MASS GENERAL BRIGHAM INCORPORATED: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- MASS GENERAL BRIGHAM INCORPORATED (EIN 02-0497927)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-10-15
- IRS object ID
- 201212899349300501
- Schema version
- 2011v1.2
- 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) |
|---|---|---|
| Timestamp | 2012-10-15T07:18:20-05:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 010494526 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Baker Newman & Noyes LLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| 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 | ReturnType |
| Tax Period Begin Date | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 020497927 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Wentworth-Douglass Physician Corporation | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | WENT | NameControl |
| Phone | 6037425252 | Phone |
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 |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Peter E Walcek | Name |
| Title | CFO/VP of Finance | Title |
| Phone | 6037422804 | Phone |
| Date Signed | 2012-10-05 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Timothy R Hepburn CPA | Name |
| PTIN | P00182393 | PTIN |
| Phone | 2078792100 | Phone |
| Date Prepared | 2012-10-05 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
Doing Business As DoingBusinessAs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Wentworth Health Partners | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Gregory J Walker | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| 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 | 26389308 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | N/A | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1998 | YearFormation |
| State Legal Domicile | NH | StateLegalDomicile |
| Activity Or Mission Description | Improve the health of the community by providing high quality healthcare. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 11 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 4 | NbrIndependentVotingMembers |
| Total Nbr Employees | 335 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 52234 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -3123 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 23560980 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 26288431 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 27938 | InvestmentIncomePriorYear |
| Investment Income Current Year | 0 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 67768 | OtherRevenuePriorYear |
| Other Revenue Current Year | 70426 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 23656686 | TotalRevenuePriorYear |
| Total Revenue Current Year | 26358857 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 29934723 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 30879639 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 11388085 | OtherExpensePriorYear |
| Other Expenses Current Year | 13569483 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 41322808 | TotalExpensesPriorYear |
| Total Expenses Current Year | 44449122 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -17666122 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -18090265 | RevenuesLessExpensesCY |
| Total Assets BOY | 3962487 | TotalAssetsBOY |
| Total Assets EOY | 4589855 | TotalAssetsEOY |
| Total Liabilities BOY | 4079036 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 4976680 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | -116549 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | -386825 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | Improve the health of the community by providing high quality health care that exceeds expectations through an integrated network of highly qualified professionals. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 39385282 | Expense |
| Revenue | 25165217 | Revenue |
| Description | 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 2011, the Corporation provided for a total of 198,259 patient visits. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 1589125 | Expense |
| Revenue | 1141406 | Revenue |
| Description | 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 300% of the federal poverty guidelines. In 2011, a total of 4,416 patient visits were recorded, with total revenue of $1,141,406 and expenses of $1,589,125 resulting in a net community benefit cost of $447,719.In addition, WDPC provided community benefits totaling nearly $400,000 in 2011. 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 300% of the federal poverty level, reduced to 200% effective 10/1/11. In 2011 WDPC provided $1,089,174 of financial aid (stated at cost). Medicaid Costs Exceeding Reimbursement totaled $459,184 for the Corporation in 2011. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 40974407 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 1 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 335 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 11 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 4 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | NH | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Peter E Walcek CFOVP of Finance | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 6037402804 | TelephoneNumber |
Address US AddressUS
| 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 | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (19 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| Neil Garvey | |||||||
| Chairman | 1.00 | X | X | 0 | 0 | 0 | |
| Roger Hamel | |||||||
| Vice Chairman | 1.00 | X | X | 0 | 0 | 0 | |
| Michael Steinberg | |||||||
| Treasurer | 1.00 | X | X | 0 | 0 | 0 | |
| Carol Bailey | |||||||
| Secretary | 1.00 | X | X | 0 | 0 | 0 | |
| Mark R Blackwood MD | |||||||
| Director/Physician (part year) | 65.00 | X | 199458 | 0 | 15447 | ||
| William Boc | |||||||
| Director (part year) | 0.50 | X | 0 | 0 | 0 | ||
| William R Brandon MD | |||||||
| Executive Director | 65.00 | X | 268637 | 0 | 7437 | ||
| Ellen L Caille | |||||||
| Executive Vice President | 2.00 | X | 0 | 290088 | 77688 | ||
| Barbara F Civiello MD | |||||||
| Director/Physician | 65.00 | X | 475884 | 0 | 27624 | ||
| Girish C Joshi MD | |||||||
| Director/Physician | 65.00 | X | 500974 | 0 | 25401 | ||
| Nancy J Pettinari MD | |||||||
| Director/Physician | 65.00 | X | 150952 | 0 | 7232 | ||
| Theodore Ristaino | |||||||
| Director (part year) | 1.00 | X | 0 | 0 | 0 | ||
| Peter E Walcek | |||||||
| CFO/VP Finance, WDH | 2.00 | X | X | 0 | 326016 | 75307 | |
| Gregory J Walker | |||||||
| President/CEO, WDH | 2.00 | X | X | 0 | 645708 | 148296 | |
| Roger Evans MD | |||||||
| Physician | 65.00 | 481303 | 0 | 27060 | X | ||
| Shubhra Ray MD | |||||||
| Physician | 65.00 | 341434 | 0 | 29476 | X | ||
| Taylor M Ortiz | |||||||
| Physician | 65.00 | 362657 | 0 | 6076 | X | ||
| Patricia A Auty MD | |||||||
| Physician | 65.00 | 348816 | 0 | 21652 | X | ||
| Cecil W Bean MD | |||||||
| Physician | 65.00 | 342827 | 0 | 16626 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 3472942 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1261812 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 485322 | TotalOtherCompensation |
| Number Individuals GT100 K | 81 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| Patient service revenu | 621110 | 25962890 | 25962890 | |
| Other related function | 621990 | 227923 | 175689 | 52234 |
| Other - UNH | 621990 | 97618 | 97618 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 26288431 | TotalProgramServiceRevenue |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 100877 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 30451 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 70426 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 70426 | TotalRevenueColumn |
| Related Or Exempt Function Income | 70426 | RelatedOrExemptFunctionIncome |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 26358857 | TotalRevenueColumn |
| Related Or Exempt Function Income | 26306623 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 52234 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1679063 | Total |
| Program Services | 1679063 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 24086293 | Total |
| Program Services | 22573674 | ProgramServices |
| Management And General | 1512619 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 275139 | Total |
| Program Services | 257860 | ProgramServices |
| Management And General | 17279 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2781955 | Total |
| Program Services | 2607248 | ProgramServices |
| Management And General | 174707 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2057189 | Total |
| Program Services | 1927998 | ProgramServices |
| Management And General | 129191 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 23034 | Total |
| Management And General | 23034 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20830 | Total |
| Management And General | 20830 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5544976 | Total |
| Program Services | 4509145 | ProgramServices |
| Management And General | 1035831 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 123184 | Total |
| Program Services | 25059 | ProgramServices |
| Management And General | 98125 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 565273 | Total |
| Program Services | 349051 | ProgramServices |
| Management And General | 216222 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3368832 | Total |
| Program Services | 3155357 | ProgramServices |
| Management And General | 213475 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 231700 | Total |
| Program Services | 198298 | ProgramServices |
| Management And General | 33402 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 534083 | Total |
| Program Services | 534083 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 582471 | Total |
| Program Services | 582471 | ProgramServices |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices |
|---|---|---|
| Provision for bad debt | 1212065 | 1212065 |
| Pharmacy expense | 623002 | 623002 |
| Dental community benefi | 447719 | 447719 |
| Transcription | 284127 | 284127 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8187 | Total |
| Program Services | 8187 | ProgramServices |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 44449122 | Total |
| Program Services | 40974407 | ProgramServices |
| Management And General | 3474715 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 68715 | BOY |
| EOY | 279189 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2112888 | BOY |
| EOY | 2555850 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 7423884 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 5672765 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1777187 | BOY |
| EOY | 1751119 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3697 | BOY |
| EOY | 3697 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3962487 | BOY |
| EOY | 4589855 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4079036 | BOY |
| EOY | 4976680 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4079036 | BOY |
| EOY | 4976680 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -116549 | BOY |
| EOY | -386825 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -116549 | BOY |
| EOY | -386825 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3962487 | BOY |
| EOY | 4589855 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -18090265 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 17819989 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule D IRS990ScheduleD
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2642982 | OtherCostOrOtherBasis |
| Depreciation | 1974361 | Depreciation |
| Book Value | 668621 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 4779539 | OtherCostOrOtherBasis |
| Depreciation | 3698404 | Depreciation |
| Book Value | 1081135 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1363 | OtherCostOrOtherBasis |
| Book Value | 1363 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 1751119 | TotalOfBookValueLandBuildings |
| Total Revenue | 26358857 | TotalRevenue |
| Total Expenses | 44449122 | TotalExpenses |
| Excess Or Deficit For Year | -18090265 | ExcessOrDeficitForYear |
| Other | $17,819,989 | OtherAmount |
| Total Adjustments | 17819989 | TotalAdjustments |
| Excess Or Deficit Per FS | -270276 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 26389308 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | 30451 | OtherRevenues |
| Revenue Not Rptd F990 | 30451 | RevenueNotRptdF990 |
| Revenue Subtotal | 26358857 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 26358857 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 44479573 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 30451 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 30451 | ExpensesNotRptdF990 |
| Expenses Subtotal | 44449122 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 44449122 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Description of Uncertain Tax Positions Under FIN 48: | Part X: | The audited financial statements contain the following paragraph in Footnote 1 pertaining to uncertain tax positions: "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 theses 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 2008." |
| Part XI, Line 8 - Other Adjustments: | Equity transfer from Wentworth-Douglass Hospital 17,819,989. | |
| Part XII, Line 2d - Other Adjustments: | Occupancy expenses allocated to building rental 30,451. | |
| Part XIII, Line 2d - Other Adjustments: | Occupancy expenses allocated to building rental 30,451. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 1 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (13 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Mark R Blackwood MD | |||||||||||||
| 151022 | 0 | 43716 | 0 | 4720 | 0 | 9310 | 0 | 6137 | 0 | 214905 | 0 | 0 | 0 |
| William R Brandon MD | |||||||||||||
| 241197 | 0 | 13417 | 0 | 14023 | 0 | 0 | 0 | 7437 | 0 | 276074 | 0 | 0 | 0 |
| Ellen L Caille | |||||||||||||
| 0 | 244925 | 0 | 35143 | 0 | 10020 | 0 | 51616 | 0 | 26072 | 0 | 367776 | 0 | 0 |
| Barbara F Civiello MD | |||||||||||||
| 356469 | 0 | 114695 | 0 | 4720 | 0 | 6370 | 0 | 21254 | 0 | 503508 | 0 | 0 | 0 |
| Girish C Joshi MD | |||||||||||||
| 186607 | 0 | 309647 | 0 | 4720 | 0 | 8729 | 0 | 16672 | 0 | 526375 | 0 | 0 | 0 |
| Nancy J Pettinari MD | |||||||||||||
| 125305 | 0 | 22527 | 0 | 3120 | 0 | 6081 | 0 | 1151 | 0 | 158184 | 0 | 0 | 0 |
| Peter E Walcek | |||||||||||||
| 0 | 279133 | 0 | 37192 | 0 | 9691 | 0 | 56035 | 0 | 19272 | 0 | 401323 | 0 | 0 |
| Gregory J Walker | |||||||||||||
| 0 | 416504 | 0 | 88826 | 0 | 140378 | 0 | 127804 | 0 | 20492 | 0 | 794004 | 0 | 0 |
| Roger Evans MD | |||||||||||||
| 476583 | 0 | 0 | 0 | 4720 | 0 | 9800 | 0 | 17260 | 0 | 508363 | 0 | 0 | 0 |
| Shubhra Ray MD | |||||||||||||
| 311615 | 0 | 24500 | 0 | 5319 | 0 | 12250 | 0 | 17226 | 0 | 370910 | 0 | 0 | 0 |
| Taylor M Ortiz | |||||||||||||
| 356691 | 0 | 3625 | 0 | 2341 | 0 | 0 | 0 | 6076 | 0 | 368733 | 0 | 0 | 0 |
| Patricia A Auty MD | |||||||||||||
| 334896 | 0 | 9200 | 0 | 4720 | 0 | 9800 | 0 | 11852 | 0 | 370468 | 0 | 0 | 0 |
| Cecil W Bean MD | |||||||||||||
| 338827 | 0 | 0 | 0 | 4000 | 0 | 0 | 0 | 16626 | 0 | 359453 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| Part I, Line 4b | Gregory J. Walker (President/CEO) - 2011 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 2011, 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 2011 plan year, for those individuals identified in Schedule J - Part II, are as follows: Peter E. Walcek = $42,466, and, Ellen L. Caille =$40,126. |
| 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, quality, and community citizenship metrics. Both budgeted performance and actual performance are measured. |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Granite Shield Insurance Exchange | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | Current officer serves both organizations | Relationship |
| Amount Of Transaction | 1172063 | AmountOfTransaction |
| Description Of Transaction | 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 $1,172,063 to GSIE in 2011. Insurance payments for Wentworth-Douglass Physician Corp. are included in that total. | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (8 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| 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 full Wentworth-Douglass Hospital (WDH) board annually. See WDH's separate Form 990 for further details. Compensation of Key Employees: The WDH CEO reviews the salaries of Wentworth-Douglass Physician Corporation's Key Employees annually and determines compensation based on performance, salary ranges and market competitive data. Compensation data is provided by an independent national consulting firm every other year. Using the Board approved salary range data, the CEO recommends salary increases. Physician salary ranges are established every other year using the Medical Group Management Association (MGMA) published salary survey data. | |
| 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 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. | |
| Form 990, Part VII, Section A, Column E | The 2011 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. | Reportable Compensation from Related Organizations |
| Form 990, Part XI, line 5: | Equity transfer from Wentworth-Douglass Hospital 17,819,989. Total to Form 990, Part XI, Line 5: 17,819,989. | Changes in Net Assets or Fund Balances: |
| Form 990, Part XII, Line 2c | 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 2010 and 2011. Consolidated financial statements were prepared for 2011. | Audit Review Process |
| Form 990, Part III, Line 4a | Wentworth-Douglass Physician Corporation does not file a separate annual community benefits report. Rather, Wentworth-Douglass Hospital (WDH) includes WDPC data with its community benefits report that is filed annually with the State of New Hampshire. WDH 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 Barrington Health Center, 2 Century Pines Drive, Barrington, NH Bellamy Health Center, 15 Old Rollinsford Road, Dover, NH Dover Family Practice, 10 Members Way, Suite 203, Dover, NH Dover Internal and Geriatric Medicine, 10 Members Way, Suite 301, Dover, NH Durham Health Center, 36 Madbury Road, Durham, NH Great Bay Family Practice, 60 Exeter Road, Unit 3, Newmarket, NH Hilltop Family Practice, 85 Main Street, Somersworth, NH Lee Family Practice, 65 Calef Highway, Suite 200, Lee, NH Marshwood Family Care, 19 Levesque Drive, Suite 2, Eliot, ME Primary Care Of Dover, 10 Members Way, Suite 300, Dover, NH South Berwick Family Practice, 31 Colcord Street, South Berwick, ME Strafford Medical Associates, 10 Members Way, Suite 302, Dover, NH Endocrinology & Diabetes, 19 Webb Place, Dover, NH Hospitalists, 789 Central Avenue, Level 2, Dover, NH Palliative Care, 789 Central Avenue, Level 3, Dover, NH Seacoast Arthritis & Osteoporosis, 15 Old Rollinsford Road, Suite 204, Dover, NH Seacoast Pulmonary (Intensivists), 789 Central Avenue, Level 3, Dover, NH Summit Infectious Disease, 15 Old Rollinsford Road, Dover, NH Wentworth Community Dental Care Center, 668 Central Avenue, Dover, NH Seacoast Integrative Medicine, 15 Old Rollinsford Road, Dover, NH Center for Medical Genetics, 17 Old Rollinsford Road, Suite 6, Dover, NH WHP After Hours, 10 Members Way, Suite 203, Dover, NH WHP Cardiovascular Group, 19 Old Rollinsford Road, Dover, NH WHP Thoracic Specialists, 789 Central Avenue, Dover, NH Plastic Surgery Specialists, 10 Members Way, Suite 303, Dover, NH | WDPC'S Facilities |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| Wentworth-Douglass Hospital | ||||||||||
| 789 Central Avenue | Dover | NH | 03820 | 020260334 | Health care | NH | 501(c)(3) | 170(b)(1) (A)(iii) | N/A | 0 |
| Wentworth-Douglass Hospital & Health Foundation | ||||||||||
| 789 Central Avenue | Dover | NH | 03820 | 510491062 | Philanthropic fund raising & stewardship | NH | 501(c)(3) | 509(a)(3) | N/A | 0 |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Wentworth-Douglass Community Health Corporation | BusinessNameLine1 |
Address US AddressUS
| 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 Activity | Health fitness center | PrimaryActivity |
| Legal Domicile State | NH | LegalDomicileState |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Type Of Entity | C | TypeOfEntity |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (3 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| Wentworth-Douglass Hospital | ||
| C | 17819989 | Actual per books |
| Wentworth-Douglass Hospital | ||
| O | 284127 | Actual per books |
| Wentworth-Douglass Hospital | ||
| J | 2296957 | Actual per books |
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