Civic Intelligence

Chmc Anesthesia Foundation Inc Retiree Medical Benefit Trust

990 • Fiscal year 2015 • EIN 26-0538595

Jul 01, 2014 to Jun 30, 2015 • Filed on May 11, 2016

Refreshing map…

300 Longwood AvenueBoston, MA 02115

(617) 355-7267

Siviq Scores

Precomputed percentiles for this filing year versus similar nonprofits in the same peer cohort.

Liabilities / Assets

18th percentile

0.00x

Tied with the lowest-debt nonprofits in its peer group.

2015 filings • 501(c)9 • $10M-$25M nonprofits • Source year 2015

Liabilities / Revenue

18th percentile

0.00x

Tied with the lowest-debt nonprofits in its peer group.

2015 filings • 501(c)9 • $10M-$25M nonprofits • Source year 2015

Net Margin

100th percentile

99%

Higher net margin than 100% of similar nonprofits.

2015 filings • 501(c)9 • $10M-$25M nonprofits • Source year 2015

Top Officer Pay

99th percentile

$1,991,827

Higher top officer pay than 99% of similar nonprofits.

Top officer pay equals 186.4% of source-year revenue.

2015 filings • 501(c)9 • $10M-$25M nonprofits • Source year 2015

Asset Growth

59th percentile

3.6%

Faster asset growth than 59% of similar nonprofits.

2015 filings • 501(c)9 • $10M-$25M nonprofits • Annualized from 2014 to 2015

Revenue Growth

21st percentile

-8.0%

Faster revenue growth than 21% of similar nonprofits.

2015 filings • 501(c)9 • $10M-$25M nonprofits • Annualized from 2014 to 2015

Assets

Up

$15,909,175

Up $545,731 (+3.6%) from 2014

Net Assets

Up

$15,909,175

Up $545,731 (+3.6%) from 2014

Liabilities

Flat

$0

Flat from 2014

Revenue

Down

$1,068,514

Down $92,900 (-8.0%) from 2014

Expenses

Down

$6,365

Down $13,449 (-68%) from 2014

Net Income

Down

$1,062,149

Down $79,451 (-7.0%) from 2014

Historical Trend

Balance Sheet Trend

The highlighted filing sits inside the broader history for assets, liabilities, and net assets.

$30M$20M$10M$0Assets 2014: $15,363,444Liabilities 2014: $0Net Assets 2014: $15,363,4442014Assets 2015: $15,909,175Liabilities 2015: $0Net Assets 2015: $15,909,1752015Assets 2016: $15,650,540Liabilities 2016: $0Net Assets 2016: $15,650,5402016Assets 2017: $17,810,572Liabilities 2017: $0Net Assets 2017: $17,810,5722017Assets 2018: $19,598,197Liabilities 2018: $0Net Assets 2018: $19,598,1972018Assets 2019: $20,371,644Liabilities 2019: $0Net Assets 2019: $20,371,6442019Assets 2020: $21,055,191Liabilities 2020: $0Net Assets 2020: $21,055,1912020Assets 2021: $27,706,296Liabilities 2021: $0Net Assets 2021: $27,706,2962021Assets 2022: $24,046,764Liabilities 2022: $0Net Assets 2022: $24,046,7642022

Highlighted filing

2015

Assets$15,909,175
Liabilities$0
Net Assets$15,909,175

Operations Trend

Revenue, expenses, and net income across loaded years, with this filing highlighted.

$2.0M$1.5M$1.0M$500K$0Revenue 2014: $1,161,414Expenses 2014: $19,814Net Income 2014: $1,141,6002014Revenue 2015: $1,068,514Expenses 2015: $6,365Net Income 2015: $1,062,1492015Revenue 2016: $405,691Expenses 2016: $15,504Net Income 2016: $390,1872016Revenue 2017: $632,949Expenses 2017: $8,292Net Income 2017: $624,6572017Revenue 2018: $1,094,590Expenses 2018: $298Net Income 2018: $1,094,2922018Revenue 2019: $1,066,331Expenses 2019: $36,552Net Income 2019: $1,029,7792019Revenue 2020: $86,825Expenses 2020: $33,000Net Income 2020: $53,8252020Revenue 2021: $1,717,804Expenses 2021: $67,172Net Income 2021: $1,650,6322021Revenue 2022: $1,504,344Expenses 2022: $65,908Net Income 2022: $1,438,4362022

Highlighted filing

2015

Revenue$1,068,514
Expenses$6,365
Net Income$1,062,149
Jump To
Filing Snapshot
Filing Period
Jul 1, 2014 to Jun 30, 2015
Signed
May 11, 2016
Return Version
2014v6.0
Gross Receipts
$5,908,457
Mission and Program Overview

Mission

The retiree medical plan is a welfare plan as defined by ERISA. The plan is funded entirely by CHMC Anesthesia Foundation, Inc. (the employer). Benefits reimburse qualifying medical expenses defined in IRC Sections 213(d), incurred by participants, spouses, and dependent children not reimbursed from other sources.

Tax-exempt employee benefit trust

Balance Sheet Detail
LineBeginningEndChange
Assets
Rtn Earn Endowment Incm Other Fnds$15,363,444$15,909,175▲ $545,731
Investments in Publicly Traded Securities$15,166,658$15,691,688▲ $525,030
Cash and Non-Interest-Bearing Accounts$196,786$217,487▲ $20,701
Pd in Cap Srpls Land Bldg Eqp Fund$0$0→ $0
Cap Stk Tr Prin Current Funds$0$0→ $0
Total Assets$15,363,444$15,909,175▲ $545,731
Liabilities
Total Liabilities$0$0→ $0
Net Assets / Fund Balance
Total Net Assets Fund Balance$15,363,444$15,909,175▲ $545,731
Total Liabilities and Net Assets / Fund Balance$15,363,444$15,909,175▲ $545,731
Compensation and Service Providers

Board Members and Trustees

NameTitle
Babu Koka MDRMB Committee Member
Charles Nargozian MDRMB Committee Member
Mark A Rockoff MDRMB Committee Member
Michael McManus MDRMB Committee Member
Paul R Hickey MDRMB Committee Member
Revenue and Support

Revenue Composition

Contributions and Grants
$0
Program Service Revenue
$0
Investment Income
$1,068,514
Other Revenue
$0
Change in Net Assets
$1,062,149
Expenses and Functional Allocation

Major Expense Lines

Line ItemAmount
Grants and Similar Amounts Paid$0
Other Expenses$0
Professional Fundraising Fees$0
Salaries, Compensation, and Employee Benefits$0
Total Fundraising Expense$0

Functional Expense Allocation

Line ItemProgramManagementFundraisingTotal
Benefits to Members---$6,365
Total Functional Expenses$0$0$0$6,365
Fundraising, Events, and Gaming
Fundraising activities
No
Gaming activities
No
Professional fundraiser used
No

Fundraising and Gaming Totals

Line ItemAmount
Professional Fundraising Fees$0
Political and Lobbying Activity
Political campaign activity
No
Subject to proxy tax
No
Governance and Compliance

Governance Checklist

Compiled or reviewed by an accountant
No
Annual disclosure for covered persons
Yes
Business relationship with family members
No
Business relationship with organization members
No
Material changes to governing documents
No
Compensation from other sources disclosed
No
CEO compensation reviewed
No
Other officer compensation reviewed
No
Conflict-of-interest policy
Yes
Audited financial statements prepared
No
Key decisions subject to board approval
No
Management duties delegated
No

Governance Explanations

Form 990, Part VI, Section B, line 11

The Form 990 is reviewed by a Trustee and by the Director of Finance and the Business Manager of CHMC Anesthesia Foundation, Inc.

Form 990, Part VI, Section B, line 12C

The Trust follows the conflict of interest policies of its tax-exempt employer, CHMC Anesthesia Foundation, Inc. The Trustees are required to file disclosure statements annually and have an affirmative obligation to disclose any situation in which they may have a conflict of interest. In the event of a conflict, the Trustee with the conflict cannot vote on any matter related to the conflict.

Form 990, Part VI, Section C, line 19

Documents are made available to the public upon request.

Form 990, Part VII, Section A, Line 1A:

RMB Committee Member Dr. Paul Hickey devoted an average of 60 hours per week to a related organization (CHMC Anesthesia Foundation, Inc.) in his position as Professor of Anesthesia. RMB Committee Member Dr. Babu Koka devoted an average of 60 hours per week to a related organization (CHMC Anesthesia Foundation, Inc.) in his position as Professor of Anesthesia. RMB Committee Member Dr. Michael McManus devoted an average of 60 hours per week to a related organization (CHMC Anesthesia Foundation, Inc.) in his position as Associate Professor of Anesthesia. RMB Committee Member Dr. Charles Nargozian devoted an average of 60 hours per week to a related organization (CHMC Anesthesia Foundation, Inc.) in his position as Assistant Professor of Anesthesia. RMB Committee Member Dr. Mark Rockoff devoted an average of 60 hours per week to a related organization (CHMC Anesthesia Foundation, Inc.) in his position as Professor of Anesthesia.

Filing and Contact Details

Filer

Filer Name
CHMC Anesthesia Foundation Inc
EIN
26-0538595
Phone
6173557267
Address
300 Longwood Avenue, Boston, MA 02115

Signing Officer

Name
Paul R Hickey MD
Title
RMB Committee Member Trustee
Phone
6173557267
Signed
2016-05-11
Discuss with paid preparer
Yes

Organization Details

Principal Officer
Paul R Hickey MD
Formed
2006
Legal Domicile
Ma
Voting Board Members
5
Independent Board Members
0
Employees
0
Volunteers
0

Preparer

Firm
Baker Newman & Noyes
Address
PO Box 507, Portland, ME 04112
Preparer
Nicholas E Porto
Phone
2078792100
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This appendix keeps the raw XML leaves available for debugging and edge-case review. The human report above is the primary experience.

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IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt2RMB Committee Member
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt3RMB Committee Member
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt4RMB Committee Member
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TotalCompensationFilingOrgAmt00
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TotalCompensationFilingOrgAmt10
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TotalCompensationFilingOrgAmt20
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TotalCompensationFilingOrgAmt30
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TotalCompensationFilingOrgAmt40
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TotalCompensationRltdOrgsAmt01991827
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TotalCompensationRltdOrgsAmt1658531
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TotalCompensationRltdOrgsAmt21061652
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TotalCompensationRltdOrgsAmt3657661
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TotalCompensationRltdOrgsAmt4994081
IRS990ScheduleJ/SeverancePaymentInd00
IRS990ScheduleJ/SupplementalInformationDetail/ExplanationTxt0All individuals listed in Schedule J, Part II, are compensated by a related organization, CHMC Anesthesia Foundation, Inc., which relied on a compensation committee, Forms 990 of other organizations, compensation surveys/studies, and approval by the board or compensation committee to establish compensation of the CEO/Executive Director in fiscal year ending June 30, 2015.
IRS990ScheduleJ/SupplementalInformationDetail/ExplanationTxt1CHMC Anesthesia Foundation, Inc. (a related organization) established the CHMC Anesthesia Foundation, Inc. 2005 Supplemental Executive Retirement Plan (SERP), effective as of January 1, 2005 to reward licensed physician employees with a benefit based on service. The SERP's sources of contributions are from employer discretionary amounts (if any), severance benefits, and elective deferrals. The amounts are vested after five years, attainment of normal retirement date, death, disability, or change in control. The following individuals on Form 990, Part VII received the following SERP payments from CHMA Anesthesia Foundation, Inc. during the year: Paul Hickey, M.D.-$285,052 Babu Koka, M.D.-$66,114 Mark Rockoff, M.D.-$27,969
IRS990ScheduleJ/SupplementalInformationDetail/FormAndLineReferenceDesc0Part I, Line 3
IRS990ScheduleJ/SupplementalInformationDetail/FormAndLineReferenceDesc1Part I, Line 4b
IRS990ScheduleJ/SupplementalNonqualRtrPlanInd01
IRS990/ScheduleORequiredInd01
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt0The Form 990 is reviewed by a Trustee and by the Director of Finance and the Business Manager of CHMC Anesthesia Foundation, Inc.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt1The Trust follows the conflict of interest policies of its tax-exempt employer, CHMC Anesthesia Foundation, Inc. The Trustees are required to file disclosure statements annually and have an affirmative obligation to disclose any situation in which they may have a conflict of interest. In the event of a conflict, the Trustee with the conflict cannot vote on any matter related to the conflict.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt2Documents are made available to the public upon request.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt3RMB Committee Member Dr. Paul Hickey devoted an average of 60 hours per week to a related organization (CHMC Anesthesia Foundation, Inc.) in his position as Professor of Anesthesia. RMB Committee Member Dr. Babu Koka devoted an average of 60 hours per week to a related organization (CHMC Anesthesia Foundation, Inc.) in his position as Professor of Anesthesia. RMB Committee Member Dr. Michael McManus devoted an average of 60 hours per week to a related organization (CHMC Anesthesia Foundation, Inc.) in his position as Associate Professor of Anesthesia. RMB Committee Member Dr. Charles Nargozian devoted an average of 60 hours per week to a related organization (CHMC Anesthesia Foundation, Inc.) in his position as Assistant Professor of Anesthesia. RMB Committee Member Dr. Mark Rockoff devoted an average of 60 hours per week to a related organization (CHMC Anesthesia Foundation, Inc.) in his position as Professor of Anesthesia.
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc0Form 990, Part VI, Section B, line 11
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc1Form 990, Part VI, Section B, line 12c
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc2Form 990, Part VI, Section C, line 19
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc3Form 990, Part VII, Section A, Line 1a:
IRS990ScheduleR/AssetExchangeInd00
IRS990ScheduleR/AssetPurchaseFromOtherOrgInd00
IRS990ScheduleR/AssetSaleToOtherOrgInd00
IRS990ScheduleR/DivRelatedOrganizationInd00
IRS990ScheduleR/GiftGrntCapContriFromOthOrgInd00
IRS990ScheduleR/GiftGrntOrCapContriToOthOrgInd00
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/ControlledOrganizationInd00
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/DirectControllingNACd0N/A
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/DisregardedEntityName/BusinessNameLine1Txt0CHMC Anesthesia Foundation Inc
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/EIN0042702169
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IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/PrimaryActivitiesTxt0To promote anesthesiology services and research
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IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/AddressLine1Txt0300 Longwood Avenue - Bader 3
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/CityNm0Boston
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/StateAbbreviationCd0MA
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/ZIPCd002115
IRS990ScheduleR/LoansOrGuaranteesFromOthOrgInd00
IRS990ScheduleR/LoansOrGuaranteesToOtherOrgInd00
IRS990ScheduleR/PaidEmployeesSharingInd00
IRS990ScheduleR/PerformOfServicesByOtherOrgInd00
IRS990ScheduleR/PerformOfServicesForOthOrgInd00
IRS990ScheduleR/ReceiptOfIntAnntsRntsRyltsInd00
IRS990ScheduleR/ReimbursementPaidByOtherOrgInd00
IRS990ScheduleR/ReimbursementPaidToOtherOrgInd00
IRS990ScheduleR/RentalOfFacilitiesToOthOrgInd00
IRS990ScheduleR/RentalOfFcltsFromOthOrgInd00
IRS990ScheduleR/SharingOfFacilitiesInd00
IRS990ScheduleR/TransferFromOtherOrgInd01
IRS990ScheduleR/TransferToOtherOrgInd00
IRS990/SchoolOperatingInd00
IRS990/SignificantChangeInd00
IRS990/SignificantNewProgramSrvcInd00
IRS990/SubjectToProxyTaxInd00
IRS990/TaxablePartyNotificationInd00
IRS990/TaxExemptBondsInd00
IRS990/TempOrPermanentEndowmentsInd00
IRS990/TerminateOperationsInd00
IRS990/TotalAssetsBOYAmt015363444
IRS990/TotalAssetsEOYAmt015909175
IRS990/TotalAssetsGrp/BOYAmt015363444
IRS990/TotalAssetsGrp/EOYAmt015909175
IRS990/TotalCompGreaterThan150KInd01
IRS990/TotalEmployeeCnt00
IRS990/TotalFunctionalExpensesGrp/TotalAmt06365
IRS990/TotalGrossUBIAmt00
IRS990/TotalLiabilitiesBOYAmt00
IRS990/TotalLiabilitiesEOYAmt00
IRS990/TotalLiabilitiesGrp/BOYAmt00
IRS990/TotalLiabilitiesGrp/EOYAmt00
IRS990/TotalNetAssetsFundBalanceGrp/BOYAmt015363444
IRS990/TotalNetAssetsFundBalanceGrp/EOYAmt015909175
IRS990/TotalOtherCompensationAmt0799940
IRS990/TotalReportableCompFromOrgAmt00
IRS990/TotalRevenueGrp/ExclusionAmt01068514
IRS990/TotalRevenueGrp/RelatedOrExemptFuncIncomeAmt00
IRS990/TotalRevenueGrp/TotalRevenueColumnAmt01068514
IRS990/TotalRevenueGrp/UnrelatedBusinessRevenueAmt00
IRS990/TotalVolunteersCnt00
IRS990/TotLiabNetAssetsFundBalanceGrp/BOYAmt015363444
IRS990/TotLiabNetAssetsFundBalanceGrp/EOYAmt015909175
IRS990/TotReportableCompRltdOrgAmt04563812
IRS990/TypeOfOrganizationTrustInd0X
IRS990/UnrelatedBusIncmOverLimitInd00
IRS990/UponRequestInd0X
IRS990/USAddress/AddressLine1Txt0300 Longwood Avenue
IRS990/USAddress/CityNm0Boston
IRS990/USAddress/StateAbbreviationCd0MA
IRS990/USAddress/ZIPCd002115
IRS990/VotingMembersGoverningBodyCnt05
IRS990/VotingMembersIndependentCnt00
IRS990/WebsiteAddressTxt0N/A
IRS990/WhistleblowerPolicyInd01
ReturnHeader/BuildTS02016-08-17 19:52:53Z
ReturnHeader/BusinessOfficerGrp/DiscussWithPaidPreparerInd01
ReturnHeader/BusinessOfficerGrp/PersonNm0Paul R Hickey MD
ReturnHeader/BusinessOfficerGrp/PersonTitleTxt0RMB Committee Member Trustee
ReturnHeader/BusinessOfficerGrp/PhoneNum06173557267
ReturnHeader/BusinessOfficerGrp/SignatureDt02016-05-11
ReturnHeader/Filer/BusinessName/BusinessNameLine1Txt0CHMC Anesthesia Foundation Inc
ReturnHeader/Filer/BusinessName/BusinessNameLine2Txt0Retiree Medical Benefit Trust
ReturnHeader/Filer/BusinessNameControlTxt0CHMC
ReturnHeader/Filer/EIN0260538595
ReturnHeader/Filer/PhoneNum06173557267
ReturnHeader/Filer/USAddress/AddressLine1Txt0300 Longwood Avenue
ReturnHeader/Filer/USAddress/CityNm0Boston
ReturnHeader/Filer/USAddress/StateAbbreviationCd0MA
ReturnHeader/Filer/USAddress/ZIPCd002115
ReturnHeader/PreparerFirmGrp/PreparerFirmEIN0010494526
ReturnHeader/PreparerFirmGrp/PreparerFirmName/BusinessNameLine1Txt0Baker Newman & Noyes
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/AddressLine1Txt0PO Box 507
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/CityNm0Portland
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/StateAbbreviationCd0ME
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/ZIPCd004112
ReturnHeader/PreparerPersonGrp/PhoneNum02078792100
ReturnHeader/PreparerPersonGrp/PreparationDt02016-05-11
ReturnHeader/PreparerPersonGrp/PreparerPersonNm0Nicholas E Porto
ReturnHeader/ReturnTs02016-05-12T13:02:05-05:00
ReturnHeader/ReturnTypeCd0990
ReturnHeader/TaxPeriodBeginDt02014-07-01
ReturnHeader/TaxPeriodEndDt02015-06-30
ReturnHeader/TaxYr02014

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