENT & FELLOWS OF HARVARD COLLEGE 042103580 4 1 1 1 319409 2 638818 1634038 165638 141145 1658531 1655773 20000 20325 62060 1634038 1595377 129560 69164 1655773 1607738 116954 129315 1595377 2208131 9456 -370199 239650 1607738 0.55000 0.45000 0 0 77250 19920 57330 75530 61211 14319 71649 CARE GROUP INVESTMENT PARTNERSHIP 1394104 F TIME DEPOSITS AT LOCAL BANKS 503226 F 1897330 TRUST RESIDUARY 240000 DUE FROM UNRESTRICTED NET ASSETS 24427 264427 DUE TO RESTRICTED NET ASSETS 24427 24427 X 750770 128126 37070 165196 585574 2969 2969 588543 672919 37070 37070 635849 2969 2969 638818 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: PART V LINE 4 TEMPORARILY RESTRICTED NET ASSETS AT JUNE 30, 2013 CONSISTED OF THE FOLLOWING: MEDICAL EDUCATION $116,146 TRUST RESIDUARY $240,000 ACCUMULATED ENDOWMENT APPRECIATION $404,385 TOTAL TEMP. RESTRICTED $760,531 PERMANENTLY RESTRICTED NET ASSETS AS OF JUNE 30, 2013 CONSIST OF INVESTMENTS, THE INCOME OF WHICH IS EXPENDABLE TO SUPPORT THE FOLLOWING: EDUCATION TECHNOLOGY $500,000 MEDICAL EDUCATION $398,000 TOTAL PERM. RESTRICTED $898,000 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE INSTITUTE HAS EVALUATED THE TAX POSITIONS TAKEN ON RETURNS FOR OPEN YEARS AND THOSE EXPECTED TO BE TAKEN ON RETURNS FOR THE YEAR ENDED JUNE 30, 2013. IT IS MANAGEMENT'S BELIEF THAT SUCH TAX POSITIONS ARE MORE LIKELY THAN NOT TO BE SUSTAINED UPON EXAMINATION BY TAX AUTHORITIES. ACCORDINGLY, NO LIABILITY FOR UNCERTAIN TAX POSITIONS HAS BEEN REFLECTED IN THESE FINANCIAL STATEMENTS. RETURNS FOR TAX YEARS BEGINNING WITH THOSE FILED FOR THE YEAR ENDED JUNE 30, 2010 ARE OPEN TO EXAMINATION. 1 MIDDLE EAST AND NORTH AFRICA 0 0 PROGRAM SERVICES EDUCATION, TRAINING AND RESEARCH 282403 0 0 0 0 0 0 282403 0 282403 0 0 0 1 0 1 1 HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS 375 LONGWOOD AVE BOSTON MA 02215 222768204 501(C)(3) 90000 0 TO SUPPORT THE MEDICAL EDUCATION RESEARCH BETH ISRAEL DEACONESS MEDICAL CENTER 330 BROOKLINE AVE BOSTON MA 02215 042103881 501(C)(3) 10436 0 TO SUPPORT THE MEDICAL EDUCATION RESEARCH ASSOCIATES 2 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: GRANT FUNDS ARE GIVEN TO THE PRINCIPAL INVESTIGATOR'S DEPARTMENT ADMINISTRATOR FOR DISTRIBUTION ACCORDING TO THE GRANT BUDGET. MONITORING OF THE RELATED RESEARCH ACTIVITY IS CONDUCTED BY THE DIRECTOR OF EDUCATION RESEARCH WITH THE PRINCIPAL INVESTIGATOR THROUGHOUT THE GRANT YEAR. 1 X 0 0 0 0 0 0 0 0 0 CHAIKOF MD PHD ELLIOT L 0 894601 0 0 0 14133 0 78374 0 32307 0 1019415 0 0 FLIER MD JEFFREY S 0 572911 0 0 0 9332 0 31995 0 19855 0 634093 0 0 ROSENBERG MD STUART A 0 622430 0 125924 0 17783 0 446875 0 20006 0 1233018 0 0 SCHWARTZSTEIN MD RICHARD M 102486 343107 10420 34883 1775 5941 5750 19250 5888 19711 126319 422892 0 0 STEVENSON MD PHD MARY ANN 0 591265 0 0 0 10010 0 46875 0 25598 0 673748 0 0 SUKHATME MD PHD VIKAS P 0 492047 0 111809 0 19663 0 33784 0 15691 0 672994 0 0 TABB MD KEVIN 0 832815 0 361512 0 137438 0 7167 0 41020 0 1379952 0 0 ZEIDEL MD MARK L 0 698208 0 0 0 12405 0 40881 0 15694 0 767188 0 0 HUGHES CAROL M 52600 98029 0 0 0 0 0 0 0 26751 52600 124780 0 0 BUEHRENS ERIC 0 103861 0 0 0 602723 0 5600 0 27590 0 739774 0 0 LEVY MD PAUL F 0 0 0 0 0 777205 0 0 0 9474 0 786679 0 0 SUPPLEMENTAL INFORMATION PART III REPORTABLE COMPENSATION LISTED IN FORM 990 PART VII INCLUDES BASE COMPENSATION, INCENTIVE COMPENSATION AND OTHER REPORTABLE COMPENSATION AS REPORTED IN FORM 990 SCHEDULE J. OTHER COMPENSATION LISTED IN FORM 990 PART VII INCLUDES DEFERRED COMPENSATION AND NON-TAXABLE BENEFITS AS REPORTED IN FORM 990 SCHEDULE J. OTHER REPORTABLE COMPENSATION: AMOUNTS NOT OTHERWISE SEPARATELY NOTED IN THIS RETURN BUT QUANTIFIED IN OTHER REPORTABLE COMPENSATION INCLUDE AMOUNTS FROM ONE OR MORE OF THE FOLLOWING ITEMS: AMOUNTS DEFERRED BY THE EMPLOYEE (PLUS EARNINGS) UNDER FULLY VESTED 457(B) PLAN; INCREASE/DECREASE IN VALUE OF NONQUALIFIED FULLY VESTED 457(B) PLAN; TAXABLE EMPLOYER-SUBSIDIZED PARKING; TAXABLE MOVING EXPENSES; EARNED TIME CASHED; TAXABLE LIFE, DISABILITY, OR LONG-TERM CARE INSURANCE; AND OTHER TAXABLE RETIREMENT BENEFITS. DEFERRED COMPENSATION: AMOUNTS NOT OTHERWISE SEPARATELY NOTED BUT QUANTIFIED IN DEFERRED COMPENSATION INCLUDE AMOUNTS FROM ONE OR MORE OF THE FOLLOWING ITEMS: EMPLOYER CONTRIBUTIONS TO 401K RETIREMENT PLAN, EMPLOYER CONTRIBUTIONS TO 403B RETIREMENT PLAN, EMPLOYER CONTRIBUTION TO PENSION PLAN NON-TAXABLE BENEFITS: AMOUNTS NOT OTHERWISE SEPARATELY NOTED BUT QUANTIFIED IN NON-TAXABLE BENEFITS INCLUDE AMOUNTS FROM ONE OR MORE OF THE NON-TAXABLE BENEFITS: EMPLOYEE CONTRIBUTIONS TO HEALTH INSURANCE, EMPLOYER CONTRIBUTIONS TO HEALTH INSURANCE, EMPLOYEE CONTRIBUTIONS TO FLEXIBLE SPENDING ACCOUNTS FOR DEPENDENT CARE AND/OR MEDICAL REIMBURSEMENT, GROUP TERM LIFE INSURANCE, DISABILITY INSURANCE ALL DIRECTORS/TRUSTEES SERVE WITHOUT COMPENSATION OR BENEFITS. COMPENSATION PAID TO OFFICERS, DIRECTORS, TRUSTEES OR KEY EMPLOYEES WAS EARNED FOR WORK PERFORMED IN A CAPACITY OTHER THAN THAT OF DIRECTOR/TRUSTEE, AS DENOTED BY THE LISTED TITLES CARL J. SHAPIRO INSTITUTE FOR EDUCATION AND RESEARCH AT HARVARD MEDICAL SCHOOL & BETH ISRAEL DEACONESS MEDICAL CENTER, INC. AND PRESIDENT AND FELLOWS OF HARVARD COLLEGE/HARVARD MEDICAL SCHOOL MAY BE REFERRED TO IN THESE EXPLANATORY NOTES TO FORM 990 PART VII AND FORM 990 SCHEDULE J AS SHAPIRO INSTITUTE AND PFHC/HMS RESPECTIVELY. HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER AND BETH ISRAEL DEACONESS MEDICAL CENTER MAY BE REFERRED TO IN THESE EXPLANATORY NOTES TO FORM 990 PART VII AND FORM 990 SCHEDULE J AS HMFP AND BIDMC RESPECTIVELY. CHAIKOF, M.D., PHD, ELLIOT TRUSTEE SHAPIRO INSTITUTE DIRECTOR (EX-OFFICIO) AND CHAIR (SURGERY) HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER DIRECTOR (EX-OFFICIO) AND CHIEF (SURGERY) BETH ISRAEL DEACONESS MEDICAL CENTER DIRECTOR AND PRESIDENT BETH ISRAEL DEACONESS DEPARTMENT OF SURGERY FOUNDATION JOHNSON & JOHNSON PROFESSOR OF SURGERY HARVARD MEDICAL SCHOOL DR. CHAIKOF PERFORMS SERVICES FOR BOTH HMFP AND BIDMC AND DEVOTES, ON AVERAGE, A COMBINED 65 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE. AS REQUIRED BY THIS FORM 990, ALTHOUGH DR. CHAIKOF IS PAID DIRECTLY BY HMFP, THE PORTION OF DR. CHAIKOF'S COMPENSATION ATTRIBUTABLE TO EACH POSITION HAS BEEN SEPARATELY REPORTED ON THIS FORM 990, AS FURTHER OUTLINED BELOW. PAYMENTS REPORTED BY HMFP: BASE COMPENSATION: 447,300 INCENTIVE COMPENSATION: 0 OTHER REPORTABLE COMPENSATION: 7,067 DEFERRED COMPENSATION: 39,187 NON-TAXABLE BENEFITS: 16,153 PAYMENTS REPORTED BY BIDMC: BASE COMPENSATION: 447,301 INCENTIVE COMPENSATION: 0 OTHER REPORTABLE COMPENSATION: 7,066 DEFERRED COMPENSATION: 39,187 NON-TAXABLE BENEFITS: 16,154 AS REQUIRED IN THIS FORM 990, COMPENSATION REPORTED BY HMFP AND BIDMC FOR THE 2012 CALENDAR YEAR INCLUDES THE FOLLOWING PAYMENTS FROM THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE/HARVARD MEDICAL SCHOOL RELATED TO DR. CHAIKOF'S POSITION AS CHAIR OF SURGERY AND JOHNSON & JOHNSON PROFESSOR OF SURGERY, HARVARD MEDICAL SCHOOL: $197,998 BASE AND OTHER REPORTABLE COMPENSATION, $31,499 DEFERRED COMPENSATION AND $6,675 NON-TAXABLE BENEFITS. EDELHEIT, PHD., LEWIS S. TRUSTEE SHAPIRO INSTITUTE DR. EDELHEIT DEVOTES, ON AVERAGE, 1 HOUR PER WEEK TO THE REPORTING ORGANIZATION. FLIER, M.D., JEFFREY S. TRUSTEE (EX-OFFICIO) AND CO-CHAIR SHAPIRO INSTITUTE DEAN OF THE FACULTY OF MEDICINE HARVARD MEDICAL SCHOOL CAROLINE SHIELDS WALKER PROFESSOR OF MEDICINE HARVARD MEDICAL SCHOOL DR. FLIER DEVOTES, ON AVERAGE, A COMBINED 60 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE. PAYMENTS REPORTED BY PFHC/HMS BASE COMPENSATION: 572,911 INCENTIVE COMPENSATION: 0 OTHER REPORTABLE COMPENSATION: 9,332 DEFERRED COMPENSATION: 31,995 NON-TAXABLE BENEFITS: 19,855 GOLDBERG, CAROL R. TRUSTEE SHAPIRO INSTITUTE DIRECTOR MEDICAL CARE OF BOSTON MANAGEMENT CORP., DBA AFFILIATED PHYSICIANS GROUP MS. GOLDBERG DEVOTES, ON AVERAGE, A COMBINED 2 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE. GRAY, PHD, MARTHA TRUSTEE SHAPIRO INSTITUTE DR. GRAY DEVOTES, ON AVERAGE, 1 HOUR PER WEEK TO THE REPORTING ORGANIZATION. KAY, STEPHEN TRUSTEE (EX-OFFICIO) SHAPIRO INSTITUTE DIRECTOR (EX-OFFICIO) CAREGROUP, INC. DIRECTOR AND BOARD CHAIR BETH ISRAEL DEACONESS MEDICAL CENTER MR. KAY DEVOTES, ON AVERAGE, A COMBINED 3 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE. RABKIN, M.D., MITCHELL T. TRUSTEE, CO-FOUNDER AND DISTINGUISHED INSTITUTE SCHOLAR SHAPIRO INSTITUTE DIRECTOR BETH ISRAEL DEACONESS HOSPITAL MILTON, INC. DIRECTOR MILTON HOSPITAL FOUNDATION, INC. PROFESSOR OF MEDICINE HARVARD MEDICAL SCHOOL DR. RABKIN DEVOTES, ON AVERAGE, A COMBINED 3 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE. ROSENBERG, M.D., STUART A TRUSTEE SHAPIRO INSTITUTE PRESIDENT AND CHIEF EXECUTIVE OFFICER HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER DIRECTOR (EX-OFFICIO) BETH ISRAEL DEACONESS MEDICAL CENTER PRESIDENT ASSOCIATED PHYSICIANS OF HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER PRESIDENT LONGWOOD MEDICAL INTERNATIONAL FOUNDATION, INC. FKA CARDIOVASCULAR ASSOCIATED PHYSICIANS OF HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER DIRECTOR BETH ISRAEL DEACONESS DEPARTMENT OF SURGERY FOUNDATION DIRECTOR BETH ISRAEL DEACONESS ORTHOPAEDIC SURGERY FOUNDATION DIRECTOR CONTINUING EDUCATION PROGRAM, INC. D/B/A BETH ISRAEL DEACONESS DEPARTMENT OF PSYCHIATRY FOUNDATION SUPPLEMENTAL INFORMATION PART III DIRECTOR BETH ISRAEL DEACONESS DEPARTMENT OF MEDICINE FOUNDATION DIRECTOR BETH ISRAEL DEACONESS DEPARTMENT OF NEONATOLOGY FOUNDATION DIRECTOR BETH ISRAEL DERMATOLOGY FOUNDATION DIRECTOR BIH PATHOLOGY FOUNDATION, INC. DIRECTOR (EX-OFFICIO) MEDICAL CARE OF BOSTON MANAGEMENT CORP., D/B/A AFFILIATED PHYSICIANS GROUP DIRECTOR (EX-OFFICIO) BETH ISRAEL DEACONESS HOSPITAL MILTON SENIOR LECTURER ON MEDICINE HARVARD MEDICAL SCHOOL DR. ROSENBERG DEVOTES, ON AVERAGE, A COMBINED 65 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE. PAYMENTS REPORTED BY HMFP: BASE COMPENSATION: 622,430 INCENTIVE COMPENSATION: 125,924 OTHER REPORTABLE COMPENSATION: 17,783 DEFERRED COMPENSATION: 446,875 NON-TAXABLE BENEFITS: 20,006 DEFERRED COMPENSATION REPORTED BY HMFP FOR THE 2012 CALENDAR YEAR INCLUDES $400,000 RELATED TO THE IMPLEMENTATION OF A RETENTION INCENTIVE PLAN ESTABLISHED BY HMFP'S BOARD OF DIRECTORS. AS REQUIRED BY THIS FORM 990, COMPENSATION REPORTED HERE IS FOR THE CALENDAR YEAR 2012 AND NO PORTION OF THIS AMOUNT WAS VESTED OR PAID DURING THAT TIME. THIS RETENTION INCENTIVE VESTS IN PERIODIC INCREMENTS IN ACCORDANCE WITH THE PLAN TERMS AND CONDITIONS PURSUANT TO WHICH ALL AMOUNTS WILL BE FULLY PAID BY JANUARY 2015. SCHWARTZSTEIN, M.D., RICHARD M. TRUSTEE, PRESIDENT AND EXECUTIVE DIRECTOR SHAPIRO INSTITUTE VICE PRESIDENT, EDUCATION - BETH ISRAEL DEACONESS MEDICAL CENTER PHYSICIAN, PULMONARY AND CRITICAL CARE HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER ELLEN AND MELVIN GORDON PROFESSOR OF MEDICAL EDUCATION HARVARD MEDICAL SCHOOL DR. SCHWARTZSTEIN PERFORMS SERVICES FOR THE SHAPIRO INSTITUTE AND HMFP AND DEVOTES, ON AVERAGE, A COMBINED 60 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE. DR. SCHWARTZSTEIN RECEIVED PAYMENTS FROM BOTH THE SHAPIRO INSTITUTE AND HMFP FOR HIS SERVICES PROVIDED IN THESE ROLES. THE PORTION OF DR. SCHWARTZSTEIN'S COMPENSATION ATTRIBUTABLE TO EACH POSITION HAS BEEN SEPARATELY REPORTED ON THIS FORM 990, AS FURTHER OUTLINED BELOW. PAYMENTS REPORTED BY SHAPIRO INSTITUTE: BASE COMPENSATION: 102,486 INCENTIVE COMPENSATION: 10,420 OTHER REPORTABLE COMPENSATION: 1,775 DEFERRED COMPENSATION: 5,750 NON-TAXABLE BENEFITS: 5,888 PAYMENTS REPORTED BY HMFP: BASE COMPENSATION: 343,107 INCENTIVE COMPENSATION: 34,883 OTHER REPORTABLE COMPENSATION: 5,941 DEFERRED COMPENSATION: 19,250 NON-TAXABLE BENEFITS: 19,711 AS REQUIRED BY FORM 990, COMPENSATION REPORTED BY HMFP FOR THE 2012 CALENDAR YEAR INCLUDES THE FOLLOWING PAYMENTS FROM THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE/HARVARD MEDICAL SCHOOL RELATED TO DR. SCHWARTZSTEIN'S POSITION AS ELLEN AND MELVIN GORDON PROFESSOR OF MEDICAL EDUCATION, HARVARD MEDICAL SCHOOL: $1,020 BASE COMPENSATION. STEVENSON, M.D., PHD, MARY ANN TRUSTEE SHAPIRO INSTITUTE CHIEF, RADIATION ONCOLOGY BETH ISRAEL DEACONESS MEDICAL CENTER DIRECTOR, SECRETARY/CLERK AND CHAIR, RADIATION ONCOLOGY HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER ASSOCIATE PROFESSOR OF RADIATION ONCOLOGY HARVARD MEDICAL SCHOOL DR. STEVENSON PERFORMS SERVICES FOR BOTH HMFP AND BIDMC AND DEVOTES, ON AVERAGE, A COMBINED 60 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE. AS REQUIRED BY THIS FORM 990, ALTHOUGH DR. STEVENSON IS PAID DIRECTLY BY HMFP, THE PORTION OF DR. STEVENSON'S COMPENSATION ATTRIBUTABLE TO EACH POSITION HAS BEEN SEPARATELY REPORTED ON THIS FORM 990, AS FURTHER OUTLINED BELOW. PAYMENTS REPORTED BY HMFP: BASE COMPENSATION: 295,633 INCENTIVE COMPENSATION: 0 OTHER REPORTABLE COMPENSATION: 5,005 DEFERRED COMPENSATION: 23,437 NON-TAXABLE BENEFITS: 12,799 PAYMENTS ALLOCATED TO BIDMC: BASE COMPENSATION: 295,632 INCENTIVE COMPENSATION: 0 OTHER REPORTABLE COMPENSATION: 5,005 DEFERRED COMPENSATION: 23,438 NON-TAXABLE BENEFITS: 12,799 SUKHATME, M.D., PHD, VIKAS P. TRUSTEE (EX-OFFICIO) SHAPIRO INSTITUTE SENIOR VICE PRESIDENT & CHIEF ACADEMIC OFFICER BETH ISRAEL DEACONESS MEDICAL CENTER NEPHROLOGIST HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER VICTOR J. ARESTY PROFESSOR OF MEDICINE- HARVARD MEDICAL SCHOOL DR. SUKHATME PERFORMS SERVICES FOR BOTH BIDMC AND HMFP AND DEVOTES, ON AVERAGE, A COMBINED 60 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE. AS REQUIRED BY THIS FORM 990, ALTHOUGH DR. SUKHATME IS PAID DIRECTLY BY HMFP, THE PORTION OF DR. SUKHATME'S COMPENSATION ATTRIBUTABLE TO EACH POSITION HAS BEEN SEPARATELY REPORTED ON THIS FORM 990, AS FURTHER OUTLINED BELOW. PAYMENTS REPORTED BY BIDMC BASE COMPENSATION: 452,224 BONUS AND INCENTIVE COMPENSATION: 102,864 OTHER REPORTABLE COMPENSATION: 18,090 DEFERRED COMPENSATION: 31,081 NON-TAXABLE BENEFITS: 14,436 PAYMENTS REPORTED BY HMFP: BASE COMPENSATION: 39,823 BONUS AND INCENTIVE COMPENSATION: 8,945 OTHER REPORTABLE COMPENSATION: 1,573 DEFERRED COMPENSATION: 2,703 NON-TAXABLE BENEFITS: 1,255 AS REQUIRED BY THIS FORM 990, COMPENSATION REPORTED BY HMFP AND BIDMC FOR THE 2012 CALENDAR YEAR INCLUDES THE FOLLOWING PAYMENTS FROM THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE/HARVARD MEDICAL SCHOOL RELATED TO DR. SUKHATME'S POSITION AS VICTOR J. ARESTY PROFESSOR OF MEDICINE, HARVARD MEDICAL SCHOOL: $92,844 BASE AND OTHER REPORTABLE COMPENSATION AND $8,784 DEFERRED COMPENSATION. SUPPLEMENTAL INFORMATION PART III TABB, M.D., KEVIN TRUSTEE (EX-OFFICIO) AND CO-CHAIR SHAPIRO INSTITUTE DIRECTOR (EX-OFFICIO), PRESIDENT AND CHIEF EXECUTIVE OFFICER BETH ISRAEL DEACONESS MEDICAL CENTER DIRECTOR (EX-OFFICIO) HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER DIRECTOR (EX-OFFICIO) BETH ISRAEL DEACONESS DEPARTMENT OF MEDICINE FOUNDATION DIRECTOR (EX-OFFICIO) BETH ISRAEL DEACONESS MEDICAL CENTER OBSTETRICS AND GYNECOLOGY FOUNDATION DIRECTOR (EX-OFFICIO) BETH ISRAEL DEACONESS DEPARTMENT OF SURGERY FOUNDATION TRUSTEE (EX-OFFICIO) BETH ISRAEL DEACONESS HOSPITAL NEEDHAM DIRECTOR (EX-OFFICIO) BETH ISRAEL DEACONESS HOSPITAL MILTON PROFESSOR OF MEDICINE HARVARD MEDICAL SCHOOL DR. TABB DEVOTES, ON AVERAGE, A COMBINED 65 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE. PAYMENTS REPORTED BY BIDMC: BASE COMPENSATION: 832,815 INCENTIVE COMPENSATION: 361,512 OTHER REPORTABLE COMPENSATION: 137,438 DEFERRED COMPENSATION: 7,167 NON-TAXABLE BENEFITS: 41,020 DR. TABB COMMENCED HIS ROLES AS PRESIDENT AND CHIEF EXECUTIVE OFFICER OF BIDMC DURING THE 2011 CALENDAR YEAR AND COMPLETED HIS RELOCATION TO MASSACHUSETTS DURING 2012. AS REQUIRED BY THIS FORM 990, COMPENSATION REPORTED HERE IS FOR THE CALENDAR YEAR 2012. ACCORDINGLY, CERTAIN PAYMENTS TO DR. TABB DURING THE PERIOD REPORTED HERE WERE PAYMENTS INTENDED TO HELP EASE THE FINANCIAL COSTS OF RELOCATION, HOUSING AND OTHER TRANSITIONAL EXPENSES INCURRED BY DR. TABB, SUCH AMOUNTS HAVE BEEN REFLECTED HERE IN THE AMOUNT OF $93,750 INCENTIVE COMPENSATION AND OTHER REPORTABLE COMPENSATION IN THE AMOUNT OF $105,191. OTHER REPORTABLE AND DEFERRED COMPENSATION FOR DR. TABB INCLUDES COMBINED PAYMENTS FROM A NONQUALIFIED RETIREMENT PLAN IN THE AMOUNT OF $19,994. THESE AMOUNTS WERE PAID PURSUANT TO THE INITIAL CONTRACT EXCEPTION DESCRIBED IN TREASURY REGULATIONS SECTION 53.4958-4(A)(3) AND BIDMC FOLLOWED THE REBUTTABLE PRESUMPTION PROCEDURES DESCRIBED IN TREASURY REGULATIONS SECTION 53.4958-6(C) IN SETTING DR. TABB'S COMPENSATION. ZEIDEL, M.D., MARK TRUSTEE SHAPIRO INSTITUTE DIRECTOR (EX-OFFICIO) AND CHIEF (MEDICINE) BETH ISRAEL DEACONESS MEDICAL CENTER DIRECTOR (EX-OFFICIO) AND CHAIR (MEDICINE) HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER DIRECTOR (EX-OFFICIO) MEDICAL CARE OF BOSTON MANAGEMENT, CORP, D/B/A AFFILIATED PHYSICIANS GROUP PRESIDENT BETH ISRAEL DEACONESS DEPARTMENT OF MEDICINE FOUNDATION, INC. HERMAN LUDWIG BLUMGART PROFESSOR OF MEDICINE HARVARD MEDICAL SCHOOL DR. ZEIDEL PERFORMS SERVICES FOR BOTH HMFP AND BIDMC AND DEVOTES, ON AVERAGE, A COMBINED 65 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE. AS REQUIRED BY THIS FORM 990, ALTHOUGH DR. ZEIDEL IS PAID DIRECTLY BY HMFP, THE PORTION OF DR. ZEIDEL'S COMPENSATION ATTRIBUTABLE TO EACH POSITION HAS BEEN SEPARATELY REPORTED ON THIS FORM 990, AS FURTHER OUTLINED BELOW. PAYMENTS REPORTED BY BIDMC: BASE COMPENSATION: 349,104 INCENTIVE COMPENSATION: 0 OTHER REPORTABLE COMPENSATION: 6,202 DEFERRED COMPENSATION: 20,441 NON-TAXABLE BENEFITS: 7,847 PAYMENTS REPORTED BY HMFP: BASE COMPENSATION: 349,104 INCENTIVE COMPENSATION: 0 OTHER REPORTABLE COMPENSATION: 6,203 DEFERRED COMPENSATION: 20,440 NON-TAXABLE BENEFITS: 7,847 AS REQUIRED IN THIS FORM 990, COMPENSATION REPORTED BY HMFP AND BIDMC FOR THE 2012 CALENDAR YEAR INCLUDES THE FOLLOWING PAYMENTS FROM THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE/HARVARD MEDICAL SCHOOL RELATED TO DR. ZEIDEL'S POSITION AS CHAIR OF MEDICINE AND HERMAN LUDWIG BLUMGART PROFESSOR OF MEDICINE, HARVARD MEDICAL SCHOOL: $143,869 BASE AND OTHER REPORTABLE COMPENSATION, $15,881 DEFERRED COMPENSATION AND $1,825 NON-TAXABLE BENEFITS. ZINNER, M.D., STEPHEN TRUSTEE SHAPIRO INSTITUTE CHARLES S. DAVIDSON PROFESSOR OF MEDICINE HARVARD MEDICAL SCHOOL DR. ZINNER DEVOTES, ON AVERAGE, 1 HOUR PER WEEK TO THE REPORTING ORGANIZATION. COUGHLIN, CHRISTINE, M. ASSOCIATE DIRECTOR SHAPIRO INSTITUTE ADMINISTRATIVE DIRECTOR, CENTER FOR EDUCATION, ACADEMIC AFFAIRS BETH ISRAEL DEACONESS MEDICAL CENTER MS. COUGHLIN PERFORMS SERVICES FOR BOTH THE SHAPIRO INSTITUTE AND BIDMC AND DEVOTES, ON AVERAGE, A COMBINED 20 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE. MS. COUGHLIN RECEIVED PAYMENTS FROM BOTH THE SHAPIRO INSTITUTE AND BIDMC FOR HER SERVICES PROVIDED IN THESE ROLES. THE PORTION OF MS. COUGHLIN'S COMPENSATION ATTRIBUTABLE TO EACH POSITION HAS BEEN SEPARATELY REPORTED ON THIS FORM 990, AS FURTHER OUTLINED BELOW. PAYMENTS REPORTED BY THE SHAPIRO INSTITUTE BASE COMPENSATION: 3,000 BONUS AND INCENTIVE COMPENSATION: 0 OTHER REPORTABLE COMPENSATION: 0 DEFERRED COMPENSATION: 0 NON-TAXABLE BENEFITS: 0 PAYMENTS REPORTED BY BIDMC: BASE COMPENSATION: 48,050 BONUS AND INCENTIVE COMPENSATION: 0 OTHER REPORTABLE COMPENSATION: 0 DEFERRED COMPENSATION: 0 NON-TAXABLE BENEFITS: 2,760 HUGHES, CAROL M. SECRETARY/CLERK AND OPERATIONS COORDINATOR SHAPIRO INSTITUTE OPERATIONS COORDINATOR, CENTER FOR EDUCATION, ACADEMIC AFFAIRS BETH ISRAEL DEACONESS MEDICAL CENTER MS. HUGHES PERFORMS SERVICES FOR BOTH THE SHAPIRO INSTITUTE AND BIDMC AND DEVOTES, ON AVERAGE, A COMBINED 60 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE. MS. HUGHES RECEIVED PAYMENTS FROM BOTH THE SHAPIRO INSTITUTE AND BIDMC FOR HER SERVICES PROVIDED IN THESE ROLES. THE PORTION OF MS. HUGHES' COMPENSATION ATTRIBUTABLE TO EACH POSITION HAS BEEN SEPARATELY REPORTED ON THIS FORM 990, AS FURTHER OUTLINED BELOW. PAYMENTS REPORTED BY THE SHAPIRO INSTITUTE BASE COMPENSATION: 52,600 BONUS AND INCENTIVE COMPENSATION: 0 OTHER REPORTABLE COMPENSATION: 0 DEFERRED COMPENSATION: 0 NON-TAXABLE BENEFITS: 0 PAYMENTS REPORTED BY THE BIDMC: BASE COMPENSATION: 98,029 BONUS AND INCENTIVE COMPENSATION: 0 OTHER REPORTABLE COMPENSATION: 0 DEFERRED COMPENSATION: 0 NON-TAXABLE BENEFITS: 26,751 WANG, DIANA TREASURER SHAPIRO INSTITUTE FINANCIAL ANALYST BETH ISRAEL DEACONESS MEDICAL CENTER MS. WANG PERFORMS SERVICES FOR BOTH THE SHAPIRO INSTITUTE AND BIDMC AND DEVOTES, ON AVERAGE, A COMBINED 20 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE. MS. WANG RECEIVED PAYMENTS FROM BOTH THE SHAPIRO INSTITUTE AND BIDMC FOR HER SERVICES PROVIDED IN THESE ROLES. THE PORTION OF MS. WANG'S COMPENSATION ATTRIBUTABLE TO EACH POSITION HAS BEEN SEPARATELY REPORTED ON THIS FORM 990, AS FURTHER OUTLINED BELOW. PAYMENTS REPORTED BY THE SHAPIRO INSTITUTE BASE COMPENSATION: 19,294 BONUS AND INCENTIVE COMPENSATION: 300 OTHER REPORTABLE COMPENSATION: 0 DEFERRED COMPENSATION: 0 NON-TAXABLE BENEFITS: 868 PAYMENTS REPORTED BY BIDMC: BASE COMPENSATION: 12,863 BONUS AND INCENTIVE COMPENSATION: 200 OTHER REPORTABLE COMPENSATION: 0 DEFERRED COMPENSATION: 0 NON-TAXABLE BENEFITS: 579 BUEHRENS, ERIC P. FORMER TRUSTEE (EX-OFFICIO) AND CO-CHAIR SHAPIRO INSTITUTE FORMER INTERIM PRESIDENT AND CHIEF EXECUTIVE OFFICER BETH ISRAEL DEACONESS MEDICAL CENTER FORMER EXECUTIVE VICE PRESIDENT AND CHIEF OPERATING OFFICER BETH ISRAEL DEACONESS MEDICAL CENTER MR. BUEHRENS SERVED ON THE SHAPIRO INSTITUTE BOARD UNTIL OCTOBER 17, 2011. MR. BUEHRENS SERVED AS THE INTERIM PRESIDENT AND CHIEF EXECUTIVE OFFICER (CEO) OF BETH ISRAEL DEACONESS MEDICAL CENTER FROM FEBRUARY 2 TO OCTOBER 17, 2011, AT WHICH TIME HE RESUMED THE POSITION OF CHIEF OPERATING OFFICER (COO). MR. BUEHRENS SERVED AS COO UNTIL JANUARY 5, 2012 AND WAS EMPLOYED BY BIDMC UNTIL FEBRUARY 29, 2012. DURING THIS TIME, MR. BUEHRENS DEVOTED, ON AVERAGE, A COMBINED 60 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE. WHILE MR. BUEHRENS SERVED AS INTERIM PRESIDENT AND CEO OF BIDMC, HE ALSO SERVED IN THE FOLLOWING POSITIONS: DIRECTOR (EX-OFFICIO) BETH ISRAEL DEACONESS MEDICAL CENTER DIRECTOR (EX-OFFICIO) HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER DIRECTOR (EX-OFFICIO) BETH ISRAEL DEACONESS DEPARTMENT OF MEDICINE FOUNDATION DIRECTOR (EX-OFFICIO) BETH ISRAEL DEACONESS MEDICAL CENTER OBSTETRICS AND GYNECOLOGY FOUNDATION DIRECTOR (EX-OFFICIO) BETH ISRAEL DEACONESS DEPARTMENT OF SURGERY FOUNDATION TRUSTEE (EX-OFFICIO) BETH ISRAEL DEACONESS HOSPITAL NEEDHAM SUPPLEMENTAL INFORMATION PART III PAYMENTS REPORTED BY BIDMC: BASE COMPENSATION: 103,861 INCENTIVE COMPENSATION: 0 OTHER REPORTABLE COMPENSATION: 602,723 DEFERRED COMPENSATION: 5,600 NON-TAXABLE BENEFITS: 27,590 OTHER REPORTABLE COMPENSATION FOR MR. BUEHRENS INCLUDES SALARY CONTINUATION PAYMENTS IN THE AMOUNT OF $568,612 PAID DURING CALENDAR YEAR 2012. OTHER REPORTABLE AND DEFERRED COMPENSATION FOR MR. BUEHRENS INCLUDES COMBINED PAYMENTS FROM A NONQUALIFIED RETIREMENT PLAN IN THE AMOUNT OF $39,094. LEVY, PAUL F. FORMER TRUSTEE SHAPIRO INSTITUTE FORMER DIRECTOR (EX-OFFICIO), PRESIDENT AND CHIEF EXECUTIVE OFFICER BETH ISRAEL DEACONESS MEDICAL CENTER MR. LEVY SERVED AS PRESIDENT AND CHIEF EXECUTIVE OFFICER (CEO) OF BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC) UNTIL FEBRUARY 2, 2011. MR. LEVY WAS PAID DIRECTLY BY BIDMC AND HIS COMPENSATION IS RPORTED BY BIDMC ON FORM 990, AS FURTHER OUTLINED BELOW: PAYMENTS REPORTED BY BIDMC: BASE COMPENSATION: 0 INCENTIVE COMPENSATION: 0 OTHER REPORTABLE COMPENSATION: 777,205 DEFERRED COMPENSATION: 0 NON-TAXABLE BENEFITS: 9,474 OTHER REPORTABLE FOR MR. LEVY REPRESENTS SALARY CONTINUATION PAYMENTS PAID DURING THE CALENDAR YEAR 2012. ORGANIZATION'S MISSION FORM 990, PART I, LINE 1: THE MISSION OF CARL J SHAPIRO INSTITUTE FOR EDUCATION AND RESEARCH AT HARVARD MEDICAL SCHOOL AND BETH ISRAEL DEACONESS MEDICAL CENTER IS TO SUPPORT, PROMOTE, AND DEVELOP INNOVATIVE PROGRAMS AND MODELS FOR THE DUAL ACTIVITIES OF TEACHING AND RESEARCH AT ACADEMIC MEDICAL CENTERS. THE INSTITUTE WILL PROVIDE INTELLECTUAL LEADERSHIP, STATE-OF-THE-ART FACILITIES AND STAFF RESOURCES TO SUPPORT THE EDUCATION AND TRAINING OF MEDICAL STUDENTS AND FELLOWS. WEBSITE ADDRESS FORM 990, PART J HTTP://WWW.BIDMC.ORG/MEDICALEDUCATION/CARLJ-D-SHAPIROINSTITUTEFOR EDUCATIONANDRESEARCH.ASPX ORGANIZATION'S MISSION FORM 990, PART III, LINE 1: THE MISSION OF THE CARL J SHAPIRO INSTITUTE FOR EDUCATION AND RESEARCH AT HARVARD MEDICAL SCHOOL AND BETH ISRAEL DEACONESS MEDICAL CENTER IS TO SUPPORT, PROMOTE, AND DEVELOP INNOVATIVE PROGRAMS AND MODELS FOR THE DUAL ACTIVITIES OF TEACHING AND RESEARCH AT ACADEMIC MEDICAL CENTERS. THE INSTITUTE WILL PROVIDE INTELLECTUAL LEADERSHIP, STATE-OF-THE-ART FACILITIES AND STAFF RESOURCES TO SUPPORT THE EDUCATION AND TRAINING OF MEDICAL STUDENTS AND FELLOWS. STATEMENT RE AUDITED FINANCIAL STATEMENTS PART IV, QUESTION 12 AND 12A EDELSTEIN & COMPANY ISSUED AN UNQUALIFIED OPINION ON THE AUDITED FINANCIAL STATEMENTS OF THE SHAPIRO INSTITUTE FOR FISCAL YEAR ENDED JUNE 30, 2013. THESE STATEMENTS WERE PREPARED IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP). CONTRIBUTIONS OF INTELLECTUAL PROPERTY PART V, QUESTION 7G THE SHAPIRO INSTITUTE DID NOT RECEIVE ANY CONTRIBUTIONS OF INTELLECTUAL PROPERTY AND AS SUCH, WAS NOT REQUIRED TO FILE FORM 8899. CONTRIBUTIONS OF CARS, BOATS, AIRPLANES AND OTHER VEHICLES PART V, QUESTION 7H THE SHAPIRO INSTITUTE DID NOT RECEIVE ANY CONTRIBUTIONS OF CARS, BOATS, AIRPLANES OR OTHER VEHICLES AND AS SUCH, WAS NOT REQUIRED TO FILE FORM 1098-C. FORM 990, PART VI, SECTION A, LINE 2 AS NOTED IN VARIOUS NARRATIVE DISCLOSURES WHICH SUPPORT THIS FORM 990 AND RELATED SCHEDULES, THE SHAPIRO INSTITUTE IS NON-PROFIT CORPORATION EXEMPT FROM INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED AND SERVES AS A SUPPORT ORGANIZATION, PROVIDING MEDICAL TRAINING AND EDUCATION TO, BETH ISRAEL DEACONESS MEDICAL CENTER, HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER, INC. AND THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE/HARVARD MEDICAL SCHOOL. EACH OF THESE ENTITIES IS ALSO A NON-PROFIT CORPORATION EXEMPT FROM INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED TWO OR MORE OF THE PERSONS LISTED IN THIS FORM 990 PART VII HAVE A BUSINESS RELATIONSHIP WITH EACH OTHER BY VIRTUE OF SITTING ON ONE OR MORE BOARDS OF DIRECTORS/TRUSTEES OR BY SERVING IN EMPLOYMENT RELATIONSHIP ONE OR MORE ENTITIES NOTED ABOVE. ADDITIONAL DETAIL RELATED TO EMPLOYMENT RELATIONSHIPS IS PROVIDED IN THE EXPLANATORY NOTES TO THIS FORM 990 SCHEDULE J. FORM 990, PART VI, SECTION A, LINE 8B MINUTES ARE DOCUMENTED FOR THE BOARD OF TRUSTEE MEETINGS. HOWEVER, THERE IS NO COMMITTEE THAT HAS THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11 FORM 990 REVIEW PROCESS THE FORM 990 IS PREPARED AND REVIEWED BY MANAGEMENT AS WELL AS DELOITTE TAX, LLP. THE COMPLETE FORM 990, INCLUDING ALL REQUIRED SCHEDULES IS PROVIDED TO EACH MEMBER OF THE BOARD OF TRUSTEES PRIOR TO SUBMISSION TO THE INTERNAL REVENUE SERVICE. IN ADDITION, A COPY OF THE FORM 990, ONCE COMPLETED, IS PRESENTED FOR DISCUSSION TO THE BOARD OF TRUSTEES AT THE ANNUAL MEETING SUBSEQUENT TO COMPLETION. FORM 990, PART VI, SECTION B, LINE 12C THE SHAPIRO INSTITUTE HAS A CONFLICT OF INTEREST POLICY WHICH PROVIDES FOR ANNUAL MONITORING OF RELATIONSHIPS WITH ITS TRUSTEES AND EMPLOYEES. BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC) AND HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER (HMFP) ARE TWO OF THE ENTITIES SUPPORTED BY THE SHAPIRO INSTITUTE, EACH OF WHICH MAINTAINS A CONFLICT OF INTEREST POLICY AND PROCESS WHICH INCLUDES ANNUAL MONITORING AND REPORTING. MANY MEMBERS OF THE SHAPIRO INSTITUTE BOARD OF TRUSTEES ARE ALSO EMPLOYEES OF BIDMC OR HMFP AND AS SUCH, THEY ARE ALSO COVERED BY THE BIDMC OR HMFP CONFLICT OF INTEREST PROCESS. FORM 990, PART VI, SECTION B, LINE 15 LINE 15A AND 15B - DESCRIPTION OF PROCESS TO DETERMINE COMPENSATION OF THE ORGANIZATION'S CEO AND OTHER OFFICERS AND KEY EMPLOYEES AS NOTED IN THIS RETURN, THE SHAPIRO INSTITUTE EXECUTIVE DIRECTOR, ALSO SERVES AS THE VICE PRESIDENT OF EDUCATION, FOR BETH ISRAEL DEACONESS MEDICAL CENTER (MEDICAL CENTER). THE MEDICAL CENTER HAS A COMPENSATION COMMITTEE THAT IS COMPOSED OF MEMBERS OF THE BOARD OF DIRECTORS. ALL MEMBERS ARE INDEPENDENT. THE COMPENSATION COMMITTEE ESTABLISHES THE POLICIES AND THE COMPENSATION STRUCTURE OF ALL SENIOR MANAGEMENT AT THE MEDICAL CENTER, INCLUDING VICE PRESIDENTS. THE COMPENSATION COMMITTEE IS RESPONSIBLE FOR ASSURING THAT THE TOTAL COMPENSATION PROVIDED TO THESE INDIVIDUALS IS FAIR AND REASONABLE USING CURRENT AND CREDIBLE MARKET PRACTICE INFORMATION AND THAT IT COMPLIES WITH APPLICABLE LEGAL AND REGULATORY GUIDELINES. IN SETTING COMPENSATION, THE COMPENSATION COMMITTEE RELIED UPON WRITTEN COMPENSATION SURVEYS AND STUDIES PRODUCED BY AN INDEPENDENT COMPENSATION CONSULTING FIRM THAT REGULARLY ASSESSES EXECUTIVE COMPENSATION AND BENEFITS OF SIMILAR ORGANIZATIONS. THE COMPENSATION COMMITTEE MET TO REVIEW THE COMPENSATION STRUCTURE OF THE INDIVIDUALS DESCRIBED ABOVE AND AT THAT TIME REVIEWED THE COMPENSATION SURVEY PREPARED BY THE INDEPENDENT COMPENSATION CONSULTING FIRM. THE COMPENSATION COMMITTEE THEN VOTED TO APPROVE THE COMPENSATION ARRANGEMENTS DISCUSSED. ALL DELIBERATIONS WERE CONTEMPORANEOUSLY DOCUMENTED IN MINUTES. SUBSEQUENT TO THE VOTE OF THE COMMITTEE, THE OUTSIDE CONSULTING FIRM PROVIDED A "REASONABLENESS LETTER" ATTESTING TO THE INDEPENDENCE OF THE COMMITTEE AND REASONABLENESS OF THE EXECUTIVE COMPENSATION. IN ADDITION, ANY COMPENSATION PAID TO THE EXECUTIVE DIRECTOR DIRECTLY BY THE SHAPIRO INSTITUTE AND NOT INCLUDED IN THE PROCESS ABOVE, IS APPROVED BY THE SHAPIRO INSTITUTE BOARD. FORM 990, PART VI, SECTION C, LINE 19 ALL APPLICABLE DOCUMENTS ARE AVAILABLE FROM THE ORGANIZATION UPON WRITTEN REQUEST. OTHER FEES FORM 990, PART IX, LINE 11G MENTORING AND PROJECT PLANNING: PROGRAM SERVICE EXPENSES 96,250. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 96,250. SIMULATION EVENT STAFF TIME: PROGRAM SERVICE EXPENSES 8,313. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,313. EDUCATION AND RESEARCH: PROGRAM SERVICE EXPENSES 6,506. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,506. ADMINISTRATIVE SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 20,261. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 20,261. BETH ISRAEL DEACONESS MEDICAL CENTER 330 BROOKLINE AVE BOSTON MA 02215 042103881 HOSPITAL MA 501(C)(3) LINE 3: 170(B)(1)(A) N/A 0 PRESIDENT & FELLOWS OF HARVARD COLLEGE MASSACHUSETTS HALL CAMBRIDGE MA 02138 042103580 COLLEGE MA 501(C)(3) LINE 3: 170(B)(1)(A) N/A 0 HARVARD MEDICAL FACULTY PHYSICIANS AT BIDMC 375 LONGWOOD AVE BOSTON MA 02215 222768204 PATIENT CARE MA 501(C)(3) LINE 3: 170(B)(1)(A) N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0