Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions. 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
LAHEY CLINIC INC
Employer identification number
04-2704683
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the 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)
(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
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year
(or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (see instructions)
..................
12
13
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.................................................
Section C. Computation of Public Support Percentage
14
Public support percentage for 2013 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2013.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
.......................
b
33 1/3% support test—2012.
If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2013.
If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization
.....................................................
b
10%-facts-and-circumstances test—2012.
If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization
................................................
18
Private foundation.
If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions
.....................................................
Schedule A (Form 990 or 990-EZ) 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)
(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.") .
6,875,831
5,730,152
6,473,588
18,315,998
21,905,192
59,300,761
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......
235,609,359
245,095,402
242,784,891
253,007,104
263,578,755
1,240,075,511
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.
242,485,190
250,825,554
249,258,479
271,323,102
285,483,947
1,299,376,272
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
2,012,000
331,350
351,041
11,500,000
12,250,000
26,444,391
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.
0
c
Add lines 7a and 7b..
2,012,000
331,350
351,041
11,500,000
12,250,000
26,444,391
8
Public support (Subtract line 7c from line 6.)
1,272,931,881
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
9
Amounts from line 6...
242,485,190
250,825,554
249,258,479
271,323,102
285,483,947
1,299,376,272
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
194,128
292,437
758,247
293,398
318,366
1,856,576
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
194,128
292,437
758,247
293,398
318,366
1,856,576
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.)
..
186,285
209,726
210,149
1,470,326
2,076,486
13
Total support. (Add lines 9, 10c, 11, and 12.)..
242,865,603
251,327,717
250,226,875
273,086,826
285,802,313
1,303,309,334
14
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public support percentage for 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
97.670 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
98.360 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
0.140 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
0.170 %
19a
33 1/3% support tests—2013.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
........
b
33 1/3% support tests—2012.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
.....
20
Private foundation.
If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 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:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
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
LAHEY CLINIC INC
Employer identification number
04-2704683
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 2
PATRICIA ROBERTS, MD, A KEY EMPLOYEE, IS MARRIED TO MICHAEL ROSENBLATT, MD, A KEY EMPLOYEE.
FORM 990, PART VI, SECTION A, LINE 6
THE LAHEY HOSPITAL AND MEDICAL CENTER CONSISTS OF THREE NON-PROFIT CORPORATIONS, LAHEY CLINIC HOSPITAL, INC. (EIN # 04-2704686), LAHEY CLINIC, INC. (EIN # 04-2704683), LAHEY CLINIC FOUNDATION, INC. (EIN # 04-2323457) ALL THREE OF THE CORPORATIONS ARE TAX EXEMPT UNDER INTERNAL REVENUE CODE SECTION 501(C) (3). LAHEY CLINIC FOUNDATION, INC. IS THE SOLE CORPORATE MEMBER OF EACH OF THE OTHER TWO CORPORATIONS. THE BOARD OF TRUSTEES (GOVERNING BODY) AND CORPORATE OFFICERS OF THE THREE CORPORATIONS CONSIST OF THE EXACT SAME MEMBERS. EFFECTIVE MAY 1, 2012, LAHEY CLINIC FOUNDATION, INC. AND NORTHEAST HEALTH SYSTEM, INC. COMPLETED A MERGER WITH EACH OTHER AND ESTABLISHED A NEW ORGANIZATION, LAHEY HEALTH SYSTEM, INC. ("LHS"), TO SERVE AS THE PARENT OF THE COMBINED HEALTH SYSTEM. ON JULY 1, 2014, LHS AND WINCHESTER HEALTHCARE MANAGEMENT, INC ENTERED INTO AN AFFILIATION. LHS IS NOW THE SOLE CORPORATE MEMBER OF LAHEY CLINIC FOUNDATION, INC., NORTHEAST HEALTH SYSTEM,INC. AND WINCHESTER HEALTHCARE MANAGEMENT, INC. THE SOLE CORPORATE MEMBER OF THE REPORTING ORGANIZATION IS LAHEY HEALTH SYSTEM, INC. THE REPORTING ORGANIZATION'S MEMBER HAS, WITH RESPECT TO THE REPORTING ORGANIZATION, THE RIGHT TO EXERCISE ALL POWERS CONFERRED ON MEMBERS OF NON-PROFIT CORPORATIONS UNDER MASSACHUSETTS GENERAL LAWS CHAPTER 180, INCLUDING, WITHOUT LIMITATION, POWERS WITH RESPECT TO THE FOLLOWING: (A) APPOINTMENT AND REMOVAL OF MEMBERS OF THE BOARD OF TRUSTEES (SUBJECT TO CERTAIN TRANSITION RULES IN PLACE THROUGH MAY 1, 2016); (B) AMENDMENT OF THE ARTICLES OF ORGANIZATION; (C) AMENDMENT OF THE BY-LAWS; (D) THE SALE, LEASE, EXCHANGE OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE CORPORATION'S ASSETS; AND (E) THE MERGER OR CONSOLIDATION OF THE CORPORATION WITH ANOTHER CORPORATION. THE ARTICLES OF INCORPORATION OF THE REPORTING ORGANIZATION WERE AMENDED JULY 1, 2014 AND THE BY-LAWS WERE AMENDED ON JULY 1, 2014 TO REFLECT THE AFOREMENTIONED CHANGES.
FORM 990, PART VI, SECTION A, LINE 7A
PLEASE SEE PREVIOUS DISCLOSURE FOR FORM 990, PART VI, SECTION A, LINE 6
FORM 990, PART VI, SECTION A, LINE 7B
PLEASE SEE PREVIOUS DISCLOSURE FOR FORM 990, PART VI, SECTION A, LINE 6
FORM 990, PART VI, SECTION B, LINE 11
MANAGEMENT PREPARED THE IRS FORM 990 ALONG WITH INDEPENDENT TAX CONSULTANTS WHO SIGN THE RETURN AS A PAID PREPARER. EXECUTIVE MANAGEMENT REVIEWED AND PRESENTED A DRAFT OF IRS FORM 990 TO THE AUDIT & COMPLIANCE COMMITTEE OF THE LAHEY HEALTH SYSTEM, INC. BOARD OF TRUSTEES PRIOR TO THE FILING DATE. A DRAFT AND THE FINAL IRS FORM 990 WERE PROVIDED TO THE ENTIRE BOARD OF TRUSTEES BEFORE THE FILING DATE VIA A SECURED WEBSITE.
FORM 990, PART VI, SECTION B, LINE 12C
ALL OFFICERS, TRUSTEES, KEY EMPLOYEES, PHYSICIANS AND MANAGEMENT EMPLOYEES AT ALL LEVELS, ARE REQUIRED TO COMPLETE AN ANNUAL CONFLICT OF INTEREST DISCLOSURE FORM. THE LHS CORPORATE COMPLIANCE DEPARTMENT MONITORS AND REVIEWS EACH DISCLOSURE FOR COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. THE CORPORATE COMPLIANCE DEPARTMENT MONITORS CONFLICTS OF INTEREST THROUGH DISCLOSURE SOFTWARE, TRAINING, AND INDIVIDUAL REVIEWS WITH PHYSICIANS, KEY EMPLOYEES, AND MANAGERS. DEPENDING ON THE CONFLICT OF INTEREST: A PERSON COULD BE ASKED TO NOT PARTICIPATE IN DECISIONS MADE ON BEHALF OF THE LAHEY HOSPITAL AND MEDICAL CENTER; A PERSON MAY BE TOLD THEY CANNOT BE A PRINCIPAL INVESTIGATOR ON A RESEARCH STUDY; A PERSON MAY BE TOLD THAT THEY CANNOT PERFORM THE TASK THAT CREATES THE CONFLICT; A PERSON COULD BE ASKED TO REMOVE THEMSELVES FROM A COMMITTEE.
FORM 990, PART VI, SECTION B, LINE 15
INDEPENDENT MEMBERS OF THE BOARD OF TRUSTEES COMPRISE THE COMPENSATION COMMITTEE. THE COMMITTEE SETS THE COMPENSATION AND BENEFITS FOR THE CEO AND ALSO REVIEWS AND APPROVES RECOMMENDATIONS FOR THE COMPENSATION AND BENEFITS FOR DISQUALIFIED INDIVIDUALS AND OTHERS. THE COMMITTEE SEEKS THE ADVICE OF EXTERNAL COMPENSATION CONSULTANTS. COMPARABILITY DATA IS PROVIDED, ANALYZED, AND DOCUMENTED BY THE EXTERNAL CONSULTANTS. THE LAHEY EXECUTIVE VICE PRESIDENT OF HUMAN RESOURCE OPERATIONS PROVIDES THE COMMITTEE WITH ANY REQUESTED INFORMATION. THE COMMITTEE MET SEVERAL TIMES THIS YEAR.
FORM 990, PART VI, SECTION C, LINE 19
THE ORGANIZATION'S GOVERNING DOCUMENTS AND AUDITED FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. THE ORGANIZATION'S CONFLICT OF INTEREST POLICY AND OTHER COMPLIANCE POLICIES ARE MADE AVAILABLE TO THE PUBLIC VIA THE ORGANIZATION'S WEBSITE. IN ADDITION, THE ORGANIZATION PRESENTS FINANCIAL INFORMATION TO THE PUBLIC AS AN ATTACHMENT TO ITS MASSACHUSETTS OFFICE OF THE ATTORNEY GENERAL FORM PC.
FORM 990, PART XI, LINE 9:
PENSION PLAN CHANGES -13,248,267. UNREALIZED GAIN ON RESTRICTED FUND INVESTMENTS 2,156,519. NET ASSETS RELEASED FROM RESTRICTIONS -1,048,717. NET ASSETS RELEASED FROM RESTRICTIONS, FOR EQUIP. PURCH. -5,034,077. ENDOWMENT ALLOCATION 2,850,829. CAPTIVE INSURANCE TRANSFER -1,358,084. CHANGE IN VALUE OF SPLIT INTEREST AGREEMENTS 73,933.
FORM 990, SCHEDULE D, PART X, LINE 2
THE ORGANIZATION'S FINANCIAL STATEMENTS DID NOT REPORT A LIABILITY FOR UNCERTAIN TAX POSITIONS UNDER FIN 48.
FORM 990, PART IV, LINE 4
LAHEY CLINIC HOSPITAL, INC., A RELATED ORGANIZATION, IS IN CONTACT WITH FEDERAL AND STATE LEGISLATORS REGARDING HEALTH CARE REFORM ISSUES THAT WOULD POTENTIALLY HAVE AN IMPACT ON THE ORGANIZATION AND ITS RELATED ORGANIZATIONS.
FORM 990, PART VI, SECTION B, LINE 14
LAHEY HOSPITAL & MEDICAL CENTER HAS WRITTEN DOCUMENT RETENTION AND DESTRUCTION POLICY KNOWN AS THE "RETENTION OF ADMINISTRATIVE AND CLINICAL DOCUMENTS". THE POLICIES, PROCEDURES, AND STANDARDS ARE MONITORED, MANAGED, AND REVISED BY THE RECORDS MANAGEMENT STEERING COMMITTEE. THE REVISED "RETENTION OF ADMINISTRATIVE AND CLINICAL DOCUMENTS" POLICY WAS APPROVED BY THE MEDICAL PRACTICE AND UTILIZATION COMMITTEE ON JULY 26, 2012.
FORM 990, PART VI, SECTION B, LINE 16B
THE ORGANIZATION NEGOTIATES ARRANGEMENTS TO INCLUDE TERMS AND SAFEGUARDS TO ENSURE THAT THE ORGANIZATION'S EXEMPT STATUS IS PROTECTED. FROM A LEGAL PERSPECTIVE, IN-HOUSE LEGAL COUNSEL, WITH THE INPUT OF EXTERNAL LEGAL COUNSEL, REVIEWS ALL PROPOSED JOINT VENTURE AND PARTNERSHIP AGREEMENTS. FROM A FINANCIAL PERSPECTIVE, LAHEY'S FINANCE MANAGEMENT TEAM REVIEWS ALL PROPOSED JOINT VENTURE AND PARTNERSHIP AGREEMENTS. BOTH REVIEWS TAKE PLACE BEFORE LAHEY HOSPITAL & MEDICAL CENTER ENTERS INTO ANY SUCH AGREEMENTS.
FORM 990, PART VII
LAHEY CLINIC FOUNDATION, INC. AND ITS RELATED ORGANIZATIONS DO NOT COMPENSATE ANY TRUSTEE IN THEIR CAPACITY AS A TRUSTEE. ALL COMPENSATION PAID IS FOR WORK PERFORMED IN THE EMPLOYEE'S JOB TITLE, WHICH IS LISTED ON FORM 990, PART VII DIRECTLY FOLLOWING THE TITLE OF "TRUSTEE".
FORM 990, PART VII, AND SCHEDULE J
COMPENSATION, BENEFIT AND PENSION EXPENSES FOR OFFICERS, TRUSTEES AND KEY EMPLOYEES, OF LAHEY CLINIC FOUNDATION, INC. ARE PAID BY LAHEY CLINIC FOUNDATION, INC. AS THE PARENT COMPANY OF LAHEY CLINIC HOSPITAL, INC., AND LAHEY CLINIC, INC., LAHEY CLINIC FOUNDATION, INC. ALLOCATES A SIGNIFICANT PORTION OF THE AFOREMENTIONED EXPENSES TO ITS AFFILIATES. THE AFFILIATES THEN REIMBURSE LAHEY CLINIC FOUNDATION, INC.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.