Liabilities / Assets
25th percentile
Tied with the lowest-debt nonprofits in its peer group.
Chmc Anesthesia Foundation Inc Retiree Medical Benefit Trust
990 • Fiscal year 2022 • 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
25th percentile
Tied with the lowest-debt nonprofits in its peer group.
Net Margin
98th percentile
Higher net margin than 98% of similar nonprofits.
Top Officer Pay
98th percentile
Higher top officer pay than 98% of similar nonprofits.
Top officer pay equals 69.0% of source-year revenue.
Asset Growth
29th percentile
Faster asset growth than 29% of similar nonprofits.
Revenue Growth
26th percentile
Faster revenue growth than 26% of similar nonprofits.
Balance Sheet
Assets
Down$24,046,764
Down $3,659,532 (-13%) from 2021
Net Assets
Down$24,046,764
Down $3,659,532 (-13%) from 2021
Liabilities
Flat$0
Flat from 2021
Revenue And Expenses
Revenue
Down$1,504,344
Down $213,460 (-12%) from 2021
Expenses
Down$65,908
Down $1,264 (-1.9%) from 2021
Net Income
Down$1,438,436
Down $212,196 (-13%) from 2021
Historical Trend
Jump To
Filing Snapshot
- Filing Period
- Jul 1, 2021 to Jun 30, 2022
- Signed
- Apr 25, 2023
- Return Version
- 2021v4.2
- Gross Receipts
- $2,804,750
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 | $27,706,296 | $24,046,764 | ▼ $3,659,532 |
| Investments in Publicly Traded Securities | $27,218,150 | $22,624,538 | ▼ $4,593,612 |
| Cash and Non-Interest-Bearing Accounts | $488,146 | $1,422,226 | ▲ $934,080 |
| Pd in Cap Srpls Land Bldg Eqp Fund | $0 | $0 | → $0 |
| Cap Stk Tr Prin Current Funds | $0 | $0 | → $0 |
| Total Assets | $27,706,296 | $24,046,764 | ▼ $3,659,532 |
| Liabilities | |||
| Total Liabilities | $0 | $0 | → $0 |
| Net Assets / Fund Balance | |||
| Total Net Assets Fund Balance | $27,706,296 | $24,046,764 | ▼ $3,659,532 |
| Total Liabilities and Net Assets / Fund Balance | $27,706,296 | $24,046,764 | ▼ $3,659,532 |
Compensation and Service Providers
Board Members and Trustees
| Name | Title |
|---|---|
| Paul R Hickey MD | Former President |
| Joseph P Cravero MD | President |
| James Dinardo MD | Director |
| Jeffrey Burns MD | Director |
| Lynne Ferrari MD | Director |
| Mark A Rockoff MD | Former Clerk |
Revenue and Support
Revenue Composition
- Contributions and Grants
- $0
- Program Service Revenue
- $0
- Investment Income
- $1,504,344
- Other Revenue
- $0
- Change in Net Assets
- $1,438,436
Expenses and Functional Allocation
Major Expense Lines
| Line Item | Amount |
|---|---|
| Other Expenses | $5 |
| 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 |
|---|---|---|---|---|
| Benefits to Members | - | - | - | $65,903 |
| Fees for Service Investment Mgmnt Fees | - | - | - | $5 |
| Total Functional Expenses | $0 | $0 | $0 | $65,908 |
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 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 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
- 2023-04-25
- 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
Raw XML AppendixShowing 400 of 428 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/GoverningBodyVotingMembersCnt | 0 | 4 |
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| IRS990/GrantToRelatedPersonInd | 0 | 0 |
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| IRS990/GrossReceiptsAmt | 0 | 2804750 |
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| IRS990/IncludeFIN48FootnoteInd | 0 | 0 |
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| 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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| IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/OtherCompensationFilingOrgAmt | 5 | 0 |
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| IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/PersonNm | 0 | Mark A Rockoff MD |
| IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/PersonNm | 1 | Joseph P Cravero MD |
| IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/PersonNm | 2 | Jeffrey Burns MD |
| IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/PersonNm | 3 | James Dinardo MD |
| IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/PersonNm | 4 | Lynne Ferrari MD |
| IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/PersonNm | 5 | Paul R Hickey MD |
| IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt | 0 | Former Clerk |
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| IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt | 2 | Director |
| IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt | 3 | Director |
| IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt | 4 | Director |
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| 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, 2022. |
| IRS990ScheduleJ/SupplementalInformationDetail/ExplanationTxt | 1 | CHMC 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 $17,807; Dr. Burns $41,400; Dr. Cravero $45,000; Dr. Dinardo $32,207; and Dr. Ferrari $30,467. During 2021, Dr. Paul Hickey had a distribution from his After-Tax Plan account in the amount of $15,734. 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 2021, Dr. Mark Rockoff had a distribution from his After-Tax Plan account in the amount of $794,329. 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. |
| 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 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. 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/ExplanationTxt | 4 | 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. |
| 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: |
| IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc | 4 | Form 990, Part VII, Section A, Line 1a: |
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| IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/PrimaryActivitiesTxt | 0 | To promote anesthesiology services and research |
| IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/PrimaryActivitiesTxt | 1 | To promote anesthesiology services and research |
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| IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/CityNm | 1 | Boston |
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| IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/ZIPCd | 1 | 02115 |
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| IRS990/WebsiteAddressTxt | 0 | N/A |
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| ReturnHeader/BuildTS | 0 | 2023-04-26 12:10:37Z |
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Document Assets
No mirrored PDF or thumbnail assets are attached yet.
Filings
Displayed year
2022 • Form 990Detailed filing. Detailed filing data is available for this year.
- Assets
- $24,046,764
- Liabilities
- $0
- Net assets
- $24,046,764
- Revenue
- $1,504,344
- Expenses
- $65,908
- Net income
- $1,438,436