Civic Intelligence

Chmc Anesthesia Foundation Inc Retiree Medical Benefit Trust

990 • Fiscal year 2021 • EIN 26-0538595

Jul 01, 2020 to Jun 30, 2021 • Filed on Apr 25, 2022

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

17th percentile

0.00x

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

2021 filings • 501(c)9 • $25M-$50M nonprofits • Source year 2021

Liabilities / Revenue

17th percentile

0.00x

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

2021 filings • 501(c)9 • $25M-$50M nonprofits • Source year 2021

Net Margin

99th percentile

96%

Higher net margin than 99% of similar nonprofits.

2021 filings • 501(c)9 • $25M-$50M nonprofits • Source year 2021

Top Officer Pay

99th percentile

$1,141,746

Higher top officer pay than 99% of similar nonprofits.

Top officer pay equals 66.5% of source-year revenue.

2021 filings • 501(c)9 • $25M-$50M nonprofits • Source year 2021

Asset Growth

92nd percentile

32%

Faster asset growth than 92% of similar nonprofits.

2021 filings • 501(c)9 • $25M-$50M nonprofits • Annualized from 2020 to 2021

Revenue Growth

100th percentile

1878%

Faster revenue growth than 100% of similar nonprofits.

2021 filings • 501(c)9 • $25M-$50M nonprofits • Annualized from 2020 to 2021

Assets

Up

$27,706,296

Up $6,651,105 (+32%) from 2020

Net Assets

Up

$27,706,296

Up $6,651,105 (+32%) from 2020

Liabilities

Flat

$0

Flat from 2020

Revenue

Up

$1,717,804

Up $1,630,979 (+1878%) from 2020

Expenses

Up

$67,172

Up $34,172 (+104%) from 2020

Net Income

Up

$1,650,632

Up $1,596,807 (+2967%) from 2020

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

2021

Assets$27,706,296
Liabilities$0
Net Assets$27,706,296

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

2021

Revenue$1,717,804
Expenses$67,172
Net Income$1,650,632
Jump To
Filing Snapshot
Filing Period
Jul 1, 2020 to Jun 30, 2021
Signed
Apr 25, 2022
Return Version
2020v4.2
Gross Receipts
$6,303,151
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$21,055,191$27,706,296▲ $6,651,105
Investments in Publicly Traded Securities$20,514,750$27,218,150▲ $6,703,400
Cash and Non-Interest-Bearing Accounts$540,441$488,146▼ $52,295
Pd in Cap Srpls Land Bldg Eqp Fund$0$0→ $0
Cap Stk Tr Prin Current Funds$0$0→ $0
Total Assets$21,055,191$27,706,296▲ $6,651,105
Liabilities
Total Liabilities$0$0→ $0
Net Assets / Fund Balance
Total Net Assets Fund Balance$21,055,191$27,706,296▲ $6,651,105
Total Liabilities and Net Assets / Fund Balance$21,055,191$27,706,296▲ $6,651,105
Compensation and Service Providers

Board Members and Trustees

NameTitle
Paul R Hickey MDFormer President
Joseph P Cravero MDPresident
Babu Koka MDDirector
James Dinardo MDDirector
Jeffrey Burns MDDirector
Lynne Ferrari MDDirector
Mark A Rockoff MDFormer Clerk
Revenue and Support

Revenue Composition

Contributions and Grants
$0
Program Service Revenue
$0
Investment Income
$1,717,804
Other Revenue
$0
Change in Net Assets
$1,650,632
Expenses and Functional Allocation

Major Expense Lines

Line ItemAmount
Other Expenses$639
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
Benefits to Members---$66,533
Fees for Service Investment Mgmnt Fees---$639
Total Functional Expenses$0$0$0$67,172
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 35% controlled entity
No
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. Jeffrey Burns, 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. Joseph P. Cravero, 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. James Dinardo, 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. Lynne Ferrari, devoted an average of 60 hours per week to a related organization (CHMC Anesthesia Foundation, Inc.) in her position as Associate Professor of Anesthesia.

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

Dr. Paul Hickey and Dr. Mark Rockoff have been listed in Part VII of Form 990 as former officers of the organization in accordance with IRS instructions. While neither served as officers at any point during the tax year covered by this return, each was listed as an officer of the Organization during one of the previous 5 years and is currently remains employed as physicians of a related organization, CHMC Anesthesia Foundation, Inc. As each earned reportable compensation in excess of $100,000 they are being listed in this Form 990 as required by the IRS Form 990 instructions.

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
Joseph Cravero MD
Title
President
Phone
6173557267
Signed
2022-04-25
Discuss with paid preparer
Yes

Organization Details

Principal Officer
Joseph Cravero MD
Formed
2006
Legal Domicile
Ma
Voting Board Members
4
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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IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/PersonNm0Paul R Hickey MD
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/PersonNm1Joseph P Cravero MD
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/PersonNm2James Dinardo MD
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/PersonNm3Jeffrey Burns MD
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/PersonNm4Lynne Ferrari MD
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/PersonNm5Mark A Rockoff MD
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/PersonNm6Babu Koka MD
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt0Former President
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt1President
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt2Director
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt3Director
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt4Director
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt5Former Clerk
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt6Director
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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, 2021.
IRS990ScheduleJ/SupplementalInformationDetail/ExplanationTxt1CHMC Anesthesia Foundation, Inc. (the Foundation), a related organization established the CHMC Anesthesia Foundation, Inc. 2016 After-Tax Retirement Plan (the Plan) to reward long-term licensed physician employees by providing a fixed annual contribution by the Foundation, and allowing the Foundation to make additional discretionary contributions. All contributions to the Plan are made by the Foundation. Employee contributions are not permitted. The Foundation's annual contribution for each participant employed at the end of the plan year (June 30) is 6% of base salary. In addition to the regular annual contribution, the Foundation makes a one-time contribution on behalf of participants first employed by the Foundation after December 21, 2008 after completing seven years of service. The amount of the contribution is $20,000 for each of the seven years in which the participant was a full-time employee (at least 32 hours per week), and $20,000 prorated, based on the participant's full-time equivalent percentage (FTE), for each year in which the participant worked part-time. Any pre-2016 account contributions are fully vested for each participant. 50% of post-2016 earnings account amounts vest after ten years of service, 75% vest after fifteen years of service, and amounts are fully vested after twenty years of service. The following amounts have been included in Schedule J, Part II, Column B(iii) related to the After-Tax Plan: Dr. Hickey $66,045; Dr. Burns $41,400; Dr. Cravero $174,469; Dr. Dinardo $31,392; Dr. Ferrari $30,467; Dr. Rockoff $18,345; and Dr. Koka $19,776. During 2020, Dr. Paul Hickey had a distribution from his After-Tax Plan account in the amount of $45,378. This amount has been reported in Schedule J, Part II, Column B(iii). Furthermore, as this amount was reported on previous Form 990s as part of deferred compensation, it is being disclosed in Schedule J, Part II, Column F. During 2020, Dr. Koka also had a distribution from her After-Tax Plan account in the amount of $14,951. This amount has been reported in Schedule J, Part II, Column B(iii). However, as Dr. Koka is a new board member during this filing period she was therefore not previously listed on a Form 990 for the Organization in the past. Accordingly, no amount is disclosed in Schedule J, Part II, Column F for her.
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. Jeffrey Burns, 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. Joseph P. Cravero, 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. James Dinardo, 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. Lynne Ferrari, devoted an average of 60 hours per week to a related organization (CHMC Anesthesia Foundation, Inc.) in her position as Associate Professor of Anesthesia.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt4Dr. Paul Hickey and Dr. Mark Rockoff have been listed in Part VII of Form 990 as former officers of the organization in accordance with IRS instructions. While neither served as officers at any point during the tax year covered by this return, each was listed as an officer of the Organization during one of the previous 5 years and is currently remains employed as physicians of a related organization, CHMC Anesthesia Foundation, Inc. As each earned reportable compensation in excess of $100,000 they are being listed in this Form 990 as required by the IRS Form 990 instructions.
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:
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc4Form 990, Part VII, Section A, Line 1a:
IRS990ScheduleR/AssetExchangeInd00
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IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/DisregardedEntityName/BusinessNameLine1Txt1CHMC Anesthesia Foundation Inc Charitable Trust
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IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/PrimaryActivitiesTxt0To promote anesthesiology services and research
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/PrimaryActivitiesTxt1To promote anesthesiology services and research
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/PublicCharityStatusTxt0Line 10
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/PublicCharityStatusTxt1Line 12a, I
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/AddressLine1Txt0300 Longwood Avenue
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/AddressLine1Txt1300 Longwood Avenue
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/CityNm0Boston
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/CityNm1Boston
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