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)
L&M HOSPITAL INC |
060646704 | 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 |
||||
|
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) |
||||
|
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 |
|---|---|
| PART IV, SECTION B, LINE 1 | THE ORGANIZATION'S SUPPORTED ORGANIZATION IS LAWRENCE & MEMORIAL HOSPITAL ("L&M HOSPITAL OR THE HOSPITAL"). THE HOSPITAL'S PARENT, LAWRENCE & MEMORIAL CORPORATION (THE "CORPORATION OR THE "SYSTEM PARENT"), HAS THE RIGHT TO APPOINT THE BOARD OF DIRECTORS OF THE ORGANIZATION. THE SYSTEM PARENT OVERSEES A COMPREHENSIVE AND INTEGRATED HEALTH CARE DELIVERY SYSTEM OPERATED BY THE SYSTEM'S AFFILIATED ENTITIES, INCLUDING THE HOSPITAL AND THE ORGANIZATION. THE SYSTEM PARENT IS ALSO A SUPPORTING ORGANIZATION TO THE HOSPITAL. IN ADDITION, THE MAJORITY OF THE ORGANIZATION'S OFFICERS ARE ALSO OFFICERS OR KEY EMPLOYEES OF THE HOSPITAL. THEREFORE, THE HOSPITAL, THROUGH ITS PARENT AND THROUGH ITS EMPLOYEES, IS ABLE TO EFFECTIVELY OPERATE, SUPERVISE AND CONTROL THE ORGANIZATION'S ACTIVITIES. EFFECTIVE AS OF SEPTEMBER 8, 2016, LAWRENCE + MEMORIAL CORPORATION AFFILIATED WITH THE YALE NEW HAVEN HEALTH SYSTEM, AND YALE NEW HAVEN HEALTH SERVICES CORPORATION BECAME THE SOLE MEMBER OF LAWRENCE + MEMORIAL CORPORATION. |
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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 | PART I, LINE 4 & PART VI, LINE 1B NUMBER OF INDEPENDENT VOTING MEMBERS OF THE GOVERNING BODY THE ORGANIZATION SOUGHT TO CONFIRM THE INDEPENDENCE OF EACH VOTING MEMBER OF ITS GOVERNING BODY BY REQUESTING THAT EACH SUCH VOTING MEMBER RESPOND TO A QUESTIONNAIRE CONTAINING THE PERTINENT INSTRUCTIONS AND DEFINITIONS AND DESIGNED TO ELICIT THE INFORMATION NECESSARY TO DETERMINE INDEPENDENCE. BASED ON RESPONSES TO THE QUESTIONNAIRES RECEIVED BY THE ORGANIZATION AND ANNUAL CONFLICTS OF INTEREST DISCLOSURES, THE ORGANIZATION WAS ABLE TO CONFIRM THAT ONE (1) VOTING MEMBER IS INDEPENDENT. THE ORGANIZATION IS A RELATED ORGANIZATION OF LAWRENCE + MEMORIAL CORPORATION. PURSUANT TO ITS BYLAWS, THE ORGANIZATION'S EXECUTIVE DIRECTOR AND THE PRESIDENT AND CHIEF EXECUTIVE OFFICER OF LAWRENCE + MEMORIAL CORPORATION SERVE AS EX-OFFICIO MEMBERS OF THE BOARD OF TRUSTEES OF THE ORGANIZATION. ALL OTHER DIRECTORS ARE APPOINTED BY LAWRENCE + MEMORIAL CORPORATION. THE ORGANIZATION'S BYLAWS FURTHER REQUIRE THAT AT LEAST HALF OF THE DIRECTORS BE PHYSICIANS, WHO ARE TYPICALLY EMPLOYED BY THE ORGANIZATION. |
| FORM 990, PART VI, SECTION A, LINE 2 | BUSINESS RELATIONSHIPS BETWEEN OFFICERS, DIRECTORS, TRUSTEES, OR KEY EMPLOYEES THE ORGANIZATION'S CURRENT OFFICERS AND/OR TRUSTEES SERVE AS OFFICERS AND/OR DIRECTORS OF TAXABLE AFFILIATES WITHIN THE ORGANIZATION'S CORPORATE SYSTEM OR JOINT VENTURES IN WHICH THE ORGANIZATION'S CORPORATE SYSTEM HAS AN OWNERSHIP INTEREST. THE INDIVIDUAL OFFICERS DO NOT HAVE PERSONAL FINANCIAL INTERESTS IN THE TAXABLE AFFILIATE AND SERVE ONLY AS A FUNCTION OF THEIR ROLES WITH THE ORGANIZATION OR WITHIN THE ORGANIZATION'S CORPORATE SYSTEM. |
| FORM 990, PART VI, SECTION A, LINE 4 | EFFECTIVE SEPTEMBER 8, 2016, LAWRENCE + MEMORIAL CORPORATION ("LMC") AND ITS RELATED ORGANIZATIONS BECAME AFFILIATED WITH THE YALE NEW HAVEN HEALTH SYSTEM PURSUANT TO THE TERMS OF AN AFFILIATION AGREEMENT BETWEEN LMC AND YALE NEW HAVEN HEALTH SERVICES CORPORATION ("YNHHSC") DATED AS OF JULY 17, 2015 (THE "AFFILIATION AGREEMENT"). AS A RESULT OF THE CLOSING OF THE AFFILIATION TRANSACTION, YNHHSC BECAME THE SOLE MEMBER OF LMC. ADDITIONALLY, THE CERTIFICATES OF INCORPORATION AND BYLAWS OF LMC AND ITS SUBSIDIARIES LAWRENCE + MEMORIAL HOSPITAL, LMW HEALTHCARE, INC., L+M PHYSICIAN ASSOCIATION, INC. AND VISITING NURSE ASSOCIATION OF SOUTHEASTERN CONNECTICUT, INC. WERE REVISED AS AGREED UPON IN THE AFFILIATION AGREEMENT TO REFLECT YNHHSC AS THE ULTIMATE CORPORATE PARENT AND DESCRIBE THE RETAINED POWERS AND OF YNHHSC CONSISTENT WITH ITS OTHER AFFILIATED ENTITIES. |
| FORM 990, PART VI, SECTION A, LINE 6 | L&M CORPORATION IS THE SOLE CORPORATE MEMBER OF L&M PHYSICIAN ASSOCIATION, INC. (LMPA). |
| FORM 990, PART VI, SECTION A, LINE 7A | THE LMPA BOARD MEMBERS ARE ELECTED BY THE BOARD OF L&M CORPORATION. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE SOLE MEMBER OF THE ORGANIZATION HAS THE POWER TO ACCEPT OR REJECT THE ANNUAL OPERATING AND CAPITAL BUDGETS OF THE ORGANIZATION; AND TO APPROVE, UPON RECOMMENDATION OF THE BOARD, SIGNIFICANT FUNDRAISING PROGRAMS AND SALE OR DISPOSITION OF ANY ASSETS AND THE INCURRING OF INDEBTEDNESS IN SPECIFIC SITUATIONS. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE FORM 990 IS PREPARED BY THE ORGANIZATION AND REVIEWED BY THE EXTERNAL TAX CONSULTANTS. A DRAFT OF THE RETURN IS PROVIDED TO MANAGEMENT FOR REVIEW. ANY NECESSARY CHANGES ARE MADE PRIOR TO THE FINAL REVIEW AND SIGNING OF THE RETURN BY THE ORGANIZATION'S INDEPENDENT TAX CONSULTANTS. THE FINAL FORM 990 IS PROVIDED TO THE BOARD PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | LMPA REQUIRES ALL BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEES TO COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE. QUESTIONNAIRES ARE COMPLETED ANNUALLY AND ARE REVIEWED BY L&M HOSPITAL'S GENERAL COUNSEL. ANY ACTUAL OR POTENTIAL CONFLICTS DISCLOSED ARE PRESENTED TO THE BOARD. APPROPRIATE CORRECTIVE ACTIONS ARE DECIDED ON A CASE BY CASE BASIS. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE OFFICERS COMPENSATION AND BENEFITS REPORTED IN PART VII ARE DETERMINED BY L&M HOSPITAL. L&M HOSPITAL EXECUTIVE COMPENSATION COMMITTEE ANNUALLY REVIEWS THE SALARIES OF ITS EXECUTIVE MANAGEMENT AND KEY EMPLOYEES. UTILIZING INDEPENDENT COMPENSATION CONSULTANTS THE EXECUTIVE COMPENSATION COMMITTEE MAKES ITS RECOMMENDATIONS. THE COMMITTEE'S DELIBERATIONS ARE REFLECTED IN ITS MINUTES. |
| FORM 990, PART VI, SECTION C, LINE 19 | ALL DOCUMENTS AVAILABLE UPON REQUEST. |
| PART VII SECTION A. | ROBERT CIOTOLA LEFT THE BOARD AS OF 12/2014. HOWEVER, HE WAS COMPENSATED FOR BEING AN EMPLOYEE IN L& M PHYSICIAN ASSOCIATION, INC. |
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