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 (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 | |||||
| (A)
CAMBRIDGE PUBLIC HEALTH COMMISSION |
043320571 | 6 | Yes | 0 | 0 | |
| Total 1 | 0 | 0 | ||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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 | ||||
| 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 2015 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-2015 |
(iii) Distributable Amount for 2015 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2015 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions) |
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| 3 Excess distributions carryover, if any, to 2015: | ||||
| a | ||||
| b | ||||
| c | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2015 distributable amount | ||||
|
i
Carryover from 2010 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2015 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2015 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2015, 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 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
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|
7 Excess distributions carryover to 2016. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a | ||||
| b | ||||
| c Excess from 2013....... | ||||
| d From 2014....... | ||||
| e From 2015....... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| INFORMATION ABOUT THE SUPPORT ORGANIZATION: | SCHEDULE A, PART I, LINE 11G: AMOUNT OF SUPPORT CHA MANAGEMENT SERVICES IS A SUPPORTING ORGANIZATION FOR ITS SOLE CORPORATE MEMBER, THE CAMBRIDGE PUBLIC HEALTH COMMISSION (D/B/A CAMBRIDGE HEALTH ALLIANCE), WHICH IS A PUBLIC INSTRUMENTALITY; CREATED BY ACT OF THE MASSACHUSETTS LEGISLATURE. PART IV, SECTION A, LINE 2: The organization's sole supported organization is the Cambridge Public Health Commission (the "Commission"). The Commission does not have an IRS determination of status under section 509(a)(1) or (2) of the Internal Revenue Code (the "Code") because it is a governmental unit. The Commission was created in 1996 by Chapter 147 of the Acts of 1996 of the Commonwealth of Massachusetts (the "Enabling Act") as "a body politic and corporate." In the Enabling Act, the Massachusetts legislature declared, "[t]he commission is hereby constituted a public instrumentality and the exercise by the commission of the powers conferred by this act shall be deemed and held to be the performance of an essential public function." The Enabling Act further stated that the Commission would be governed and controlled by a board, all of whom would be appointed by the City Manager of Cambridge, and that the Commission would compile and submit an "annual assessment" of existing programs, funding, and proposals for improvements to the City Manager and the City Clerk. Consequently, the Commission is an organization described in section 170(b)(1)(A)(v) and, by extension, section 509(a)(1) of the Code. The Commission operates, supervises, and controls the organization in the same manner that it operates, supervises, and controls, the organization's sister subsidiary, Somerville Hospital. By letter to Somerville Hospital dated July 25, 2013, the Internal Revenue Service stated, "we determined that you are a Type I supporting organization under 509(a)(3). A Type I supporting organization is operated, supervised, or controlled by one or more publicly supported charities." There have been no changes to the Commission's operation, supervision, or control of the organization since July 25, 2013. |
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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 I, LINE 1 AND PART III, LINE 1: | Mission CHA Management Services, Inc. is a wholly-owned subsidiary of the Cambridge Public Health Commission (CPHC), a public health system created by and existing pursuant to special act of the Massachusetts legislature. The organization receives and holds certain financial assets for its parent CPHC in furtherance of CPHC's mission. CPHC is the legal entity that is licensed to operate healthcare facilities and provide health related services to the communities it serves. FORM 990, PART VI, LINE 2: CERTAIN OFFICERS AND DIRECTORS ARE ALSO EMPLOYEES OF CAMBRIDGE PUBLIC HEALTH COMMISSION OR ITS OTHER WHOLLY-OWNED SUBSIDIARIES. |
| FORM 990, PART VI, LINE 6: | Organizational members Cambridge Public Health Commission d/b/a Cambridge Health Alliance is the sole corporate member of CHA Management Services Inc. |
| FORM 990, PART VI, LINE 7A: | Election of the Board of Directors CAMBRIDGE PUBLIC HEALTH COMMISSION D/B/A Cambridge Health Alliance has the right to appoint, AND DOES APPOINT, members of the Board of Directors. |
| FORM 990, PART VI, LINE 7B: | Decision approval Certain actions of the Board of Directors must be approved by CAMBRIDGE PUBLIC HEALTH COMMISSION D/B/A Cambridge Health Alliance (CHA), the organization's sole corporate member, as set forth in the bylaws, including adoption of the budget, any merger, consolidation, joint venture, or affiliation with the organization, any capital transaction, and incurrence of debt. CHA has authority to approve or deny any SUCH decision made by the organization's Board of Directors. Items can be recommended to the board of CHA or its committees for review and approval. |
| FORM 990, PART VI, LINE 11A: | Form 990 review process CHA Management Services' Form 990 is prepared with the assistance of its outside tax accountants and paid preparer (PricewaterhouseCoopers). The organization's internal management and CHA employees reviewed the Form 990 and provided comments and changes. Once the return has been updated the FoRM 990 is presented for further review to each voting member of the governing body and the CHA Finance Committee. PricewaterhouseCoopers then finalizes the ForM 990 based on the review and feedback of the CHA Finance Committee. Copies of the completed Form 990 were distributed in electronic or paper form to members of the governing body prior to filing with the IRS. |
| FORM 990, PART VI, LINE 12C: | Conflict of Interest Policy The organization regularly and consistently monitors and enforces compliance with the Conflict of Interest Policy with its officers and directors by annually surveying each such person and sharing the results with each group. Officers and directors are also given a copy of the Conflict of Interest Policy along with the annual survey and are reminded of their obligation to promptly report any new potential conflicts that arise. The compliance officer reviews the responses. If a conflict of interest is determined, the applicable individual is precluded from participating in deliberation on or decision-making regarding the topic giving rise to the conflict. Each conflict policy contains disciplinary provisions to address violations of the policy. |
| FORM 990, PART VI, LINE 14: | Document Retention and Destruction Policy 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, 2016. |
| FORM 990, PART VI, LINE 15A: | PROCESS FOR DETERMINING COMPENSATION THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES OF THE ORGANIZATION'S SOLE MEMBER, CAMBRIDGE PUBLIC HEALTH COMMISSION D/B/A CAMBRIDGE HEALTH ALLIANCE (CHA), IS THE AUTHORIZED BODY FOR REVIEWING THE COMPENSATION OF THE CHA CEO AND OTHER CHA SENIOR EXECUTIVES. THE CHA CEO OR OTHER CHA SENIOR EXECUTIVE SERVES OR HAS SERVED AS THE PRESIDENT OF THE ORGANIZATION. THE COMMITTEE RELIED UPON COMPARABILITY DATA OBTAINED BY AN INDEPENDENT CONSULTANT WHEN APPROVING THE CEO'S 2015 COMPENSATION AND DISCUSSED THEIR FINDINGS WITH THE CHA BOARD OF TRUSTEES AND DOCUMENTED THEIR DECISIONS IN THE BOARD MINUTES. FORM 990, PART VI, LINE 15B: CHA'S COMPENSATION COMMITTEE IS THE "AUTHORIZED BODY" FOR REVIEWING COMPENSATION OF ALL OFFICERS AND KEY EMPLOYEES OF CHA AND ITS SUBSIDIARIES, INCLUDING THE ORGANIZATION. THE COMPENSATION COMMITTEE ALSO REVIEWS ALL DEPARTMENT CHIEF COMPENSATION. THE COMPENSATION COMMITTEE CONSISTS OF INDEPENDENT MEMBERS AND REVIEWS AND RECOMMENDS COMPENSATION BASED ON MARKET DATA AND BENCHMARKS PROVIDED BY INDEPENDENT CONSULTANTS. |
| FORM 990, PART VI, LINE 19: | The governing documents, conflict of interest policy and financial statements are made available to the public either by mail or in person at the organization's office, depending on the form of request. |
| FORM 990, PART VIII, LINE 7 | On November 1, 2011, Network Health, Inc. ("NHI") sold all assets and liabilities with the exception of NHI's 403b Retirement Savings Plan to Network Health, LLC, a subsidiary of Tufts Health Plan, for $130 million. In connection with the purchase and sale agreement, an "Earn-out Purchase Price" clause provides for additional consideration to be paid from the buyer to the seller based on future earnings of NHI LLC and will be in effect for three years. The ALliance received $20 million for the earn out in 2016. Prior to the date of sale, Network Health, Inc. (now named CHA Managememt Services, Inc.) operated Medicaid managed care plan and Commonwealth Care health insurance program pursuant to contracts with the Massachusetts Executive Office of Health and Human Services. |
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