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.") .... | 511,507 | 528,115 | 524,445 | 582,891 | 489,620 | 2,636,578 |
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....... | 0 | |||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | 0 | |||||
| 4 | Total. Add lines 1 through 3 | 511,507 | 528,115 | 524,445 | 582,891 | 489,620 | 2,636,578 |
| 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).. | 0 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 2,636,578 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 511,507 | 528,115 | 524,445 | 582,891 | 489,620 | 2,636,578 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 0 | |||||
| 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.).. | 0 | |||||
| 11 | Total support Add lines 7 through 10. | 2,636,578 | |||||
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 | 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.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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 VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| 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 |
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|
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) |
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|
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 |
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| Return Reference | Explanation |
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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 |
|---|---|
| PART I, LINE 1 & PART III, LINE 1: | To serve as a collaboration among the member organizations to improve the health of the surrounding communities through research, education, program and policy development. Accomplishments include projects on child mental health, women's health issues, obesity studies and prevention projects, emergency preparedness and public health. PART VI, LINE 2: Pursuant to the ICH bylaws, each member may appoint directors to the governing body, which is the ICH Board of Directors. Cambridge Public Health Commission (d/b/a Cambridge Health Alliance) and Partners Healthcare System, Inc. each appoints three (3) directors, and Beth Israel Deaconess Medical Center appoints one (1) director. These directors may have a business relationship with each other by virtue of the fact that they may share a common employer. PART VI, LINE 4: Effective December 31, 2014 the organization accepted the resignation of Mount Auburn Hospital (a member of Caregroup Health System). Beth Israel Deaconess Medical Center (also a member of Caregroup Health System) was elected a member effective January 1, 2015. PART VI, LINE 6: Through December 31, 2014 the organization has the following members: Cambridge Public Health Commission (D/B/A Cambridge Health Alliance), Partners Healthcare System, Inc. and Mount Auburn Hospital (originally Caregroup Health System). Effective January 1, 2015, Mount Auburn Hospital was replaced with Beth Israel Deaconess Medical Center. |
| PART VI, LINE 7a: | The three members have the right to appoint 7 of the 12 directors to the board. The board (or if so delegated, the nominating committee) has the right to appoint the remaining 5 independent directors, which means individuals who, in the reasonable discretion of the board, are not otherwise affiliated with any of the members. |
| PART VI, LINE 7B: | CERTAIN ACTIONS OF THE BOARD OF DIRECTORS MUST BE APPROVED BY CAMBRIDGE HEALTH ALLIANCE, PARTNERS HEALTHCARE SYSTEMS, INC., AND BETH ISRAEL DEACONESS MEDICAL CENTER, INSTITUTE FOR COMMUNITY HEALTH, INC.'S SOLE CORPORATE MEMBERS, AS SET FORTH IN THE BYLAWS, INCLUDING ADOPTION OF THE BUDGET, ANY MERGER, CONSOLIDATION, JOINT VENTURE, OR AFFILIATION WITH INSTITUTE FOR COMMUNITY HEALTH, INC., ANY CAPITAL TRANSACTIONS, AND INCURRENCE OF DEBT. CAMBRIDGE HEALTH ALLIANCE, PARTNERS HEALTHCARE SYSTEMS, INC., AND BETH ISRAEL DEACONESS MEDICAL CENTER HAVE AUTHORITY TO APPROVE OR DENY ANY DECISION MADE BY INSTITUTE FOR COMMUNITY HEALTH, INC.'S BOARD OF DIRECTORS. ITEMS CAN BE RECOMMENDED TO THE BOARD OF CAMBRIDGE HEALTH ALLIANCE, PARTNERS HEALTHCARE SYSTEMS, INC., AND BETH ISRAEL DEACONESS MEDICAL CENTER, OR ITS COMMITTEES FOR REVIEW AND APPROVAL. |
| PART VI, LINE 11: | ICH's Form 990 was prepared with the assistance of its outside tax accountants and paid preparer (PriceWaterhouseCoopers). ICH's internal management and CHA employees reviewed the Form 990 and provided comments and changes. Copies of the completed Form 990 were distributed in electronic or paper form to directors on ICH's governing body prior to filing with the IRS. |
| PART VI, LINE 12C: | The organization has a conflict of interest policy for its directors, officers and key employees. The organization monitors and enforces compliance with these conflict of interest policies by surveying its officers, directors and key employees, who each receive a copy of the conflict of interest policy along with the survey and who are reminded of his or her obligation to promptly report any new potential conflicts that arise. PART VI, LINE 14: THE ORGANIZATION HAS AN ACTIVE DOCUMENT RETENTION AND DESTRUCTION POLICY APPROVED BY MANAGEMENT. THIS POLICY HAS NOT BEEN APPROVED BY THE BOARD OR A COMMITTEE OF THE BOARD AS OF JUNE 30, 2015. |
| PART VI, LINE 15A: | ICH's Executive Director is employed by one of its members, namely the Cambridge Public Health Commission d/b/a Cambridge Health Alliance (CHA). CHA is a related organization. CHA reviewed market data and internal comparables to determine the salary for ICH's Executive Director. ICH's Board of Directors voted and approved the budget for ICH, including the Executive Director's compensation. |
| PART VI, LINE 19: | THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC EITHER BY MAIL OR IN PERSON AT THE ORGANIZATION'S OFFICE, DEPENDING ON THE FORM OF REQUEST. PART VII AND PART IX: ICH does not have any employees rather its employees are carried on the payroll of CHA, a related organization. The Form 990, Part IX shows salary expense because ICH reimburses the associated payroll/benefits expense to CHA. The ICH board approves the associated payroll/benefits expense as part of the ICH budget approval process. |
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