Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (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 listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| Total | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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 VI.).. | ||||||
| 11 | Total support Add lines 7 through 10. | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 1,186,691 | 750,287 | 1,936,978 | |||
| 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...... | 133,508,274 | 104,757,594 | 238,265,868 | |||
| 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. | 134,694,965 | 105,507,881 | 240,202,846 | |||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | 0 | |||||
| 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.. | 0 | |||||
| 8 | Public support (Subtract line 7c from line 6.) | 240,202,846 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 134,694,965 | 105,507,881 | 240,202,846 | |||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 73,408 | 85 | 73,493 | |||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 73,408 | 85 | 73,493 | |||
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | 1,649,445 | 1,198,663 | 2,848,108 | |||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 136,417,818 | 106,706,629 | 243,124,447 | |||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e | Discount claimed for blockage or other factors (explain in detail in Part VI): | |||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| 7 | Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions) | |||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2014 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2014 |
(iii) Distributable Amount for 2014 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2014 from Section C, line 6 |
||||
|
2
Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions) |
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| 3 Excess distributions carryover, if any, to 2014: | ||||
| a From 2009.......X | ||||
| b From 2010.......X | ||||
| c From 2011.......X | ||||
| d From 2012.......X | ||||
| e From 2013....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2014 distributable amount | ||||
|
i
Carryover from 2009 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2014 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2014 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
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|
6
Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
||||
|
7 Excess distributions carryover to 2015. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a From 2010.......X | ||||
| b From 2011.......X | ||||
| c From 2012.......X | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| SCHEDULE A, PART III, LINE 15 - PUBLIC SUPPORT %: | SAINTS MEDICAL CENTER WAS A DORMANT SHELL CORPORATION FOLLOWING THE ASSET ACQUISITION IN 2012 BY THE LOWELL GENERAL HOSPITAL. CIRCLE HEALTH, INC. (THE "CORPORATION"), WAS THE SOLE MEMBER OF SAINTS MEDICAL CENTER. NO ASSETS WERE HELD BY SAINTS MEDICAL CENTER SINCE SAINTS MEDICAL CENTER WAS IN A DORMANT STATE. A PUBLIC CHARITY SEEKING TO DISSOLVE, MUST RECEIVE THE APPROVAL OF THE SUPREME JUDICIAL COURT ("SJC") FOR THE DISSOLUTION. THE FOUNDATION HAS GATHERED THE REQUIRED INFORMATION IN ORDER TO AFFECT A TIMELY AND LAWFUL DISSOLUTION AS SET FORTH IN THE GUIDELINES FOR THE COMMONWEALTH OF MASSACHUSETTS. THE PROCEDURES AND REQUIREMENTS INCLUDE PROVIDING NOTICE TO THE ATTORNEY GENERAL'S NON-PROFIT ORGANIZATIONS/PUBLIC CHARITIES DIVISION ("AGO"), OBTAINING THE AGO'S ASSENT AND OBTAINING THE APPROVAL OF THE SUPREME JUDICIAL COURT ("SJC"). THE SJC DISSOLVED SAINTS MEDICAL CENTER ON JANUARY 5, 2016. |
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Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | CIRCLE HEALTH INC, EIN 22-2579798 WAS THE SOLE MEMBER OF SAINTS MEDICAL CENTER, INC. |
| FORM 990, PART VI, SECTION A, LINE 7A | YES, CERTAIN DECISIONS WERE SUBJECT TO THE APPROVAL OF THE "MEMBER" WHICH WAS CIRCLE HEALTH, INC. |
| FORM 990, PART VI, SECTION A, LINE 7B | YES, CERTAIN DECISIONS WERE SUBJECT TO THE APPROVAL OF THE "MEMBER" WHICH WAS CIRCLE HEALTH, INC. SEE SECTION 3.3 OF THE BYLAWS BELOW WHICH LISTS THE ITEMS REQUIRING SUCH APPROVAL: 3.3. POWERS AND RIGHTS. THE MEMBER SHALL HAVE THE FOLLOWING POWERS AND RIGHTS, IN ADDITION TO SUCH OTHER POWERS AND RIGHTS AS ARE VESTED IN IT BY LAW, THE ARTICLES OF ORGANIZATION OR THESE BYLAWS, AND THE CORPORATION SHALL NOT EFFECT ANY OF THE FOLLOWING MATTERS WITHOUT THE APPROVAL THE MEMBER): (A)TO APPROVE ANY CHANGE IN THE WRITTEN STATEMENTS OF PHILOSOPHY AND MISSION OF THE CORPORATION OR ANY SUBSIDIARY OF THE CORPORATION AND TO MONITOR COMPLIANCE WITH SAME; (B)TO AMEND AND TO REPEAL THE ARTICLES OF ORGANIZATION AND THE BYLAWS OF THE CORPORATION, AND TO APPROVE THE ADOPTION, AMENDMENT OR REPEAL OF THE CHARTER AND THE BYLAWS (OR OTHER GOVERNING INSTRUMENTS) OF ANY SUBSIDIARY OF THE CORPORATION; (C)IN THE CASE OF ANY SUBSIDIARY OF THE CORPORATION WHOSE BYLAWS PROVIDE FOR TRUSTEES OR DIRECTORS TO BE ELECTED OR APPOINTED BY THE CORPORATION, TO APPROVE THE PERSONS PROPOSED TO BE ELECTED OR APPOINTED AS TRUSTEES OR DIRECTORS OF SUCH SUBSIDIARY OF THE CORPORATION PRIOR TO THEIR ELECTION APPOINTMENT BY THE BOARD OF TRUSTEES OF THE CORPORATION, AND TO SUSPEND OR REMOVE ANY TRUSTEE OR DIRECTOR OF SUCH SUBSIDIARY OF THE CORPORATION WITH OR WITHOUT CAUSE; (D)TO APPROVE THE CHAIRPERSON AND VICE CHAIRPERSON OF THE BOARD OF TRUSTEES OF THE CORPORATION AND THE CHAIRPERSON AND VICE CHAIRPERSON OF THE GOVERNING BOARD OF ANY SUBSIDIARY OF THE CORPORATION, AND TO SUSPEND OR REMOVE THEM WITH OR WITHOUT CAUSE; (E)TO APPROVE THE PRESIDENT OF THE CORPORATION AND THE PRESIDENT OF ANY SUBSIDIARY OF THE CORPORATION, AND TO SUSPEND OR REMOVE HIM WITHOUT OR WITHOUT CAUSE. (F)TO APPROVE ALL PLANS OF MERGER, CONSOLIDATION, REORGANIZATION OR DISSOLUTION OF THE CORPORATION OR ANY SUBSIDIARY OF THE CORPORATION, OR THE SALE, LEASE, ASSIGNMENT, TRANSFER OR ENCUMBRANCE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION OR ANY SUBSIDIARY OF THE CORPORATION OR OF ANY PROPERTY OF THE CORPORATION OR ANY SUBSIDIARY OF THE CORPORATION VALUED IN EXCESS OF $1,000,000 (OR SUCH OTHER AMOUNT AS IS SET BY THE MEMBER IN WRITING FROM TIME TO TIME), OR THE PURCHASE OR ACQUISITION BY THE CORPORATION OR ANY SUBSIDIARY OF THE CORPORATION OF AN INTEREST IN ANY CORPORATION, PARTNERSHIP, JOINT VENTURE OR OTHER ENTITY, WHETHER NEWLY CREATED OR PREVIOUSLY EXISTING, WHICH INTEREST, IN THE CASE OF A FOR PROFIT ENTITY, REPRESENTS TWENTY-FIVE PERCENT OR MORE OF THE VOTING POWER THEREOF OR EQUITY INTEREST THEREIN, OR, IN THE CASE OF A NON-PROFIT ENTITY, REPRESENTS TWENTY-FIVE PERCENT OR MORE OF THE VOTING POWER THEREOF OR MEMBERSHIP INTEREST THEREIN; (G)TO APPROVE ALL DEBT OF THE CORPORATION OR ANY SUBSIDIARY OF THE CORPORATION IN EXCESS OF $2,000,000 (OR SUCH OTHER AMOUNT AS IS SET BY THE MEMBER IN WRITING FROM TIME TO TIME) BEFORE SUCH DEBT IS INCURRED, AND TO APPROVE ALL CHANGES TO THE TERMS OF ANY SUCH DEBT; (H)TO APPROVE THE ACQUISITION, SALE, LEASE, TRANSFER OR ENCUMBRANCE OF ANY REAL ESTATE, OR THE CONSTRUCTION OR DESTRUCTION OF ANY IMPROVEMENTS THEREON, BY THE CORPORATION OR ANY SUBSIDIARY OF THE CORPORATION VALUED IN EXCESS OF $1,000,000 (OR SUCH OTHER AMOUNT AS IS SET BY THE MEMBER IN WRITING FROM TIME TO TIME); (I)TO APPROVE THE SALE, ASSIGNMENT OR TRANSFER BY THE CORPORATION OR ANY SUBSIDIARY OF THE CORPORATION OF ANY EQUITY INTEREST OR MEMBERSHIP INTEREST IN ANY SUBSIDIARY OF THE CORPORATION; TO APPROVE ANY RECLASSIFICATION OR OTHER CHANGE OF ANY CAPITAL STOCK OR OTHER EQUITY SECURITY OF ANY SUBSIDIARY OF THE CORPORATION, OR ANY RECAPITALIZATION OF ANY SUBSIDIARY OF THE CORPORATION; AND TO APPROVE THE ISSUANCE OF, OR THE CREATION OF ANY OBLIGATION TO ISSUE, ANY EQUITY SECURITY OF ANY SUBSIDIARY OF THE CORPORATION, OR ANY INCREASE OR DECREASE IN THE TOTAL NUMBER OF SHARES OF AUTHORIZED CAPITAL STOCK OR OTHER EQUITY SECURITY OF ANY SUBSIDIARY OF THE CORPORATION; (J)TO ENTER INTO OR TERMINATE A FORMAL INSTITUTIONAL AFFILIATION WITH A HOSPITAL SYSTEM BY THE CORPORATION OR ANY SUBSIDIARY OF THE CORPORATION; (K)TO APPROVE THE BYLAWS OF THE CORPORATION'S MEDICAL STAFF AND ANY AMENDMENTS THERETO; AND (L)TO EXERCISE ALL POWERS OF AND AUTHORIZE ALL ACTIONS BY THE CORPORATION IN ITS CAPACITY AS THE INCORPORATOR OR MEMBER OF ANY SUBSIDIARY OF THE CORPORATION, OTHER THAN THE POWER TO APPOINT OR ELECT TRUSTEES OR DIRECTORS OF ANY SUBSIDIARY OF THE CORPORATION, WHICH POWER AND AUTHORITY SHALL BE EXERCISED BY THE BOARD OF TRUSTEES OF THE CORPORATION, SUBJECT TO THE APPROVAL OF THE MEMBER UNDER SECTION 3.3(C) (AND TO THE EXTENT THAT THE TRUSTEES OF THE CORPORATION MAY HAVE ANY SUCH POWER OR AUTHORITY WITH RESPECT THERETO UNDER LAW OR OTHERWISE, ALL SUCH POWER AND AUTHORITY SHALL BE DEEMED TO BE DELEGATED EXCLUSIVELY TO AND MAY BE EXERCISED SOLELY BY THE MEMBER). FOR PURPOSES OF THESE BYLAWS, THE TERM "SUBSIDIARY" SHALL INCLUDE ANY CORPORATION, LIMITED LIABILITY COMPANY, PARTNERSHIP, JOINT VENTURE OR OTHER ENTITY IN WHICH THIS CORPORATION HAS, EITHER DIRECTLY OR INDIRECTLY THROUGH ONE OR MORE SUBSIDIARIES, AN INTEREST REPRESENTING, IN THE CASE OF A FOR-PROFIT ENTITY, TWENTY-FIVE PERCENT (25%) OR MORE OF THE VOTING POWER THEREOF OR EQUITY INTEREST THEREIN, OR, IN THE CASE OF A NON-PROFIT ENTITY, TWENTY-FIVE PERCENT (25%) OR MORE OF THE VOTING POWER THEREOF OR MEMBERSHIP INTEREST THEREIN. |
| FORM 990, PART VI, SECTION B, LINE 11 | FORM 990 WAS PREPARED BY THE CONTROLLER AND REVIEWED BY CBIZ TOFIAS. THE CHAIRPERSON OF BOARD OF TRUSTEES WAS RESPONSIBLE FOR THE REVIEW OF THE DRAFT FORM 990 PRIOR TO FILING. THE CHAIRPERSON OF THE BOARD OF DIRECTORS WAS PROVIDED A COPY AND WAS ULTIMATLEY RESPONSIBLE FOR ACCEPTANCE OF THE DRAFT FORM 990 AND ITS APPROVAL FOR FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | SAINTS MEDICAL CENTER WAS A DORMANT ORGANIZATION BUT WAS SUBJECT TO THE CONFLICT OF INTEREST POLICY OF LOWELL GENERAL HOSPITAL. ALL TRUSTEES SIGNED AN ANNUAL CONFLICT OF INTEREST STATEMENT FOLLOWING THE POLICY OF LOWELL GENERAL HOSPITAL AS OUTLINED BELOW: ALL OFFICERS, BOARD MEMBERS, AND KEY EMPLOYEES WERE SUBJECT TO THE CONFLICT OF INTEREST POLICY. ANY ACTUAL OR POTENTIAL CONFLICTS WERE FORWARDED TO THE COMPLIANCE COMMITTEE FOR CONSIDERATION. IN THE EVENT OF AN ACTUAL OR POTENTIAL CONFLICT, THE CONFLICTED INDIVIDUAL WAS PROHIBITED FROM PARTICIPATING IN DELIBERATIONS OR DECISIONS RELATING TO THE MATTER. A COMPLIANCE COMMITTEE MEETING WAS HELD EVERY OTHER MONTH TO ADDRESS CONCERNS. |
| FORM 990, PART VI, SECTION B, LINE 15 | FORM 990, PART VI, SECTION B, LINE 15A & 1 SAINTS MEDCIAL CENTER, INC. WAS A DORMANT ORGANIZATION. COMPENSATION FOR THE FORMER CEO AND OTHER OFFICERS FOLLOWED THE PROCESS OF LOWELL GENERAL HOSPITAL. |
| FORM 990, PART VI, SECTION C, LINE 18 | 990 IS MADE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART VI, SECTION C, LINE 19 | GOVERNING DOCUMENTS ARE PROVIDED TO AND MADE AVAILABLE ON THE SECRETARY OF STATE WEBSITE AND MADE AVAILABLE UPON REQUEST ALONG WITH CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS. |
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