Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
STURDY MEMORIAL HOSPITAL INC
Employer identification number
04-2768252
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization?
................
11g(i)
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of support?
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3..
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public Support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year(or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
13
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2011.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
......................
b
33 1/3% support test—2010.
If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2011.
If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization
..................................................
b
10%-facts-and-circumstances test—2010.
If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported organization
..............................................
18
Private Foundation
If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions
...................................................
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c
Add lines 7a and 7b..
8
Public Support (Subtract line 7c from line 6.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13
Total support (Add lines 9, 10c, 11 and 12.).
14
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public Support Percentage for 2011 (line 8 column (f) divided by line 13 column (f))
.........
15
16
Public support percentage from 2010 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2010 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2011.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
..........
b
33 1/3% support tests—2010.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
....
20
Private Foundation
If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 4
Part IV
Supplemental Information.
Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2011
Additional Data
Software ID:
11000129
Software Version:
v1.00
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
STURDY MEMORIAL HOSPITAL INC
Employer identification number
04-2768252
Identifier
Return Reference
Explanation
F990_P05_S00_L02a
Form 990, Part V, Line 2a
Sturdy Memorial Hospital is a common paymaster for Sturdy Memorial Associates and Sturdy Memorial Foundation. Therefore, the total number of employees listed in Part V, line 2a includes only employees from the Hospital (1,577). The total number of employees on the Form W-3 is 1,928.
F990_P06_S0A_L01a
Form 990, Part VI, Section A, Line 1a
The bylaws of Sturdy Memorial Hospital state that "the Executive Committee shall have the power to transact all regular business of the Hospital during the interim between the meetings of the Board of Managers except for such matters as are specified in Section 55 of the [Massachusetts] General Laws, Chapter 156B." The Executive Committee consists only of members of the Board of Managers of Sturdy Memorial Hospital.
F990_P06_S0A_L02
Form 990, Part VI, Section A, Line 2
In accordance with Hospital by-laws, three members of the City of Attleboro's City Hall office must be directors of the Hospital's Board of Managers. They are Kevin Dumas (Mayor), Ethel Sandbach (Treasurer) and Frank Cook (City Council).
F990_P06_S0A_L06
Form 990, Part VI, Section A, Line 6
Sturdy Memorial Foundation, Inc., a Massachusetts charitable corporation, acting through its Board of Directors, is the sole Member of the Sturdy Memorial Hospital Corporation.
F990_P06_S0A_L07a
Form 990, Part VI, Section A, Line 7a
The Board of Managers of Sturdy Memorial Hospital consists of those persons who serve as the Directors of Sturdy Memorial Foundation, Inc. Foundation Members are eligible to attend all meetings of the Corporation and to hold office. New Members are elected to membership by the existing Members for 3 year terms.
F990_P06_S0B_L11b
Form 990, Part VI, Section B, Line 11b
The Form 990 is prepared by a financial analyst and reviewed by the Controller and Chief Financial Officer. Because the hospital is relatively small, the Controller or CFO may prepare some of the schedules in any given year. This results in all schedules being reviewed by at least one manager who was not also responsible for completing the schedule. In addition, the compensation and benefits information is reviewed with the Vice President of Human Resources. Once complete, the Form 990 and all schedules are copied, distributed and reviewed with the Executive Committee. The Executive Committee is a sub-committee of the Board of Managers with the power to transact all regular business of the hospital. The CFO and Controller attend the Executive Committee meeting to facilitate the review and answer any questions regarding the Form 990.
F990_P06_S0B_L12c
Form 990, Part VI, Section B, Line 12c
The hospital adopted a Conflict of Interest Policy on May 5, 1995. Under the direction of the Integrity Officer, all managers and supervisors (including officers and key employees) must complete and sign an annual Conflict of Interest Disclosure Statement. The Statement requires disclosure of any outside interests in any business, outside activity, gifts, or entertainment that may have influenced the employee. In addition, the employee must disclose if they have shared any hospital information for their own personal advantage or if they had any knowledge of any integrity or ethical issues not previously reported. These signed Statements are reviewed by the Integrity Officer and any potential conflicts are resolved. Article V, Section 12 of the Hospital by-laws requires Board members to disclose any potential conflict. Board members, officers and key employees must attest in writing each year, to any potential conflict. The conflict of interest statements are reviewed by the President and Chief Financial Officer and any potential conflicts are resolved.
F990_P06_S0B_L14
Form 990, Part VI, Section B, Line 14
The hospital does not have a written document retention and destruction policy but does comply with Massachusetts law with respect to record retention requirements. For example, Massachusetts law requires that the hospital maintain its medical records for a minimum of 20 years. Where state law does not require retention limits, the hospital uses the "Business Records Retention Schedule" from the Office of the Federal Register and other relevant and reliable sources (such as attorney letters and recommendations from accounting firms). The hospital is considering creating a formal policy.
F990_P06_S0B_L15
Form 990, Part VI, Section B, Line 15
The CEO and senior managers, as well as all other hospital employees, are compensated on a merit system. The CEO and senior managers prepare goals at the start of each fiscal year and are evaluated for merit increases based on those goals and their accomplishments relative to the goals. The CEO's evaluation extends to her responsibilities as the Chief Executive of Sturdy Memorial Associates (a fifty-two physician multi-specialty group practice) as well as her responsibilities at the remaining affiliated corporations. Her compensation is paid entirely by the hospital (there is no additional compensation from the related organizations). Several of the other senior managers have responsibilities that extend to the affiliated corporations. The CEO's accomplishments (relative to the established goals) are documented in an annual report which is submitted to the Chairman of the Board of Managers. The Board Chairman is provided with comparative market data, obtained through compensation surveys, from an independent consultant specializing in such matters. The comparative data is for similar hospitals in Massachusetts and is sent directly from the independent consultant to the Board Chairman. The data includes comprehensive salary and benefits information for CEOs and senior managers (key employees) including comparison of base pay, incentive pay, benefits and total compensation. In addition, the Chairman is provided with performance information for Massachusetts hospitals obtained through the Division of Health Care Finance and Policy. The Vice President of Human Resources provides the Chairman with the CEO's current actual salary and benefits. The Chairman of the Board of Managers provides the above information along with the annual report of the CEO's accomplishments (relative to established goals) and a history of the CEO's compensation to the Executive Committee, which serves as the Compensation Committee for this purpose. The Executive Committee reviews the comparative data for CEO base salary, bonus (incentive) and total compensation, along with the survey data for benefits. Based on the goals achieved and the comparative data provided, the Executive Committee votes to approve the salary, bonus, and benefits of the CEO. A summary of the discussion and the decision of the Executive Committee are reflected in the meeting minutes. The Chairman of the Board of Managers communicates the decision regarding compensation changes in a letter to the Vice President of Human Resources to execute the change. The CEO uses comparative market data, obtained from an independent consultant, for the hospital senior managers (key employees). The CEO compares the senior managers' current base salary and bonus (incentive pay) to the survey data. The senior managers' performance is evaluated based on the goals established at the start of the year. The CEO determines the base pay amount and bonus for each senior manager based on performance and the compensation survey. Base salary and bonus payments for each senior manager, including survey information, are reviewed with the Executive Committee by the CEO. The Executive Committee votes to accept the recommendations of the CEO except for the CFO, the Executive Committee votes to approve the CFO's compensation.
F990_P06_S0B_L16b
Form 990, Part VI, Section B, Line 16b
The hospital does not have a written policy or procedure requiring the hospital to evaluate its participation in joint venture arrangements under applicable federal law; however, any joint venture agreement would be reviewed and approved by outside counsel. The hospital currently has one partnership agreement, which is to provide radiation therapy services (LLC). The patient volume, from the hospital's service area alone, would not have justified the cost of purchasing the radiation therapy building and equipment as well as providing the service. The hospital partnered with another local not-for-profit hospital and a for-profit company which specializes in building and managing radiation therapy services. The LLC is governed by a Board consisting of three persons, one from each of the organizations, thus ensuring that the two not-for-profit hospitals together have sufficient control over the organization to ensure their exempt purpose. In addition, Article I of the LLC Agreement, requires that the LLC "shall operate under a charity care policy that is consistent with the charity care policies of its charitable Members". The LLC has not engaged in activites that would jeopardize the hospital's exemption, such as lobbying activities.
F990_P06_S0C_L19
Form 990, Part VI, Section C, Line 19
The Hospital makes available copies of its by-laws, conflict of interest policy, and financial statements to the general public upon request.
F990_P07_S0A_L01a
Form 990, Part VII, Section A, Line 1a
Average hours worked per week - The following employees devoted a portion of their average hours worked per week to related organizations (Sturdy Memorial Associates and Sturdy Memorial Foundation) as stated in Shedule R: Joseph Casey - 7 hrs; Linda Shyavitz - 8 hrs; Cheryl Barrows - 8 hrs; Lisa McCluskie - 13 hrs. ...... Compensation disclosure - Certain executives, as disclosed in Schedule J, receive supplemental retirement benefits. Six of those executives, Linda Shyavitz, Bruce Auerbach, Joseph Casey, Dan Pietro, Lisa McCluskie and Brian Kelly, are long-term employees and the retirement benefits they earned at the beginning of their career were minimal. This has resulted in significantly higher contributions for these executives now. Also, reportable compensation includes a non-qualified retirement contribution for the CEO and other senior managers in calendar year 2011, primarily to provide adequate benefits for prior years of service.
F990_P11_S00_L05
Form 990, Part XI, Line 5
Net unrealized gains/(losses) on investments = $17,876,333. Pension and other post-retirement liability adjustments = -$8,216,800.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.