2014-08-14T15:52:11-05:00 2013-09-30 020400296 Brad Borbidge PA 197 Loudon Road Concord NH 03301 990 2012-10-01 042104788 VNA & Hospice of Cooley Dickinson Inc VNA& 4135841060 168 Industrial Drive Northampton MA 01060 Joanne Marqusee 4135841060 2014-08-14 1 Dimitrios Panacopoulos CPA P01603705 6032240849 2012 2015-11-30 17:44:51Z Joanne Marqusee 168 Industrial Drive Northampton MA 01060 12648376 0 X www.vnaandhospice.org X 1950 MA The VNA & Hospice provides high quality hospice and home health services to all those entrusted in our care. 27 14 139 124 0 0 390501 1215721 9990369 11368433 41280 32794 31428 31428 10453578 12648376 0 0 0 0 7093778 8252380 0 0 0 2549509 2657277 9643287 10909657 810291 1738719 5269225 7035818 1330011 1357885 3939214 5677933 The VNA & Hospice provides high quality hospice and home health services to all those entrusted in our care. 0 0 7173538 8640292 Home Care - Provides acute home health care services to patients that can be cared for at home. 1908496 2728141 Hospice - Provide support care for terminally ill on a 24 hour basis. 9082034 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 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 1 1 0 0 1 24 0 1 139 1 0 0 0 0 0 0 0 0 0 0 X 27 14 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 1 0 MA X Laurie Lamoureux 4135822300 30 Locust street Northampton MA 01060 X Sanford Belden 2.00 0.00 X X 0 0 0 Kevin Lake 2.00 0.00 X X 0 0 0 Craig N Melin 0.00 50.00 X X 0 488667 36057 Matthew Pitoniak 2.00 0.00 X X 0 0 0 Charles Staelin 2.00 0.00 X X 0 0 0 Henry Rosenberg MD 1.00 32.00 X 0 90693 25720 Margaret Russo MD 1.00 20.00 X 0 196516 17695 Kathleen Scoble 1.00 0.00 X 0 0 0 Peter Siersma MD 1.00 40.00 X 0 246137 25421 John Todd 1.00 0.00 X 0 0 0 Margo Welch 1.00 0.00 X 0 0 0 Geoffrey Zucker MD 1.00 0.00 X 0 0 0 Peter Slavin MD 1.00 50.00 X 0 1828105 343359 William Stapleton 1.00 0.00 X 0 0 0 Michael Blute MD 1.00 50.00 X 0 955471 14089 Elizabeth Mort MD 1.00 50.00 X 0 599311 52817 David Brown MD 1.00 50.00 X 0 580371 57453 Alan Anthony James 1.00 50.00 X 0 252767 24225 Kenneth Bordewieck 1.00 0.00 X 0 0 0 Thomas Caine 1.00 0.00 X 0 0 0 Stephen Cavanagh 1.00 0.00 X 0 0 0 O B Clifford 1.00 0.00 X 0 0 0 James Donnelly MD 1.00 0.00 X 0 0 0 William Gorth 1.00 0.00 X 0 0 0 Mahnaz Mahdavi 1.00 0.00 X 0 0 0 John Nunnelly 1.00 0.00 X 0 0 0 Danielle Ramdath 1.00 0.00 X 0 0 0 Nancy Reeves 1.00 0.00 X 0 0 0 Edith Peter 0.00 50.00 X 0 282650 17367 Jeanne Ryan 50.00 0.00 X 149133 0 11695 149133 5520688 625898 1 0 1 0 Simione Healthcare Consultants 4130 Whitney Ave Hamden CT 06518 Consulting 109901 AMN Healthcare 12400 High Bluff Drive San Diego CA 92130 Rehab Staffing 106524 2 1800 1213921 1215721 Home Care 621610 8640292 8640292 Hospice 621610 2728141 2728141 11368433 32794 32794 31428 0 31428 31428 31428 12648376 11368433 0 64222 160825 160825 6447592 5537622 909970 192785 161843 30942 923440 775228 148212 527738 443036 84702 7037 7037 42000 42000 789807 508627 281180 102003 85632 16371 41881 35159 6722 69997 58762 11235 299338 251294 48044 315162 305546 9616 45997 38614 7383 121565 102054 19511 25496 21404 4092 Program Supplies 549137 549137 Telephone 92986 78062 14924 Printing and Publicatio 70475 59164 11311 Other Expenses 44660 37492 7168 39736 33358 6378 10909657 9082034 1827623 0 3204646 3893596 1765269 1725804 62414 168426 1703464 1443844 214972 259620 21924 988372 5269225 7035818 699453 799880 562977 492747 67581 65258 1330011 1357885 X 3917290 4689561 21924 988372 3939214 5677933 5269225 7035818 1738719 0 X 0 1 X 1 0 X 218715 300153 345905 390501 1215721 2470995 8399199 8695820 8908624 9990369 11368433 47362445 8617914 8995973 9254529 10380870 12584154 49833440 0 0 0 49833440 47087 46079 70538 41280 32794 237778 47087 46079 70538 41280 32794 237778 8665001 9042052 9325067 10422150 12616948 50071218 0.99530 0.99520 0.00470 0.00480 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1703464 1443844 259620 259620 Assets Limited As To Use 988372 988372 Due To Third Party Payors 14556 Due To Affiliate 50702 65258 12648376 0 12648376 0 12648376 10909657 0 10909657 0 10909657 Part IV, Line 11f - The Agency is a public charity under Section 501(c)(3) of the Internal Revenue Code. As a public charity, the Agency is exempt from state and federal income taxes on income earned in accordance with its tax exempt purpose. Unrelated business income is subject to state and federal income tax. Management has evaluated the Agencys tax position and concluded that the Agency has no unrelated business income or uncertain tax positions that require adjustment to the financial statements. 0 1 0 0 0 0 0 0 0 Craig N Melin 0 394419 0 21588 0 72660 0 15000 0 21057 0 524724 0 0 Margaret Russo MD 0 185790 0 10614 0 112 0 6707 0 10988 0 214211 0 0 Peter Siersma MD 0 242330 0 0 0 3807 0 6906 0 18515 0 271558 0 0 Peter Slavin MD 0 1318832 0 135000 0 374273 0 309895 0 33464 0 2171464 0 0 Michael Blute MD 0 525500 0 429400 0 571 0 0 0 14089 0 969560 0 0 Elizabeth Mort MD 0 416650 0 93033 0 89628 0 34501 0 18316 0 652128 0 0 David Brown MD 0 413365 0 114022 0 52984 0 34497 0 22956 0 637824 0 0 Alan Anthony James 0 184809 0 45855 0 22103 0 23450 0 775 0 276992 0 0 Edith Peter 0 238625 0 3138 0 40887 0 14797 0 2570 0 300017 0 0 Jeanne Ryan 141094 0 0 0 8039 0 7101 0 4594 0 160828 0 0 0 Part I, Line 4b Part I, Line 4b: The organization offers a Supplemental Retirement Plan (SRP) for Senior Executives. These amounts are already included in the compensation disclosed on Schedule J, Part II. Jeanne Ryan received this benefit through VNA & Hospice of Cooley Dickinson, Inc. at $7,012. Craig Melin and Edith Peter received this benefit through Cooley Dickinson Hospital, Inc. at $41,877 and $18,343 respectively. Peter Slavin, MD, MBA participates in a Supplemental Nonqualified Retirement Plan through Partners HealthCare, the benefit amount is $295,398. Part I, Line 3: Craig N. Melin received compensation from Cooley Dickinson Hospital, Inc. in his capacity as CEO. Cooley Dickinson Hospital, Inc. made use of the procedures described on line 3 in establishing such compensation. Part II: Other reportable compensation, column B(III) may include supplemental retirement plan benefit contributions, employee deferrals to section 457 plans, taxable life or disability, and the taxable benefit of an employer provided automobile. PART 1, Line 6 105 is the actual number of individuals who gave their time through our Volunteer Services between October 1, 2012 and September 31, 2013. In addition, 19 individuals served as voluntary Trustees on the organizations Board of Trustees and Board Committees. Form 990, Part VI, Section A, line 2 The same individuals serve as Officers and Trustees on the Boards of Cooley Dickinson Health Care Corporation, Cooley Dickinson Hospital, and VNA & Hospice of Cooley Dickinson. Six of the thirteen Trustees of CD Practice Associates also serve on the Boards of Cooley Dickinson Health Care Corporation, Cooley Dickinson Hospital, and VNA & Hospice of Cooley Dickinson. Form 990, Part VI, Section A, line 6 The sole member of the Corporation shall be Cooley Dickinson Health Care Corporation. Form 990, Part VI, Section A, line 7a The Board of Trustees of the Corporation shall elect the Elected Trustees. Form 990, Part VI, Section A, line 7b The membership body is the Board of Trustees. Form 990, Part VI, Section B, line 11 VNA & Hospice of Cooley Dickinson, Inc. worked with it's independent auditor, Brad Borbidge, PA to prepare the form 990. The Form was then reviewed internally by management and following that review, the Corporation's management presented the Form 990 to the Board of Trustees Audit and Compliance Committee for review and comment. The completed form 990, including all schedules, with the exception of schedule B, the schedule of contributors, was provided electronically to each member of the board of trustees prior to filing with the IRS. Schedule B was present at the July board meeting and was made available for viewing after the meeting or by scheduling an appointment with Laurie Lamoureux, Vice President of Finance. Form 990, Part VI, Section B, line 12c All employees of VNA & Hospice of Cooley Dickinson, Inc. are provided copies of the Organization's conflict of interest policy as well as a questionnaire upon hire. Each individual is required to sign that they have received and understand the policy. They are also asked to disclose any real or perceived conflicts of interest. The completed forms are returned to the Organization's compliance officer who is responsible for monitoring and enforcing the conflict of interest policy. Annually thereafter, employees are asked if they understand the policy and have anything to report as part of the annual performance evaluation. There is ongoing monitoring to ensure all new employees fill out the questionnaire and ongoing employees are asked as part of the review process. Trustees and senior managers have the additional requirement of completing an annual questionnaire. All completed questionnaires are reviewed by the compliance officer who consults with legal counsel and takes action as appropriate to understand the relationships and raise awareness. The compliance officer also reports annually to the board of trustees on policy enforcement. Form 990, Part VI, Section B, line 15b The CEO/Assistant Secretary and the CFO/Assistant Treasurer are compensated by Cooley Dickinson Hospital, Inc. Form 990, Part VI, Section C, line 19 The Organization's governing documents are filed with the Massachusetts Secretary of State and the financial statements are filed with the Massachusetts Attorney General, all of which are open to public inspection. Further, the form 990, financial statements, and conflict of interest policy are available to the public upon request. PART VII, Section A, Line 1a Henry Rosenberg MD, Margaret Russo, MD, and Peter Siersma, MD are compensated by CD Practice Associates, working an average of 32 hours, 20 hours, and 40 hours per week respectively; Craig Melin and Edith Peter are compensated by Cooley Dickinson Hospital Inc, each working an average of 50 hours per week. Michael Blute MD, David Brown MD, Alan Anthony James, Elizabeth Mort MD MPH, and Peter Slavin MD MBA are compensated by Partners HealthCare System each working an average of 50 hours per week. The Massachusetts General Hospital (MGH) 55 Fruit Street Boston MA 02114 041564655 HealthCare MA 501 (c)(3) Line 7 PHS 1 The General Hospital Corporation 55 Fruit Street Boston MA 02114 042697983 HealthCare MA 501 (c)(3) Line 3 MGH 1 Massachusetts General Physicians Org 55 Fruit Street Boston MA 02114 042807148 HealthCare MA 501 (c)(3) Line 9 MGH 1 The MGH Health Services Corporation 55 Fruit Street Boston MA 02114 222717383 HealthCare MA 501 (c)(3) Line 11a MGH 1 The MGH Institute of Health Professions 36 First Avenue Charlestown MA 02129 042868893 Med Education MA 501 (c)(3) Line 2 MGH 1 Mclean Healthcare Inc (MHC) 115 Mill Street Belmont MA 02478 204572876 Admin Support MA 501 (c)(3) Line 11a MGH 1 The Mclean Hospital Corporation 115 Mill Street Belmont MA 02478 042697981 HealthCare MA 501 (c)(3) Line 3 MHC 1 Martha's Vineyard Hospital Inc (MVH) 1 Linton Lane Oaks Bluff MA 02557 042104691 HealthCare MA 501 (c)(3) Line 3 MGH 1 WNR Inc 1 Linton Lane Oaks Bluff MA 02557 043419920 Nursing Services MA 501 (c)(3) Line 9 MVH 1 Nantucket Cottage Hospital 57 Prospect Street Nantucket MA 02554 042103823 HealthCare MA 501 (c)(3) Line 3 MGH 1 Nantucket Cottage Hospital Foundation 57 Prospect Street Nantucket MA 02554 043829745 Admin Support MA 501 (c)(3) Line 11a NCH 1 Brigham and Women's Health Care (BWHC) 75 Francis Street Boston MA 02115 042921338 Admin Support MA 501 (c)(3) Line 7 PHS 1 The Brigham and Women's Hospital (BWH) 75 Francis Street Boston MA 02115 042312909 HealthCare MA 501 (c)(3) Line 3 BWHC 1 Biosciences Research Foundation Inc 75 Francis Street Boston MA 02115 222483849 Promote Res MA 501 (c)(3) Line 11a BWHC 1 BWH Research Inc 75 Francis Street Boston MA 02115 043011445 Med Research MA 501 (c)(3) Line 11a BWHC 1 Brigham Community Practices Inc 75 Francis Street Boston MA 02115 222588069 HealthCare MA 501 (c)(3) Line 9 BWHC 1 Brigham and Women's Phys Org (BWPO) 75 Francis Street Boston MA 02115 043466314 HealthCare MA 501 (c)(3) Line 9 BWHC 1 BWH Anesthesia Res & Educ Foundation 75 Francis Street Boston MA 02115 043492603 Med Res & Edu MA 501 (c)(3) Line 7 BWPO 1 Brigham Medical Res & Edu Foundation 75 Francis Street Boston MA 02115 043539249 Med Res & Edu MA 501 (c)(3) Line 11a BWPO 1 Brigham & Women's OB-GYN Res & Edu 75 Francis Street Boston MA 02115 043494863 Med Res & Edu MA 501 (c)(3) Line 7 BWPO 1 Brigham Pathology Res & Edu Foundation 75 Francis Street Boston MA 02115 043541111 Med Res & Edu MA 501 (c)(3) Line 11a BWPO 1 Brigham Radiology Res & Edu Foundation 75 Francis Street Boston MA 02115 043425905 Med Res & Edu MA 501 (c)(3) Line 11a BWPO 1 Brigham and Women's Faulkner Hosp 1153 Centre Street Boston MA 02130 042768256 HealthCare MA 501 (c)(3) Line 3 BWHC 1 Village Manor Nursing Home Inc 1153 Centre Street Boston MA 02130 042775265 Nursing Home MA 501 (c)(3) Line 3 BWFH 1 Partners Continuing Care Inc (PCC) Prudential Tower 800 Boylston Boston MA 02199 260003495 Admin Support MA 501 (c)(3) Line 11a PHS 1 Spaulding Rehabilitation Hospital Corp 300 First Avenue Charlestown MA 02129 042551124 HealthCare MA 501 (c)(3) Line 3 PCC 1 Rehab Hospital of the Cape & Islands 311 Service Road East Sandwich MA 02537 043071419 HealthCare MA 501 (c)(3) Line 3 PCC 1 Shaughnessy-Kaplan Rehabilitation Hosp Dove Avenue Salem MA 01970 043067082 HealthCare MA 501 (c)(3) Line 3 PCC 1 Partners Home Care Inc(PHC) 281 Winter Street Waltham MA 02451 042918280 Home Health MA 501 (c)(3) Line 9 PCC 1 Partners Hospice Inc 48 Woerd Avenue 102 Waltham MA 02453 042730504 Home Health MA 501 (c)(3) Line 7 PHC 1 FRC Inc 101 Merrimac Street Boston MA 02114 222632121 HealthCare MA 501 (c)(3) Line 3 PCC 1 NSMC HealthCare Inc (NSHC) 81 Highland Avenue Salem MA 01970 043294420 Admin Support MA 501 (c)(3) Line 11a PHS 1 North Shore Medical Center Inc 81 Highland Avenue Salem MA 01970 043399616 HealthCare MA 501 (c)(3) Line 3 NSHC 1 North Shore Physicians Group Inc 81 Highland Avenue Salem MA 01970 043080484 HealthCare MA 501 (c)(3) Line 11a NSHC 1 Newton-Wellesley Healthcare System (NWHC) 2014 Washington Street Newton MA 02462 204295282 Admin Support MA 501 (c)(3) Line 11a PHS 1 Newton-Wellesley Hospital 2014 Washington Street Newton MA 02462 042103611 HealthCare MA 501 (c)(3) Line 3 NWHC 1 Newton-Wellesley Ambulatory Services 2014 Washington Street Newton MA 02462 222560501 HealthCare MA 501 (c)(3) Line 11a NWHC 1 Newton-Wellesley Hosp Charitable Found 2014 Washington Street Newton MA 02462 043455952 Fundraising MA 501 (c)(3) Line 7 NWHC 1 Newton-Wellesley Children's Corner Inc 2014 Washington Street Newton MA 02462 042650246 Child Care MA 501 (c)(3) Line 9 NWHC 1 Partners Medical International Inc 100 Cambridge Street Boston MA 02114 043197711 Med Training MA 501 (c)(3) Line 11a PHS 1 The Friends of the Brigham & Women's Hosp 75 Francis Street Boston MA 02115 042239449 Fundraising MA 501 (c)(3) Line 11a BWHC 1 Spaulding Hospital - Cambridge Inc 1575 Cambridge Street Cambridge MA 02138 270273715 Hospital MA 501 (c)(3) Line 3 PCC 1 Nantucket Physician Organization Inc 57 Prospect Street Nantucket MA 02554 264349357 HealthCare MA 501 (c)(3) Line 9 MGH 1 Neighborhood Health Plan Inc (NHP) 253 Summer Street Boston MA 02210 042932021 Insurance MA 501 (c)(4) n/a PHS 1 Community Medical Alliance Inc 253 Summer Street Boston MA 02210 043454185 Insurance MA 501 (c)(3) Line 11a NHP 1 Cooley Dickinson Hospital Inc 30 Locust Street Northampton MA 01060 222617175 Hospital MA 501 (c)(3) Line 3 CDHCC 1 Cooley Dickinson Health Care Corp (CDHCC) 30 Locust Street Northampton MA 01060 042103561 Admin Support MA 501 (c)(3) Line 11a MGH 1 CD Practice Associates Inc PO Box 911 Northampton MA 01060 043194547 HealthCare MA 501 (c)(3) Line 9 CDHCC 1 McLean Child Care Center Inc 115 Mill Street Belmont MA 02478 042932850 Child Care MA 501 (c)(3) Line 11a MHC 1 BSC Inc 75 Francis Street Boston MA 02115 042987478 Communication MA BWHC C 1 Partners Community HealthCare Inc 800 Boylston Street Boston MA 02199 043236175 HealthCare MA PHS C 158006725 127565017 1.00000 1 Newton-Wellesley Physician Hospital Org 2014 Washington Street Newton MA 02462 043209749 HealthCare MA NWHC C 6134194 9499927 1.00000 1 0 0 0 0 0 0 0 0 0 1 0 0 1 0 1 1 0 0 0 Cooley Dickinson Hospital Inc M 121519 Actual Cost Cooley Dickinson Hospital Inc P 223417 Actual Cost