Liabilities / Assets
20th percentile
Tied with the lowest-debt nonprofits in its peer group.
Chmc Anesthesia Foundation Inc Retiree Medical Benefit Trust
990 • Fiscal year 2017 • EIN 26-0538595
Refreshing map…
Siviq Scores
Precomputed percentiles for this filing year versus similar nonprofits in the same peer cohort.
0.00x
Liabilities / Revenue
21st percentile
Tied with the lowest-debt nonprofits in its peer group.
Net Margin
99th percentile
Higher net margin than 99% of similar nonprofits.
Top Officer Pay
100th percentile
Higher top officer pay than 100% of similar nonprofits.
Top officer pay equals 271.2% of source-year revenue.
Asset Growth
71st percentile
Faster asset growth than 71% of similar nonprofits.
Revenue Growth
93rd percentile
Faster revenue growth than 93% of similar nonprofits.
Balance Sheet
Assets
Up$17,810,572
Up $2,160,032 (+14%) from 2016
Net Assets
Up$17,810,572
Up $2,160,032 (+14%) from 2016
Liabilities
Flat$0
Flat from 2016
Revenue And Expenses
Revenue
Up$632,949
Up $227,258 (+56%) from 2016
Expenses
Down$8,292
Down $7,212 (-47%) from 2016
Net Income
Up$624,657
Up $234,470 (+60%) from 2016
Historical Trend
Jump To
Filing Snapshot
- Filing Period
- Jul 1, 2016 to Jun 30, 2017
- Signed
- Apr 23, 2018
- Return Version
- 2016v3.0
- Gross Receipts
- $3,312,811
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
| Line | Beginning | End | Change |
|---|---|---|---|
| Assets | |||
| Rtn Earn Endowment Incm Other Fnds | $15,650,540 | $17,810,572 | ▲ $2,160,032 |
| Investments in Publicly Traded Securities | $15,362,940 | $17,425,091 | ▲ $2,062,151 |
| Cash and Non-Interest-Bearing Accounts | $287,600 | $385,481 | ▲ $97,881 |
| Pd in Cap Srpls Land Bldg Eqp Fund | $0 | $0 | → $0 |
| Cap Stk Tr Prin Current Funds | $0 | $0 | → $0 |
| Total Assets | $15,650,540 | $17,810,572 | ▲ $2,160,032 |
| Liabilities | |||
| Total Liabilities | $0 | $0 | → $0 |
| Net Assets / Fund Balance | |||
| Total Net Assets Fund Balance | $15,650,540 | $17,810,572 | ▲ $2,160,032 |
| Total Liabilities and Net Assets / Fund Balance | $15,650,540 | $17,810,572 | ▲ $2,160,032 |
Compensation and Service Providers
Board Members and Trustees
| Name | Title |
|---|---|
| Paul R Hickey MD | President/Treasurer |
| Babu Koka MD | Director |
| Charles Nargozian MD | Director |
| Michael McManus MD | Director |
| Mark A Rockoff MD | Clerk |
Revenue and Support
Revenue Composition
- Contributions and Grants
- $0
- Program Service Revenue
- $0
- Investment Income
- $632,949
- Other Revenue
- $0
- Change in Net Assets
- $624,657
Expenses and Functional Allocation
Major Expense Lines
| Line Item | Amount |
|---|---|
| Other Expenses | $8,292 |
| Grants and Similar Amounts Paid | $0 |
| Professional Fundraising Fees | $0 |
| Salaries, Compensation, and Employee Benefits | $0 |
| Total Fundraising Expense | $0 |
Functional Expense Allocation
| Line Item | Program | Management | Fundraising | Total |
|---|---|---|---|---|
| Fees for Service Investment Mgmnt Fees | - | - | - | $8,292 |
| Total Functional Expenses | $0 | $0 | $0 | $8,292 |
Fundraising, Events, and Gaming
- Fundraising activities
- No
- Gaming activities
- No
- Professional fundraiser used
- No
Fundraising and Gaming Totals
| Line Item | Amount |
|---|---|
| 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 11B
“The Form 990 is reviewed by a Trustee and by the Director of Finance and the Controller 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
- 2018-04-23
- 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
Raw XML Appendix390 raw XML fields
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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| IRS990/CashNonInterestBearingGrp/EOYAmt | 0 | 385481 |
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| IRS990/FormationYr | 0 | 2006 |
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| IRS990/GoverningBodyVotingMembersCnt | 0 | 5 |
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| IRS990/GrantsToOrganizationsInd | 0 | 0 |
| IRS990/GrantToRelatedPersonInd | 0 | 0 |
| IRS990/GrossAmountSalesAssetsGrp/SecuritiesAmt | 0 | 2991586 |
| IRS990/GrossReceiptsAmt | 0 | 3312811 |
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| IRS990/IncludeFIN48FootnoteInd | 0 | 0 |
| IRS990/IndependentAuditFinclStmtInd | 0 | 0 |
| IRS990/IndependentVotingMemberCnt | 0 | 0 |
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| IRS990/IndoorTanningServicesInd | 0 | 0 |
| IRS990/InfoInScheduleOPartIIIInd | 0 | X |
| IRS990/InfoInScheduleOPartVIIInd | 0 | X |
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| IRS990/InvestmentIncomeGrp/TotalRevenueColumnAmt | 0 | 321225 |
| IRS990/InvestmentInJointVentureInd | 0 | 0 |
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| IRS990/LoanOutstandingInd | 0 | 0 |
| IRS990/LocalChaptersInd | 0 | 0 |
| IRS990/MaterialDiversionOrMisuseInd | 0 | 0 |
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| IRS990/MethodOfAccountingCashInd | 0 | X |
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| IRS990/MinutesOfGoverningBodyInd | 0 | 1 |
| IRS990/MissionDesc | 0 | 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. |
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| IRS990/NetAssetsOrFundBalancesEOYAmt | 0 | 17810572 |
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| IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/OtherCompensationFilingOrgAmt | 4 | 0 |
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| IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/OtherCompensationRltdOrgsAmt | 1 | 68362 |
| IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/OtherCompensationRltdOrgsAmt | 2 | 156450 |
| IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/OtherCompensationRltdOrgsAmt | 3 | 65280 |
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| IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/PersonNm | 0 | Paul R Hickey MD |
| IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/PersonNm | 1 | Babu Koka MD |
| IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/PersonNm | 2 | Michael McManus MD |
| IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/PersonNm | 3 | Charles Nargozian MD |
| IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/PersonNm | 4 | Mark A Rockoff MD |
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| IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt | 1 | Director |
| IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt | 2 | Director |
| IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt | 3 | Director |
| IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt | 4 | Clerk |
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| IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TotalCompensationFilingOrgAmt | 3 | 0 |
| IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TotalCompensationFilingOrgAmt | 4 | 0 |
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| IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TotalCompensationRltdOrgsAmt | 2 | 704562 |
| IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TotalCompensationRltdOrgsAmt | 3 | 567417 |
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| IRS990ScheduleJ/SeverancePaymentInd | 0 | 0 |
| IRS990ScheduleJ/SupplementalInformationDetail/ExplanationTxt | 0 | All 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, 2017. |
| IRS990ScheduleJ/SupplementalInformationDetail/ExplanationTxt | 1 | CHMC 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 contributions from CHMA Anesthesia Foundation, Inc. during the year which are included in Schedule J, Part II, Column C as deferred compensation: Paul Hickey, M.D. - $61,630 Michael McManus, M.D. - $22,425 Charles Nargozian, M.D. - $20,301 Mark Rockoff, M.D. - $36,690 Babu Koka, M.D. - $19,200 After a vesting period these contributions will be included as part of taxable wages in the W-2 of each individual. During 2016, Dr. Paul Hickey had a vested amount of $182,285 which has been reported in Schedule J, Part II, Column B(iii). Furthermore, as these amounts were reported on previous 990s as part of total compensation earned, they are being disclosed in Schedule J, Part II, Column F. |
| IRS990ScheduleJ/SupplementalInformationDetail/FormAndLineReferenceDesc | 0 | Part I, Line 3 |
| IRS990ScheduleJ/SupplementalInformationDetail/FormAndLineReferenceDesc | 1 | Part I, Line 4b |
| IRS990ScheduleJ/SupplementalNonqualRtrPlanInd | 0 | 1 |
| IRS990/ScheduleORequiredInd | 0 | 1 |
| IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt | 0 | The Form 990 is reviewed by a Trustee and by the Director of Finance and the Controller of CHMC Anesthesia Foundation, Inc. |
| IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt | 1 | 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. |
| IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt | 2 | Documents are made available to the public upon request. |
| IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt | 3 | 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. |
| IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc | 0 | Form 990, Part VI, Section B, line 11b |
| IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc | 1 | Form 990, Part VI, Section B, line 12c |
| IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc | 2 | Form 990, Part VI, Section C, line 19 |
| IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc | 3 | Form 990, Part VII, Section A, Line 1a: |
| IRS990ScheduleR/AssetExchangeInd | 0 | 0 |
| IRS990ScheduleR/AssetPurchaseFromOtherOrgInd | 0 | 0 |
| IRS990ScheduleR/AssetSaleToOtherOrgInd | 0 | 0 |
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| IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/PrimaryActivitiesTxt | 0 | To promote anesthesiology services and research |
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| IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/ZIPCd | 0 | 02215 |
| IRS990ScheduleR/LoansOrGuaranteesFromOthOrgInd | 0 | 0 |
| IRS990ScheduleR/LoansOrGuaranteesToOtherOrgInd | 0 | 0 |
| IRS990ScheduleR/PaidEmployeesSharingInd | 0 | 0 |
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| IRS990ScheduleR/TransferToOtherOrgInd | 0 | 0 |
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| IRS990/SignificantChangeInd | 0 | 0 |
| IRS990/SignificantNewProgramSrvcInd | 0 | 0 |
| IRS990/SubjectToProxyTaxInd | 0 | 0 |
| IRS990/TaxablePartyNotificationInd | 0 | 0 |
| IRS990/TaxExemptBondsInd | 0 | 0 |
| IRS990/TempOrPermanentEndowmentsInd | 0 | 0 |
| IRS990/TerminateOperationsInd | 0 | 0 |
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| IRS990/TotalAssetsEOYAmt | 0 | 17810572 |
| IRS990/TotalAssetsGrp/BOYAmt | 0 | 15650540 |
| IRS990/TotalAssetsGrp/EOYAmt | 0 | 17810572 |
| IRS990/TotalCompGreaterThan150KInd | 0 | 1 |
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| IRS990/TotalNetAssetsFundBalanceGrp/EOYAmt | 0 | 17810572 |
| IRS990/TotalOtherCompensationAmt | 0 | 659606 |
| IRS990/TotalReportableCompFromOrgAmt | 0 | 0 |
| IRS990/TotalRevenueGrp/ExclusionAmt | 0 | 632949 |
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| IRS990/WebsiteAddressTxt | 0 | N/A |
| IRS990/WhistleblowerPolicyInd | 0 | 1 |
| ReturnHeader/BuildTS | 0 | 2018-06-14 16:35:46Z |
| ReturnHeader/BusinessOfficerGrp/DiscussWithPaidPreparerInd | 0 | 1 |
| ReturnHeader/BusinessOfficerGrp/PersonNm | 0 | Paul R Hickey MD |
| ReturnHeader/BusinessOfficerGrp/PersonTitleTxt | 0 | RMB Committee Member Trustee |
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| ReturnHeader/BusinessOfficerGrp/SignatureDt | 0 | 2018-04-23 |
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| ReturnHeader/Filer/BusinessName/BusinessNameLine2Txt | 0 | Retiree Medical Benefit Trust |
| ReturnHeader/Filer/BusinessNameControlTxt | 0 | CHMC |
| ReturnHeader/Filer/EIN | 0 | 260538595 |
| ReturnHeader/Filer/PhoneNum | 0 | 6173557267 |
| ReturnHeader/Filer/USAddress/AddressLine1Txt | 0 | 300 Longwood Avenue |
| ReturnHeader/Filer/USAddress/CityNm | 0 | Boston |
| ReturnHeader/Filer/USAddress/StateAbbreviationCd | 0 | MA |
| ReturnHeader/Filer/USAddress/ZIPCd | 0 | 02115 |
| ReturnHeader/FilingSecurityInformation/AtSubmissionCreationDeviceId | 0 | 45A87A58F6C00BCB2409326513FED20CCB94F06D |
| ReturnHeader/FilingSecurityInformation/AtSubmissionFilingDeviceId | 0 | 2CC4C4610C7CE537855CCDE76D04A8640C960E3E |
| ReturnHeader/FilingSecurityInformation/FilingLicenseTypeCd | 0 | P |
| ReturnHeader/FilingSecurityInformation/IPAddress/IPv4AddressTxt | 0 | 208.105.168.164 |
| ReturnHeader/FilingSecurityInformation/IPDt | 0 | 2018-04-23 |
| ReturnHeader/FilingSecurityInformation/IPTimezoneCd | 0 | ED |
| ReturnHeader/FilingSecurityInformation/IPTm | 0 | 10:46:09 |
| ReturnHeader/PreparerFirmGrp/PreparerFirmEIN | 0 | 010494526 |
| ReturnHeader/PreparerFirmGrp/PreparerFirmName/BusinessNameLine1Txt | 0 | Baker Newman & Noyes |
| ReturnHeader/PreparerFirmGrp/PreparerUSAddress/AddressLine1Txt | 0 | PO Box 507 |
| ReturnHeader/PreparerFirmGrp/PreparerUSAddress/CityNm | 0 | Portland |
| ReturnHeader/PreparerFirmGrp/PreparerUSAddress/StateAbbreviationCd | 0 | ME |
| ReturnHeader/PreparerFirmGrp/PreparerUSAddress/ZIPCd | 0 | 04112 |
| ReturnHeader/PreparerPersonGrp/PhoneNum | 0 | 2078792100 |
| ReturnHeader/PreparerPersonGrp/PreparationDt | 0 | 2018-04-23 |
| ReturnHeader/PreparerPersonGrp/PreparerPersonNm | 0 | Nicholas E Porto |
| ReturnHeader/ReturnTs | 0 | 2018-04-26T14:17:27-05:00 |
| ReturnHeader/ReturnTypeCd | 0 | 990 |
| ReturnHeader/TaxPeriodBeginDt | 0 | 2016-07-01 |
| ReturnHeader/TaxPeriodEndDt | 0 | 2017-06-30 |
| ReturnHeader/TaxYr | 0 | 2016 |
Document Assets
No mirrored PDF or thumbnail assets are attached yet.
Filings
Displayed year
2017 • Form 990Detailed filing. Detailed filing data is available for this year.
- Assets
- $17,810,572
- Liabilities
- $0
- Net assets
- $17,810,572
- Revenue
- $632,949
- Expenses
- $8,292
- Net income
- $624,657
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