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.") . | 169,070 | 231,439 | 285,221 | 140,293 | 384,260 | 1,210,283 |
| 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...... | 10,159,822 | 11,394,589 | 11,867,989 | 9,812,834 | 12,464,530 | 55,699,764 |
| 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. | 10,328,892 | 11,626,028 | 12,153,210 | 9,953,127 | 12,848,790 | 56,910,047 |
| 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.) | 56,910,047 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 10,328,892 | 11,626,028 | 12,153,210 | 9,953,127 | 12,848,790 | 56,910,047 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 5,231 | 45,531 | 89,592 | 83,467 | 96,790 | 320,611 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 5,231 | 45,531 | 89,592 | 83,467 | 96,790 | 320,611 |
| 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.).. | 10,334,123 | 11,671,559 | 12,242,802 | 10,036,594 | 12,945,580 | 57,230,658 |
| 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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| Software ID: | |
| Software Version: |
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 2 | NORMAND DESCHENE IS A DIRECTOR AND THE PRESIDENT/CEO OF CIRCLE HEALTH, INC. WHICH IS THE PARENT OF CIRCLE HOME, INC. HE IS ALSO THE CEO OF THE LOWELL GENERAL HOSPITAL, A SUBSIDIARY OF CIRCLE HEALTH, INC. HE IS ALSO A DIRECTOR OF ENTERPRISE BANK. SUSAN GREEN IS THE EXECUTIVE VICE PRESIDENT AND CFO OF CIRCLE HEALTH, INC. AND THE LOWELL GENERAL HOSPITAL. JOSEPH WHITE IS A DIRECTOR AND PRESIDENT OF THE LOWELL GENERAL HOSPITAL, A SUBSIDIARY OF CIRCLE HEALTH, INC AND ALSO AN OFFICER OF CIRCLE HEALTH, INC. NAOMI PRENDERGAST IS A DIRECTOR OF CIRCLE HOME, INC. AND ON THE BOARD OF GOVERNERS FOR CIRCLE HEALTH, INC., AS WELL AS THE CEO OF D'YOUVILLE LIFE & WELLNESS COMMUNITY. CIRCLE HOME, INC. IS A VENDOR OF D'YOUVILLE LIFE & WELLNESS. CIRCLE HOME INC.'S CFO ALSO SERVES AS A DIRECTOR OF D'YOUVILLE LIFE & WELLNESS COMMUNITY. MARGARET LEMIRE-BERTHEL IS A DIRECTOR AS WELL AS AN EMPLOYEE OF THE LOWELL GENERAL HOSPITAL; A SUBSIDIARY OF CIRCLE HEALTH, INC. JAMES O'DONNELL IS A DIRECTOR AS WELL AS A CORPORATOR OF THE LOWELL GENERAL HOSPITAL. DANIEL MANSUR IS A DIRECTOR AS WELL AS A DIRECTOR OF THE LOWELL GENERAL HOSPITAL AND VICE CHAIR CIRCLE HEALTH, INC. AS A PRACTICING ATTORNEY, HIS CLIENT LIST INCLUDES OTHER DIRECTORS. TUSHAR PATEL, M.D. IS A DIRECTOR AS WELL AS THE PRESIDENT OF THE MEDICAL STAFF OF THE LOWELL GENERAL HOSPITAL. STEVEN JONCAS IS A DIRECTOR AS WELL AS A CORPORATOR OF THE LOWELL GENERAL HOSPITAL. HE ALSO PROVIDES REAL ESTATE CONSULTING SERVICES TO THE LOWELL COMMUNITY HEALTH CENTER WHO IS INTERESTED IN PROVIDING LEASED SPACE TO CIRCLE HOME, INC. BRAIN STAFFORD IS A DIRECTOR AS WELL AS A DIRECTOR OF THE LOWELL GENERAL HOSPITAL. THE LOWELL GENERAL HOSPITAL IS A SUBSIDIARY OF CIRCLE HEALTH, INC. AS A PRACTICING PUBLIC ACCOUNTANT HIS CLIENT LIST INCLUDES OTHER DIRECTORS. EFFIE DRAGON IS A DIRECTOR AND AN OFFICER OF CENTRAL PLAZA REALTY. CIRCLE HOME, INC. LEASES PARKING SPACES FROM CENTRAL PLAZA REALTY. CENTRAL PLAZA REALTY PURCHASED A BUILDING AND LAND FROM CIRCLE HOME, INC. IN 2015. PETER T. O'HEARN IS A DIRECTOR AS WELL AS A CORPORATOR OF THE LOWELL GENERAL HOSPITAL. PETER ALSO WRITES A SMALL FIDELITY BOND FOR THE PENSION PLAN. GINGER PEARSON IS ON THE BOARD OF GOVERNORS FOR CIRCLE HEALTH, INC. AND IS A DIRECTOR OF CIRCLE HOME, INC. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE SOLE CORPORATE MEMBER OF CIRCLE HOME, INC. IS CIRCLE HEALTH, INC. |
| FORM 990, PART VI, SECTION A, LINE 7A | A MINIMUM OF 80% OF THE DIRECTORS OF CIRCLE HOME, INC. ARE CLASSIFIED AS CIRCLE HEALTH, INC. DIRECTORS. THE BALANCE ARE CIRCLE HOME, INC. DIRECTORS |
| FORM 990, PART VI, SECTION A, LINE 7B | THE MEMBER OF CIRLCE HOME, INC. IS CIRCLE HEALTH, INC. CIRCLE HEALTH HAS THE FOLLOWING RESERVE POWERS: - ORGANIZE OR ACQUIRE AN AFFILIATE OR SUBSIDIARY; - AUTHORIZE THE DISSOLUTION, MERGER OR CONSOLIDATION OF THE CORPORATION; - AUTHORIZE THE SALE OR OTHER TRANSFER OF ALL OR SUBSTANTIALLY ALL OF THE CORPORATION'S ASSETS; - AMEND THE CORPORATION'S ARTICLES OF ORGANIZATION OR BYLAWS; - ADOPT ANNUAL OPERATING OR CAPITAL BUDGETS; - AUTHORIZE OFF-BUDGET EXPENDITURES ABOVE $100,000; - ADOPT STRATEGIC PLANS; - COMMENCE ANY CLINICAL SERVICE THAT WAS NOT OFFERED BY THE CORPORATION AS OF THE EFFECTIVE DATE OF THIS BYLAW PROVISION OR TERMINATE ANY CLINICAL SERVICE THAT WAS OFFERED BY THE CORPORATION AS OF SUCH DATE; - BORROW MONEY, UNLESS ALREADY APPROVED IN THE CORPORATION'S CURRENT BUDGET; - UNDERTAKE COMMUNITY-WIDE FUND-RAISING ACTIVITIES; - CHANGE THE CORPORATION'S INDEPENDENT AUDITOR; - ENGAGE THE EXECUTIVE DIRECTOR OF THE CORPORATION; AND - ADOPT OR MAKE MATERIAL MODIFICATIONS TO PERSONNEL POLICIES AND PROCEDURES INCLUDING POLICIES WITH REGARD TO COMPENSATION AND BENEFITS. IN ADDITION, IN ORDER TO FACILITATE THE DEVELOPMENT OF AN EFFECTIVE INTEGRATED HEALTH CARE DELIVERY SYSTEM UNDER THE AUSPICES OF THE MEMBER, AND IN ORDER TO ASSURE THAT THE PUBLIC PERCEPTION OF THE MEMBER AND THE CONSTITUENTS OF ITS SYSTEM IS ONE OF COORDINATION, THE MEMBER SHALL HAVE THE FOLLOWING POWERS WITH RESPECT TO THE CORPORATION: - TO REQUIRE THE CORPORATION TO INITIATE STRATEGIC PLANNING PROCESSES CONSISTENT WITH THOSE OF THE MEMBER AND THE OTHER CONSTITUENTS OF ITS HEALTH CARE SYSTEM. - TO REQUIRE THE CORPORATION TO COORDINATE CLINICAL SERVICES WITH THE MEMBER AND THE OTHER CONSTITUENTS OF ITS HEALTH CARE SYSTEM. - TO REQUIRE THE CORPORATION TO COORDINATE FUND-RAISING ACTIVITIES WITH THE MEMBER AND THE OTHER CONSTITUENTS OF ITS HEALTH CARE SYSTEM. |
| FORM 990, PART VI, SECTION B, LINE 11 | A COPY OF THE COMPLETE FORM 990 IS EMAILED TO THE BOARD OF DIRECTORS FOR THEIR REVIEW AND COMMENT PRIOR TO FILING. ANY IDENTIFIED CHANGES BASED UPON COMMENTS ARE MADE AS INDICATED. |
| FORM 990, PART VI, SECTION B, LINE 12C | ALL NEW HIRES AND NEW BOARD MEMBERS RECEIVE THE ORGANIZATION'S CORPORATE COMPLIANCE PLAN. THEY DISCLOSE AT THAT POINT IN TIME ANY CONFLICTS OF INTEREST. BOARD MEMBERS ALSO COMPLETE A 990 QUESTIONAIRE. ON AN ANNUAL BASIS EMPLOYEES ALSO REVIEW THE CORPORATE COMPLIANCE PLAN AND INDICATE ANY POTENTIAL CONFLICTS OF INTEREST. BOARD MEMBERS ON AN ANNUAL BASIS REVIEW THE BYLAWS RELATING TO CONFLICT OF INTEREST AND COMPLETE A 990 QUESTIONAIRE. |
| FORM 990, PART VI, SECTION B, LINE 15 | ON AN ANNUAL BASIS THE ORGANIZATION PARTICIPATES IN A SALARY SURVEY AND EVALUATES ALL POSITIONS AGAINST THE SURVEY. THE INFORMATION IS SHARED WITH THE BOARD PRESIDENT FOR REVIEW WHEN EVALUATING THE EXECUTIVE DIRECTORS SALARY AND ANY COMPENSATION CHANGES. OFFICERS ARE NOT PAID. FOR KEY EMPLOYEES, THE SALARY SURVEY IS REVIEWED ANNUALLY BY HUMAN RESOURCES AND THE EXECUTIVE DIRECTOR. BASED UPON THAT SURVEY SALARY RANGES OR PAY MAY BE ADJUSTED. THIS INFORMATION IS SHARED WITH THE PERSONNEL COMMITTEE BY THE EXECUTIVE DIRECTOR. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILALE UPON REQUEST. |
| FORM 990, PART XI, LINE 9: | TRANSFER FROM AFFILIATE - COMMONWEALTH NURSING SERVICES, INC. 400,000. DEFINED BENEFIT PENSION ADJUSTMENT -1,092,659. |
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