Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
MediumBullet Do not enter Social Security numbers on this form as it may be made public. By law, the IRS
generally cannot redact the information on the form.
MediumBullet Information about Form 990 and its instructions is at www.IRS.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
A For the 2013 calendar year, or tax year beginning 10-01-2013 , 2013, and ending 09-30-2014
BCheck if applicable:
CName of organization
JORDAN HEALTH SYSTEMS INC
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
275 SANDWICH STREET NO 317
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
PLYMOUTH, MA02360
D Employer identification number

04-2103805
E Telephone number

G Gross receipts $ 4,873,844
F Name and address of principal officer:
JASON RADZEVICH
275 SANDWICH STREET NO 317
PLYMOUTH,MA02360
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.BIDPLYMOUTH.ORG
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1985
M State of legal domicile: MA
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: SEE SCHEDULE O.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 19
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 13
5 Total number of individuals employed in calendar year 2013 (Part V, line 2a) ...... 5 9
6 Total number of volunteers (estimate if necessary) ............. 6 13
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b 0
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 1,017,792 1,921,798
9 Program service revenue (Part VIII, line 2g) ......... 2,743,947 2,579,912
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 342,520 300,373
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 115,249 792
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 4,219,508 4,802,875
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 0 0
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 3,266,103 4,446,502
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 19,200
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet592,781    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 353,465 291,067
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 3,619,568 4,756,769
19 Revenue less expenses. Subtract line 18 from line 12....... 599,940 46,106
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 8,477,022 17,244,693
21 Total liabilities (Part X, line 26)............. 3,013,425 4,638,225
22 Net assets or fund balances. Subtract line 21 from line 20..... 5,463,597 12,606,468
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ............
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2013)
Form 990 (2013)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III ..............
1
Briefly describe the organization’s mission: SEE SCHEDULE O.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ......................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ............................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 2,988,861 including grants of $   ) (Revenue $ 2,252,324 )
SEE SCHEDULE O.
4b (Code:   ) (Expenses $ 661,677 including grants of $   ) (Revenue $ 327,588 )
SEE SCHEDULE O.
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet3,650,538
Form 990 (2013)
Form 990 (2013)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment........................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part I..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part II........
4
 
No
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C,
Part III............................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part IClick to see attachment........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes," complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If "Yes," complete Schedule D, Part VClick to see attachment......
10
Yes
 
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If "Yes," complete Schedule D, Part VI.Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIClick to see attachment.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment............
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment.........................
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If "Yes," complete Schedule D, Parts XI and XII Click to see attachment.................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E....
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?.....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I (see instructions).... Click to see attachment
17
Yes
 
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............ Click to see attachment
18
Yes
 
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III................... Click to see attachment
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H....
20a
 
No
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return?
20b
 
 
Form 990 (2013)
Form 990 (2013)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II...
21
 
No
22
Did the organization report more than $5,000 of grants or other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........
22
 
No
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
 
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I........ Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I................... Click to see attachment
25b
 
No
26
Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? If so, complete Schedule L, Part II.................... Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part III......... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV .......................... Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If "Yes,"
complete Schedule L, Part IV..................... Click to see attachment
28b
Yes
 
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If "Yes," complete Schedule L, Part IV... Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M.............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1........................ Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
 
No
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2...
35b
 
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2............. Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2013)
Form 990 (2013)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V ..............
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
0
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
 
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
9
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?..........................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions?...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
Yes
 
b
If "Yes," did the organization notify the donor of the value of the goods or services provided?.....
7b
Yes
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?............................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?............................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?............
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?..........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?.......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year. ....................
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
Form 990 (2013)
Form 990 (2013)
Page 6
Part VI
Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI ..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year .....................
1a
19
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
13
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
Yes
 
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
Yes
 
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done.......................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
No
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
MA , CA , CT , MD , MA , NH , NJ , NC , PA , RI , VA
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization:
MediumBulletMARY DWYER275 SANDWICH STPLYMOUTHMA02360 (508) 746-2000
Form 990 (2013)
Form 990 (2013)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII ..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) MICHAEL BABINI........................................................................
DIRECTOR
 1.00
.......................1.00 		X           0 0 0
(2) LYLE LAWRENCE BAZZINOTTI........................................................................
VICE CHAIR, DIRECTOR
 2.00
.......................2.00 		X           0 0 0
(3) JOHN CARNUCCIO........................................................................
DIRECTOR
 1.00
.......................1.00 		X           0 0 0
(4) LYON CARTER II........................................................................
DIRECTOR
 1.00
.......................1.00 		X           0 0 0
(5) FREDERIC CLIFFORD........................................................................
DIRECTOR
 1.00
.......................1.00 		X           0 0 0
(6) SHAWN D DAHLEN........................................................................
DIRECTOR
 1.00
.......................1.00 		X           0 0 0
(7) STEVEN FISCHER........................................................................
DIRECTOR
 1.00
.......................64.00 		X           0 677,771 53,113
(8) NANCY FORMELLA RN MSN........................................................................
DIRECTOR
 1.00
.......................59.00 		X           0 580,224 13,778
(9) KENNETH FOSDICK........................................................................
DIRECTOR
 1.00
.......................1.00 		X           0 0 0
(10) WILLIAM P GAGNON........................................................................
DIRECTOR
 1.00
.......................1.00 		X           0 0 0
(11) CLARK HINKLEY........................................................................
CHAIR, DIRECTOR
 5.00
.......................10.00 		X           0 0 0
(12) PETER J HOLDEN........................................................................
PRES, CEO, DIR (EX-OFF)
 1.00
.......................64.00 		X   X       780,856 0 36,537
(13) STANLEY MLEWIS MD........................................................................
DIRECTOR
 1.00
.......................64.00 		X           0 628,645 47,002
(14) PETER MUNCEY ESQ........................................................................
SECRETARY, DIRECTOR
 1.00
.......................1.00 		X           0 0 0
(15) KIMBERLY SCHEUB MD........................................................................
DIRECTOR
 1.00
.......................1.00 		X           0 0 0
(16) WILFRED SHEEHAN........................................................................
DIRECTOR
 1.00
.......................1.00 		X           0 0 0
(17) KEELAS SMALL........................................................................
DIRECTOR
 1.00
.......................1.00 		X           0 0 0
Form 990 (2013)
Form 990 (2013)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) WALTER STANWOOD MD........................................................................
DIR(EXOFF), MED STF PRES
 1.00
.......................16.00 		X           0 82,075 0
(19) STEPHEN TREHU MD........................................................................
DIRECTOR, INTERIM CMO
 1.00
.......................59.00 		X           0 16,051 0
(20) JOSEPH IANNONI........................................................................
TREASURER, CFO
 1.00
.......................59.00 		    X       385,218 0 123,941
(21) JASON RADZEVICH........................................................................
TREASURER, CFO
 1.00
.......................59.00 		    X       0 277,380 5,509
(22) JAMES FANALE MD........................................................................
SVP DEVELOPMENT
 30.00
.......................30.00 		        X   224,390 224,392 126,998
(23) DONNA DOHERTY RN........................................................................
CHIEF NURSING OFFICER
 1.00
.......................59.00 		        X   257,175 0 42,450
(24) RON RUTHERFORD........................................................................
VP & CIO
 1.00
.......................59.00 		        X   66,948 139,542 30,605
(25) ANDREA HOLLERAN........................................................................
VP, EXTERNAL AFFAIRS
 1.00
.......................59.00 		        X   180,128 0 45,037
(26) CYNTHIA OUTHOUSE........................................................................
VP, PHILANTHROPY
 12.00
.......................48.00 		        X   34,513 138,051 37,964
(27) JAMES ALBERT........................................................................
FORMER VP & CIO
 12.00
.......................48.00 		          X 223,469 0 14,524
(28) MARK DEMATTEO MD........................................................................
FORMER DIR & MED ST PRES
 0.00
.......................60.00 		          X 0 494,966 0




1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 2,152,697 3,259,097 577,458
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet7
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet0
Form 990 (2013)
Form 990 (2013)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII .............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512-514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c 141,162
d Related organizations...1d  
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		1,780,636
g Noncash contributions included in lines
1a-1f:$ 		 
h Total. Add lines 1a-1f.......MediumBullet 1,921,798
Program Service RevenueAmt Business Code
2a MANAGEMENT REVENUE 900099 2,579,912 2,579,912    
b
c
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 2,579,912
OtherAmt RevenueAmt 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 77,384     77,384
4 Income from investment of tax-exempt bond proceeds..MediumBullet        
5 Royalties...........MediumBullet        
(i) Real (ii) Personal
6a Gross rents 3,388  
b Less: rental expenses 0  
c Rental income or (loss) 3,388  
d Net rental income or (loss).......MediumBullet 3,388     3,388
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 222,989  
b Less: cost or other basis and sales expenses 0  
c Gain or (loss) 222,989  
d Net gain or (loss)..........MediumBullet 222,989     222,989
8a Gross income from fundraising events (not including
$ 141,162
of contributions reported on line 1c). See Part IV, line 18 ..
a 59,958
b Less: direct expenses ...b 68,896
c Net income or (loss) from fundraising events..MediumBullet -8,938   -8,938
9a Gross income from gaming activities.
See Part IV, line 19 ...
a 8,415
b Less: direct expenses ...b 2,073
c Net income or (loss) from gaming activities...MediumBullet 6,342     6,342
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet        
Miscellaneous Revenue Business Code
11a            
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet  
12 Total revenue. See Instructions......MediumBullet 4,802,875 2,579,912 0 301,165
Form 990 (2013)
Form 990 (2013)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX ...............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21    
2 Grants and other assistance to individuals in the United States. See Part IV, line 22    
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16    
4 Benefits paid to or for members    
5 Compensation of current officers, directors, trustees, and key employees .... 1,326,552 1,326,552    
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 237,993 237,993    
7 Other salaries and wages 2,667,402 1,805,846 435,397 426,159
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 51,425 45,542 5,883  
9 Other employee benefits ....... 33,450 29,623 3,827  
10 Payroll taxes ........... 129,680 114,844 14,836  
11 Fees for services (non-employees):        
a Management ......        
b Legal ......... 10,000   10,000  
c Accounting ........... 21,996   21,996  
d Lobbying ...........        
e Professional fundraising services. See Part IV, line 17 19,200 19,200
f Investment management fees ......        
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........        
12 Advertising and promotion ....        
13 Office expenses ....... 195,479 40,848 7,209 147,422
14 Information technology ......        
15 Royalties ..        
16 Occupancy ...........        
17 Travel ............ 61,722 47,526 14,196  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ......        
19 Conferences, conventions, and meetings .... 295 189 106  
20 Interest ...........        
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization ..... 1,575 1,575    
23 Insurance ..............        
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a
b
c
d
e All other expenses        
25 Total functional expenses. Add lines 1 through 24e 4,756,769 3,650,538 513,450 592,781
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2013)
Form 990 (2013)
Page 11
Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash–non-interest-bearing .............   1 0
2 Savings and temporary cash investments ......... 598,752 2 547,581
3 Pledges and grants receivable, net ........... 15,311 3  
4 Accounts receivable, net .............   4  
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
  5  
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
  6  
7 Notes and loans receivable, net .............   7  
8 Inventories for sale or use ..............   8  
9 Prepaid expenses and deferred charges ..........   9  
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 10,218,293
b Less: accumulated depreciation ..... 10b 1,575 1,435,215 10c 10,216,718
11 Investments—publicly traded securities .......... 5,440,412 11 5,755,719
12 Investments—other securities. See Part IV, line 11 .....   12  
13 Investments—program-related. See Part IV, line 11 .....   13  
14 Intangible assets ...............   14  
15 Other assets. See Part IV, line 11 ........... 987,332 15 724,675
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 8,477,022 16 17,244,693
Liabilities 17 Accounts payable and accrued expenses ......... 949,618 17 1,933,888
18 Grants payable .................   18  
19 Deferred revenue ................   19  
20 Tax-exempt bond liabilities .............   20  
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22  
23 Secured mortgages and notes payable to unrelated third parties ..   23  
24 Unsecured notes and loans payable to unrelated third parties ....   24  
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.................... 2,063,807 25 2,704,337
26 Total liabilities. Add lines 17 through 25......... 3,013,425 26 4,638,225
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. 999,567 27 7,939,043
28 Temporarily restricted net assets ........... 791,412 28 727,326
29 Permanently restricted net assets ........... 3,672,618 29 3,940,099
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds ........   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ........... 5,463,597 33 12,606,468
34 Total liabilities and net assets/fund balances ........ 8,477,022 34 17,244,693
Form 990 (2013)
Form 990 (2013)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI ..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
4,802,875
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
4,756,769
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
46,106
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
5,463,597
5
Net unrealized gains (losses) on investments ...............
5
-14,961
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
7,111,726
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
12,606,468
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII .............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
 
No
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
 
 
Form 990 (2013)
Form 990, Special Condition Description:
Special Condition Description
Additional Data


Software ID:  
Software Version:  
SCHEDULE A
(Form 990 or 990EZ)

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.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
right arrow Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
Name of the organization
JORDAN HEALTH SYSTEMS INC
 
Employer identification number

04-2103805
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
f
g
(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 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 monetary support
Yes No Yes No Yes No
Total  

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 2
Part II
Support Schedule for Organizations Described in Sections 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) right arrow (a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .... 394,939 819,525 2,440,805 1,017,792 1,921,798 6,594,859
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 3 394,939 819,525 2,440,805 1,017,792 1,921,798 6,594,859
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).. 1,909,799
6 Public support. Subtract line 5 from line 4. 4,685,060
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (f) Total
7 Amounts from line 4.. 394,939 819,525 2,440,805 1,017,792 1,921,798 6,594,859
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... 74,296 88,477 106,630 121,176 77,384 467,963
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..       184,200 71,761 255,961
11 Total support (Add lines 7 through 10). 7,318,783
12
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.................................................right arrow
Section C. Computation of Public Support Percentage
14
14
64.010 %
15
15
52.410 %
16a
b
17a
b
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 ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 3
Part III
Support Schedule for Organizations Described in Section 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) right arrow (a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (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) right arrow (a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (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
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and 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) 2013

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Name of the organization
JORDAN HEALTH SYSTEMS INC
 
Employer identification number

04-2103805
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......................... Arrow Bullet $  
Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
Page 2
Name of organization
JORDAN HEALTH SYSTEMS INC
  		Employer identification number

04-2103805
Part I
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

   
RESTRICTED
RESTRICTED
RESTRICTED, RESTRICTEDRESTRICTED

$RESTRICTED


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
Page 3
Name of organization
JORDAN HEALTH SYSTEMS INC
  		Employer identification number

04-2103805
Part II
Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
Page 4
Name of organization
JORDAN HEALTH SYSTEMS INC
  		Employer identification number

04-2103805
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Additional Data


Software ID:  
Software Version:  
SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions. SchDMd Bullet Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
JORDAN HEALTH SYSTEMS INC
 
Employer identification number

04-2103805
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) .....    
4 Aggregate value at end of year ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2013

Schedule D (Form 990) 2013
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIII and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance .... 4,464,031 4,201,310 1,900,408 1,974,011 1,821,150
b Contributions ........ 306,013 234,591 2,155,122 214,177 140,922
c Net investment earnings, gains, and losses 203,672 156,877 369,076 -76,824 11,939
d Grants or scholarships .....          
e Other expenditures for facilities
and programs ........ 		306,290 128,747 223,296 210,956  
f Administrative expenses ....          
g End of year balance ...... 4,667,426 4,464,031 4,201,310 1,900,408 1,974,011
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet84.420 %
c
Temporarily restricted endowment SchDMd Bullet15.580 %
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
No
(ii) related organizations ........................
3a(ii)
 
No
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11a. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   10,214,093 10,214,093
b Buildings ................        
c Leasehold improvements ............        
d Equipment ................   4,200 1,575 2,625
e Other .................        
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 10,216,718
Schedule D (Form 990) 2013

Schedule D (Form 990) 2013
Page 3
Part VII
Investments—Other Securities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11b. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11c. See Form 990, Part X, line 13.
(a) Description of investment (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes  
OTHER LONG TERM LIABILITIES 1,464,235
OTHER CURRENT LIABILITIES 149,102
DUE TO AFFILIATES 1,091,000






Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 2,704,337
2. Liability for uncertain tax positions In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII ..................................................
Schedule D (Form 990) 2013

Schedule D (Form 990) 2013
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1 Total revenue, gains, and other support per audited financial statements ....... 1 248,456,014
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d 245,467,551
e Add lines 2a through 2d ..................... 2e 245,467,551
3 Subtract line 2e from line 1..................... 3 2,988,463
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIII.) ........... 4b 1,814,412
c Add lines 4a and 4b....................... 4c 1,814,412
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5 4,802,875
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1 Total expenses and losses per audited financial statements ........... 1 214,069,880
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIII.) ............ 2d 209,244,215
e Add lines 2a through 2d...................... 2e 209,244,215
3 Subtract line 2e from line 1..................... 3 4,825,665
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIII.) ............ 4b -68,896
c Add lines 4a and 4b....................... 4c -68,896
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5 4,756,769
Part XIII
Supplemental Information
Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Return Reference Explanation
PART V, LINE 4: THE JORDAN HEALTH SYSTEMS, INC (JHSI) ENDOWMENT FUNDS ARE INTENDED TO ENSURE THAT JHSI'S AFFILIATE, BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH'S (BIDPLYMOUTH OR HOSPITAL). BID-PLYMOUTH ACCOMPLISHES ITS CHARITABLE MISSION OF IMPROVING THE HEALTH AND WELL-BEING OF ITS PATIENTS AND COMMUNITY BY PROVIDING A FULL CONTINUUM OF HEALTHCARE SERVICES WITH EXCELLENCE AND COMPASSION AS WELL AS PROVIDING ACCESS TO TERTIARY CARE IN CLOSE COLLABORATION WITH ITS SOLE MEMBER, BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC OR MEDICAL CENTER). BID-PLYMOUTH DOES THIS REGARDLESS OF THE PATIENT'S ABILITY TO PAY, RACE, COLOR, RELIGION, SEX, SEXUAL ORIENTATION, NATIONAL ORIGIN, ANCESTRY, AGE, OR DISABILITY. THE SPECIFIC USES OF THE ENDOWMENT VARY DEPENDING ON THE NATURE OF RESTRICTIONS, IF ANY, IMPOSED BY DONORS. UNDER JSHI'S CURRENT INVESTMENT SPENDING POLICY, WHICH IS WITHIN THE GUIDELINES SPECIFIED UNDER MASSACHUSETTS STATE LAW, 4% OF THE AVERAGE OF THE FAIR MARKET VALUE OF QUALIFYING LONG-TERM INVESTMENTS APPLIED TO A THREE-YEAR MOVING AVERAGE WITH A ONE YEAR LAG IS APPROPRIATED AS STATED BY THE DONOR. IN ESTABLISHING THIS POLICY, JSHI CONSIDERED THE EXPECTED RETURN ON ITS ENDOWMENT AND ITS PROGRAMMING NEEDS. ACCORDINGLY, JHSI EXPECTS THE CURRENT SPENDING POLICY TO ALLOW ITS ENDOWMENT TO MAINTAIN ITS PURCHASING POWER AND TO PROVIDE A PREDICTABLE AND STABLE SOURCE OF REVENUE FOR THE ANNUAL OPERATING BUDGET. ADDITIONAL REAL GROWTH WILL BE PROVIDED THROUGH NEW GIFTS OR EXCESS INVESTMENT RETURN.
PART X, LINE 2: AS NOTED THROUGHOUT THIS FILING, BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC) IS THE SOLE MEMBER OF JORDAN HEALTH SYSTEMS, INC (JHSI) AND BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH (BID-PLYMOUTH). THE CONSOLIDATED FINANCIAL STATEMENTS OF JHSI AND AFFILIATES ARE INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF BIDMC AND AFFILIATES. THE TEXT OF THE FOOTNOTE BELOW IS FROM THE BIDMC CONSOLIDATED FINANCIAL STATEMENTS. BIDMC, APG, NEEDHAM, MILTON, PLYMOUTH AND HMFP HAVE BEEN DETERMINED BY THE INTERNAL REVENUE SERVICE TO BE ORGANIZATIONS DESCRIBED IN INTERNAL REVENUE CODE (THE CODE) SECTION 501(C)(3) AND, THEREFORE, ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE MEDICAL CENTER RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. RECOGNIZED INCOME TAX POSITIONS ARE MEASURED AT THE LARGEST AMOUNT OF BENEFIT THAT IS GREATER THAN FIFTY PERCENT LIKELY TO BE REALIZED UPON SETTLEMENT. CHANGES IN MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN JUDGMENT OCCURS. THE MEDICAL CENTER DID NOT RECOGNIZE THE EFFECT OF ANY INCOME TAX POSITIONS IN EITHER 2014 OR 2013.
PART XI, LINE 2D - OTHER ADJUSTMENTS: CONSOLIDATED ENTITIES NET OF ELIMINATIONS 236,684,473. EFFECTS OF AFFILIATION 8,783,078.
PART XI, LINE 4B - OTHER ADJUSTMENTS: RESTRICTED CONTRIBUTIONS 1,660,510. RESTRICTED REVENUE 222,798. DIRECT FUNDRAISING EXPENSES -68,896.
PART XII, LINE 2D - OTHER ADJUSTMENTS: CONSOLIDATED ENTITIES NET OF ELIMINATIONS 209,244,215.
PART XII, LINE 4B - OTHER ADJUSTMENTS: DIRECT FUNDRAISING EXPENSES -68,896.
Schedule D (Form 990) 2013

Additional Data


Software ID:  
Software Version:  




SCHEDULE G (Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Supplemental Information Regarding
Fundraising or Gaming Activities
Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. right arrowAttach to Form 990 or Form 990-EZ. right arrowSee separate instructions.
right arrowInformation about Schedule G (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
JORDAN HEALTH SYSTEMS INC
 
Employer identification number

04-2103805
Part I
Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17.
Form 990-EZ filers are not required to complete this part.
1
Indicate whether the organization raised funds through any of the following activities. Check all that apply.
a e
b f
c g
d
2a
Did the organization have a written or oral agreement with any individual (including officers, directors, trustees
or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?
b
If "Yes," list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.
(i) Name and address of individual
or entity (fundraiser) 		(ii) Activity (iii) Did fundraiser have custody or control of contributions? (iv) Gross receipts
from activity 		(v) Amount paid to
(or retained by)
fundraiser listed in
col. (i) 		(vi) Amount paid to
(or retained by)
organization
Yes No
 
GUTHRIE AND ASSOC
189 EARLE DR
 
KINGSTON, RI02852 		STRAT AND PLAN   No 0 19,200 0
             
             
             
             
             
             
             
             
             
Total .................right arrow   19,200  
3
List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing.
CA, CT, MA, MD, ME, NH, NJ, NC, PA, RI, VA
For Paperwork Reduction Act Notice, see the Instructions for Form 990or 990-EZ.
Cat. No. 50083H
Schedule G (Form 990 or 990-EZ) 2013
Schedule G (Form 990 or 990-EZ) 2013
Page 2
Part II
Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.
(a) Event #1

GOLF TOURNAMENT
(event type) 		(b) Event #2

GOLF TOURNAMENT
(event type) 		(c) Other events

2
(total number) 		(d) Total events
(add col. (a) through col. (c))
VerticalRevenue 1 Gross receipts . . . 139,735 35,047 26,338 201,120
2 Less: Contributions . . 104,387 19,611 17,164 141,162
3 Gross income (line 1
minus line 2) . . . 		35,348 15,436 9,174 59,958
VerticalDirectExpenses 4 Cash prizes . . . 2,000     2,000
5 Noncash prizes . . 800     800
6 Rent/facility costs . . 21,600   1,568 23,168
7 Food and beverages . 2,629 13,627 9,063 25,319
8 Entertainment . . . 500     500
9 Other direct expenses . 11,844 2,803 2,462 17,109
10 Direct expense summary. Add lines 4 through 9 in column (d) ........... right arrow 68,896
11 Net income summary. Subtract line 10 from line 3, column (d)........... right arrow -8,938
Part III
Gaming. Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.
VerticalRevenue (a) Bingo (b) Pull tabs/Instant
bingo/progressive bingo 		(c) Other gaming (d) Total gaming (add col.(a) through col.(c))
1 Gross revenue . . . .        
VerticalDirectExpenses 2 Cash prizes . . . .        
3 Non-cash prizes . . .        
4 Rent/facility costs . . .        
5 Other direct expenses . .        
6 Volunteer labor . . .
%
%
%
7 Direct expense summary. Add lines 2 through 5 in column (d) ........... right arrow  
8 Net gaming income summary. Subtract line 7 from line 1, column (d) ......... right arrow  
9
Enter the state(s) in which the organization operates gaming activities:
a
Is the organization licensed to operate gaming activities in each of these states? ............
b
If "No," explain:
 
10a
Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? .....
b
If "Yes," explain:
 
Schedule G (Form 990 or 990-EZ) 2013
Schedule G (Form 990 or 990-EZ) 2013
Page 3
11
Does the organization operate gaming activities with nonmembers? .................
12
Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity
formed to administer charitable gaming? ..........................
13
Indicate the percentage of gaming activity operated in:
a
The organization's facility ......................
13a
%
b
An outside facility ........................
13b
%
14
Enter the name and address of the person who prepares the organization's gaming/special events books and records:
Name right arrow
Address right arrow
15a
Does the organization have a contract with a third party from whom the organization receives gaming
revenue? ......................................
b
If "Yes," enter the amount of gaming revenue received by the organization right arrow $   and the
amount of gaming revenue retained by the third party right arrow $   .
c
If "Yes," enter name and address of the third party:
Name right arrow
Address right arrow
 
 
16
Gaming manager information:
Name right arrow
Gaming manager compensation right arrow $  
Description of services provided right arrow
 
17
Mandatory distributions:
a
Is the organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license? ............................
b
Enter the amount of distributions required under state law distributed to other exempt organizations or spent
in the organization's own exempt activities during the tax year right arrow$  
Part IV
Supplemental Information. Provide the explanations required by Part I, line 2b, columns (iii) and (v), and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also complete this part to provide any additional information (see instructions).
Return Reference Explanation
Schedule G (Form 990 or 990-EZ) 2013
Additional Data


Software ID:  
Software Version:  
Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
SchJMediumBullet Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
JORDAN HEALTH SYSTEMS INC
 
Employer identification number

04-2103805
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..
2
 
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ................
4a
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
Yes
 
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
Yes
 
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
Yes
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2013

Schedule J (Form 990) 2013
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1)STEVEN FISCHERDIRECTOR (i)
(ii)		 0
507,111 		0
119,165 		0
51,495 		0
12,750 		0
40,363 		0
730,884 		0
0
(2)NANCY FORMELLA RN MSNDIRECTOR (i)
(ii)		 0
451,541 		0
108,000 		0
20,683 		0
0 		0
13,778 		0
594,002 		0
0
(3)PETER J HOLDENPRES, CEO, DIR (EX-OFF) (i)
(ii)		 489,380
0 		100,000
0 		191,476
0 		12,750
0 		23,787
0 		817,393
0 		0
0
(4)STANLEY MLEWIS MDDIRECTOR (i)
(ii)		 0
482,970 		0
133,403 		0
12,272 		0
28,050 		0
18,952 		0
675,647 		0
0
(5)JOSEPH IANNONITREASURER, CFO (i)
(ii)		 325,259
0 		47,895
0 		12,064
0 		101,844
0 		22,097
0 		509,159
0 		0
0
(6)JASON RADZEVICHTREASURER, CFO (i)
(ii)		 0
277,169 		0
0 		0
211 		0
1,283 		0
4,226 		0
282,889 		0
0
(7)JAMES FANALE MDSVP DEVELOPMENT (i)
(ii)		 188,403
188,404 		27,686
27,687 		8,301
8,301 		52,551
52,550 		10,949
10,948 		287,890
287,890 		0
0
(8)DONNA DOHERTY RNCHIEF NURSING OFFICER (i)
(ii)		 224,580
0 		31,575
0 		1,020
0 		19,925
0 		22,525
0 		299,625
0 		0
0
(9)RON RUTHERFORDVP & CIO (i)
(ii)		 66,050
134,279 		0
0 		898
5,263 		4,135
3,250 		2,454
20,766 		73,537
163,558 		0
0
(10)ANDREA HOLLERANVP, EXTERNAL AFFAIRS (i)
(ii)		 170,975
0 		8,652
0 		501
0 		18,693
0 		26,344
0 		225,165
0 		0
0
(11)CYNTHIA OUTHOUSEVP, PHILANTHROPY (i)
(ii)		 32,469
129,877 		1,601
6,402 		443
1,772 		3,456
13,823 		4,137
16,548 		42,106
168,422 		0
0
(12)JAMES ALBERTFORMER VP & CIO (i)
(ii)		 76,768
0 		10,000
0 		136,701
0 		13,790
0 		734
0 		237,993
0 		0
0
(13)MARK DEMATTEO MDFORMER DIR & MED ST PRES (i)
(ii)		 0
494,966 		0
0 		0
0 		0
0 		0
0 		0
494,966 		0
0
Schedule J (Form 990) 2013

Schedule J (Form 990) 2013
Page 3
Part III
Supplemental Information
Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Return Reference Explanation
PART I, LINES 4A-B AS NOTED IN THIS FILING, JAMES ALBERT SERVED AS THE VICE PRESIDENT AND CHIEF INFORMATION OFFICER UNTIL MAY 2013. MR. ALBERT BECAME ELIGIBLE FOR CERTAIN SALARY CONTINUATION PAYMENTS ON LEAVING JHSI AND BID-PLYMOUTH AS NOTED IN MORE DETAIL IN THE DISCLOSURES BELOW. SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN AS NOTED THROUGHOUT THIS FILING, JORDAN HEALTH SYSTEMS INC. IS AN AFFILIATE OF BID-PLYMOUTH AND BOTH ENTITIES ARE EXEMPT FROM INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC) OF 1986, AS AMENDED. DURING THE 2013 CALENDAR YEAR, JORDAN HEALTH SYSTEMS, INC. (JHSI) MAINTAINED AN IRC SECTION 457(B) PLAN PURSUANT TO WHICH THE ELIGIBLE EMPLOYEE COULD DEFER PART OF HIS COMPENSATION. THIS PLAN IS STRICTLY EMPLOYEE FUNDED WITH NO EMPLOYER DEFERRALS. UNDER THE DEFINITIONS TO THIS FORM 990, THIS PLAN IS CONSIDERED A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN. AMOUNTS DEFERRED AND AMOUNTS PAID OUT TO THE PARTICIPANT ARE INCLUDED IN FORM 990 SCHEDULE J, PART II, COLUMN B(III), OTHER REPORTABLE COMPENSATION, IN ACCORDANCE WITH THE INSTRUCTIONS TO THIS FORM 990. DURING THAT SAME PERIOD, BID-PLYMOUTH AND JORDAN HEALTH SYSTEMS, INC. (JHSI) MAINTAINED TWO IRC SECTION 457(F) PLANS. THESE PLANS ARE STRICTLY EMPLOYER FUNDED WITH NO EMPLOYEE DEFERRALS. UNDER THE DEFINITIONS TO THIS FORM 990, THESE PLANS ARE CONSIDERED SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLANS. EMPLOYER CONTRIBUTIONS TO EMPLOYEES ARE INCLUDED IN FORM 990 SCHEDULE J, PART II, COLUMN C, RETIREMENT AND OTHER DEFERRED COMPENSATION. DISTRIBUTIONS FROM THESE PLANS ARE INCLUDED IN FORM 990 SCHEDULE J, PART II COLUMN B(III), OTHER REPORTABLE COMPENSATION, IN ACCORDANCE WITH THE INSTRUCTIONS TO THIS FORM 990. ADDITIONAL DETAIL IS INCLUDED BELOW IN THE ADDITIONAL EXPLANATORY FOOTNOTES TO THIS FORM 990 SCHEDULE J.
PART I, LINE 7 NON-FIXED PAYMENTS BID-PLYMOUTH'S AND JHSI'S EXECUTIVE COMPENSATION PACKAGES INCLUDE OPPORTUNITIES TO EARN INCENTIVE COMPENSATION BASED ON A COMBINATION OF MEETING OR EXCEEDING BID-PLYMOUTH'S OBJECTIVES FOR QUALITY AND PATIENT SAFETY, BID-PLYMOUTH'S CONSOLIDATED OPERATING MARGIN, AND MEETING INDIVIDUAL GOALS AND OBJECTIVES. THE INCENTIVE COMPENSATION FOR EACH EXECUTIVE IS REVIEWED AND APPROVED BY THE BID-PLYMOUTH EXECUTIVE COMPENSATION COMMITTEE, WHICH AS PREVIOUSLY NOTED, IS FULLY STAFFED BY INDEPENDENT MEMBERS.
PART I, LINE 8 INITIAL CONTRACT EXCEPTION ALL AMOUNTS PAID TO JAMES ALBERT, CYNTHIA OUTHOUSE, DONNA DOHERTY, RN, JAMES FANALE, M.D., PETER HOLDEN, ANDREA HOLLERAN, JOSEPH IANNONI AND JASON RADZEVICH DURING THE CALENDAR YEAR 2013 AND PAID BY JHSI WERE PAID PURSUANT TO THE INITIAL CONTRACT EXCEPTION DESCRIBED IN TREASURY REGULATIONS SECTION 53.4958-4(A)(3) AND BID-PLYMOUTH AND JHSI FOLLOWED THE REBUTTABLE PRESUMPTION PROCEDURES DESCRIBED IN TREASURY REGULATIONS SECTION 53.4958-6(C) IN SETTING COMPENSATION FOR THE LISTED INDIVIDUALS.
SCHEDULE J ADDITIONAL EXPLANATORY FOOTNOTES JORDAN HEALTH SYSTEMS, INC. 2013 FORM 990 SCHEDULE J ADDITIONAL EXPLANATORY FOOTNOTES: REPORTABLE COMPENSATION LISTED IN FORM 990 PART VII INCLUDES BASE COMPENSATION, INCENTIVE COMPENSATION AND OTHER REPORTABLE COMPENSATION AS REPORTED IN FORM 990 SCHEDULE J. OTHER COMPENSATION LISTED IN FORM 990 PART VII INCLUDES DEFERRED COMPENSATION AND NON-TAXABLE BENEFITS AS REPORTED IN FORM 990 SCHEDULE J. REPORTABLE COMPENSATION: AMOUNTS NOT OTHERWISE SEPARATELY NOTED IN THIS RETURN BUT QUANTIFIED IN OTHER REPORTABLE COMPENSATION INCLUDE AMOUNTS FROM ONE OR MORE OF THE FOLLOWING ITEMS: AMOUNTS DEFERRED BY THE EMPLOYEE (PLUS EARNINGS) UNDER FULLY VESTED 457(B) PLAN; INCREASE/DECREASE IN VALUE OF NONQUALIFIED FULLY VESTED 457(B) PLAN; TAXABLE EMPLOYER-SUBSIDIZED PARKING; TAXABLE MOVING EXPENSES; TAXABLE LIFE, DISABILITY, OR LONG-TERM CARE INSURANCE; AND OTHER TAXABLE RETIREMENT BENEFITS DEFERRED COMPENSATION: AMOUNTS NOT OTHERWISE SEPARATELY NOTED BUT QUANTIFIED IN DEFERRED COMPENSATION INCLUDE AMOUNTS FROM ONE OR MORE OF THE FOLLOWING ITEMS: EMPLOYER CONTRIBUTIONS TO 401K RETIREMENT PLAN, EMPLOYER CONTRIBUTIONS TO 403B RETIREMENT PLAN, EMPLOYER CONTRIBUTION TO PENSION PLAN NON-TAXABLE BENEFITS: AMOUNTS NOT OTHERWISE SEPARATELY NOTED BUT QUANTIFIED IN NON-TAXABLE BENEFITS INCLUDE AMOUNTS FROM ONE OR MORE OF THE NON-TAXABLE BENEFITS: EMPLOYEE CONTRIBUTIONS TO HEALTH INSURANCE, EMPLOYER CONTRIBUTIONS TO HEALTH INSURANCE, EMPLOYEE CONTRIBUTIONS TO FLEXIBLE SPENDING ACCOUNTS FOR DEPENDENT CARE AND/OR MEDICAL REIMBURSEMENT, GROUP TERM LIFE INSURANCE, DISABILITY INSURANCE ALL DIRECTORS/TRUSTEES SERVE WITHOUT COMPENSATION OR BENEFITS. COMPENSATION PAID TO OFFICERS, DIRECTORS, TRUSTEES OR KEY EMPLOYEES WAS EARNED FOR WORK PERFORMED IN A CAPACITY OTHER THAN THAT OF DIRECTOR/TRUSTEE, AS DENOTED BY THE LISTED TITLES JORDAN HEALTH SYSTEMS INC., BETH ISRAEL DEACONESS HOSPITAL-PLYMOUTH, BETH ISRAEL DEACONESS HOSPITAL-MILTON, BETH ISRAEL DEACONESS HOSPITAL-NEEDHAM, BETH ISRAEL DEACONESS MEDICAL CENTER AND JORDAN PHYSICIAN ASSOCIATES MAY BE REFERRED TO IN THESE EXPLANATORY NOTES TO FORM 990 PART VII AND FORM 990 SCHEDULE J AS JHSI, BID-PLYMOUTH, BID-MILTON, BID-NEEDHAM, BIDMC, AND JPA RESPECTIVELY. IN ADDITION, BIDMC IS THE SOLE MEMBER OF MEDICAL CARE OF BOSTON MANAGEMENT CORP. D/B/A AFFILIATED PHYSICIANS GROUP WHICH MAY BE REFERRED TO IN THESE EXPLANATORY NOTES AS APG. BABINI, MICHAEL DIRECTOR JORDAN HEALTH SYSTEMS, INC. DIRECTOR BETH ISRAEL DEACONESS HOSPITAL-PLYMOUTH MR. BABINI DEVOTES, ON AVERAGE, A COMBINED 2 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE. BAZZINOTTI, LYLE LAWRENCE VICE CHAIR, DIRECTOR JORDAN HEALTH SYSTEMS, INC. VICE CHAIR, DIRECTOR BETH ISRAEL DEACONESS HOSPITAL-PLYMOUTH MS. BAZZINOTTI DEVOTES, ON AVERAGE, A COMBINED 4 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE. CARNUCCIO, JOHN DIRECTOR JORDAN HEALTH SYSTEMS, INC. DIRECTOR BETH ISRAEL DEACONESS HOSPITAL-PLYMOUTH MR. CARNUCCIO DEVOTES, ON AVERAGE, A COMBINED 2 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE. CARTER II, LYON DIRECTOR JORDAN HEALTH SYSTEMS, INC. DIRECTOR BETH ISRAEL DEACONESS HOSPITAL-PLYMOUTH MR. CARTER DEVOTES, ON AVERAGE, A COMBINED 2 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE. CLIFFORD, FREDERIC DIRECTOR JORDAN HEALTH SYSTEMS, INC. DIRECTOR BETH ISRAEL DEACONESS HOSPITAL-PLYMOUTH MR. CLIFFORD DEVOTES, ON AVERAGE, A COMBINED 2 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE.
SCHEDULE J ADDITIONAL EXPLANATORY FOOTNOTES(CONTINUED) DAHLEN, SHAWN D. DIRECTOR JORDAN HEALTH SYSTEMS, INC. DIRECTOR BETH ISRAEL DEACONESS HOSPITAL-PLYMOUTH MR. DAHLEN DEVOTES, ON AVERAGE, A COMBINED 2 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE. FISCHER, STEVEN DIRECTOR JORDAN HEALTH SYSTEMS, INC. DIRECTOR BETH ISRAEL DEACONESS HOSPITAL-PLYMOUTH SENIOR VICE PRESIDENT AND CHIEF FINANCIAL OFFICER BETH ISRAEL DEACONESS MEDICAL CENTER TRUSTEE BETH ISRAEL DEACONESS HOSPITAL NEEDHAM MR. FISCHER BEGAN HIS TERM ON JHSI AND BID-PLYMOUTH'S BOARDS ON JANUARY 1, 2014. MR. FISCHER DEVOTES, ON AVERAGE, A COMBINED 65 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE. DURING THE PERIOD COVERED BY THIS FILING AND FOR THE 2013 CALENDAR YEAR, MR. FISCHER PERFORMED SERVICES FOR BIDMC. AS REQUIRED BY THIS FORM 990, MR. FISCHER'S COMPENSATION HAS BEEN REPORTED AS FURTHER OUTLINED BELOW. PAYMENTS MADE BY BIDMC: BASE COMPENSATION: 507,111 INCENTIVE COMPENSATION: 119,165 OTHER REPORTABLE COMPENSATION: 51,495 DEFERRED COMPENSATION: 12,750 NON-TAXABLE BENEFITS: 40,363 OTHER REPORTABLE AND DEFERRED COMPENSATION FOR MR. FISCHER INCLUDES COMBINED PAYMENTS FROM A NONQUALIFIED RETIREMENT PLAN IN THE AMOUNT OF $60,562. FORMELLA, R.N., M.S.N., NANCY DIRECTOR JORDAN HEALTH SYSTEMS, INC. DIRECTOR BETH ISRAEL DEACONESS HOSPITAL-PLYMOUTH CHIEF OPERATING OFFICER BETH ISRAEL DEACONESS MEDICAL CENTER MS. FORMELLA BEGAN HER TERM ON JHSI AND BID-PLYMOUTH'S BOARDS ON JANUARY 1, 2014. MS. FORMELLA BEGAN HER TERM AS CHIEF OPERATING OFFICER (COO) OF BIDMC ON MARCH 13, 2013. MS. FORMELLA DEVOTES, ON AVERAGE, A COMBINED 60 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE. DURING THE PERIOD COVERED BY THIS FILING AND FOR THE 2013 CALENDAR YEAR, MS. FORMELLA PERFORMED SERVICES FOR BIDMC. AS REQUIRED BY THIS FORM 990, MS. FORMELLA'S COMPENSATION HAS BEEN REPORTED AS FURTHER OUTLINED BELOW. PAYMENTS MADE BY BIDMC: BASE COMPENSATION: 451,541 INCENTIVE COMPENSATION: 108,000 OTHER REPORTABLE COMPENSATION: 20,683 DEFERRED COMPENSATION: 0 NON-TAXABLE BENEFITS: 13,778 FOSDICK, KENNETH DIRECTOR JORDAN HEALTH SYSTEMS, INC. DIRECTOR BETH ISRAEL DEACONESS HOSPITAL-PLYMOUTH MR. FOSDICK DEVOTES, ON AVERAGE, A COMBINED 2 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE. GAGNON, WILLIAM P. DIRECTOR JORDAN HEALTH SYSTEMS, INC. DIRECTOR BETH ISRAEL DEACONESS HOSPITAL-PLYMOUTH MR. GAGNON DEVOTES, ON AVERAGE, A COMBINED 2 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE. HINKLEY, CLARK CHAIR, DIRECTOR JORDAN HEALTH SYSTEMS, INC. CHAIR, DIRECTOR BETH ISRAEL DEACONESS HOSPITAL-PLYMOUTH CHAIR, DIRECTOR JORDAN PHYSICIAN ASSOCIATES MR. HINKLEY DEVOTES, ON AVERAGE, A COMBINED 15 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE.
SCHEDULE J ADDITIONAL EXPLANATORY FOOTNOTES(CONTINUED) HOLDEN, PETER J. PRESIDENT, CHIEF EXECUTIVE OFFICER, DIRECTOR JORDAN HEALTH SYSTEMS, INC. PRESIDENT, CHIEF EXECUTIVE OFFICER, DIRECTOR (EX-OFFICIO) BETH ISRAEL DEACONESS HOSPITAL-PLYMOUTH PRESIDENT, CHIEF EXECUTIVE OFFICER, DIRECTOR (EX-OFFICIO) JORDAN PHYSICIAN ASSOCIATES MR. HOLDEN DEVOTES, ON AVERAGE, A COMBINED 65 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE. DURING THE PERIOD COVERED BY THIS FILING AND FOR THE 2013 CALENDAR YEAR, MR. HOLDEN PERFORMED SERVICES FOR BID-PLYMOUTH AND JPA AND WAS COMPENSATED BY JHSI, AS FURTHER OUTLINED BELOW. PAYMENTS MADE BY JHSI AND REPORTED BY BID-PLYMOUTH AND JPA: BASE COMPENSATION: 489,380 INCENTIVE COMPENSATION: 100,000 OTHER REPORTABLE COMPENSATION: 191,476 DEFERRED COMPENSATION: 12,750 NON-TAXABLE BENEFITS: 23,787 OTHER REPORTABLE COMPENSATION FOR MR. HOLDEN INCLUDES A DISTRIBUTION IN THE AMOUNT OF $155,182 AND A DEFERRAL IN THE AMOUNT OF $15,700 UNDER A 457(B) PLAN. LEWIS, M.D., STANLEY DIRECTOR JORDAN HEALTH SYSTEMS, INC. DIRECTOR BETH ISRAEL DEACONESS HOSPITAL-PLYMOUTH SENIOR VICE PRESIDENT, NETWORK INTEGRATION BETH ISRAEL DEACONESS MEDICAL CENTER CARDIOLOGIST HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER, INC. DIRECTOR (EX-OFFICIO) MEDICAL CARE OF BOSTON MANAGEMENT CORPORATION D/B/A AFFILIATED PHYSICIANS GROUP TRUSTEE BETH ISRAEL DEACONESS HOSPITAL NEEDHAM DIRECTOR BETH ISRAEL DEACONESS HOSPITAL MILTON ASSOCIATE PROFESSOR OF MEDICINE HARVARD MEDICAL SCHOOL DR. LEWIS BEGAN HIS TERM ON BID-PLYMOUTH AND JORDAN HEALTH SYSTEMS' BOARDS ON JANUARY 1, 2014. DR. LEWIS DEVOTES, ON AVERAGE, A COMBINED 65 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE. DR. LEWIS PERFORMS SERVICES FOR BOTH BIDMC AND HMFP. AS REQUIRED BY FORM 990, ALTHOUGH DR. LEWIS IS PAID DIRECTLY BY HMFP, THE PORTION OF DR. LEWIS' COMPENSATION ATTRIBUTABLE TO HIS SERVICES PERFORMED AT BIDMC HAS BEEN SEPARATELY REPORTED ON FORM 990, AS FURTHER OUTLINED BELOW. PAYMENTS REPORTED BY BIDMC: BASE COMPENSATION: 434,673 INCENTIVE COMPENSATION: 120,063 OTHER REPORTABLE COMPENSATION: 11,045 DEFERRED COMPENSATION: 25,245 NON-TAXABLE BENEFITS: 17,057 PAYMENTS REPORTED BY HMFP: BASE COMPENSATION: 48,297 INCENTIVE COMPENSATION: 13,340 OTHER REPORTABLE COMPENSATION: 1,227 DEFERRED COMPENSATION: 2,805 NON-TAXABLE BENEFITS: 1,895
SCHEDULE J ADDITIONAL EXPLANATORY FOOTNOTES(CONTINUED) MUNCEY, ESQ., PETER SECRETARY, DIRECTOR BETH ISRAEL DEACONESS HOSPITAL-PLYMOUTH SECRETARY, DIRECTOR JORDAN HEALTH SYSTEMS, INC. MR. MUNCEY DEVOTES, ON AVERAGE, A COMBINED 2 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE. SCHEUB, M.D., KIMBERLY DIRECTOR JORDAN HEALTH SYSTEMS, INC. DIRECTOR BETH ISRAEL DEACONESS HOSPITAL-PLYMOUTH DR. SCHEUB DEVOTES, ON AVERAGE, A COMBINED 2 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE. SHEEHAN, WILFRED DIRECTOR JORDAN HEALTH SYSTEMS, INC. DIRECTOR BETH ISRAEL DEACONESS HOSPITAL-PLYMOUTH MR. SHEEHAN DEVOTES, ON AVERAGE, A COMBINED 2 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE. SMALL, KEELAS DIRECTOR JORDAN HEALTH SYSTEMS, INC. DIRECTOR BETH ISRAEL DEACONESS HOSPITAL-PLYMOUTH MS. SMALL DEVOTES, ON AVERAGE, A COMBINED 2 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE. STANWOOD, M.D., WALTER DIRECTOR (EX-OFFICIO), PRESIDENT OF THE MEDICAL STAFF JORDAN HEALTH SYSTEMS, INC. DIRECTOR (EX-OFFICIO), PRESIDENT OF THE MEDICAL STAFF BETH ISRAEL DEACONESS HOSPITAL-PLYMOUTH ORTHOPEDIST BETH ISRAEL DEACONESS HOSPITAL-PLYMOUTH DR. STANWOOD'S TERM AS PRESIDENT OF THE MEDICAL STAFF AND DIRECTOR (EX-OFFICIO) OF THE JHSI AND BID-PLYMOUTH BOARDS BEGAN SEPTEMBER 18, 2013. DR. STANWOOD DEVOTES, ON AVERAGE, 16 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE. DR. STANWOOD IS AN ORTHOPEDIST AND PROVIDES ADMINISTRATIVE AND CLINICAL OVERSIGHT TO THE ORTHOPEDIC CLINIC AT BID-PLYMOUTH. AS REQUIRED BY THIS FORM 990, COMPENSATION REPORTED BY BID-PLYMOUTH FOR THE 2013 CALENDAR YEAR INCLUDES $81,033 PAID TO PLYMOUTH BAY ORTHOPEDICS AND RELATED TO THESE ADMINISTRATIVE AND CLINICAL OVERSIGHT RESPONSIBILITIES. PAYMENTS REPORTED BY BID-PLYMOUTH: BASE COMPENSATION: 82,075 INCENTIVE COMPENSATION: 0 OTHER REPORTABLE COMPENSATION: 0 DEFERRED COMPENSATION: 0 NON-TAXABLE BENEFITS: 0
SCHEDULE J ADDITIONAL EXPLANATORY FOOTNOTES(CONTINUED) TREHU, M.D., STEPHEN DIRECTOR AND INTERIM CHIEF MEDICAL OFFICER JORDAN HEALTH SYSTEMS, INC. DIRECTOR AND INTERIM CHIEF MEDICAL OFFICER BETH ISRAEL DEACONESS HOSPITAL-PLYMOUTH RADIOLOGIST BETH ISRAEL DEACONESS HOSPITAL - PLYMOUTH DR. TREHU'S TERM AS INTERIM CHIEF MEDICAL OFFICER BEGAN ON SEPTEMBER 1, 2014 AND HE DEVOTES, ON AVERAGE, 10 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE. DR. TREHU IS A RADIOLOGIST AND PROVIDES ADMINISTRATIVE AND CLINICAL OVERSIGHT TO THE DEPARTMENT OF RADIOLOGY AT BID-PLYMOUTH. AS REQUIRED BY THIS FORM 990, COMPENSATION REPORTED FOR THE 2013 CALENDAR YEAR INCLUDES $16,051 PAID TO RADIOLOGY ASSOCIATES OF PLYMOUTH AND RELATED TO THESE ADMINISTRATIVE AND CLINICAL OVERSIGHT RESPONSIBILITIES. PAYMENTS REPORTED BY BID-PLYMOUTH BASE COMPENSATION: 16,051 INCENTIVE COMPENSATION: 0 OTHER REPORTABLE COMPENSATION: 0 DEFERRED COMPENSATION: 0 NON-TAXABLE BENEFITS: 0 IANNONI, JOSEPH VICE PRESIDENT OF FINANCE, CHIEF FINANCIAL OFFICER AND TREASURER JORDAN HEALTH SYSTEMS, INC. VICE PRESIDENT OF FINANCE, CHIEF FINANCIAL OFFICER AND TREASURER BETH ISRAEL DEACONESS HOSPITAL-PLYMOUTH VICE PRESIDENT OF FINANCE, CHIEF FINANCIAL OFFICER AND TREASURER JORDAN PHYSICIAN ASSOCIATES MR. IANNONI RESIGNED FROM THE ABOVE ROLES EFFECTIVE FEBRUARY 18, 2014 AND DEVOTED, ON AVERAGE, 60 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE. DURING THE PERIOD COVERED BY THIS FILING AND FOR THE 2013 CALENDAR YEAR, MR. IANNONI PERFORMED SERVICES FOR JHSI, BID-PLYMOUTH AND JPA AND WAS COMPENSATED BY JHSI, AS FURTHER OUTLINED BELOW. PAYMENTS MADE BY JHSI AND REPORTED BY BID-PLYMOUTH AND JPA: BASE COMPENSATION: 325,259 INCENTIVE COMPENSATION: 47,895 OTHER REPORTABLE COMPENSATION: 12,064 DEFERRED COMPENSATION: 101,844 NON-TAXABLE BENEFITS: 22,097 DEFERRED COMPENSATION REPORTED FOR MR. IANNONI INCLUDES A 457(F) PLAN CONTRIBUTION IN THE AMOUNT OF $90,000. RADZEVICH, JASON CHIEF FINANCIAL OFFICER AND TREASURER JORDAN HEALTH SYSTEMS, INC. CHIEF FINANCIAL OFFICER AND TREASURER BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH VICE PRESIDENT, FINANCE AND CHIEF FINANCIAL OFFICER BETH ISRAEL DEACONESS HOSPITAL MILTON VICE PRESIDENT, FINANCE AND CHIEF FINANCIAL OFFICER MILTON HOSPITAL FOUNDATION CHIEF FINANCIAL OFFICER COMMUNITY PHYSICIANS ASSOCIATES MR. RADZEVICH RESIGNED FROM HIS POSITIONS AS VICE PRESIDENT, FINANCE AND CHIEF FINANCIAL OFFICER AT BID-MILTON AND THE MILTON HOSPITAL FOUNDATION AND AS CHIEF FINANCIAL OFFICER AT COMMUNITY PHYSICIANS ASSOCIATES EFFECTIVE APRIL 1, 2014. MR. RADZEVICH COMMENCED HIS POSITIONS AS CHIEF FINANCIAL OFFICER AND TREASURER AT BID-PLYMOUTH AND JORDAN HEALTH SYSTEMS INC. ON MAY 5, 2014. AS REQUIRED BY FORM 990, COMPENSATION REPORTED IN THIS FILING FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2014 REPRESENTS PAYMENTS MADE BY BID-MILTON DURING THE CALENDAR YEAR 2013. MR. RADZEVICH DEVOTED, ON AVERAGE, A COMBINED 60 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE. PAYMENTS REPORTED BY BID-MILTON: BASE COMPENSATION: 277,169 INCENTIVE COMPENSATION: 0 OTHER REPORTABLE COMPENSATION: 211 DEFERRED COMPENSATION: 1,283 NON-TAXABLE BENEFITS: 4,226 DOHERTY, R.N., DONNA VICE PRESIDENT, PATIENT CARE SERVICES AND CHIEF NURSING OFFICER BETH ISRAEL DEACONESS HOSPITAL-PLYMOUTH MS. DOHERTY DEVOTES, ON AVERAGE, 60 HOURS PER WEEK TO THE RELATED ENTITY FOR THE POSITION LISTED HERE. DURING THE PERIOD COVERED BY THIS FILING AND FOR THE 2013 CALENDAR YEAR, MS. DOHERTY PERFORMED SERVICES FOR BID-PLYMOUTH AND WAS COMPENSATED BY JHSI, AS FURTHER OUTLINED BELOW. PAYMENTS MADE BY JHSI AND REPORTED BY BID-PLYMOUTH: BASE COMPENSATION: 224,580 INCENTIVE COMPENSATION: 31,575 OTHER REPORTABLE COMPENSATION: 1,020 DEFERRED COMPENSATION: 19,925 NON-TAXABLE BENEFITS: 22,525 DEFERRED COMPENSATION REPORTED FOR MS. DOHERTY INCLUDES A 457(F) PLAN CONTRIBUTION IN THE AMOUNT OF $11,600.
SCHEDULE J ADDITIONAL EXPLANATORY FOOTNOTES(CONTINUED) FANALE, M.D., JAMES SENIOR VICE PRESIDENT, SYSTEMS DEVELOPMENT JORDAN HEALTH SYSTEMS, INC. SENIOR VICE PRESIDENT, SYSTEMS DEVELOPMENT BETH ISRAEL DEACONESS HOSPITAL-PLYMOUTH TRUSTEE (EX-OFFICIO) JORDAN PHYSICIAN ASSOCIATES DIRECTOR MEDICAL CARE OF BOSTON MANAGEMENT CORP. D/B/A AFFILIATED PHYSICIANS GROUP DR. FANALE DEVOTES, ON AVERAGE, A COMBINED 60 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE. DR. FANALE RESIGNED FROM HIS POSITION AS SENIOR VICE PRESIDENT, SYSTEMS DEVELOPMENT AT BID-PLYMOUTH AND JHSI AND AS TRUSTEE (EX-OFFICIO) AT JPA AND DIRECTOR AT APG EFFECTIVE SEPTEMBER 2, 2014. DURING THE PERIOD COVERED BY THIS FILING, AND FOR THE 2013 CALENDAR YEAR, DR. FANALE PERFORMED SERVICES FOR JHSI AND BID-PLYMOUTH AND WAS COMPENSATED BY JHSI, AS REQUIRED BY THIS FORM 990, THE PORTION OF DR. FANALE'S COMPENSATION ATTRIBUTABLE TO EACH POSITION HAS BEEN SEPARATELY REPORTED ON THIS FORM 990, AS FURTHER OUTLINED BELOW. PAYMENTS REPORTED BY JHSI BASE COMPENSATION: 188,403 INCENTIVE COMPENSATION: 27,686 OTHER REPORTABLE COMPENSATION: 8,301 DEFERRED COMPENSATION: 52,551 NON-TAXABLE BENEFITS: 10,949 PAYMENTS REPORTED BY BID-PLYMOUTH BASE COMPENSATION: 188,404 INCENTIVE COMPENSATION: 27,687 OTHER REPORTABLE COMPENSATION: 8,301 DEFERRED COMPENSATION: 52,550 NON-TAXABLE BENEFITS: 10,948 DEFERRED COMPENSATION REPORTED FOR DR. FANALE INCLUDES A 457(F) PLAN CONTRIBUTION IN THE AMOUNT OF $93,000 RUTHERFORD, RON VICE PRESIDENT AND CHIEF INFORMATION OFFICER JORDAN HEALTH SYSTEMS, INC. VICE PRESIDENT AND CHIEF INFORMATION OFFICER BETH ISRAEL DEACONESS HOSPITAL-PLYMOUTH VICE PRESIDENT AND CHIEF INFORMATION OFFICER JORDAN PHYSICIAN ASSOCIATES FORMER DEPUTY CHIEF INFORMATION OFFICER BETH ISRAEL DEACONESS HOSPITAL-PLYMOUTH FORMER DEPUTY CHIEF INFORMATION OFFICER JORDAN PHYSICIAN ASSOCIATES FORMER DEPUTY CHIEF INFORMATION OFFICER JORDAN HEALTH SYSTEMS, INC. MR. RUTHERFORD SERVED AS THE DEPUTY CHIEF INFORMATION OFFICER UNTIL AUGUST 1, 2013 WHEN HE BECAME THE VICE PRESIDENT AND CHIEF INFORMATION OFFICER. MR. RUTHERFORD DEVOTES, ON AVERAGE, A COMBINED 60 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE. IN HIS POSITIONS AS VICE PRESIDENT AND CHIEF INFORMATION OFFICER FOR BID-PLYMOUTH AND JPA, MR. RUTHERFORD RECEIVES PAYMENTS DIRECTLY FROM JHSI. ADDITIONALLY, MR. RUTHERFORD WAS COMPENSATED BY BID-PLYMOUTH FOR SERVICES PROVIDED TO BID-PLYMOUTH AND JPA IN THE ROLE OF DEPUTY CHIEF INFORMATION OFFICER. THE COMPENSATION PAID BY EACH ENTITY IS FURTHER OUTLINED BELOW. PAYMENTS MADE BY JHSI AND REPORTED BY BID-PLYMOUTH AND JPA: BASE COMPENSATION: 66,050 INCENTIVE COMPENSATION: 0 OTHER REPORTABLE COMPENSATION: 898 DEFERRED COMPENSATION: 4,135 NON-TAXABLE BENEFITS: 2,454 PAYMENTS MADE BY BID-PLYMOUTH AND REPORTED BY BID-PLYMOUTH AND JPA: BASE COMPENSATION: 134,279 INCENTIVE COMPENSATION: 0 OTHER REPORTABLE COMPENSATION: 5,263 DEFERRED COMPENSATION: 3,250 NON-TAXABLE BENEFITS: 20,766
SCHEDULE J ADDITIONAL EXPLANATORY FOOTNOTES(CONTINUED) HOLLERAN, ANDREA VICE PRESIDENT OF EXTERNAL AFFAIRS BETH ISRAEL DEACONESS HOSPITAL-PLYMOUTH MS. HOLLERAN DEVOTES, ON AVERAGE, 60 HOURS PER WEEK TO THE REPORTING ORGANIZATION. DURING THE PERIOD COVERED BY THIS FILING AND FOR THE 2013 CALENDAR YEAR, MS. HOLLERAN PERFORMED SERVICES FOR BID-PLYMOUTH AND WAS COMPENSATED BY JHSI, AS FURTHER OUTLINED BELOW. PAYMENTS MADE BY JHSI AND REPORTED BY BID-PLYMOUTH: BASE COMPENSATION: 170,975 INCENTIVE COMPENSATION: 8,652 OTHER REPORTABLE COMPENSATION: 501 DEFERRED COMPENSATION: 18,693 NON-TAXABLE BENEFITS: 26,344 DEFERRED COMPENSATION REPORTED FOR MS. HOLLERAN INCLUDES A 457(F) PLAN CONTRIBUTION IN THE AMOUNT OF $10,500 OUTHOUSE, CYNTHIA VICE PRESIDENT OF PHILANTHROPY BETH ISRAEL DEACONESS HOSPITAL-PLYMOUTH VICE PRESIDENT OF PHILANTHROPY JORDAN HEALTH SYSTEMS, INC. MS. OUTHOUSE DEVOTES, ON AVERAGE, A COMBINED 60 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE. DURING THE PERIOD COVERED BY THIS FILING AND FOR THE 2013 CALENDAR YEAR, MS. OUTHOUSE PERFORMS SERVICES FOR BID-PLYMOUTH AND JHSI AND WAS COMPENSATED BY JHSI. AS REQUIRED BY THIS FORM 990, THE PORTION OF MS. OUTHOUSE'S COMPENSATION ATTRIBUTABLE TO EACH POSITION HAS BEEN SEPARATELY REPORTED ON THIS FORM 990, AS FURTHER OUTLINED BELOW. PAYMENTS REPORTED BY JHSI: BASE COMPENSATION: 32,469 INCENTIVE COMPENSATION: 1,601 OTHER REPORTABLE COMPENSATION: 443 DEFERRED COMPENSATION: 3,456 NON-TAXABLE BENEFITS: 4,137 PAYMENTS REPORTED BY BID-PLYMOUTH: BASE COMPENSATION: 129,877 INCENTIVE COMPENSATION: 6,402 OTHER REPORTABLE COMPENSATION: 1,772 DEFERRED COMPENSATION: 13,823 NON-TAXABLE BENEFITS: 16,548 DEFERRED COMPENSATION REPORTED FOR MS. OUTHOUSE INCLUDES A 457(F) PLAN CONTRIBUTION IN THE AMOUNT OF $9,700 ALBERT, JAMES FORMER VICE PRESIDENT AND CHIEF INFORMATION OFFICER JORDAN PHYSICIAN ASSOCIATES FORMER VICE PRESIDENT AND CHIEF INFORMATION OFFICER BETH ISRAEL DEACONESS HOSPITAL-PLYMOUTH FORMER VICE PRESIDENT AND CHIEF INFORMATION OFFICER JORDAN HEALTH SYSTEMS, INC. MR. ALBERT SERVED AS THE VICE PRESIDENT AND CHIEF INFORMATION OFFICER UNTIL MAY 2013 AND DEVOTED, ON AVERAGE, 60 HOURS PER WEEK TO THE REPORTING ORGANIZATION. DURING THE 2013 CALENDAR YEAR, MR. ALBERT PREFORMED SERVICES FOR BID-PLYMOUTH AND JPA AND WAS COMPENSATED BY JHSI, AS FURTHER OUTLINED BELOW. PAYMENTS MADE BY JHSI AND REPORTED BY BID-PLYMOUTH AND JPA: BASE COMPENSATION: 76,768 INCENTIVE COMPENSATION: 10,000 OTHER REPORTABLE COMPENSATION: 136,701 DEFERRED COMPENSATION: 13,790 NON-TAXABLE BENEFITS: 734 OTHER REPORTABLE COMPENSATION FOR MR. ALBERT INCLUDES SALARY CONTINUATION PAYMENTS PAID IN THE AMOUNT OF $134,833 DURING THE CALENDAR YEAR 2013. DEFERRED COMPENSATION REPORTED FOR MR. ALBERT INCLUDES A 457(F) PLAN CONTRIBUTION IN THE AMOUNT OF $10,500 DEMATTEO, M.D., MARK EMERGENCY MEDICINE PHYSICIAN FORMER DIRECTOR (EX-OFFICIO) AND PRESIDENT OF THE MEDICAL STAFF BETH ISRAEL DEACONESS HOSPITAL-PLYMOUTH FORMER DIRECTOR (EX-OFFICIO) AND PRESIDENT OF THE MEDICAL STAFF JORDAN HEALTH SYSTEMS, INC. DR. DEMATTEO SERVED AS DIRECTOR (EX-OFFICIO) AND PRESIDENT OF THE MEDICAL STAFF OF BID-PLYMOUTH AND JHSI UNTIL JULY 17, 2013, AND DEVOTES ON AVERAGE, 60 HOURS PER WEEK TO THE REPORTING ORGANIZATION AND ALL RELATED ENTITIES FOR THE POSITIONS LISTED HERE. DR. DEMATTEO IS AN EMERGENCY MEDICINE PHYSICIAN AND PROVIDES EMERGENCY MEDICINE AND URGENT CARE SERVICES AND MEDICAL ADMINISTRATIVE SERVICES AT THE SYKES EMERGENCY DEPARTMENT AT BID-PLYMOUTH. AS REQUIRED BY THIS FORM 990, COMPENSATION REPORTED BY BID-PLYMOUTH FOR THE 2013 CALENDAR YEAR INCLUDES $475,174 PAID TO BAYSIDE EMERGENCY MEDICAL ASSOCIATES, P.C. AND RELATED TO THESE MEDICAL AND ADMINISTRATIVE RESPONSIBILITIES. PAYMENTS MADE BY BID-PLYMOUTH: BASE COMPENSATION: 494,966 INCENTIVE COMPENSATION: 0 OTHER REPORTABLE COMPENSATION: 0 DEFERRED COMPENSATION: 0 NON-TAXABLE BENEFITS: 0
Schedule J (Form 990) 2013

Additional Data


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Software Version:  
Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBullet See separate instructions.
MediumBulletInformation about Schedule L (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
JORDAN HEALTH SYSTEMS INC
 
Employer identification number

04-2103805
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501(c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No





2
Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22
(a) Name of interested person (b) Relationship with organization (c) Purpose of loan (d) Loan to or from the organization? (e)Original principal amount (f)Balance due (g) In default? (h) Approved by board or committee? (i)Written agreement?
To From Yes No Yes No Yes No
Total ......Small Bullet $  
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of assistance (d) Type of assistance (e) Purpose of assistance
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2013
Schedule L (Form 990 or 990-EZ) 2013
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) STANLEY LEWIS MD
  		FAMILY RELATIONSHIP 66,459 SALARY   No
(2) MARK DEMATTEO MD
  		FORMER TRUSTEE 7,140,048 EMERGENCY DEPARTMENT SERVICES & STAFF   No
Part V
Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).
Return Reference Explanation
SCHEDULE L PART IV COLUMN (D) STANLEY M. LEWIS, M.D, A DIRECTOR SITTING ON THE BOARD OF BID-PLYMOUTH, SERVES ON THE BOARDS OF DIRECTORS FOR MEDICAL CARE OF BOSTON MANAGEMENT CORP D/B/A AFFILIATED PHYSICIANS GROUP (APG), THE BOARD OF TRUSTEES FOR BETH ISRAEL DEACONESS HOSPITAL NEEDHAM (BIDN) AND BETH ISRAEL DEACONESS HOSPITAL MILTON (BID-MILTON). DR. LEWIS IS ALSO THE SENIOR VICE PRESIDENT FOR NETWORK INTEGRATION AT BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC) AND A CARDIOLOGIST AT HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER (HMFP).JASON JONATHAN LEWIS IS DR. LEWIS' SON AND IS A MEDICAL RESIDENT AT BIDMC. DR. JASON JONATHAN LEWIS' SALARY AND OTHER INCOME INCLUDE:BASE COMPENSATION: $59,677INCENTIVE COMPENSATION: $0OTHER REPORTABLE COMPENSATION: $8DEFERRED COMPENSATION: $0NON-TAXABLE BENEFITS: $6,774MARK DEMATTEO, M.D., FORMER PRESIDENT OF THE MEDICAL STAFF AND FORMER EX-OFFICIO DIRECTOR OF BETH ISRAEL HOSPITAL PLYMOUTH (BID-PLYMOUTH) AND JORDAN HEALTH SYSTEMS, INC. (JHSI) ALSO SERVED AS THE CHAIR OF THE DEPARTMENT OF EMERGENCY MEDICINE FOR BID-PLYMOUTH DURING THE PERIOD COVERED BY THIS FILING. DR. DE MATTEO IS ALSO THE PRESIDENT OF BAYSIDE EMERGENCY MEDICAL ASSOCIATES, P.C. (BEMA) AND DURING THE PERIOD COVERED BY THIS FILING, BID-PLYMOUTH PAID $7,140,048 TO BEMA FOR THE PROVISION OF SERVICES INCLUDING STAFFING THE EMERGENCY DEPARTMENT TO PROVIDE FULL COVERAGE OF THE DEPARTMENT AT ALL TIMES AND THE MEDICAL DIRECTOR OF THE EMERGENCY DEPARTMENT.VARIOUS CURRENT AND FORMER OFFICERS, DIRECTORS/TRUSTEES AND KEY EMPLOYEES OF BID- PLYMOUTH AND JHSI MAY ALSO HOLD POSITIONS WITH OTHER ENTITIES WHICH MAKE CHARITABLE CONTRIBUTIONS TO BID-PLYMOUTH AND/OR JHSI. SUCH CONTRIBUTIONS HAVE NOT BEEN INCLUDED IN THE DISCLOSURES ABOVE. BID-PLYMOUTH AND JHSI MAINTAIN AN ACCOUNTABLE BUSINESS EXPENSE REIMBURSEMENT PLANS. FROM TIME TO TIME, BID-PLYMOUTH OR JHSI MAY REIMBURSE ITS OFFICERS, DIRECTORS/TRUSTEES AND/OR KEY EMPLOYEES FOR EXPENSES THEY INCURRED AND WHICH ARE PROPERLY ORDINARY AND NECESSARY BUSINESS EXPENSES OF THE REPORTING ENTITY. THE POLICIES AND PROCEDURES REQUIRED BY THE ACCOUNTABLE BUSINESS PLAN MUST BE FOLLOWED IN ORDER TO RECEIVE REIMBURSEMENT FOR SUCH EXPENSES AND IT IS POSSIBLE THAT ONE OR MORE INDIVIDUALS RECEIVED NON-TAXABLE REIMBURSEMENTS WHICH TOTALED $10,000 OR MORE DURING THE FISCAL PERIOD COVERED BY THIS FILING. ALL OF THE ABOVE TRANSACTIONS WERE NEGOTIATED AT ARMS-LENGTH AND IN ACCORDANCE WITH THE BID-PLYMOUTH, JHSI AND/OR BIDMC CONFLICT OF INTEREST POLICIES.
Schedule L (Form 990 or 990-EZ) 2013

Additional Data


Software ID:  
Software Version:  




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.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
Name of the organization
JORDAN HEALTH SYSTEMS INC
 
Employer identification number

04-2103805
Return Reference Explanation
FORM 990, PART I & PART III, LINE 1 DESCRIPTION OF ORGANIZATION'S MISSION JORDAN HEALTH SYSTEMS INC. (JHSI) SUPPORTS THE MISSION OF BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH BY PROVIDING MANAGEMENT AND PHILANTHROPIC SERVICES TO THE HOSPITAL. THE MISSION OF THE BETH ISRAEL DEACONESS HOSPITAL-PLYMOUTH, INC. (BID-PLYMOUTH OR HOSPITAL) IS TO IMPROVE THE HEALTH AND WELL-BEING OF ITS PATIENTS AND COMMUNITY BY PROVIDING A FULL CONTINUUM OF HEALTHCARE SERVICES WITH EXCELLENCE AND COMPASSION AS WELL AS ACCESS TO TERTIARY CARE IN CLOSE COLLABORATION WITH ITS SOLE MEMBER, BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC OR MEDICAL CENTER), REGARDLESS OF THE PATIENT'S ABILITY TO PAY, RACE, COLOR, RELIGION, SEX, SEXUAL ORIENTATION, NATIONAL ORIGIN, ANCESTRY, AGE, OR DISABILITY. SERVING THE GREATER PLYMOUTH REGION BID-PLYMOUTH AND ITS AFFILIATES COLLABORATE WITH COMMUNITY LEADERS, PUBLIC AND PRIVATE AGENCIES AND BUSINESSES, TO PROVIDE HEALTH PROMOTION, HEALTH PROTECTION, AND PREVENTIVE SERVICES TO MEET THE BROAD RANGE OF OUR COMMUNITY'S HEALTH AND WELLNESS NEEDS AS IDENTIFIED THROUGH COMMUNITY FEEDBACK AND FORMAL COMMUNITY NEEDS ASSESSMENTS. AS PART OF ITS MISSION TO SUPPORT COMMUNITY HEALTH, THE HOSPITAL IS COMMITTED TO ASSESSING ROOT CAUSES OF HEALTH DISPARITIES AND TO ASSISTING IN IMPROVING HEALTH CARE FOR THE DISADVANTAGED AND UNDERSERVED. BID-PLYMOUTH IS A 155-BED ACUTE CARE HOSPITAL SERVING MORE THAN 250,000 RESIDENTS IN PLYMOUTH AND BARNSTABLE COUNTIES, INCLUDING THE COMMUNITIES OF BOURNE, CARVER, DUXBURY, HALIFAX, KINGSTON, LAKEVILLE, PEMBROKE, PLYMPTON, PLYMOUTH, MARSHFIELD, MIDDLEBORO, SANDWICH AND WAREHAM. THE HOSPITAL IS THE REGION'S LEADING PROVIDER OF HIGH-QUALITY HEALTHCARE, PROVIDING COMPREHENSIVE HEALTHCARE RANGING FROM PRIMARY AND PREVENTIVE CARE TO SPECIALTY SERVICES. THROUGHOUT BID-PLYMOUTH, QUALITY IMPROVEMENT IS PARAMOUNT AND ENCOMPASSES BOTH CLINICAL OUTCOMES AND THE SERVICE COMPONENTS OF ALL INTERACTIONS WITH PATIENTS AND THEIR FAMILIES. BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC OR MEDICAL CENTER), IS A NATIONALLY RECOGNIZED TERTIARY CARE ACADEMIC MEDICAL CENTER, IS A TEACHING HOSPITAL OF HARVARD MEDICAL SCHOOL AND IS THE SOLE MEMBER OF BID-PLYMOUTH. BIDMC IS EXEMPT FROM INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED AND IS RECOGNIZED NATIONALLY FOR THE CLINICAL EXCELLENCE OF ITS FACULTY AND THE PATIENT CARE PROVIDED, AS WELL AS FOR THE MAGNITUDE AND BREADTH OF ITS RESEARCH AND FOR ITS COMMITMENT TO MEDICAL EDUCATION. MANY BID-PLYMOUTH PHYSICIANS ALSO HOLD APPOINTMENTS AT HARVARD OR OTHER MAJOR MEDICAL SCHOOLS AND ARE TIED CLOSELY WITH THEIR COLLEAGUES AT OTHER ACADEMIC MEDICAL CENTERS.
FORM 990, PART III, LINE 4A JHSI EMPLOYS THE SENIOR LEADERSHIP OF BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH AND PROVIDES THEIR SERVICES TO MANAGE THE HOSPITAL OPERATIONS.
FORM 990, PART III, LINE 4B PHILANTHROPY SERVICES JHSI PROVIDES FUND RAISING SERVICES TO BETH DEACONESS HOSPITAL PLYMOUTH, IDENTIFIES SOURCES OF PHILANTHROPIC GIVING TO SUPPORT THE HOSPITAL'S MISSION, AND MANAGES FUND RAISING EVENTS FOR THE BENEFIT OF THE HOSPITAL.
QUESTION 12 AND 12A - STATEMENT RE AUDITED FINANCIAL STATEMENTS THE BOSTON, MA OFFICE OF KPMG ISSUED AN UNQUALIFIED OPINION ON THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF JORDAN HEALTH SYSTEMS INC AND ITS AFFILIATES FOR FISCAL YEAR ENDED SEPTEMBER 30, 2014. THESE STATEMENTS WERE PREPARED IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP) AND INCLUDED THE ACCOUNTS OF BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH, JORDAN PHYSICIAN ASSOCIATES, JORDAN HEALTH SYSTEMS, INC, JORDAN COMMUNITY ACCOUNTABLE CARE ORGANIZATION (ACO) AND ATLANTIC MEDICAL MANAGEMENT, INC.
QUESTION 7G CONTRIBUTIONS OF INTELLECTUAL PROPERTY JORDAN HEALTH SYSTEMS INC. DID NOT RECEIVE ANY CONTRIBUTIONS OF INTELLECTUAL PROPERTY AND AS SUCH, WAS NOT REQUIRED TO FILE FORM 8899.
QUESTION 7H CONTRIBUTIONS OF CARS, BOATS, AIRPLANES AND OTHER VEHICLES JORDAN HEALTH SYSTEMS INC. DID NOT RECEIVE ANY CONTRIBUTIONS OF CARS, BOATS, AIRPLANES OR OTHER VEHICLES AND AS SUCH, WAS NOT REQUIRED TO FILE FORM 1098-C.
FORM 990, PART VI, SECTION A, LINE 2 THE FOLLOWING JORDAN HEALTH SYSTEMS INC. OFFICERS, DIRECTORS/TRUSTEES, AND KEY EMPLOYEES HAVE BUSINESS OR FAMILY RELATIONSHIPS: SHAWN D. DAHLEN AND JOHN CARNUCCIO BUSINESS RELATIONSHIP SHAWN D. DAHLEN AND FREDERIC CLIFFORD BUSINESS RELATIONSHIP SHAWN D. DAHLEN AND CLARK HINKLEY BUSINESS RELATIONSHIP AS NOTED IN VARIOUS NARRATIVE DISCLOSURES WHICH SUPPORT THIS FORM 990 AND RELATED SCHEDULES, CAREGROUP, INC. (CAREGROUP) IS A MASSACHUSETTS NON-PROFIT CORPORATION EXEMPT FROM INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED. CAREGROUP'S PURPOSE IS TO OVERSEE THE FINANCIAL WELL-BEING OF THE AFFILIATED ENTITIES WHICH MAKE UP THE CAREGROUP SYSTEM. CAREGROUP SERVES AS THE SOLE MEMBER AND A SUPPORT ORGANIZATION OF BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC OR MEDICAL CENTER). BIDMC IS THE SOLE MEMBER OF BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH, INC. (BID-PLYMOUTH) AND JORDAN HEALTH SYSTEMS, INC. (JHSI), BETH ISRAEL DEACONESS HOSPITAL NEEDHAM, INC. (BIDN), MEDICAL CARE OF BOSTON MANAGEMENT CORPORATION, D/B/A AFFILIATED PHYSICIANS GROUP (APG) AND BETH ISRAEL DEACONESS HOSPITAL MILTON, INC. (BID-MILTON). IN ADDITION, HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER, INC. (HMFP) IS THE DEDICATED PHYSICIAN PRACTICE OF THE MEDICAL CENTER AND AN ENTITY INTEGRALLY RELATED TO HELPING THE MEDICAL CENTER AND ITS AFFILIATES ACCOMPLISH THEIR CHARITABLE PURPOSES. CAREGROUP ALSO SERVES AS THE SOLE MEMBER AND A SUPPORT ORGANIZATION OF NEW ENGLAND BAPTIST HOSPITAL (NEBH) AND MOUNT AUBURN HOSPITAL (MAH), WHICH IN TURN SERVE AS THE SOLE MEMBER OF NEW ENGLAND BAPTIST MEDICAL ASSOCIATES (NEBMA) AND MOUNT AUBURN PROFESSIONAL SERVICES (MAPS), RESPECTIVELY. EACH OF THE ENTITIES LISTED IN THIS PARAGRAPH MAY, IN TURN, SERVE AS MEMBER OF ADDITIONAL ENTITIES WITHIN THE CAREGROUP NETWORK OF AFFILIATES. TWO OR MORE OF THE PERSONS LISTED IN THIS FORM 990 PART VII HAVE A BUSINESS RELATIONSHIP WITH EACH OTHER BY VIRTUE OF SITTING ON ONE OR MORE BOARDS OF DIRECTORS/TRUSTEES OR BY SERVING IN AN EMPLOYMENT RELATIONSHIP WITH ONE OR MORE ENTITIES WITHIN THE CAREGROUP NETWORK OF AFFILIATED ORGANIZATIONS. ADDITIONAL DETAIL IS PROVIDED IN THE EXPLANATORY NOTES TO THIS FORM 990 SCHEDULE J.
FORM 990, PART VI, SECTION A, LINE 4 ON JANUARY 1, 2014, BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC OR MEDICAL CENTER), A NATIONALLY RECOGNIZED TERTIARY CARE ACADEMIC MEDICAL CENTER AND A TEACHING HOSPITAL OF HARVARD MEDICAL SCHOOL BECAME THE SOLE MEMBER OF JORDAN HEALTH SYSTEMS, INC. (JHSI). BIDMC IS EXEMPT FROM INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED AND IS RECOGNIZED NATIONALLY FOR THE CLINICAL EXCELLENCE OF ITS FACULTY AND THE PATIENT CARE PROVIDED, AS WELL AS FOR THE MAGNITUDE AND BREADTH OF ITS RESEARCH AND FOR ITS COMMITMENT TO MEDICAL EDUCATION. BIDMC HAS CERTAIN RIGHTS AND RESERVED POWERS AS MEMBER OF JHSI AS NOTED BELOW.
FORM 990, PART VI, SECTION A, LINE 6 BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC OR MEDICAL CENTER) IS A TERTIARY CARE ACADEMIC MEDICAL CENTER. BIDMC, A FLAGSHIP TEACHING HOSPITAL OF HARVARD MEDICAL SCHOOL, IS KNOWN FOR ITS EXEMPLARY PATIENT CARE, CONDUCTING "LEADING EDGE" CLINICAL AND BASIC SCIENCE RESEARCH AND SUPPORTING OUTSTANDING EDUCATIONAL PROGRAMS. BIDMC IS A HOSPITAL EXEMPT FROM INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC) OF 1986 AS AMENDED, AND ACTING THROUGH ITS BOARD OF DIRECTORS, IS THE SOLE MEMBER OF THE JORDAN HEALTH SYSTEMS, INC. (JHSI). BIDMC ALSO SERVES AS THE SOLE MEMBER OF BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH WHICH, AS NOTED THROUGHOUT THIS NARRATIVE, IS AN AFFILIATE OF JHSI.
FORM 990, PART VI, SECTION A, LINE 7A PURSUANT TO THE JHSI AMENDED AND RESTATED BYLAWS, THE BOARD SHALL CONSIST OF THOSE PERSONS SERVING FROM TIME TO TIME AS THE DULY ELECTED AND APPOINTED DIRECTORS OF BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH (BID-PLYMOUTH OR HOSPITAL).THE MEDICAL CENTER AS SOLE CORPORATE MEMBER OF BID-PLYMOUTH HAS THE RIGHT TO APPOINT THREE OF THE HOSPITAL'S MAXIMUM OF SEVENTEEN (17) ELECTED VOTING DIRECTORS AND TWO (2) EX-OFFICIO VOTING DIRECTORS. THE REMAINING DIRECTORS ARE NOMINATED BY THE BOARD OF DIRECTORS AND SUBMITTED TO THE MEMBER FOR APPROVAL. A DIRECTOR MAY BE REMOVED FROM OFFICE BY THE MEMBER, EITHER WITH OR WITHOUT CAUSE. THE MEMBER SHALL FILL ANY BOARD VACANCIES WITH PERSONS NOMINATED BY THE BOARD, UNLESS THE VACANCY IS CREATED BY THE DEPARTURE OF A MEMBER-APPOINTED DIRECTOR, IN WHICH CASE THE MEMBER MAY ELECT A PERSON NOT NOMINATED BY THE BOARD. ADDITIONALLY, THE MEDICAL CENTER AS SOLE MEMBER HAS THE FOLLOWING RIGHTS: 1.THE MEMBER SHALL HAVE THE FOLLOWING RESERVED POWERS WHICH IT MAY EXERCISE ON ITS OWN INITIATIVE UPON A TWO-THIRDS (2/3) VOTE OF ITS DIRECTORS ELIGIBLE TO VOTE ON ITS BOARD OF DIRECTORS, WITH OR WITHOUT THE APPROVAL OF JHSI'S BOARD OF DIRECTORS OR UPON A MAJORITY VOTE OF ITS DIRECTORS ELIGIBLE TO VOTE IN THE EVENT THAT JHSI'S BOARD OF DIRECTORS HAS RECOMMENDED ANY OF THE LISTED ACTIONS: A.REMOVE A MEMBER OF THE JHSI BOARD OF DIRECTORS; B.ESTABLISH OR MODIFY THE COMPENSATION OF, AND/OR APPOINT OR REMOVE THE JHSI PRESIDENT AND CHIEF EXECUTIVE OFFICER UPON PRIOR CONSULTATION WITH JHSI'S BOARD OF DIRECTORS; C.AMEND THE JSHI BYLAWS OR ARTICLES OF ORGANIZATION; D.CAUSE JHSI TO ENTER INTO: (I)MANAGED CARE CONTRACTS, OTHER PAYER AGREEMENTS, EXCLUSIVE CONTRACTS, AGREEMENTS-NOT-TO-COMPETE, OR SIMILAR ARRANGEMENTS (II)CONTRACTS FOR MANAGEMENT SERVICES WITH POTENTIALLY SIGNIFICANT MULTI-YEAR BUDGETARY IMPACT; OR (III)OTHER MULTI-YEAR SERVICE CONTRACTS WITH POTENTIALLY SIGNIFICANT MULTI-YEAR BUDGETARY IMPACT; E.MERGE OR OTHERWISE CONSOLIDATE JHSI WITH ANOTHER ENTITY; F.DISPOSE OF ALL OR SUBSTANTIALLY ALL OF JHSI'S PROPERTY AND ASSETS OR DISPOSE OF ANY JHSI SUBSIDIARY OR AFFILIATED CORPORATION; G.CREATE OR ACQUIRE A JHSI SUBSIDIARY OR AFFILIATED CORPORATION; H.DISCONTINUE OR INSTITUTE A CLINICAL DEPARTMENT OR DEPARTMENTS OR PROGRAMS, WHICH COULD REASONABLY BE ANTICIPATED TO MATERIALLY AND ADVERSELY AFFECT JHSI'S FINANCIAL STATUS OR ITS ABILITY TO CONTINUE TO CONDUCT ITS BUSINESS; I.TO THE EXTENT LEGALLY PERMISSIBLE, TAKE SUCH ACTIONS TO CAUSE JHSI'S ASSETS TO BE TRANSFERRED, OTHER THAN IN THE ORDINARY COURSE OF CONDUCT OF JHSI'S BUSINESS, TO THE MEMBER TO ADVANCE THE CHARITABLE PURPOSES OF THE MEMBER OR JHSI; AND J.TO DISSOLVE JHSI TO THE EXTENT PERMITTED BY LAW.
FORM 990, PART VI, SECTION A, LINE 7B 2.IN ADDITION, THE FOLLOWING ACTIONS OF JHSI'S BOARD OF DIRECTORS REQUIRE THE PRIOR APPROVAL OF THE MEMBER: A.ANY ACTION LISTED AS A MEMBER RESERVED POWER IN THE BYLAWS; B.APPROVAL OF JHSI'S STRATEGIC, FINANCIAL AND OPERATIONAL PLANS; C.APPROVAL OF JHSI'S ANNUAL OPERATING AND CAPITAL BUDGETS; D.CAPITAL EXPENDITURES BEYOND THE APPROVED CAPITAL BUDGET; E.THE BORROWING OF, OR INCURRENCE OF DEBT F.THE APPOINTMENT OF THE INDEPENDENT AUDITOR AND APPROVAL OF THE INDEPENDENT FINANCIAL AUDITS; G.ENTRY INTO MANAGED CARE CONTRACTS, EXCLUSIVE CONTRACTS AND OTHER MULTI-YEAR MATERIAL CONTRACTS; H.ENTRY INTO ANY PARTNERSHIP/AFFILIATION ARRANGEMENTS OR JOINT VENTURE PROPOSALS; I.THE CREATION, ACQUISITION OR DISPOSAL OF ANY SUBSIDIARY OR AFFILIATED CORPORATION; J.THE ADDITION OR ELIMINATION OF ANY CLINICAL DEPARTMENTS OR PROGRAMS; AND K.AMENDMENTS TO THE JHSI BYLAWS OR ARTICLES OF ORGANIZATION.
FORM 990, PART VI, SECTION B, LINE 11 PRIOR TO FILING THE FORM 990, RELATED SCHEDULES AND REQUIRED DISCLOSURES (RETURN), THE RETURN IS REVIEWED BY JHSI'S AND BID-PLYMOUTH'S CHIEF FINANCIAL OFFICER, THE TAX DIRECTOR OF CAREGROUP, AND THE RETURN IS REVIEWED AND SIGNED BY DELOITTE TAX, LLP. AS NOTED IN THIS RETURN, CAREGROUP IS THE SOLE MEMBER OF BETH ISRAEL DEACONESS MEDICAL CENTER WHICH IS, IN TURN, THE SOLE MEMBER OF BID-PLYMOUTH AND JHSI. THE COMPLETE FORM 990, INCLUDING ALL SCHEDULES AND ATTACHMENTS, IS PRESENTED TO THE BID-PLYMOUTH AUDIT COMMITTEE FOR REVIEW AND DISCUSSION. A COPY OF THE COMPLETE RETURN IS THEN PROVIDED TO EACH MEMBER OF THE JHSI BOARD OF DIRECTORS PRIOR TO SUBMISSION TO THE INTERNAL REVENUE SERVICE.
FORM 990, PART VI, SECTION B, LINE 12C JORDAN HEALTH SYSTEMS, INC. (JHSI) HAS A WRITTEN, COMPREHENSIVE CONFLICT OF INTEREST POLICY. PURSUANT TO THAT POLICY, ALL OFFICERS, DIRECTORS AND KEY EMPLOYEES OF JHSI ARE ASKED TO COMPLETE AN ANNUAL CONFLICT OF INTEREST/TAX QUESTIONNAIRE FORM WHICH IS DESIGNED TO REQUIRE DISCLOSURE OF ANY BUSINESS RELATIONSHIPS MAINTAINED BY OFFICERS, DIRECTORS OR KEY EMPLOYEES AND THEIR FAMILY MEMBERS AND WHICH MAY RESULT IN A CONFLICT OF INTEREST. THE COMBINATION FORM IS ALSO USED TO GATHER THE INFORMATION NECESSARY FOR THE JHSI TO COMPLETELY AND ACCURATELY PROCESS AND COMPLETE FORM 990 SCHEDULE L, TRANSACTIONS WITH INTERESTED PERSONS AND FORM 990 PART VI QUESTION 2, FAMILY AND BUSINESS RELATIONSHIPS BETWEEN OFFICERS, DIRECTORS/TRUSTEES AND KEY EMPLOYEES. THE BID-PLYMOUTH OFFICE OF COMPLIANCE AND BUSINESS CONDUCT ADMINISTERS THE POLICY AND THE CONFLICT OF INTEREST/TAX QUESTIONNAIRE ANNUALLY AND PROVIDES A SUMMARY OF POSITIVE RESPONSES FOR REVIEW AND DETERMINATION OF ANY POTENTIAL OR ACTUAL CONFLICT. THE POSITIVE RESPONSES ARE REVIEWED BY A CONFLICT OF INTEREST SUB-COMMITTEE COMPRISING OF THE CHIEF COMPLIANCE AND PRIVACY OFFICER, THE CHIEF FINANCIAL OFFICER, THE CONTROLLER AND THE EXECUTIVE ADMINISTRATIVE ASSISTANT. ANY ACTIVITY THAT REQUIRES ACTION UNDER THE CONFLICT OF INTEREST POLICY IS SUBJECT TO ONGOING REVIEW BY BID-PLYMOUTH. PURSUANT TO THE CONFLICT OF INTEREST POLICY, CERTAIN ACTIVITIES WHICH COULD CREATE CONFLICTS OF INTEREST ARE PROHIBITED WHILE OTHER TYPES OF RELATIONSHIPS ARE PERMITTED, SUBJECT TO COMPLIANCE WITH A PLAN TO REQUIRE DISCLOSURE AND RECUSAL, INCLUDING APPROPRIATE DOCUMENTATION IN THE MINUTES.
FORM 990, PART VI, SECTION B, LINE 15 AS NOTED THROUGHOUT THIS FILING, BID-PLYMOUTH IS AN ENTITY EXEMPT FROM INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED, AND AN AFFILIATE OF JORDAN HEALTH SYSTEMS, INC. (JHSI). BID-PLYMOUTH HAS AN EXECUTIVE COMPENSATION COMMITTEE WHICH IS COMPOSED OF MEMBERS OF THE JHSI AND BID-PLYMOUTH BOARD OF DIRECTORS. ALL MEMBERS ARE INDEPENDENT. THE BID-PLYMOUTH COMPENSATION COMMITTEE ESTABLISHES THE COMPENSATION STRUCTURE OF THE JHSI AND BID-PLYMOUTH CHIEF EXECUTIVE OFFICER, CHIEF NURSING OFFICER, CHIEF FINANCIAL OFFICER, CHIEF MEDICAL OFFICER, CHIEF OPERATING OFFICER, CHIEF INFORMATION OFFICER SR. VICE PRESIDENTS AND VICE PRESIDENTS. THE BID-PLYMOUTH EXECUTIVE COMPENSATION COMMITTEE IS RESPONSIBLE FOR ASSURING THAT THE TOTAL COMPENSATION PROVIDED TO THESE INDIVIDUALS IS FAIR AND REASONABLE USING CURRENT AND CREDIBLE MARKET PRACTICE INFORMATION AND THAT IT COMPLIES WITH APPLICABLE LEGAL AND REGULATORY GUIDELINES. THE EXECUTIVE COMPENSATION COMMITTEE APPROVES RECOMMENDATIONS FOR INCENTIVE COMPENSATION TO THESE INDIVIDUALS ON AN ANNUAL BASIS AND AS SUCH, REVIEWS TOTAL COMPENSATION PROVIDED TO THESE INDIVIDUALS ANNUALLY. IN SETTING COMPENSATION, THE EXECUTIVE COMPENSATION COMMITTEE RELIED UPON WRITTEN COMPENSATION SURVEY STUDIES PRODUCED BY AN INDEPENDENT COMPENSATION CONSULTING FIRM THAT REGULARLY ASSESSES EXECUTIVE COMPENSATION AND BENEFITS OF SIMILAR ORGANIZATIONS. THE EXECUTIVE COMPENSATION COMMITTEE MET TO REVIEW THE COMPENSATION STRUCTURE OF THE INDIVIDUALS DESCRIBED ABOVE AND AT THAT TIME REVIEWED THE COMPENSATION SURVEY DATA PREPARED BY AN INDEPENDENT CONSULTING FIRM. TO ENSURE INDEPENDENCE, ONCE THE DATA WAS PRESENTED, NO BID-PLYMOUTH STAFF WAS PRESENT FOR THESE DISCUSSIONS. THE EXECUTIVE COMPENSATION COMMITTEE VOTED TO APPROVE THE COMPENSATION ARRANGEMENTS OF ALL INDIVIDUALS LISTED ABOVE.
FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST AT THE FOLLOWING LOCATION: JORDAN HEALTH SYSTEMS, INC. C/O BETH ISRAEL DEACONESS HOSPITAL-PLYMOUTH, INC. 275 SANDWICH STREET PLYMOUTH, MA 02360
FORM 990, PART XI, LINE 9: EFFECTS OF AFFILIATION 8,783,078. NET TRANSFERS TO AFFILIATES -1,671,352.
FORM 990 PART XII QUESTION 2B, 2C AND 2D AS PREVIOUSLY REPORTED IN THIS FILING, THE BOSTON, MA OFFICE OF KPMG ISSUED AN UNQUALIFIED OPINION ON THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF JORDAN HEALTH SYSTEMS AND ITS AFFILIATES FOR FISCAL YEAR ENDED SEPTEMBER 30, 2014. THESE STATEMENTS WERE PREPARED IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP) AND INCLUDED THE ACCOUNTS OF BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH, JORDAN PHYSICIAN ASSOCIATES, JORDAN HEALTH SYSTEMS, INC, (JHSI) JORDAN COMMUNITY ACCOUNTABLE CARE ORGANIZATION (ACO) AND ATLANTIC MEDICAL MANAGEMENT, INC. IN ADDITION, AS PREVIOUSLY NOTED, BETH ISRAEL DEACONESS MEDICAL CENTER, A TERTIARY CARE ACADEMIC MEDICAL CENTER, FLAGSHIP TEACHING HOSPITAL OF HARVARD MEDICAL SCHOOL, AN ENTITY EXEMPT FROM INCOME TAXES UNDER 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED, IS THE SOLE MEMBER OF BID-PLYMOUTH AND JHSI AND THE FINANCIAL RECORDS OF THESE ENTITIES ARE ALSO PART OF THE BIDMC CONSOLIDATED AUDITED FINANCIAL STATEMENT PROCESS,. FOR THE PERIOD COVERED BY THIS FILING THE BOSTON, MA OFFICE OF KPMG ISSUED AN UNQUALIFIED OPINION ON BOTH SETS OF FINANCIAL STATEMENTS. THE JHSI PROCESS IS MONITORED AND REVIEWED INTERNALLY BY THE BID-PLYMOUTH AUDIT COMMITTEE AND THE MEDICAL CENTER COMPLIANCE, AUDIT AND RISK COMMITTEE.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2013

Additional Data


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SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.
MediumBullet Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
JORDAN HEALTH SYSTEMS INC
 
Employer identification number

04-2103805
Part I
Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income


 		(e)
End-of-year assets


 		(f)
Direct controlling
entity










Part II
Identification of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section


 		(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled entity?
Yes No
(1) ASSOC PHYS HARVARD MED FAC PHY AT BIDMC

375 LONGWOOD AVE

BOSTON,MA02215
32-0058309 		TO PROVIDE EMERGENCY MEDICAL SERVICES MA 501(C)(3) LINE 11A, I HMFP AT BIDMC
 
 
No
(2) BI ANAESTHESIA FOUNDATION INC

330 BROOKLINE AVE

BOSTON,MA02215
04-2997215 		SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HFMP AND HMS MA 501(C)(3) LINE 11A, I HMFP AT BIDMC
 
 
No
(3) BI COMMUNITY FOUNDATION INC

330 BROOKLINE AVE

BOSTON,MA02215
04-2776678 		INACTIVE CORPORATION MA 501(C)(3) LINE 7 N/A
 
No
(4) BI DEACONESS DEPARTMENT OF MEDICINE FOUNDATION INC

330 BROOKLINE AVE

BOSTON,MA02215
04-3079630 		SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HFMP AND HMS MA 501(C)(3) LINE 11A, I HMFP AT BIDMC
 
 
No
(5) BI DEACONESS DEPARTMENT OF NEONATOLOGY FOUNDATION INC

330 BROOKLINE AVE

BOSTON,MA02215
20-8253452 		SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HFMP AND HMS MA 501(C)(3) LINE 11A, I HMFP AT BIDMC
 
 
No
(6) BI DEACONESS DEPARTMENT OF NEUROLOGY FOUNDATION INC

330 BROOKLINE AVE

BOSTON,MA02215
04-3030397 		SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HFMP AND HMS MA 501(C)(3) LINE 11A, I HMFP AT BIDMC
 
 
No
(7) BI DEACONESS DEPARTMENT OF ORTHOPAEDIC SURGERY FOUNDATION INC

330 BROOKLINE AVE

BOSTON,MA02215
20-4974585 		SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HFMP AND HMS MA 501(C)(3) LINE 11A, I HMFP AT BIDMC
 
 
No
(8) BI DEACONESS DEPARTMENT OF SURGERY FOUNDATION INC

110 FRANCIS STREET

BOSTON,MA02215
02-0671240 		SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HFMP AND HMS MA 501(C)(3) LINE 11A, I HMFP AT BIDMC
 
 
No
(9) BI DEACONESS HOSPITAL - NEEDHAM INC

148 CHESTNUT ST

NEEDHAM,MA00000
04-3229679 		HOSPITAL FOR THE TREATMENT, CARE AND RELIEF OF SICK AND SUFFERING PERSONS. MA 501(C)(3) LINE 3 BETH ISRAEL DEACONESS MEDICAL CENTER INC
 
 
No
(10) BETH ISRAEL DEACONESS MEDICAL CENTER

330 BROOKLINE AVE

BOSTON,MA02215
04-2103881 		THE OPERAION OF A WORLD CLASS ACADEMIC MEDICAL CENTER IN BOSTON, MA MA 501(C)(3) LINE 3 CAREGROUP INC
 
 
No
(11) BIDMC AND CHILDREN'S HOSPITAL MEDICAL CARE CORP

300 LONGWOOD AVE

BOSTON,MA02215
04-3200113 		OUTPATIENT AMBULATORY CARE CENTER IN LEXINGTON, MA MA 501(C)(3) LINE 11A, I N/A
 
No
(12) BIDMC OBSTETRICS AND GYNECOLOGY FOUNDATION INC

330 BROOKLINE AVE

BOSTON,MA02215
04-2794855 		SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HFMP AND HMS MA 501(C)(3) LINE 11A, I HMFP AT BIDMC
 
 
No
(13) BI DERMATOLOGY FOUNDATION INC

330 BROOKLINE AVE

BOSTON,MA02215
04-3117601 		SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HFMP AND HMS MA 501(C)(3) LINE 11A, I HMFP AT BIDMC
 
 
No
(14) BIH PATHOLOGY FOUNDATION INC

330 BROOKLINE AVE

BOSTON,MA02215
22-2548374 		SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HFMP AND HMS MA 501(C)(3) LINE 11A, I HMFP AT BIDMC
 
 
No
(15) BIH RADIOLOGIC FOUNDATION INC

330 BROOKLINE AVE

BOSTON,MA02215
04-2571853 		SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HFMP AND HMS MA 501(C)(3) LINE 11A, I HMFP AT BIDMC
 
 
No
(16) LONGWOOD MEDICAL INTL FOUNDATION

185 PILGRIM ROAD BOST

BOSTON,MA02215
04-3208878 		INACTIVE CORPORATION MA 501(C)(3) LINE 11A, I HMFP AT BIDMC
 
 
No
(17) CAREGROUP INC

109 BROOKLINE AVE

BOSTON,MA02215
22-2629185 		OVERSEE FINCIAL HEALTH OF AFFILIATES MA 501(C)(3) LINE 11D, III-O N/A
 
No
(18) CARL J SHAPIRO INSTITUTE

330 BROOKLINE AVE

BOSTON,MA02215
04-3326928 		DEVELOP INNOVATIVE PROG AND MODELS FOR TEACHING AND RESEARCH MA 501(C)(3) LINE 11A, I N/A
 
No
(19) CONTINUING EDU PROGRAM DBA BID DEPT OF PSYCH FDN

C/O HARVARD MED SCH 401 PARK DR

BOSTON,MA02215
04-3242952 		SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HFMP AND HMS MA 501(C)(3) LINE 11A, I HMFP AT BIDMC
 
 
No
(20) MED CARE OF BOSTON MGMT CORP DBA AFFILIATED PHYS GROUP

400 HUNNEWELL ST

NEEDHAM,MA02494
04-2810972 		OUTPATIENT, PRIMARY CARE AND SPECIALTY SERVICES MA 501(C)(3) LINE 9 BETH ISRAEL DEACONESS MEDICAL CENTER INC
 
 
No
(21) MOUNT AUBURN HOSPITAL

330 MOUNT AUBURN ST

CAMBRIDGE,MA02138
04-2103606 		HOSPITAL FOR THE TREATMENT, CARE AND RELIEF OF SICK AND SUFFERING PERSONS MA 501(C)(3) LINE 3 CAREGROUP INC
 
 
No
(22) MOUNT AUBURN PROFESSIONAL SERVICES INC

330 MOUNT AUBURN ST

CAMBRIDGE,MA02138
04-3026897 		OFFERING MEDICAL CARE IN GENERAL AND SPECIALIZED PRACTICES MA 501(C)(3) LINE 11A, I MOUNT AUBURN HOSPITAL
 
 
No
(23) NEW ENGLAND BAPTIST HOSPITAL

125 PARKER HILL AVE

BOSTON,MA02120
04-2103612 		ORTHOPEDIC SPECIALTY HOSPITAL MA 501(C)(3) LINE 3 CAREGROUP INC
 
 
No
(24) NEW ENGLAND BAPTIST MEDICAL ASSOCIATES INC

125 PARKER HILL AVE

BOSTON,MA02120
04-3235796 		OUTPATIENT MEDICAL SERVICES TO THE VARIOUS COMMUNITIES SERVICED BY NEBH MA 501(C)(3) LINE 3 NEW ENGLAND BAPTIST HOSPITAL INC
 
 
No
(25) RIVERBROOK CORPORATION

109 BROOKLINE AVE

BOSTON,MA02215
04-2828955 		TO HOLD TITLE TO PROPERTY FOR CAREGROUP, INC. MA 501(C)(2)   CAREGROUP INC
 
 
No
(26) HARVARD MEDICAL COLLABORATIVE INC

25 SHATTUCK ST

BOSTON,MA02115
04-3476764 		COORDINATE AND PROVIDE STATEGIC PLANNING OPP FOR HMS MA 501(C)(3) LINE 11A, I N/A
 
No
(27) HARVARD MEDICAL FACULTY PHYSICIANS AT BIDMC INC

375 LONGWOOD AVE

BOSTON,MA02215
22-2768204 		GENERAL AND SPECIALIZED MEDICAL SERVICES TO THE PATIENTS OF BIDMC AND OTHERS MA 501(C)(3) LINE 9 N/A
 
No
(28) BETH ISRAEL DEACONESS HOSPITAL - MILTON INC

199 REEDSDALE RD

MILTON,MA02186
04-2103604 		HOSPITAL FOR THE TREATMENT, CARE AND RELIEF OF SICK AND SUFFERING PERSONS. MA 501(C)(3) LINE 3 BETH ISRAEL DEACONESS MEDICAL CENTER INC
 
 
No
(29) COMMUNITY PHYSICIAN ASSOCIATES INC

199 REEDSDALE RD

MILTON,MA02186
04-3243146 		OUTPATIENT AND PRIMARY CARE SERVICES MA 501(C)(3) LINE 3 MILTON HOSPITAL FOUNDATION INC
 
 
No
(30) MILTON HOSPITAL FOUNDATION INC

199 REEDSDALE RD

MILTON,MA02186
22-2566792 		PROMOTE HEALTHCARE MA 501(C)(3) LINE 11A, I BETH ISRAEL DEACONESS MEDICAL CENTER INC
 
 
No
(31) BETH ISRAEL DEACONESS HOSPITAL - PLYMOUTH INC

275 SANDWICH ST

PLYMOUTH,MA02186
22-2667354 		HOSPITAL FOR THE TREATMENT, CARE AND RELIEF OF SICK AND SUFFERING PERSONS. MA 501(C)(3) LINE 3 BETH ISRAEL DEACONESS MEDICAL CENTER INC
 
 
No
(32) JH REALTY CORP

275 SANDWICH ST

PLYMOUTH,MA02360
22-2677673 		REAL ESTATE MA 501(C)(3) LINE 11A, I BETH ISRAEL DEACONESS-PLYMOUTH
 
 
No
(33) JORDAN AMBULATORY HEALTH CARE

36 CORDAGE PARK CIRCLE

PLYMOUTH,MA02360
22-2667348 		PROVIDE MEDICAL SERVICES MA 501(C)(3) LINE 11A, I BETH ISRAEL DEACONESS-PLYMOUTH
 
 
No
(34) JORDAN HEALTH FOUNDATION

175 SANDWICH ST

PLYMOUTH,MA02360
51-0432984 		PROMOTE HEALTHCARE MA 501(C)(3) LINE 11A, I BETH ISRAEL DEACONESS-PLYMOUTH
 
 
No
(35) JORDAN PHYSICIANS ASSOCIATES INC

275 SANDWICH ST

PLYMOUTH,MA02360
04-3228556 		OUTPATIENT AND PRIMARY CARE SERVICES MA 501(C)(3) LINE 9 JORDAN HEALTH SYSTEMS INC
 
 
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V-UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) ADVANCED VASCULAR CARE LLC

375 LONGWOOD AVE
BOSTON,MA02215
26-1647880 		TO PROVIDE MEDICAL SUPPORT SERVICES MA N/A
                  
(2) BETH ISRAEL DEACONESS PHYS ORG LLC DBA BIDCO

ONE UNIVERSITY AVE NORTH ENTRANCE
WESTWOOD,MA02090
04-3426253 		COORDINATED, SAFE AND COST EFFECTIVE PATIENT CARE AT BIDMC MA N/A
                  
(3) BIDCO PHYSICIAN LLC

ONE UNIVERSITY AVE NORTH ENTRANCE
WESTWOOD,MA02090
04-3426253 		COORDINATED, SAFE AND COST EFFECTIVE PATIENT CARE AT BIDMC MA N/A
                  
(4) BIDCO HOSPITAL LLC

ONE UNIVERSITY AVE NORTH ENTRANCE
WESTWOOD,MA02090
46-1643790 		COORDINATED, SAFE AND COST EFFECTIVE PATIENT CARE AT BIDMC MA N/A
                  
(5) CAREGROUP CLINICAL RESEARCH LLC

109 BROOKLINE AVENUE
BOSTON,MA02215
30-0228711 		TO PARTICIPATE IN A CLINICAL RESEARCH PARTNERSHIP MA N/A
                  
(6) CAREGROUP INVESTMENT PARTNERSHIP LLP

109 BROOKLINE AVENUE
BOSTON,MA02215
04-3278109 		INVESTMENT PARTNERSHIP MA N/A
                  
(7) CHARLTON MRI SERVICES LLC

330 BROOKLINE AVENUE
BOSTON,MA02215
26-4662778 		PROVISION OF PATIENT CARE SERVICES MA N/A
                  
(8) PHYSICIAN PROFESSIONAL SERVICES LLP

10 CABOT ROAD
MEDFORD,MA02215
04-3275078 		TO PROVIDE MEDICAL BILLING SERVICES MA N/A
                  
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
 		(b)
Primary activity
 		(c)
Legal
domicile
(state or foreign
country)
 		(d)
Direct controlling
entity
 		(e)
Type of entity
(C corp, S corp,
or trust) 		(f)
Share of total income
 		(g)
Share of end-of-year
assets
 		(h)
Percentage
ownership
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) MILTON PHYSICIAN-HOSPITAL ORGANIZATION INC

199 REEDSDALE ROAD
MILTON,MA02186
04-3213042 		PHYSICIAN/HOSPITAL ORGANIZATION MA N/A
 C         No
(2) ANESTHESIA FINANCIAL SOLUTIONS INC

330 BROOKLINE AVE
BOSTON,MA02215
04-3571311 		INACTIVE CORPORATION MA N/A
 C         No
(3) JORDON COMMUNITY ACO INC

275 SANDWICH ST
PLYMOUTH,MA02360
45-4047430 		COORDINATED, SAFE AND COST EFFECTIVE PATIENT CARE AT BID-PLYMOUTH MA N/A
 C         No
(4) ATLANTIC MEDICAL MANAGEMENT INC

275 SANDWICH ST
PLYMOUTH,MA02360
04-3161451 		INACTIVE CORPORATION MA N/A
 C         No






Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 3
Part V
Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
 
No
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
Yes
 
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
Yes
 
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved





Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(e)
Are all partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V?UBI
amount in box 20
of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R (see instructions).
Return Reference Explanation
Schedule R (Form 990) 2013
Additional Data


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