Civic Intelligence

Chmc Anesthesia Foundation Inc Retiree Medical Benefit Trust

990 • Fiscal year 2018 • EIN 26-0538595

Jul 01, 2017 to Jun 30, 2018 • Filed on Apr 03, 2019

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

21st percentile

0.00x

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

2018 filings • 501(c)9 • $10M-$25M nonprofits • Source year 2018

Liabilities / Revenue

21st percentile

0.00x

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

2018 filings • 501(c)9 • $10M-$25M nonprofits • Source year 2018

Net Margin

99th percentile

100%

Higher net margin than 99% of similar nonprofits.

2018 filings • 501(c)9 • $10M-$25M nonprofits • Source year 2018

Top Officer Pay

100th percentile

$1,444,698

Higher top officer pay than 100% of similar nonprofits.

Top officer pay equals 132.0% of source-year revenue.

2018 filings • 501(c)9 • $10M-$25M nonprofits • Source year 2018

Asset Growth

72nd percentile

10%

Faster asset growth than 72% of similar nonprofits.

2018 filings • 501(c)9 • $10M-$25M nonprofits • Annualized from 2017 to 2018

Revenue Growth

96th percentile

73%

Faster revenue growth than 96% of similar nonprofits.

2018 filings • 501(c)9 • $10M-$25M nonprofits • Annualized from 2017 to 2018

Assets

Up

$19,598,197

Up $1,787,625 (+10%) from 2017

Net Assets

Up

$19,598,197

Up $1,787,625 (+10%) from 2017

Liabilities

Flat

$0

Flat from 2017

Revenue

Up

$1,094,590

Up $461,641 (+73%) from 2017

Expenses

Down

$298

Down $7,994 (-96%) from 2017

Net Income

Up

$1,094,292

Up $469,635 (+75%) from 2017

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

2018

Assets$19,598,197
Liabilities$0
Net Assets$19,598,197

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

2018

Revenue$1,094,590
Expenses$298
Net Income$1,094,292
Jump To
Filing Snapshot
Filing Period
Jul 1, 2017 to Jun 30, 2018
Signed
Apr 3, 2019
Return Version
2017v2.3
Gross Receipts
$3,757,992
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$17,810,572$19,598,197▲ $1,787,625
Investments in Publicly Traded Securities$17,425,091$19,009,331▲ $1,584,240
Cash and Non-Interest-Bearing Accounts$385,481$588,866▲ $203,385
Pd in Cap Srpls Land Bldg Eqp Fund$0$0→ $0
Cap Stk Tr Prin Current Funds$0$0→ $0
Total Assets$17,810,572$19,598,197▲ $1,787,625
Liabilities
Total Liabilities$0$0→ $0
Net Assets / Fund Balance
Total Net Assets Fund Balance$17,810,572$19,598,197▲ $1,787,625
Total Liabilities and Net Assets / Fund Balance$17,810,572$19,598,197▲ $1,787,625
Compensation and Service Providers

Board Members and Trustees

NameTitle
Paul R Hickey MDPresident/Treasurer
Babu Koka MDDirector
Charles Nargozian MDDirector
Michael McManus MDDirector
Mark A Rockoff MDClerk
Revenue and Support

Revenue Composition

Contributions and Grants
$0
Program Service Revenue
$0
Investment Income
$1,094,590
Other Revenue
$0
Change in Net Assets
$1,094,292
Expenses and Functional Allocation

Major Expense Lines

Line ItemAmount
Other Expenses$298
Grants and Similar Amounts Paid$0
Professional Fundraising Fees$0
Salaries, Compensation, and Employee Benefits$0
Total Fundraising Expense$0

Functional Expense Allocation

Line ItemProgramManagementFundraisingTotal
Fees for Service Investment Mgmnt Fees---$298
Total Functional Expenses$0$0$0$298
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 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
2019-04-03
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/PersonNm4Mark A Rockoff MD
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IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt1Director
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt2Director
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt3Director
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt4Clerk
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IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TotalCompensationRltdOrgsAmt3594598
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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, 2018.
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. There were no contributions from CHMA Anesthesia Foundation, Inc. during the year to the plan for any individuals listed on Part VII-A or Schedule J. After a vesting period contributions to the plan, if any, will be included as part of taxable wages in the W-2 of each individual. During 2017, Dr. Michael McManus had a vested amount of $71,305, Dr. Charles Nargozian had a vested amount of $37,790, and Dr. Babu Koka had a vested amount of $91,450. These amounts have 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/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 Controller 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 11b
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:
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IRS990/WebsiteAddressTxt0N/A
IRS990/WhistleblowerPolicyInd01
ReturnHeader/BuildTS02019-02-21 02:37:17Z
ReturnHeader/BusinessOfficerGrp/DiscussWithPaidPreparerInd01
ReturnHeader/BusinessOfficerGrp/PersonNm0Paul R Hickey MD
ReturnHeader/BusinessOfficerGrp/PersonTitleTxt0RMB Committee Member Trustee
ReturnHeader/BusinessOfficerGrp/PhoneNum06173557267
ReturnHeader/BusinessOfficerGrp/SignatureDt02019-04-03
ReturnHeader/Filer/BusinessName/BusinessNameLine1Txt0CHMC Anesthesia Foundation Inc
ReturnHeader/Filer/BusinessName/BusinessNameLine2Txt0Retiree Medical Benefit Trust
ReturnHeader/Filer/BusinessNameControlTxt0CHMC
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ReturnHeader/FilingSecurityInformation/IPAddress/IPv4AddressTxt0208.105.168.164
ReturnHeader/FilingSecurityInformation/IPDt02019-04-03
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ReturnHeader/FilingSecurityInformation/IPTm014:42:30
ReturnHeader/PreparerFirmGrp/PreparerFirmEIN0010494526
ReturnHeader/PreparerFirmGrp/PreparerFirmName/BusinessNameLine1Txt0Baker Newman & Noyes
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/AddressLine1Txt0PO Box 507
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/CityNm0Portland
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/StateAbbreviationCd0ME
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ReturnHeader/PreparerPersonGrp/PhoneNum02078792100
ReturnHeader/PreparerPersonGrp/PreparationDt02019-04-03
ReturnHeader/PreparerPersonGrp/PreparerPersonNm0Nicholas E Porto
ReturnHeader/ReturnTs02019-04-11T10:07:20-05:00
ReturnHeader/ReturnTypeCd0990
ReturnHeader/TaxPeriodBeginDt02017-07-01
ReturnHeader/TaxPeriodEndDt02018-06-30
ReturnHeader/TaxYr02017

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