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)
STURDY MEMORIAL HOSPITAL INC |
042768252 | 3 | 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 |
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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 |
|---|---|
| Employees Reported on Form W-3 | Form 990, Part V, Line 2a Sturdy Memorial Hospital, Inc. is the common paymaster for Sturdy Memorial Associates, Inc. Form W-3 is filed under Sturdy Memorial Hospitals employee identification number and included 376 Sturdy Memorial Associate, Inc. employees. Federal Employment tax Returns Form 990, Part V, Line 2b Sturdy Memorial Hospital, Inc. is the common paymaster for Sturdy Memorial Associates, Inc. and files all required federal employment forms. |
| Members or stockholders | Form 990, Part VI, Section A, Line 6 Sturdy Memorial Foundation, Inc., a Massachusetts charitable corporation, acting through its Board of Directors, is the sole member of Sturdy Memorial Associates, Inc. |
| MEMBERS OR STOCKHOLDERS WHO MAY ELECT MEMBERS OF GOVERNING BODY | Form 990, Part VI, Section A, Line 7a Foundation members are eligible to attend all meetings of the Corporation and to hold office. New members are elected to membership by the existing members for three year terms. The Members elect and may remove or suspend trustees of Sturdy Memorial Associates, Inc. |
| DECISIONS SUBJECT TO APPROVAL | Form 990, Part VI, Section A, Line 7b All matters involving real property, including without necessary limitation, sales, leases and purchases, shall first require approval of the Member acting through the Board of Directors of Sturdy Memorial Foundation, Inc. |
| FORM 990 REVIEW PROCESS | Form 990, Part VI, Section B, Line 11b THE FORM 990 IS PREPARED BY STURDY MEMORIAL'S TAX PROVIDERS, GRANT THORNTON LLP, USING INFORMATION PROVIDED BY MANAGEMENT UPON COMPLETION OF THE ANNUAL INDEPENDENT AUDIT. THE INFORMATION PROVIDED IS THE RESPONSIBILITY OF THE CFO AND THE STURDY FISCAL SERVICES DEPARTMENT. THE RETURN IS REVIEWED BY GRANT THORNTON LLP, THE CONTROLLER AND CFO, AND compensation and benefit sections are specifically reviewed BY THE VICE PRESIDENT OF HUMAN RESOURCES FOR STURDY MEMORIAL HOSPITAL, INC. THE FORM 990 IS THEN PRESENTED TO THE AUDIT COMMITTEE FOR REVIEW AND RECOMMENDATION OF APPROVAL. PRIOR TO FILING THE FORM 990 WITH THE INTERNAL REVENUE SERVICE, THE COMPLETE FORM AND ALL SCHEDULES ARE PROVIDED TO EVERY BOARD MEMBER AND ANY QUESTIONS ARE ANSWERED. |
| Conflict of Interest Policy monitoring and enforcement | Form 990, Part VI, Section B, Line 12c Sturdy Memorial Associates, Inc. follows the Conflict of Interest Policy of Sturdy Memorial Hospital, Inc., its affiliate. Under the direction of the Hospital's Integrity Officer, all managers and supervisors (including officers and key employees) must complete and sign an annual Conflict of Interest Disclosure Statement. The Statement requires disclosure of any outside interests in any business, outside activity, gifts or entertainment that may have influenced the employee. In addition, the employee must disclose if they have shared any hospital information for their own personal advantage or if they had knowledge of any integrity or ethical issues not previously reported. These signed statements are reviewed by the Integrity Officer and any potential conflicts are resolved. The Integrity Officer discusses disclosed conflicts with the reporter, so that the reporter knows what business activities they cannot participate in (e.g., purchasing decisions, board votes, etc.). Any gifts received that create a conflict or are in violation of the Conflict of Interest Policy must be returned or paid for by the individual at fair market value. CONFLICTED INDIVIDUALS ARE NOT ALLOWED TO VOTE ON AREAS RELATED TO THEIR CONFLICT OR PARTICIPATE IN OTHER DECISIONS SURROUNDING THE ENTITY THEY HAVE A CONFLICT WITH. The Integrity Officer reports annually to the Board of Directors of any new conflicts. Article VI of the Associates by-laws requires Board members to disclose any potential conflict. Board members, officers and key employees must attest in writing each year, to any potential conflict. The Conflict of Interest Statements are reviewed by the Executive Director and Chief Financial Officer and any potential conflicts are resolved. DOCUMENT RETENTION AND DESTRUCTION POLICY Form 990, Part VI, Section B, Line 14 During fiscal year 2016 Sturdy Memorial Associates did not have a written document RETENTION and destruction policy but does comply with Massachusetts law with respect to record retention requirements. Where state law does not require retention limits, the Associates uses the "Business Records Retention Schedule" from the Office of the Federal Register and other relevant and reliable sources (such as attorney letters and recommendations from accounting forms). A formal policy has been drafted and is expected to be implemented in fiscal year 2017. |
| Process FoR determining compensation | Form 990, Part VI, Section B, Line 15 The CEO (Executive Director), the CFO and the Director of Operations of Sturdy Memorial Associates, Inc. are compensated entirely through Sturdy Memorial Hospital, Inc. which is why there is no compensation reported on Form 990, Part VII, column D. The CEO and senior managers listed on the Form 990 are compensated on a merit system, as part of their compensation review in Sturdy Memorial Hospital, Inc. The CEO and senior managers prepare goals at the start of each fiscal year and are evaluated for merit increases based on those goals and their accomplishments relative to the goals. The CEO's accomplishments (relative to the established goals) are documented in an annual report which is submitted to the Chairman of the Board of Managers. The Board Chairman is provided with comparative market data obtained through compensation surveys prepared by an independent consultant specializing in such matters. The comparative data is for similar hospitals in Massachusetts and is sent directly from the independent consultant to the Board Chairman. The data includes comprehensive salary and benefits information for CEOs and senior managers (key employees) including comparison of base pay, incentive pay, benefits and total compensation. In addition, the Chairman is provided with performance information for Massachusetts hospitals obtained through the Massachusetts Center for Health Information & Analysis. The Hospital's Vice President of Human Resources provides the Chairman with the CEO's current actual salary and benefits. The Chairman of the Board of Managers provides the above information along with the annual report of the CEO's accomplishments (relative to established goals including the hospital and the Associates) and a history of the CEO's compensation to the Executive Committee which serves as the Compensation Committee for this purpose. The Executive Committee reviews the comparative data for the CEO base salary, bonus (incentive) and total compensation along with the survey data for benefits. Based on the goals achieved and the comparative data provided, the Executive Committee votes to approve the salary, bonus and benefits of the CEO. A summary of the discussion and the decision of the Executive Committee are reflected in the meeting minutes. The Chairman of the Board of Managers communicates the decision regarding compensation changes in a letter to the Vice President of Human Resources to execute the change. The CEO uses comparative market data, obtained from an independent consultant, for the hospital senior managers. The CEO compares the senior managers current base salary and bonus (incentive pay) to the survey data. The senior managers' performance is evaluated based on the goals established at the start of the year. The CEO determines the base pay amount and bonus for each senior manager based on performance and the compensation survey. Base salary and bonus payments for each senior manager, including survey information, are reviewed with the Executive Committee by the CEO. The Executive Committee votes to accept the recommendations of the CEO for all senior managers except the CFO. The Executive Committee votes to approve the CFO's compensation separately. |
| How documents are made available to the public | Form 990, Part VI, Section C, Line 19 Sturdy Memorial Associates, Inc. makes available copies of its by-laws, the conflict of interest policy of Sturdy Memorial Hospital, Inc. and financial statements to the public upon request. |
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