MASS GENERAL BRIGHAM INCORPORATED: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- MASS GENERAL BRIGHAM INCORPORATED (EIN 02-0497927)
- Tax period
- 2013-01-01 to 2013-12-31
- Filed
- 2014-11-06
- IRS object ID
- 201423109349300032
- Schema version
- 2013v3.0
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2014-11-06T09:53:39-06:00 | ReturnTs |
| Tax Period End | 2013-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 010494526 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BAKER NEWMAN & NOYES | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 507 | AddressLine1 |
| City | PORTLAND | City |
| State | ME | State |
| ZIP Code | 04112 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 020497927 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Wentworth-Douglass Physician Corporation | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | WENT | BusinessNameControlTxt |
| Phone | 6037425252 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 789 Central Avenue | AddressLine1 |
| City | Dover | City |
| State | NH | State |
| ZIP Code | 038202526 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Peter E Walcek | PersonNm |
| Person Title | CFO/VP of Finance | PersonTitleTxt |
| Phone | 6037422804 | PhoneNum |
| Signature | 2014-10-16 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Nicholas E Porto | PreparerPersonNm |
| PTIN | P01310283 | PTIN |
| Phone | 2078792100 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Wentworth Health Partners | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Gregory J Walker | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 789 Central Avenue | AddressLine1 |
| City | Dover | City |
| State | NH | State |
| ZIP Code | 038202526 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $32,781,726 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | N/A | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1998 | FormationYr |
| Legal Domicile State | NH | LegalDomicileStateCd |
| Activity Or Mission | Improve the health of the community by providing high quality healthcare. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 4 | VotingMembersIndependentCnt |
| Total Employee | 371 | TotalEmployeeCnt |
| Total Volunteers | 4 | TotalVolunteersCnt |
| Total Gross UBI | $58,764 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $76,795 | PYContributionsGrantsAmt |
| CY Contributions Grants | $5,031 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $30,632,994 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $32,670,189 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | -$1,320 | CYInvestmentIncomeAmt |
| PY Other Revenue | $75,343 | PYOtherRevenueAmt |
| CY Other Revenue | $73,599 | CYOtherRevenueAmt |
| PY Total Revenue | $30,785,132 | PYTotalRevenueAmt |
| CY Total Revenue | $32,747,499 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $33,913,580 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $37,618,695 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $14,964,696 | PYOtherExpensesAmt |
| CY Other Expenses | $15,457,889 | CYOtherExpensesAmt |
| PY Total Expenses | $48,878,276 | PYTotalExpensesAmt |
| CY Total Expenses | $53,076,584 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$18,093,144 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$20,329,085 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $4,939,969 | TotalAssetsBOYAmt |
| Total Assets EOY | $5,111,146 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $5,726,634 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $6,464,459 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$786,665 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$1,353,313 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Improve the health of the community by providing high quality health care that exceeds expectations through an integrated network of highly qualified professionals. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $48,435,245 | ExpenseAmt |
| Revenue | $32,530,595 | RevenueAmt |
| Desc | Wentworth-Douglass Physician Corporation (WDPC) was formed in response to a community needs assessment that identified a lack of primary care and specialty services in the community. The formation of the Physician Corporation and recruitment of primary care and specialty physicians closed the gap by improving access to medical services in Dover, NH and surrounding areas. (See Schedule O for a list of facilities operated by WDPC.)In 2013, the Corporation provided for a total of 202,511 patient visits. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $587,427 | ExpenseAmt |
| Revenue | $154,429 | RevenueAmt |
| Desc | The Wentworth-Douglass Community Dental Center is open to low-income, uninsured adults and children living in Wentworth-Douglass Hospital's primary service area (Dover, Durham, Madbury, Lee, Barrington, Somersworth, Rollinsford, NH and Berwick and So. Berwick, ME) or patients of the physician practices who have a family income at or below 200% of the federal poverty guidelines. In 2013, a total of 2,898 patient visits were recorded, resulting in a net community benefit cost of $385,142.In addition, WDPC provided community benefits totaling nearly $398,000 in 2013. The Corporation supports numerous community based programs, including the Community Dental Center.WDPC provides financial aid information and resources to assist patients with their healthcare bills. Medical care is provided at no charge for eligible patients at 200% of the federal poverty level. In 2013 WDPC provided $398,000 of financial aid (stated at cost). Medicaid Costs Exceeding Reimbursement totaled $169,503 for the Corporation in 2013. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $49,022,672 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | Yes (1) | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 371 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 4 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | NH | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Peter E Walcek CFOVP of Finance | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6037402804 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 789 Central Avenue | AddressLine1 |
| City | Dover | City |
| State | NH | State |
| ZIP Code | 038202526 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (18 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| William R Brandon MD part year | ||||||||
| Executive Director | 65.00 | 0.00 | Yes (X) | $280,106 | $0 | $17,097 | ||
| Ellen L Caille part year | ||||||||
| Executive Vice President | 2.00 | 48.00 | Yes (X) | $0 | $305,409 | $83,380 | ||
| Paul R Cass DO | ||||||||
| Director/Physician | 2.00 | 50.00 | Yes (X) | $0 | $443,435 | $84,428 | ||
| Barbara F Civiello MD part year | ||||||||
| Director/Physician | 65.00 | 0.00 | Yes (X) | $524,033 | $0 | $28,670 | ||
| Matthew Goldberg DO | ||||||||
| Director/Physician | 65.00 | 0.00 | Yes (X) | $254,892 | $0 | $10,868 | ||
| Nancy J Pettinari MD | ||||||||
| Director/Physician | 65.00 | 0.00 | Yes (X) | $248,535 | $0 | $8,066 | ||
| Gary Usher MD part year | ||||||||
| Director/Physician | 65.00 | 0.00 | Yes (X) | $284,245 | $0 | $12,013 | ||
| Neil Garvey | ||||||||
| Chairman | 1.00 | 3.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| Roger Hamel | ||||||||
| Vice Chairman | 1.00 | 3.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| Michael Steinberg | ||||||||
| Treasurer | 1.00 | 5.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| Carol Bailey | ||||||||
| Secretary | 1.00 | 3.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| Gregory J Walker | ||||||||
| President/CEO, WDH | 2.00 | 53.00 | Yes (X) | $0 | $725,687 | $151,609 | Yes (X) | |
| Peter E Walcek | ||||||||
| CFO/VP Finance, WDH | 2.00 | 53.00 | Yes (X) | $0 | $343,239 | $86,022 | Yes (X) | |
| Roger Evans MD | ||||||||
| Physician | 65.00 | 0.00 | $452,648 | $0 | $27,185 | Yes (X) | ||
| Girish C Joshi MD | ||||||||
| Physician | 65.00 | 0.00 | $462,813 | $0 | $31,491 | Yes (X) | ||
| Lazaro A Diaz MD | ||||||||
| Physician | 65.00 | 0.00 | $471,655 | $0 | $25,929 | Yes (X) | ||
| Silvia Milancovici MD | ||||||||
| Physician | 65.00 | 0.00 | $416,283 | $0 | $31,494 | Yes (X) | ||
| William S Danford MD | ||||||||
| Physician | 65.00 | 2.00 | $449,001 | $0 | $27,173 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $3,844,211 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,817,770 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $625,425 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 94 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $5,031 | RelatedOrganizationsAmt |
| Total Contributions | $5,031 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| Patient Service Revenue | 621110 | $30,818,190 | $30,818,190 | |
| Other Related Function Income | 621990 | $1,543,460 | $1,484,696 | $58,764 |
| Meaningful Use | 621110 | $308,539 | $308,539 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $32,670,189 | TotalProgramServiceRevenueAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $104,606 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $31,007 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $73,599 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $73,599 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $73,599 | RelatedOrExemptFuncIncomeAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $1,900 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $3,220 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$1,320 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$1,320 | TotalRevenueColumnAmt |
| Exclusion | -$1,320 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $32,747,499 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $32,685,024 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $58,764 | UnrelatedBusinessRevenueAmt |
| Exclusion | -$1,320 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,668,525 | TotalAmt |
| Program Services | $1,668,525 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,764,586 | TotalAmt |
| Program Services | $27,912,956 | ProgramServicesAmt |
| Management And General | $1,851,630 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $311,103 | TotalAmt |
| Program Services | $291,566 | ProgramServicesAmt |
| Management And General | $19,537 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,365,314 | TotalAmt |
| Program Services | $3,153,972 | ProgramServicesAmt |
| Management And General | $211,342 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,509,167 | TotalAmt |
| Program Services | $2,351,591 | ProgramServicesAmt |
| Management And General | $157,576 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,910 | TotalAmt |
| Management And General | $1,910 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,004 | TotalAmt |
| Management And General | $20,004 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,458,369 | TotalAmt |
| Program Services | $5,264,112 | ProgramServicesAmt |
| Management And General | $1,194,257 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $85,498 | TotalAmt |
| Management And General | $85,498 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,313,200 | TotalAmt |
| Program Services | $1,079,016 | ProgramServicesAmt |
| Management And General | $234,184 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,175,854 | TotalAmt |
| Program Services | $2,976,410 | ProgramServicesAmt |
| Management And General | $199,444 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $241,160 | TotalAmt |
| Program Services | $162,630 | ProgramServicesAmt |
| Management And General | $78,530 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $241,168 | TotalAmt |
| Program Services | $241,168 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $613,201 | TotalAmt |
| Program Services | $613,201 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $783,805 | TotalAmt |
| Program Services | $783,805 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| Provision for Bad Debt | $1,503,139 | $1,503,139 |
| Dental Community Benefi | $432,998 | $432,998 |
| Pharmacy Expense | $292,900 | $292,900 |
| Transcription | $292,090 | $292,090 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,593 | TotalAmt |
| Program Services | $2,593 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $53,076,584 | TotalAmt |
| Program Services | $49,022,672 | ProgramServicesAmt |
| Management And General | $4,053,912 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $182,972 | BOYAmt |
| EOY | $135,410 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,602,573 | BOYAmt |
| EOY | $3,078,008 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $8,677,230 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $6,783,199 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,150,727 | BOYAmt |
| EOY | $1,894,031 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,697 | BOYAmt |
| EOY | $3,697 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,939,969 | BOYAmt |
| EOY | $5,111,146 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,726,634 | BOYAmt |
| EOY | $6,464,459 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,726,634 | BOYAmt |
| EOY | $6,464,459 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$786,665 | BOYAmt |
| EOY | -$1,353,313 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$786,665 | BOYAmt |
| EOY | -$1,353,313 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,939,969 | BOYAmt |
| EOY | $5,111,146 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$20,329,085 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $19,762,437 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| 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) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,839,441 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,228,073 | DepreciationAmt |
| Book Value | $611,368 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,837,789 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,555,126 | DepreciationAmt |
| Book Value | $1,282,663 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $1,894,031 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $32,342,915 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $28,414 | OtherRevenueAmt |
| Revenue Not Reported | $28,414 | RevenueNotReportedAmt |
| Revenue Subtotal | $32,314,501 | RevenueSubtotalAmt |
| Other Revenues Not Included | $432,998 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $432,998 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $32,747,499 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $52,672,000 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $28,414 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $28,414 | ExpensesNotReportedAmt |
| Expenses Subtotal | $52,643,586 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $432,998 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $432,998 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $53,076,584 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part X, Line 2: | WDHS, The Hospital, WDPC and the Foundation are not-for-profit corporations as described in Section 501(c)(3) of the Internal Revenue Code and are exempt from federal income taxes pursuant to Section 501(a) of the Code. Management evaluated these not-for-profit corporations' tax positions and concluded these not-for-profit corporations have maintained their tax-exempt status, do not have any significant unrelated business income and have taken no uncertain tax positions that require adjustment to or disclosure in the accompanying consolidated financial statements. With few exceptions, these not-for-profit corporations are no longer subject to tax examination by the U.S. federal or state tax authorities for years prior to 2010. |
| Part XI, Line 2d - Other Adjustments: | Occupancy Expenses Allocated to Building Rental 28,414. |
| Part XI, Line 4b - Other Adjustments: | Dental Community Benefit 432,998. |
| Part XII, Line 2d - Other Adjustments: | Occupancy Expenses Allocated to Building Rental 28,414. |
| Part XII, Line 4b - Other Adjustments: | Dental Community Benefit 432,998. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (14 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| William R Brandon MD part year | ||||||||||||||
| Executive Director | $251,046 | $0 | $25,439 | $0 | $3,621 | $0 | $1,324 | $0 | $15,773 | $0 | $297,203 | $0 | $0 | $0 |
| Ellen L Caille part year | ||||||||||||||
| Executive Vice President | $0 | $241,615 | $0 | $36,274 | $0 | $27,520 | $0 | $51,911 | $0 | $31,469 | $0 | $388,789 | $0 | $0 |
| Paul R Cass DO | ||||||||||||||
| Director/Physician | $0 | $352,160 | $0 | $64,354 | $0 | $26,921 | $0 | $68,458 | $0 | $15,970 | $0 | $527,863 | $0 | $0 |
| Barbara F Civiello MD part year | ||||||||||||||
| Director/Physician | $387,554 | $0 | $114,259 | $0 | $22,220 | $0 | $10,200 | $0 | $18,470 | $0 | $552,703 | $0 | $0 | $0 |
| Matthew Goldberg DO | ||||||||||||||
| Director/Physician | $173,668 | $0 | $76,581 | $0 | $4,643 | $0 | $7,818 | $0 | $3,050 | $0 | $265,760 | $0 | $0 | $0 |
| Nancy J Pettinari MD | ||||||||||||||
| Director/Physician | $181,450 | $0 | $63,026 | $0 | $4,059 | $0 | $7,336 | $0 | $730 | $0 | $256,601 | $0 | $0 | $0 |
| Gary Usher MD part year | ||||||||||||||
| Director/Physician | $229,796 | $0 | $49,715 | $0 | $4,734 | $0 | $0 | $0 | $12,013 | $0 | $296,258 | $0 | $0 | $0 |
| Gregory J Walker | ||||||||||||||
| President/CEO, WDH | $0 | $410,195 | $0 | $111,478 | $0 | $204,014 | $0 | $125,854 | $0 | $25,755 | $0 | $877,296 | $0 | $0 |
| Peter E Walcek | ||||||||||||||
| CFO/VP Finance, WDH | $0 | $294,269 | $0 | $38,390 | $0 | $10,580 | $0 | $59,527 | $0 | $26,495 | $0 | $429,261 | $0 | $0 |
| Roger Evans MD | ||||||||||||||
| Physician | $422,901 | $0 | $9,500 | $0 | $20,247 | $0 | $10,200 | $0 | $16,985 | $0 | $479,833 | $0 | $0 | $0 |
| Girish C Joshi MD | ||||||||||||||
| Physician | $260,802 | $0 | $197,912 | $0 | $4,099 | $0 | $8,473 | $0 | $23,018 | $0 | $494,304 | $0 | $0 | $0 |
| Lazaro A Diaz MD | ||||||||||||||
| Physician | $392,178 | $0 | $57,757 | $0 | $21,720 | $0 | $0 | $0 | $25,929 | $0 | $497,584 | $0 | $0 | $0 |
| Silvia Milancovici MD | ||||||||||||||
| Physician | $380,136 | $0 | $13,966 | $0 | $22,181 | $0 | $7,499 | $0 | $23,995 | $0 | $447,777 | $0 | $0 | $0 |
| William S Danford MD | ||||||||||||||
| Physician | $345,129 | $0 | $99,152 | $0 | $4,720 | $0 | $2,501 | $0 | $24,672 | $0 | $476,174 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3 | The President/CEO of Wentworth-Douglass Physician Corp is an employee of Wentworth-Douglass Hospital, a related organization, and WDPC does not maintain any procedures to establish his compensation. However, the Hospital uses its executive committee, an independent national compensation consultant, compensation surveys, and requires final approval by its independent Board Members to determined executive compensation for all vice-presidents and above. |
| Part I, Lines 4a-b | In 2013, William R. Brandon (former board member/executive director) received a gross serverance payment of $185,790. Gregory J. Walker (President/CEO) - 2013 total contributions to the 457(f) plan = $113,104. This supplemental retirement plan contribution is intended to fund benefits accruing and payable at retirement for multiple years of service that began in calendar year 1997. In 2013, the Hospital funded a supplemental executive retirement plan which provides benefits to other qualifying executives. The contributions are intended to provide a forfeitable supplemental retirement benefit and are being provided in consideration for many years of service to the Hospital. The respective contributions for the 20123 plan year, for those individuals identified in Schedule J - Part II, are as follows: Peter E. Walcek = $47,405, Ellen L. Caille = $41,730, and Paul R. Cass = $55,708. WDH sponsors a split-dollar life insurance employee benefit program for certain officers and key employees. Split dollar life insurance is an arrangement in which the employee is the owner of the life insurance policy and the premiums are paid by the employer. Pursuant to WDH's split-dollar agreement, and the collateral assignment therein, the employer's share of the policy premiums paid is recovered either upon termination of the policy or at the death of the participant. Note that the split-dollar arrangement is part of an employee benefit program and economically not a direct extension of credit. Furthermore, the reportable compensation of the respective employees includes the annual value of the life insurance. Total premiums paid during 12/31/13 were $21,444 for Peter E. Walcek. The taxable value of the life insurance policy has been included in each individuals' W-2. The policies are intended to provide an additional retirement benefit for these individuals' multiple years of service. |
| Part I, Line 7 | At-risk compensation for Wentworth-Douglass executives, which is subject to review and paid annually. Wentworth-Douglass Physician Corporation has an incentive-based compensation model that uses relative value units (RVUs) as a measure for determining physician compensation within the Medical Group Management Association published salary ranges. The model includes a base salary plus incentive compensation that has both productivity and performance components inclusive of patient satisfaction and quality. Both budgeted performance and actual performance are measured. |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Gregory J Walker | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | President/CEO | RelationshipDescriptionTxt |
| Transaction | $0 | TransactionAmt |
| Transaction | Gregory J. Walker, President/CEO is an officer of Granite Shield Insurance Exchange (GSIE). Wentworth-Douglass Hospital made a capital contribution of $250,000 to Granite Shield Insurance Exchange (GSIE) in February of 2011 bringing the Hospital's ownership interest in GSIE to approximately 11%. WDH also made captive insurance payments totaling $1,653,470 to GSIE in 2013. Insurance payments for Wentworth-Douglass Physician Corp. are included in that total. | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 6 | Wentworth-Douglass Health System (WDHS), a New Hampshire nonprofit corporation, was formed as the result of the corporate restructuring of Wentworth-Douglass Hospital (WDH) into an integrated health system. WDHS serves as the parent company of WDH and its affiliates Wentworth-Douglass Hospital and Health Foundation (WDHHF) and Wentworth-Douglass Physician Corporation (WDPC), all of which are New Hampshire nonprofit corporations that have been recognized as being 501(c)(3) organizations. These corporations share a common mission with WDH. WDHS is intended to act as a supporting organization of WDH, serving in the role of the "parent company" of the Hospital and the affiliates. WDHS is the sole member of WDPC. |
| Form 990, Part VI, Section A, line 7a | WDHS will appoint the Board members for WDPC. |
| Form 990, Part VI, Section A, line 7b | Wentworth-Douglass Health System has the power to appoint and remove directors of WDPC, and all actions pertaining to the property, business, and affairs of WDPC, including WDPC's annual budget, are subject to the approval of WDHS. |
| Form 990, Part VI, Section B, line 11 | A draft of the Form 990 is initially reviewed in detail by key Wentworth-Douglass Hospital finance employees. Thereafter, the final draft is presented to the full board prior to filing with the IRS. Each member of the Board and Finance Committee is provided with a draft of the Form 990 in advance of each meeting. |
| Form 990, Part VI, Section B, line 12c | A copy of WDPC'S Conflict Of Interest Policy is distributed annually to all officers, trustees, medical staff officers and committee members, and the management team. All are required to report any conflicts and sign, date, and return the policy, whether or not a conflict exists, to confirm compliance. Conflicts are disclosed in accordance with State of New Hampshire RSA 7:19-a, in the local newspaper, and submitted to the New Hampshire Attorney General. |
| Form 990, Part VI, Section B, line 15 | CEO's Compensation: The compensation and benefits of Wentworth-Douglass Hospital's CEO are reviewed, adjusted and voted on by the Wentworth-Douglass Hospital (WDH) independent Board Members annually. See WDH's separate Form 990 for further details. Compensation of Key Employees: The CEO reviews the salaries of key employees annually and recommends compensation based on performance, salary ranges and market competitive data. Compensation data is provided by an independent national consulting firm every other year. The CEO presents salary range data for key employees to the board annually for approval. Using the Board approved salary range data, the CEO recommends salary increases for vice presidents to the WDH Board for approval and the vice presidents recommend salary increases for Directors and other management positions to the CEO, for approval. All compensation for vice presidents and above requires final approval by the WDH independent Board Members. |
| Form 990, Part VI, Section C, line 19 | Wentworth-Douglass Physician Corporation (WDPC) files audited financial statements annually with the New Hampshire Attorney General's Charitable Trust Unit and informs the Director of Charitable Trusts of any pecuniary benefit transactions that have occurred between the Foundation and a board member or officer. Notices of such transactions of $5,000 or more are also published in the local newspaper in accordance with NH RSA 7:19-a, II(d). Current copies of the Bylaws, Conflict Of Interest Policy, and Form 990 are on file with the Charitable Trust Unit. The Organization also makes these documents available upon request. |
| Form 990, Part VII, Section A | Reportable Compensation from Related Organizations: The 2013 compensation reported for Gregory Walker, Peter Walcek, and Ellen Caille was paid by Wentworth-Douglass Hospital for their services as full-time executives. Gregory Walker and Peter Walcek each worked an average of 55 hours per week and Ellen Caille 50 hours per week. Of the respective hours worked by each, an average of 2 hours per week was dedicated to Wentworth-Douglass Physician Corporation. |
| Form 990, Part IX, line 11g | Temp Help: Program service expenses 3,332. Management and general expenses 0. Fundraising expenses 0. Total expenses 3,332. Purchased Services: Program service expenses 5,260,780. Management and general expenses 1,038,993. Fundraising expenses 0. Total expenses 6,299,773. Consulting: Program service expenses 0. Management and general expenses 155,264. Fundraising expenses 0. Total expenses 155,264. |
| Form 990, Part XI, line 9: | Equity Transfer from Wentworth-Douglass Hospital 19,762,437. |
| Form 990, Part XII, Line 2c | Audit Review Process: The audit process for WDPC is overseen by the Finance Committee, in conjunction with that for Wentworth-Douglass Hospital. The audit process for the financial statements did not change from the prior year. Independent accountants performed the audit in both 2012 and 2013. Consolidated financial statements were prepared for 2013. |
| Form 990, Part III, Line 4a | WDPC'S Facilities: Wentworth-Douglass Physician Corporation does not file a separate annual community benefit report. Rather, Wentworth-Douglass Hospital (WDH) includes WDPC data with its community benefit report that is filed annually with the State of New Hampshire. WDHS owns 100% of WDPC, and oversees all of WDPC's primary care and specialty practices, outpatient physician clinics and its dental clinic, which are located as follows: Adult & Children's Medicine, 10 Members Way, Suite 201, Dover, NH Allergy Associates of NH, 10 Members Way, Suite 200, Dover, NH Barrington Health Center, 8 Century Pines Drive, Barrington, NH Bellamy Health Center, 15 Old Rollinsford Road, Dover, NH Center for Medical Genetics, 15 Old Rollinsford Road, Suite 201, Dover, NH Coastal Neurology Services, 158 E. NH Route 108, Suite 5, Dover, NH Diabetes Services: Inpatient Services, 789 Central Avenue, Dover, NH Dover Family Practice, 10 Members Way, Suite 203, Dover, NH Dover Internal and Geriatric Medicine, 10 Members Way, Suite 301, Dover, NH Dover Women's Health, 700 Central Avenue, Dover, NH Durham Health Center, 36 Madbury Road, Durham, NH Endocrinology and Diabetes, 10 Members Way, Suite 400, Dover, NH Great Bay Family Practice, 60 Exeter Road, Suite 300, Newmarket, NH Gynecology and Infertility Associates, 15 Old Rollinsford Road, Suite 102, Dover, NH Hilltop Family Practice, 85 Main Street, Somersworth, NH Lee Family Practice, 65 Calef Highway, Suite 200, Lee, NH Manchester Urology Association at Dover, 10 Members Way, Suite 402, Dover, NH Marshwood Family Care, 19 Levesque Drive, Suite 2, Eliot, ME Outpatient Diabetes Services, 10 Members Way, Suite 203, Dover, NH Palliative Care, 789 Central Avenue, Level 2, Dover, NH Plastic Surgery Specialists, 10 Members Way, Suite 303, Dover, NH Primary Care Of Dover, 10 Members Way, Suite 300, Dover, NH Seacoast Arthritis & Osteoporosis Center, 10 Members Way, Suite 403, Dover, NH Seacoast Cancer Center, 789 Central Avenue, Dover, NH Seacoast General Surgery, 750 Central Avenue, Suite N, Dover, NH Seacoast Integrative Medicine, 15 Old Rollinsford Road, Dover, NH Seacoast Pulmonary (Intensivists), 789 Central Avenue, Level 1, Dover, NH South Berwick Family Practice, 31 Colcord Street, South Berwick, ME Strafford Medical Associates, 10 Members Way, Suite 302, Dover, NH Summit Infectious Disease, 789 Central Avenue, Dover, NH The Hosptial Medicine Team (formerly Hospitalists), 789 Central Avenue, Level 2, Dover, NH WD Community Dental Center, 668 Central Avenue, Dover, NH WHP After Hours, 10 Members Way, Suite 203, Dover, NH WHP Behavioral Health Services, 10 Members Way, Suite 302, Dover, NH WHP Cardiovascular Group, 19 Old Rollinsford Road, Dover, NH WHP Thoracic Surgery Specialists, 789 Central Avenue, Dover, NH Wound Healing Institute, 789 Central Avenue, Dover, NH |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Wentworth-Douglass Hospital | |||||||||||
| 789 Central Avenue | Dover | NH | 03820 | 020260334 | Health care | NH | 501(c)(3) | Line 3 | Wentworth-Douglass Health System | 0 | |
| Wentworth-Douglass Hospital & Health Foundation | |||||||||||
| 789 Central Avenue | Dover | NH | 03820 | 510491062 | Philanthropic fund raising & stewardship | NH | 501(c)(3) | Line 11b, II | Wentworth-Douglass Health System | 0 | |
| Wentworth-Douglass Health System | |||||||||||
| 789 Central Avenue | Dover | NH | 03820 | 461635259 | Support and further charitable activities of Hospital and related entities | NH | 501(c)(3) | Line 11b, II | 0 | N/A | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Wentworth-Douglass Community Health Corporation | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 789 Central Avenue | AddressLine1 |
| City | Dover | City |
| State | NH | State |
| ZIP Code | 03820 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 020399963 | EIN |
| Primary Activities | Health fitness center | PrimaryActivitiesTxt |
| Legal Domicile State | NH | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Entity Type | C | EntityTypeTxt |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
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