Form990
Click to see list of attachments
Department of the TreasuryInternal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
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MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2019
Open to Public Inspection
A For the 2019 calendar year, or tax year beginning 10-01-2017 , and ending 09-30-2018
BCheck if applicable:
CName of organization
Lifespan Physician Group Inc
 
 
Doing business as
 
 
Number and street (or P.O. box if mail is not delivered to street address)
167 Point Street
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
Providence, RI02903
D Employer identification number

05-0389801
E Telephone number

G Gross receipts $ 201,970,536
F Name and address of principal officer:
Steven Lampert MD
167 Point Street
Providence,RI02903
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.lifespan.org
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:  
L Year of formation: 1981
M State of legal domicile: RI
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: The mission of Lifespan Physician Group, Inc. (LPG) is to provide accountable patient-centered, high quality, efficient, value-based, and innovative care to serve the health care needs of the communities in Rhode Island and elsewhere.(continued in Schedule O)
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 15
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 0
5 Total number of individuals employed in calendar year 2019 (Part V, line 2a) ...... 5 1,084
6 Total number of volunteers (estimate if necessary) ............. 6 1
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 0
b Net unrelated business taxable income from Form 990-T, line 39 ......... 7b  
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) .........   0
9 Program service revenue (Part VIII, line 2g) ......... 189,742,614 201,905,024
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 32,226 65,512
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 1,199 0
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12) 189,776,039 201,970,536
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...   16,161
14 Benefits paid to or for members (Part IX, column (A), line 4).....   0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 154,917,086 169,829,933
16a Professional fundraising fees (Part IX, column (A), line 11e) .....   0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 34,858,953 32,124,442
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 189,776,039 201,970,536
19 Revenue less expenses. Subtract line 18 from line 12.......   0
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 25,647,532 27,956,305
21 Total liabilities (Part X, line 26)............. 28,091,932 29,146,705
22 Net assets or fund balances. Subtract line 21 from line 20..... -2,444,400 -1,190,400
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
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Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ..........
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y Form 990 (2019)
Form 990 (2019)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III..............
1
Briefly describe the organization’s mission: LPG was organized to provide accountable patient-centered, high quality, efficient, value-based, and innovative care to serve the health care needs of the communities in Rhode Island and elsewhere.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? .....................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program
services? ...........................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 39,156,936 including grants of $   ) (Revenue $ 39,501,773 )
LPG Anesthesiology:The providers of LPG's anesthesiology practice provide anesthesia care for adults, children, and adolescents undergoing surgery at Lifespan hospitals and outpatient centers. The physicians and specialty-trained nurses of this group make up the largest anesthesia group in Rhode Island and bring their expertise from many of the nation's top training programs. Services include preoperative assessments and consultations, state-of-the-art equipment for general, regional, and intravenous sedation techniques, subspecialty expertise in ambulatory, cardiac, neurosurgical, thoracic, vascular, and regional anesthesia, as well as postoperative acute and chronic pain management.
4b (Code:   ) (Expenses $ 26,571,023 including grants of $   ) (Revenue $ 18,591,111 )
LPG Newport:LPG Newport's physician practices include specialties such as family practice, pulmonology, dermatology, neurology, physiatry, behavioral health, rheumatology, endocrinology, hematology/oncology, child and adolescent psychiatry, neurosurgery, orthopedics, and OB/Gyn services.
4c (Code:   ) (Expenses $ 21,408,828 including grants of $   ) (Revenue $ 21,408,828 )
LPG Pediatrics:LPG's Pediatric practice group is comprised of a group of pediatricians and specialists who provide routine health check-ups, treat illnesses, lead immunization clinics, and staff Rhode Island Hospital's (RIH) pediatric division-Hasbro Children's Hospital. Operating expenses for this practice group directly charged to LPG during the fiscal year ended September 30, 2018 amounted to $21,408,828, representing primarily payroll and fringe benefit expenses funded by RIH.
4d Other program services (Describe in Schedule O.)
(Expenses $ 89,299,084 including grants of $   ) (Revenue $ 122,403,312 )
4e Total program service expensesMediumBullet176,435,871
Form 990 (2019)
Form 990 (2019)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? ...
2
 
No
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part I.............
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part II.........
4
 
No
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C, Part III..
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part IClick to see attachment.........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part IIClick to see attachment....
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes,"
complete Schedule D, Part IIIClick to see attachment..............
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi endowments? If "Yes," complete Schedule D, Part V......
10
 
 
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10? If "Yes," complete
Schedule D, Part VI. Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIClick to see attachment.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment............
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If "Yes," complete
Schedule D, Parts XI and XIIClick to see attachment......................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States? .....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV.....
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I(see instructions) ....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H....
20a
 
No
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return?
20b
 
 
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.....Click to see attachment
21
Yes
 
Form 990 (2019)
Form 990 (2019)
Page 4
Part IV
Checklist of Required Schedules (continued)
Yes
No
22
Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........Click to see attachment
22
 
No
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a...............
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds? ...............
24c
 
No
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I ....
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I.......................
25b
 
No
26
Did the organization report any amount on Part X, line 5 or 22 for receivables from or payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part II...........
26
 
No
27
Did the organization provide a grant or other assistance to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or employee thereof, a grant selection committee member, or to a 35% controlled entity (including an employee thereof) or family member of any of these persons?
If "Yes," complete
Schedule L, Part III.........................
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, key employee, creator or founder, or substantial contributor? If "Yes," complete Schedule L, Part IV......................
28a
 
No
b
A family member of any individual described in line 28a? If "Yes," complete Schedule L, Part IV.....
28b
 
No
c
A 35% controlled entity of one or more individuals and/or organizations described in lines 28a or 28b? If "Yes," complete Schedule L, Part IV.....................
28c
 
 
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M .................
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II........................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I............Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1.........................Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
 
No
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2 ...
35b
 
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2............. Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V...........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable ..
1a
58
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
Form 990 (2019)
Form 990 (2019)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance (continued)
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
1,084
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
 
No
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)? ..
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? ..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions? ...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? ......................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? ....................
7a
 
No
b
If "Yes," did the organization notify the donor of the value of the goods or services provided? .....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? .........................
7c
 
No
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
0
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? ......................
7g
 
No
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? ..........................
7h
 
No
8
Sponsoring organizations maintaining donor advised funds. Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? ........
8
 
No
9
Sponsoring organizations maintaining donor advised funds.
a
Did the sponsoring organization make any taxable distributions under section 4966?........
9a
 
No
b
Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?...
9b
 
No
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
No
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state? .........
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
No
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
15
Is the organization subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or excess parachute payment(s) during the year? ....................
If "Yes," see instructions and file Form 4720, Schedule N.
15
 
 
16
Is the organization an educational institution subject to the section 4968 excise tax on net investment income? ..
If "Yes," complete Form 4720, Schedule O.
16
 
 
Form 990 (2019)
Form 990 (2019)
Page 6
Part VI
Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
1a
15
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent
1b
0
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
Yes
 
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? .
4
Yes
 
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
 
No
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
 
No
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .......................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done...................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the states with which a copy of this Form 990 is required to be filedMediumBullet
RI
18
Section 6104 requires an organization to make its Form 1023 (or 1024-A if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, address, and telephone number of the person who possesses the organization's books and records:
MediumBulletMary A Wakefield593 Eddy Street   Providence,RI02903 (401) 444-7093
Form 990 (2019)
Form 990 (2019)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

See instructions for the order in which to list the persons above.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W-2/1099-MISC) 		(E)
Reportable compensation from related organizations (W-2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) Timothy J Babineau MD......................................................................
Chair
 1.00
.................
39.00 		X   X       0 2,217,856 527,817
(2) Christina A Bandera MD......................................................................
Trustee- 11/17
 40.00
.................
0.00 		X           424,435 0 42,473
(3) Bradley J Collins MD......................................................................
Trustee
 40.00
.................
0.00 		X           307,042 0 38,223
(4) Kwame Dapaah-Afriyie MD......................................................................
Trustee- 11/17
 0.25
.................
0.00 		X           0 0 0
(5) Kristopher R Davignon MD......................................................................
Trustee- 11/17
 40.00
.................
0.00 		X           610,995 0 42,699
(6) Phyllis A Dennery MD......................................................................
Trustee
 40.00
.................
0.00 		X           606,665 0 46,217
(7) Curtis E Doberstein MD......................................................................
Trustee
 40.00
.................
0.00 		X           0 1,249,913 40,136
(8) Larry A Evans MD......................................................................
Trustee- 11/17
 40.00
.................
0.00 		X           429,832 0 43,793
(9) Lloyd Feit MD......................................................................
Trustee- 11/17
 40.00
.................
0.00 		X           349,563 0 22,255
(10) Richard G Gillerman MD......................................................................
Trustee- 11/17
 20.00
.................
20.00 		X           0 527,614 24,338
(11) Richard J Goldberg MD......................................................................
Trustee- 11/17
 0.50
.................
39.50 		X           0 633,042 37,011
(12) Steven Lampert MD......................................................................
President
 40.00
.................
0.00 		X   X       684,539 0 6,284
(13) Daniel J Levine MD......................................................................
Trustee
 40.00
.................
0.00 		X           422,214 99,970 48,039
(14) Paul Y Liu MD......................................................................
Trustee
 40.00
.................
0.00 		X           703,965 0 40,525
(15) Debra Lobato-Barrera PhD......................................................................
Trustee
 1.00
.................
39.00 		X           164,644 0 32,968
(16) Suzanne E McLaughlin MD......................................................................
Trustee
 40.00
.................
0.00 		X           176,462 0 31,797
(17) Michael E Migliori MD......................................................................
Trustee
 40.00
.................
0.00 		X           390,495 0 39,708
Form 990 (2019)
Form 990 (2019)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W-2/1099-MISC) 		(E)
Reportable compensation from related organizations (W-2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) Margaret A Miller MD........................................................................
Trustee
 20.00
.......................20.00 		X           371,228 0 41,857
(19) John B Murphy MD........................................................................
Secretary
 25.00
.......................15.00 		X   X       0 807,439 24,980
(20) Gildasio Oliveira Jr MD........................................................................
Trustee
 40.00
.......................0.00 		X           824,492 0 40,334
(21) Chanika Phornphutkul MD........................................................................
Trustee
 40.00
.......................0.00 		X           205,794 0 35,920
(22) Athena Poppas MD........................................................................
Trustee
 40.00
.......................0.00 		X           412,645 151,061 36,565
(23) Henry T Sachs III MD........................................................................
Trustee- 11/17
 1.00
.......................39.00 		X           0 395,365 72,679
(24) Meera V Simoes MD........................................................................
Trustee- 11/17
 40.00
.......................0.00 		X           301,793 0 39,365
(25) Adrian D Velasquez MD........................................................................
Trustee- 11/17
 40.00
.......................0.00 		X           315,055 0 25,665
(26) Marilyn J Weigner MD........................................................................
Trustee- 11/17
 1.00
.......................39.00 		X           400,836 100,146 43,882
(27) Mary A Wakefield........................................................................
Treasurer
 2.00
.......................38.00 		    X       0 1,022,911 282,563
(28) Patricia H Richards........................................................................
VP of Operations
 40.00
.......................0.00 		      X     0 378,302 29,795
(29) Anthony L Gallo MD........................................................................
Physician
 40.00
.......................0.00 		        X   653,660 0 41,353
(30) Ziya L Gokaslan MD........................................................................
Physician
 40.00
.......................0.00 		        X   1,481,742 0 40,525
(31) Rolf H Langeland MD........................................................................
Physician
 40.00
.......................0.00 		        X   568,770 0 40,085
(32) Rachel A Sullivan MD........................................................................
Physician
 40.00
.......................0.00 		        X   595,886 0 40,027
(33) Steven A Toms MD........................................................................
Physician
 40.00
.......................0.00 		        X   898,879 0 40,525
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)...........MediumBullet 12,301,631 7,583,619 1,940,403
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet485
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such
individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
University Surgical Associates Inc

2 Dudley Street
Providence,RI02905 		Physician Services 2,091,465
University Medicine Fdtn Inc

110 Elm Street
Providence,RI02903 		Physician Services 1,362,171
Quorum Health Resources LLC

1573 Mallory Lane
Brentwood,TN37027 		Consulting Services 1,105,864
Nationwide Anesthesia Services Inc

104 Malone St
Sandersville,GA31082 		Medical Services 728,891
Medicus Hospitalists LLC

22 Roulston Road
Windham,NH03087 		Physician Services 685,221
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet18
Form 990 (2019)
Form 990 (2019)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII.............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512 - 514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues..1b  
c Fundraising events..1c  
d Related organizations1d  
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and similar amounts not included above1f  
g Noncash contributions included in lines 1a - 1f:$ 1g  
h Total. Add lines 1a-1f.......MediumBullet 0
Program Service RevenueAmt Business Code
2a Hospital Support Revenue 621110 82,802,064 82,802,064    
b Laboratory Lease Revenue 621500 179,276 179,276    
c Patient Service Revenue 621110 118,923,684 118,923,684    
d
e
f All other program service revenue.        
g Total. Add lines 2a–2f .....MediumBullet 201,905,024
OtherAmtRevenueAmt 3 Investment income (including dividends, interest, and othersimilar amounts) ......MediumBullet 65,512     65,512
4 Income from investment of tax-exempt bond proceedsMediumBullet 0      
5 Royalties...........MediumBullet 0      
(ii) Personal (i) Real
6a Gross rents     6a
b Less: rental expenses     6b
c Rental income or (loss)     6c
d Net rental income or (loss).......MediumBullet 0      
(ii) Other (i) Securities
7a Gross amount from sales of assets other than inventory     7a
b Less: cost or other basis and sales expenses     7b
c Gain or (loss)     7c
d Net gain or (loss).........MediumBullet 0      
8a Gross income from fundraising events (not including $   of contributions reported on line 1c). See Part IV, line 18 ....
8a  
b Less: direct expenses ... 8b  
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
9a  
b Less: direct expenses ... 9b  
c Net income or (loss) from gaming activities..MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances ..
10a  
b Less: cost of goods sold .. 10b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Business Code Miscellaneous Revenue
11a            
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet 0
12 Total revenue. See instructions.....MediumBullet 201,970,536 201,905,024   65,512
Form 990 (2019)
Form 990 (2019)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX..............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising
expenses
1 Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 .... 16,161 16,161
2 Grants and other assistance to domestic individuals. See Part IV, line 22 ........... 0  
3 Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. ............. 0  
4 Benefits paid to or for members ....... 0  
5 Compensation of current officers, directors, trustees, and key employees ........... 10,518,988 8,392,342 2,126,646  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ......... 0      
7 Other salaries and wages........ 132,872,347 120,610,330 12,262,017  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 5,727,094 5,181,804 545,290  
9 Other employee benefits ....... 12,976,163 10,304,663 2,671,500  
10 Payroll taxes ........... 7,735,341 6,961,807 773,534  
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 0      
c Accounting ........... 0      
d Lobbying ........... 0      
e Professional fundraising services. See Part IV, line 17 0  
f Investment management fees ...... 0      
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) 1,448,215 1,040,865 407,350  
12 Advertising and promotion .... 36,279 15,832 20,447  
13 Office expenses ....... 149,203 145,344 3,859  
14 Information technology ...... 289,198 215,475 73,723  
15 Royalties .. 0      
16 Occupancy ........... 6,518,766 5,970,469 548,297  
17 Travel ............ 62,506 55,559 6,947  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials . 0      
19 Conferences, conventions, and meetings .... 13,020 11,931 1,089  
20 Interest ........... 0      
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization .. 770,085 764,210 5,875  
23 Insurance ... 7,362,832 6,894,303 468,529  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a Purchased Services 5,460,623   5,460,623  
b Provision for Bad Debts 3,933,265 3,921,940 11,325  
c Drugs & IV Solutions 1,996,717 1,996,717    
d Professional Allowance 1,927,174 1,924,724 2,450  
e All other expenses 2,156,559 2,011,395 145,164  
25 Total functional expenses. Add lines 1 through 24e 201,970,536 176,435,871 25,534,665 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2019)
Form 990 (2019)
Page 11
Part X
Balance Sheet
Check if Schedule O contains a response or note to any line in this Part IX..............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash–non-interest-bearing ........   1 0
2 Savings and temporary cash investments ......... 147,939 2 55,622
3 Pledges and grants receivable, net ......   3 0
4 Accounts receivable, net ............. 3,822,668 4 6,821,039
5 Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
  5 0
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
  6 0
7 Notes and loans receivable, net ...........   7 0
8 Inventories for sale or use ............   8 0
9 Prepaid expenses and deferred charges ...... 98,117 9 55,952
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 5,544,641
b Less: accumulated depreciation 10b 2,080,143 3,246,402 10c 3,464,498
11 Investments—publicly traded securities .   11 0
12 Investments—other securities. See Part IV, line 11 .....   12 0
13 Investments—program-related. See Part IV, line 11 ..   13 0
14 Intangible assets ............... 1,040,058 14 895,273
15 Other assets. See Part IV, line 11 ........... 17,292,348 15 16,663,921
16 Total assets. Add lines 1 through 15 (must equal line 33)... 25,647,532 16 27,956,305
Liabilities 17 Accounts payable and accrued expenses ..... 16,051,881 17 17,650,339
18 Grants payable ...   18  
19 Deferred revenue .........   19 3,000
20 Tax-exempt bond liabilities .........   20  
21 Escrow or custodial account liability. Complete Part IV of Schedule D   21  
22 Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
  22  
23 Secured mortgages and notes payable to unrelated third parties ..   23  
24 Unsecured notes and loans payable to unrelated third parties ..   24  
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D 12,040,051 25 11,493,366
26 Total liabilities. Add lines 17 through 25.. 28,091,932 26 29,146,705
Net Assets or Fund Balance Organizations that follow FASB ASC 958, check here MediumBullet and complete lines 27, 28, 32, and 33.
27 Net assets without donor restrictions ..........   27  
28 Net assets with donor restrictions ...........   28  
Organizations that do not follow FASB ASC 958, check here MediumBullet and complete lines 29 through 33.
29 Capital stock or trust principal, or current funds .....   29  
30 Paid-in or capital surplus, or land, building or equipment fund ...   30  
31 Retained earnings, endowment, accumulated income, or other funds   31  
32 Total net assets or fund balances ........... -2,444,400 32 -1,190,400
33 Total liabilities and net assets/fund balances ........ 25,647,532 33 27,956,305
Form 990 (2019)
Form 990 (2019)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
201,970,536
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
201,970,536
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
0
4
Net assets or fund balances at beginning of year (must equal Part X, line 32, column (A)) ..
4
-2,444,400
5
Net unrealized gains (losses) on investments ...............
5
 
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
1,254,000
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 32, column (B))
10
-1,190,400
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII.............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
 
No
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
 
 
Form 990 (2019)
Form 990 (2019)
Additional Data


Software ID: 17005038
Software Version: 2017v2.2
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ.
right arrow Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2019
Open to Public
Inspection
Name of the organization
Lifespan Physician Group Inc
 
Employer identification number

05-0389801
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)
1
2
3
4
5
6
7
8
9
10
11
12
a
b
c
d
e
f
Enter the number of supported organizations ...............................  
g
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 10 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
Total
 
   
For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2019

Schedule A (Form 990 or 990-EZ) 2019
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2015 (b) 2016 (c) 2017 (d) 2018 (e) 2019 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..            
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.  
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2015 (b) 2016 (c) 2017 (d) 2018 (e) 2019 (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  
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2019

Schedule A (Form 990 or 990-EZ) 2019
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2015 (b) 2016 (c) 2017 (d) 2018 (e) 2019 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .           0
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 54,619,950 86,826,839 172,616,971 189,742,614 201,905,024 705,711,398
3 Gross receipts from activities that are not an unrelated trade or business under section 513 .....           0
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...           0
5 The value of services or facilities furnished by a governmental unit to the organization without charge           0
6 Total. Add lines 1 through 5 54,619,950 86,826,839 172,616,971 189,742,614 201,905,024 705,711,398
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..            
8 Public support. (Subtract line 7c from line 6.) 705,711,398
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2015 (b) 2016 (c) 2017 (d) 2018 (e) 2019 (f) Total
9 Amounts from line 6... 54,619,950 86,826,839 172,616,971 189,742,614 201,905,024 705,711,398
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. 839 14,056 6,034 32,226 65,512 118,667
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.           0
c Add lines 10a and 10b. 839 14,056 6,034 32,226 65,512 118,667
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.           0
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..           0
13 Total support. (Add lines 9, 10c, 11, and 12.).. 54,620,789 86,840,895 172,623,005 189,774,840 201,970,536 705,830,065
14
Section C. Computation of Public Support Percentage
15
15
99.980 %
16
16
99.990 %
Section D. Computation of Investment Income Percentage
17
17
0.020 %
18
18
0.010 %
19a
b
20
Schedule A (Form 990 or 990-EZ) 2019

Schedule A (Form 990 or 990-EZ) 2019
Page 4
Part IV
Supporting Organizations
(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.)
Section A. All Supporting Organizations
Yes
No
1
Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.
1
 
 
2
Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).
2
 
 
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.
3a
 
 
b
Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.
3b
 
 
c
Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.
3c
 
 
4a
Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 12a or 12b in Part I, answer (b) and (c) below.
4a
 
 
b
Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.
4b
 
 
c
Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.
4c
 
 
5a
Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).
5a
 
 
b
Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?
5b
 
 
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
 
 
6
Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.
6
 
 
7
Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .
7
 
 
8
Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).
8
 
 
9a
Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.
9a
 
 
b
Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.
9b
 
 
c
Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.
9c
 
 
10a
Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.
10a
 
 
b
Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).
10b
 
 
Schedule A (Form 990 or 990-EZ) 2019

Schedule A (Form 990 or 990-EZ) 2019
Page 5
Part IV
Supporting Organizations (continued)
Yes
No
11
Has the organization accepted a gift or contribution from any of the following persons?
a
A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?
11a
 
 
b
A family member of a person described in (a) above?
11b
 
 
c
A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.
11c
 
 
Section B. Type I Supporting Organizations
Yes
No
1
Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.
1
 
 
2
Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.
2
 
 
Section C. Type II Supporting Organizations
Yes
No
1
Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).
1
 
 
Section D. All Type III Supporting Organizations
Yes
No
1
Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?
1
 
 
2
Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).
2
 
 
3
By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.
3
 
 
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer (a) and (b) below.
Yes
No
a
Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.
2a
 
 
b
Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.
2b
 
 
3
Parent of Supported Organizations. Answer (a) and (b) below.
a
Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.
3a
 
 
b
Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.
3b
 
 
Schedule A (Form 990 or 990-EZ) 2019

Schedule A (Form 990 or 990-EZ) 2019
Page 6
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations
1
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
Schedule A (Form 990 or 990-EZ) 2019

Schedule A (Form 990 or 990-EZ) 2019
Page 7
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)
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 2019 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-2019 		(iii)
Distributable
Amount for 2019
1 Distributable amount for 2019 from Section C, line 6  
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI).
See instructions.		  
3 Excess distributions carryover, if any, to 2019:
a From 2014.......  
b From 2015.......  
c From 2016.......  
d From 2017.......  
e From 2018.......  
fTotal of lines 3a through e  
g Applied to underdistributions of prior years  
h Applied to 2019 distributable amount  
i Carryover from 2014 not applied (see
instructions) 		 
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.  
4Distributions for 2019 from Section D, line 7:
$  
a Applied to underdistributions of prior years  
b Applied to 2019 distributable amount  
c Remainder. Subtract lines 4a and 4b from 4.  
5 Remaining underdistributions for years prior to
2019, if any. Subtract lines 3g and 4a from line 2.
If the amount is greater than zero, explain in Part VI.
See instructions.		  
6 Remaining underdistributions for 2019. Subtract
lines 3h and 4b from line 1. If the amount is greater
than zero, explain in Part VI. See instructions.		  
7 Excess distributions carryover to 2020. Add lines
3j and 4c.		  
8 Breakdown of line 7:
a Excess from 2015.....  
b Excess from 2016.....  
c Excess from 2017.....  
d Excess from 2018.....  
e Excess from 2019.....  
Schedule A (Form 990 or 990-EZ) (2019)

Schedule A (Form 990 or 990-EZ) 2019
Page 8
Part VI
Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Return Reference Explanation
Schedule A (Form 990 or 990-EZ) 2019


Additional Data


Software ID: 17005038
Software Version: 2017v2.2
SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet Attach to Form 990.
SchDMd Bullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2019
Open to Public Inspection
Name of the organization
Lifespan Physician Group Inc
 
Employer identification number

05-0389801
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate value of contributions to (during year)    
3 Aggregate value of grants from (during year)    
4 Aggregate value at end of year ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ...................... 2a  
b Total acreage restricted by conservation easements .................... 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............
6
Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenue included on Form 990, Part VIII, line 1 .........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:
a
Revenue included on Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2019

Schedule D (Form 990) 2019
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b If "Yes," explain the arrangement in Part XIII and complete the following table: Amount
c Beginning balance ............................. 1c  
d Additions during the year ............................ 1d  
e Distributions during the year .......................... 1e  
f Ending balance ................................ 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...
b
If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....
Part V
Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.
(a) Current year (b) Prior year (c) Two years back (d) Three years back (e) Four years back
1a Beginning of year balance ....          
b Contributions ...          
c Net investment earnings, gains, and losses          
d Grants or scholarships ...          
e Other expenditures for facilities
and programs ... 		         
f Administrative expenses ....          
g End of year balance ......          
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Term endowment SchDMd Bullet  
The percentages on lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) Unrelated organizations .................
3a(i)
 
 
(ii) Related organizations .................
3a(ii)
 
 
b
If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis
(investment) 		(b) Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .....      
b Buildings ....   606,719 89,325 517,394
c Leasehold improvements   513,034 106,322 406,712
d Equipment ....   3,588,017 1,651,815 1,936,202
e Other .....   836,871 232,681 604,190
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..SchDMdBullet 3,464,498
Schedule D (Form 990) 2019

Schedule D (Form 990) 2019
Page 3
Part VII
Investments—Other Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b) Book value (c) Method of valuation:
Cost or end-of-year market value
(1) Financial derivatives.........    
(2) Closely-held equity interests........    
(3)Other
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.
(a) Description of investment (b) Book value (c) Method of valuation:
Cost or end-of-year market value
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1)Due from Affiliates 16,473,006
(2)Other Receivables 36,421
(3)Third-party Payor Settlements 154,494
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 16,663,921
Part X
Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
(1) Federal income taxes  
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 11,493,366
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII
Schedule D (Form 990) 2019

Schedule D (Form 990) 2019
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains (losses) on investments .... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1.................. 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIII.) ........... 4b  
c Add lines 4a and 4b.................... 4c  
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1 Total expenses and losses per audited financial statements ........... 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities ......... 2a  
b Prior year adjustments ............ 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d.................... 2e  
3 Subtract line 2e from line 1................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIII.) ............ 4b  
c Add lines 4a and 4b..................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
Part XIII
Supplemental Information
Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Return Reference Explanation
Part X : FIN48 Footnote Lifespan Physician Group, Inc. (LPG) is a not-for-profit corporation as described in Section 501(c)(3) of the Internal Revenue Code (the Code) and is exempt from Federal income taxes pursuant to Section 501(a) of the Code. LPG recognizes the effect of income tax positions only if those positions are more likely than not to be sustained. Recognized income tax positions are measured at the largest amount of benefit that is greater than fifty percent likely to be realized upon settlement. Changes in measurement are reflected in the period in which the change in judgment occurs. LPG did not recognize the effect of any income tax positions in either 2018 or 2017.
Schedule D (Form 990) 2019


Additional Data


Software ID: 17005038
Software Version: 2017v2.2





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Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990.
lBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2019
Open to Public
Inspection
Name of the organization
Lifespan Physician Group Inc
 
Employer identification number
05-0389801
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient
that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC section
(if applicable)		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
noncash assistance		 (h) Purpose of grant
or assistance
(1) The Miriam Hospital Fdtn
167 Point Street
Providence,RI02903 		05-0377502 501(c)(3) 10,000 0     Philanthropy
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
1
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
0
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2019

Schedule I (Form 990) 2019
Page 2
Part III
Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a) Type of grant or assistance (b) Number of
recipients		 (c) Amount of
cash grant		 (d) Amount of
noncash assistance		 (e) Method of valuation (book,
FMV, appraisal, other)		 (f) Description of noncash assistance
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Part IV
Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.
Return Reference Explanation
Grantmaker's Description of How Grants are Used The organizations that are granted assistance are non-profit organizations (typically 501(c)(3)) whose missions are similar to that of Lifespan Physician Group, Inc., including promoting and advancing medical research, education and training in medicine, promoting medical-related sciences, and providing clinical practice.
Schedule I (Form 990) 2019



Additional Data


Software ID: 17005038
Software Version: 2017v2.2


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet Attach to Form 990.
SchJMediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2019
Open to Public Inspection
Name of the organization
Lifespan Physician Group Inc
 
Employer identification number

05-0389801
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........
1b
Yes
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ..
2
Yes
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? .............
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.
5
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ....................
5a
 
No
b
Any related organization? .......................
5b
 
No
If "Yes," on line 5a or 5b, describe in Part III.
6
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ..................
6a
 
No
b
Any related organization? ......................
6b
 
No
If "Yes," on line 6a or 6b, describe in Part III.
7
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
Yes
 
8
Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................
8
 
No
9
If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2019

Schedule J (Form 990) 2019
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation in column (B) reported as deferred on prior Form 990
(i) Base
compensation 		(ii) Bonus & incentive
compensation 		(iii) Other reportable compensation
1Adrian D Velasquez MD
Trustee- 11/17 		(i)

(ii)		 283,299
-------------
  		31,300
-------------
  		456
-------------
  		14,030
-------------
  		11,635
-------------
  		340,720
-------------
  		 
-------------
 
2Anthony L Gallo MD
Physician 		(i)

(ii)		 274,432
-------------
  		378,655
-------------
  		573
-------------
  		14,779
-------------
  		26,574
-------------
  		695,013
-------------
  		 
-------------
 
3Athena Poppas MD
Trustee 		(i)

(ii)		 335,844
-------------
149,584 		73,479
-------------
  		3,322
-------------
1,477 		10,545
-------------
4,695 		14,755
-------------
6,570 		437,945
-------------
162,326 		 
-------------
 
4Bradley J Collins MD
Trustee 		(i)

(ii)		 276,390
-------------
  		30,198
-------------
  		454
-------------
  		13,342
-------------
  		24,881
-------------
  		345,265
-------------
  		 
-------------
 
5Chanika Phornphutkul MD
Trustee 		(i)

(ii)		 193,601
-------------
  		8,525
-------------
  		3,668
-------------
  		9,924
-------------
  		25,996
-------------
  		241,714
-------------
  		 
-------------
 
6Christina A Bandera MD
Trustee- 11/17 		(i)

(ii)		 385,222
-------------
  		36,100
-------------
  		3,113
-------------
  		15,240
-------------
  		27,233
-------------
  		466,908
-------------
  		 
-------------
 
7Curtis E Doberstein MD
Trustee 		(i)

(ii)		  
-------------
1,120,911 		 
-------------
125,000 		 
-------------
4,002 		 
-------------
15,240 		 
-------------
24,896 		 
-------------
1,290,049 		 
-------------
 
8Daniel J Levine MD
Trustee 		(i)

(ii)		 258,369
-------------
97,668 		158,665
-------------
  		5,180
-------------
2,302 		11,060
-------------
4,180 		23,803
-------------
8,996 		457,077
-------------
113,146 		 
-------------
 
9Debra Lobato-Barrera PhD
Trustee 		(i)

(ii)		 160,668
-------------
  		 
-------------
  		3,976
-------------
  		10,015
-------------
  		22,953
-------------
  		197,612
-------------
  		 
-------------
 
10Gildasio Oliveira Jr MD
Trustee 		(i)

(ii)		 586,878
-------------
  		222,576
-------------
  		15,038
-------------
  		13,970
-------------
  		26,364
-------------
  		864,826
-------------
  		 
-------------
 
11Henry T Sachs III MD
Trustee- 11/17 		(i)

(ii)		  
-------------
288,680 		 
-------------
66,336 		 
-------------
40,349 		 
-------------
50,225 		 
-------------
22,454 		 
-------------
468,044 		 
-------------
29,546
12John B Murphy MD
Secretary 		(i)

(ii)		  
-------------
531,893 		 
-------------
160,000 		 
-------------
115,546 		 
-------------
6,750 		 
-------------
18,230 		 
-------------
832,419 		 
-------------
 
13Kristopher R Davignon MD
Trustee- 11/17 		(i)

(ii)		 454,161
-------------
  		155,788
-------------
  		1,046
-------------
  		15,240
-------------
  		27,459
-------------
  		653,694
-------------
  		 
-------------
 
14Larry A Evans MD
Trustee- 11/17 		(i)

(ii)		 421,544
-------------
  		4,186
-------------
  		4,102
-------------
  		15,240
-------------
  		28,553
-------------
  		473,625
-------------
  		 
-------------
 
15Lloyd Feit MD
Trustee- 11/17 		(i)

(ii)		 334,429
-------------
  		10,981
-------------
  		4,153
-------------
  		15,240
-------------
  		7,015
-------------
  		371,818
-------------
  		 
-------------
 
16Margaret A Miller MD
Trustee 		(i)

(ii)		 318,381
-------------
  		48,750
-------------
  		4,097
-------------
  		15,240
-------------
  		26,617
-------------
  		413,085
-------------
  		 
-------------
 
17Marilyn J Weigner MD
Trustee- 11/17 		(i)

(ii)		 261,366
-------------
99,069 		136,984
-------------
  		2,486
-------------
1,077 		11,050
-------------
4,190 		20,768
-------------
7,874 		432,654
-------------
112,210 		 
-------------
 
18Mary A Wakefield
Treasurer 		(i)

(ii)		  
-------------
684,712 		 
-------------
209,000 		 
-------------
129,199 		 
-------------
264,493 		 
-------------
18,070 		 
-------------
1,305,474 		 
-------------
97,769
19Meera V Simoes MD
Trustee- 11/17 		(i)

(ii)		 252,131
-------------
  		49,160
-------------
  		502
-------------
  		12,744
-------------
  		26,621
-------------
  		341,158
-------------
  		 
-------------
 
20Michael E Migliori MD
Trustee 		(i)

(ii)		 375,046
-------------
  		11,785
-------------
  		3,664
-------------
  		15,240
-------------
  		24,468
-------------
  		430,203
-------------
  		 
-------------
 
21Patricia H Richards
VP of Operations 		(i)

(ii)		  
-------------
232,248 		 
-------------
46,200 		 
-------------
99,854 		 
-------------
8,100 		 
-------------
21,695 		 
-------------
408,097 		 
-------------
 
22Paul Y Liu MD
Trustee 		(i)

(ii)		 656,179
-------------
  		41,250
-------------
  		6,536
-------------
  		15,240
-------------
  		25,285
-------------
  		744,490
-------------
  		 
-------------
 
23Phyllis A Dennery MD
Trustee 		(i)

(ii)		 539,183
-------------
  		60,000
-------------
  		7,482
-------------
  		15,240
-------------
  		30,977
-------------
  		652,882
-------------
  		 
-------------
 
24Rachel A Sullivan MD
Physician 		(i)

(ii)		 432,608
-------------
  		162,500
-------------
  		778
-------------
  		15,240
-------------
  		24,787
-------------
  		635,913
-------------
  		 
-------------
 
25Richard G Gillerman MD
Trustee- 11/17 		(i)

(ii)		  
-------------
390,262 		 
-------------
86,576 		 
-------------
50,776 		 
-------------
5,400 		 
-------------
18,938 		 
-------------
551,952 		 
-------------
 
26Richard J Goldberg MD
Trustee- 11/17 		(i)

(ii)		  
-------------
436,184 		 
-------------
98,000 		 
-------------
98,858 		 
-------------
16,200 		 
-------------
20,811 		 
-------------
670,053 		 
-------------
 
27Rolf H Langeland MD
Physician 		(i)

(ii)		 510,976
-------------
  		 
-------------
  		57,794
-------------
  		15,240
-------------
  		24,845
-------------
  		608,855
-------------
  		 
-------------
 
28Steven A Toms MD
Physician 		(i)

(ii)		 894,876
-------------
  		 
-------------
  		4,003
-------------
  		15,240
-------------
  		25,285
-------------
  		939,404
-------------
  		 
-------------
 
29Steven Lampert MD
President 		(i)

(ii)		 474,318
-------------
  		115,000
-------------
  		95,221
-------------
  		5,400
-------------
  		884
-------------
  		690,823
-------------
  		 
-------------
 
30Suzanne E McLaughlin MD
Trustee 		(i)

(ii)		 170,676
-------------
  		5,265
-------------
  		521
-------------
  		8,024
-------------
  		23,773
-------------
  		208,259
-------------
  		 
-------------
 
31Timothy J Babineau MD
Chair 		(i)

(ii)		  
-------------
1,261,691 		 
-------------
600,490 		 
-------------
355,675 		 
-------------
501,925 		 
-------------
25,892 		 
-------------
2,745,673 		 
-------------
267,558
32Ziya L Gokaslan MD
Physician 		(i)

(ii)		 1,344,884
-------------
  		129,375
-------------
  		7,483
-------------
  		15,240
-------------
  		25,285
-------------
  		1,522,267
-------------
  		 
-------------
 
Schedule J (Form 990) 2019

Schedule J (Form 990) 2019
Page 3
Part III
Supplemental Information
Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.
Return Reference Explanation
Part I, Line 1a: Relevant information in regards to selections on 1a. Tax Indemnification and Grossed Up Payments:The Lifespan Executive Long Term Disability program provides financial protection to designated Lifespan physicians and executives in the event that they become disabled. Premiums are paid to the insurance carrier by the insureds on an after-tax basis to allow for income replacement at a reasonable cost. The income associated with the premiums is grossed up to cover the total cost of the benefit as provided in the Lifespan Executive Benefit Plan and is included in Medicare wages, more specifically on Schedule J, Part II, Column B (iii).LPG also purchased professional liability prior acts coverage for certain newly-hired physicians in calendar year 2017. Premiums were paid to insurance carriers by the insureds on an after-tax basis. The income associated with the premiums is grossed-up to cover the total cost of the benefit as provided in the physicians' employment contracts and is included in Medicare wages, more specifically on Schedule J, Part II, Column B (iii).Housing Allowances or Residences for Personal Use:A temporary housing allowance may be provided on a case-by-case basis as part of the recruitment of key executives. The allowance is documented in the individual employment contract or employment offer. In calendar year 2017 LPG provided this benefit to two executives and the taxable amounts paid for the temporary housing resulting from relocation are included in Medicare wages, more specifically on Schedule J, Part II, Column B (iii).
Part I, Line 7: Non-Fixed payments not listed above Certain physicians and executives participate in incentive compensation plans arranged through individual contractual agreements which stipulate non-fixed payments based on meeting criteria based on various quality and productivity markers.
Schedule J (Form 990) 2019

Additional Data


Software ID: 17005038
Software Version: 2017v2.2
SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2019
Open to Public
Inspection
Name of the organization
Lifespan Physician Group Inc
 
Employer identification number

05-0389801
Return Reference Explanation
Form 990, Part III, Line 4d: Other Program Services Description OTHER PROGRAM SERVICES 4: LPG employs many physicians and physician groups from Lifespans affiliated hospitals. Included among these various groups are the physicians working within the organization's OB/Gyn Associates group (OGA), the Cardiovacular Institute (CVI), neurosurgeons, pediatricians and plastic surgeons from Rhode Island Hospital (RIH), and Hospitalists from The Miriam Hospital (TMH). OTHER PROGRAM SERVICES 5: The LPG Department of Neurosurgery at RIH offers patient-focused, state-of-the-art clinical care in highly-equipped and modern facilities. Each of LPG's skilled surgeons has specific neurosurgical subspecialty expertise, including surgery for brain tumors and epilepsy, cerebrovascular surgery, skull-base surgery, radiosurgery, complex spine surgery, and pediatric neurosurgery. In addition to providing care to patients and families from all over New England and the nation, as well as from outside the United States, LPG surgeons are faculty members at The Warren Alpert Medical School of Brown University, where they conduct research as well as teach and mentor the next generation of neurosurgeons. Operating expenses and revenue for Neurosurgery during the fiscal year ended September 30, 2018 were $12,331,896 and $6,489,555, respectively.Ob-Gyn Associates (OGA) has been caring for women for more than 40 years. OGA is committed to bringing together intelligent, talented, and compassionate professionals in order to provide exceptional care for women based on the latest research, technological advances, and holistic approaches. With six locations in Rhode Island and Massachusetts, OGA was the first practice in Rhode Island to offer midwifery care and is one of only two practices in Rhode Island that offer deliveries in the Alternative Birthing Center of Women & Infants Hospital. OGA is also the only group in Rhode Island that has practice-wide protocols for high-risk obstetrics. OGA has the advantage of many highly trained and experienced providers with easy access to medical specialists at LPG's Women's Medicine Collaborative (WMC). OGA and WMC work in partnership with one another, consulting on difficult cases and assisting each other in numerous surgeries. Operating expenses and revenue for OGA during the fiscal year ended September 30, 2018 were $13,508,818 and $10,055,951, respectively. Operating expenses and revenue for WMC during the fiscal year ended September 30, 2018 were $4,110,099 and $2,221,756, respectively.The CVI was created in an effort to meet the demands of the changing health care environment and to enhance the level of cardiovascular care provided to the community. CVI includes approximately 55 cardiologists along with support staff at three ambulatory care centers and two comprehensive cardiac centers. This innovative program brought together the well-known cardiac programs of both RIH and TMH in 2012 and places a stronger emphasis on extending these programs into the community, where it is more convenient for patients to receive care. LPG's portion of CVI's program expenses consists primarily of CVI's expanded office-based services. CVI specialists work as a team across all disciplines, combining their expertise to provide an individualized treatment plan for each patient, whether the need is consultative, diagnostic, interventional, surgical, or rehabilitative. Operating expenses and revenue for this practice group during the fiscal year ended September 30, 2018 were $13,597,061 and $12,208,581, respectively. OTHER PROGRAM SERVICES 6: LPG Pediatrics:LPG's Pediatric practice group is comprised of a group of pediatricians and specialists who provide routine health check-ups, treat illnesses, lead immunization clinics, and staff Rhode Island Hospital's (RIH) pediatric division-Hasbro Children's Hospital. Operating expenses for this practice group directly charged to LPG during the fiscal year ended September 30, 2018 amounted to $21,408,828, representing primarily payroll and fringe benefit expenses funded by RIH. OTHER PROGRAM SERVICES 7: Operating expenses and revenue for the TMH Hospitalists during the fiscal year ended September 30, 2018 were $10,151,863 and $6,611,156, respectively. OTHER PROGRAM SERVICES 8: Operating expenses and revenue for the RIH Plastic Surgery Group during the fiscal year ended September 30, 2018 were $7,729,605 and $5,708,891, respectively.The remaining LPG revenue represents amounts funded by Lifespan's affiliated hospitals in order to bring LPG to a break-even point in its statement of operations.
Form 990, Part VI, Line 1a: Explanation of Delegated Broad Authority to Committee Included among the LPG Board of Trustees are two Lifespan Designees (Designees), physicians designated by Lifespan Corporation (Lifespan) who are licensed to practice medicine in the State of Rhode Island and who serve at the pleasure of Lifespan. The Designees have the right, acting alone by concurrent approval of both Designees, to initiate action on and approve any of the following matters:(a) To approve and/or initiate the enumerated joint powers of the Trustees listed within LPG's bylaws, except to the extent that under Rhode Island law a greater number of Trustees of LPG is required to affirmatively approve a joint power action. To the extent that Rhode Island law requires a greater number of Trustees to make a recommendation or resolution on a joint power matter before undertaking such joint power action, all Trustees shall take such prior vote on such matter in accordance with the bylaws in the manner specified by concurrent approval of the Designees.(b) To initiate a joint power action listed in part (a) above, this ability can only be exercised by the Designees in the event of a Board deadlock on a matter first presented for action at a regular or special meeting of the Board of Trustees of LPG. (c) LPG shall cause the Designees' authority to approve and initiate actions to be reserved to LPG in the bylaws (or applicable organizational documents) of any subsidiary of which LPG is the sole or controlling member, partner, trustee, or stockholder, or that LPG otherwise owns or controls.
Form 990, Part VI, Line 2: Description of Business or Family Relationship of Officers, Directors, Et Timothy J. Babineau, M.D., Chair, and Mary A. Wakefield, EVP/CFO, are board members of VNA Technicare, Inc. (VNA), a related for-profit corporation. Ms. Wakefield is also an officer of VNA.
Form 990, Part VI, Line 4: Description of Significant Changes to Organizational Documents The bylaws of LPG have been amended so that the composition of the Board of Trustees shall be comprised of individuals nominated and selected from the LPG membership, having at least one year of employment with the organization, and being in good standing. Twelve of the Trustees shall be physician members in good standing. Seven of the Trustees shall have the respective designations or affiliations set forth below:- two physicians designated by Lifespan, who shall serve at the pleasure of Lifespan, each with vote;- the President of LPG, ex-officio with vote;- the Chief Financial Officer of Lifespan, or his/her designee, ex-officio without vote; and- Community Trustees, up to three individuals, external to LPG and Lifespan, with substantive business and leadership experience, preferably in the local healthcare industry, without vote.A Trustee term is three years long. The term begins at each Annual Meeting of LPG, during which certain Trustees vacate their seats, while new Trustees are presented and seated. Term - Initial Slate. An Initial Slate of twelve Trustees will be selected and nominated for approval by the Governance and Nominating Committee (G&NC) through the selection process outlined below. An Initial Slate Trustee will be randomly chosen to have an initial term of either one, two, or three years. As the Initial Slate of Trustees serves out their terms after one, two, and three years, the G&NC will nominate and select candidates for a slate of four additional Trustees. Each Initial Slate Trustee may be appointed to serve two additional consecutive terms of three years each.Term After Year 3. After the twelve Initial Slate Trustees have served at least their initial term, the G&NC will annually nominate and select a slate of four additional Trustees. Each Trustee then appointed will serve a three-year term. Term Limits. A Trustee may only be appointed to serve a maximum of three consecutive terms. Upon the completion of three terms, the Trustee shall wait one year before once again being qualified for a reappointment to the Board. All Trustees shall hold office until the expiration of their respective terms or until their respective successors are duly elected and qualified, or until they sooner die, resign, are removed, or become disqualified. An appointed Trustee shall cease to be a Trustee if he/she does not have an active Medical Staff appointment and clinical privileges at any Lifespan hospital. Upon the occurrence of a mid-term vacancy, a new Trustee shall be appointed to finish serving that term. Afterwards that trustee may, in their own right, be appointed to serve up to three consecutive terms.Lifespan Designees. The Lifespan Designees shall serve until their successors are elected or appointed, as the case may be. The Lifespan Designees shall serve at the pleasure of Lifespan, or until such person sooner dies, resigns, is removed, or becomes disqualified. Lifespan shall consult with the Board of Trustees prior to any removal, change and/or reappointment of any Lifespan Designee, provided, however, that in no event shall the authority of Lifespan to appoint the Lifespan Designees be limited by or subject to approval of the Board of Trustees of LPG.Ex-Officio Trustees. A person serving as a Trustee in an ex-officio capacity shall serve as long as such person holds the position that qualifies such person to serve as a Trustee. Such person shall cease to be an ex-officio Trustee upon ceasing to hold the position that qualifies the person to be a Trustee, and any successor to such position, whether acting, interim, or permanent, shall immediately succeed such person as Trustee.Community Trustee. A person serving as a Community Trustee shall serve terms equal in length to an LPG Trustee, with the same maximum number of consecutive terms.
Form 990, Part VI, Line 11b: Form 990 Review Process The preparation and filing of the Form 990 and supporting schedules is the responsibility of the Executive Vice President & Chief Financial Officer (EVP/CFO) and Lifespan's Finance Department, with review by Lifespan's tax advisors, KPMG LLP (KPMG). The Form 990 is prepared by the accounting staff upon completion of Lifespan's annual independent audit and reviewed by the Corporate Services Tax Compliance Manager, the Director of Finance, and the Vice President of Finance - Corporate Services. The Form 990 is forwarded to KPMG for further review. KPMG provides the Tax Compliance Manager with any recommended changes which are reviewed, and if agreed upon, are incorporated into the return. The draft Form 990 is then provided to the EVP/CFO for final management review. Prior to filing the return with the Internal Revenue Service, a copy of the entire form is sent to LPG's Board of Trustees in advance of its next Board meeting, at which the EVP/CFO discusses highlights of the Form. All questions and concerns of the members of the Board are addressed by the EVP/CFO and incorporated into the Form 990 when appropriate. Once the Form 990 is complete and ready to be filed, the members of the Board are notified via email that a copy of the final version of the Form 990 is accessible through a password-protected website portal. The EVP/CFO is authorized to file the Form 990.
Form 990, Part VI, Line 19: Other Organization Documents Publicly Available Lifespan currently makes its annual and quarterly consolidated financial statements available to the public via DAC (Digital Assurance Certification, LLC), a disclosure dissemination agent for issuers of tax-exempt bonds which electronically posts and transmits Lifespan's financial information to repositories and investors alike. Copies of LPG's Articles of Incorporation, Bylaws, and Conflict of Interest Policy are available upon request from the office of the Lifespan EVP/CFO, either in person or by mail.
Other Changes In Net Assets Or Fund Balances - Other Increases Change in funded status of pension plan = $1254000
Form 990, Part I, Line 1: Lifespan Physician Group (LPG) primarily serves hospitals affiliated with Lifespan Corporation. Additionally, it is LPG's mission to promote and advance medical research, education and training in medicine, medical-related sciences, and clinical practice.
Form 990, Part VI, Section B, Line 12c: Lifespan Corporation has a Conflict of Interest Policy that is applicable to all affiliates, including LPG, and administered by Lifespan's Corporate Compliance Department as follows: Each designated person subject to Lifespan's conflict of interest policy is required to provide Lifespan with an initial disclosure statement and thereafter an annual statement attesting that: (i) the designated person has read and is familiar with this policy, and (ii) the designated person and, to the best of his/her knowledge, family members, have not in the past engaged in, are not presently engaging in, or plan to engage in, any activity which contravenes this policy.If, at any time during the course of employment or association, a designated person has reason to believe that an existing or contemplated activity may contravene this policy, the person shall submit a full written description of the activity to the Lifespan Compliance Officer or the Office of the General Counsel to seek a determination as to whether the contemplated activity does or does not contravene this policy. This requirement shall be acknowledged as part of the annual performance evaluation process. If the activity in question involves either the Chief Executive Officer, the Senior Vice President and General Counsel, or a Trustee, a full written disclosure must be made to, and a determination sought from, the Chairman of the Board of Directors of Lifespan Corporation.Annually, the Lifespan Compliance Officer shall review and report to the Lifespan Executive Corporate Compliance Committee and to the Lifespan Audit and Compliance Committee on the administration of this policy.Failure on the part of any designated person to comply with this policy, including failure to submit in a timely fashion the conflict of interest disclosure statement, will be grounds for removal from his/her position and/or termination of his/her employment with Lifespan.
Form 990, Part VI, Section B, Lines 15 a&b: The following applies to Lifespan and all of its affiliates, including LPG:EXECUTIVE COMPENSATIONLifespan's executive compensation philosophy balances appropriate stewardship of resources and the need to be competitive in recruiting and retaining talented individuals. It incorporates market-competitive and performance-related principles, and covers the President and CEO of Lifespan as well as other officers, senior management, and key employees. Lifespan's executive compensation program complies both with law and with contemporary ethical norms, and is administered consistent with the organization's tax-exempt status under Section 501(c)(3) of the Internal Revenue Code (IRC) and the avoidance of transactions subject to intermediate sanctions under Section 4958 of the IRC. Executive compensation is also administered consistent with Lifespan's Corporate Compliance Policy on Excess Benefit Transactions.The Compensation Committee of the Lifespan Corporation Board of Directors (the Committee), comprised of disinterested Lifespan Board members, is responsible for diligent oversight of executive compensation to ensure compliance with IRC requirements. Its duties include:* Approving eligibility for participation in the executive compensation program * Approving changes in compensation for existing executive participants * Approving guidelines, such as salary ranges and contract terms, on appropriate levels of compensation for other key employees* Approving new, and modifying or terminating existing, executive compensation plans including, but not limited to, annual incentive and executive benefit plans* Approving performance objectives associated with Lifespan's annual incentive plan, including measuring points, and using audited actual performance relative to these objectives as a precondition to approving the payment of any awards under the plan* Authorizing periodic performance benchmark studies to be conducted for purposes of assessing Lifespan's performance within the healthcare industry and the degree to which total remuneration levels at Lifespan are generally commensurate with Lifespan performance relative to healthcare industry performance* Conducting an annual performance review of Lifespan's Chief Executive Officer. The Chair of the Committee conducts and documents this review, based on his/her observations and interpretation of feedback from members of the Board of Directors.* Selecting and engaging qualified, independent, third-party compensation valuation consultants that the Committee charges with rendering opinions with respect to the reasonableness and comparability of compensation as well as the comparative organizations against which compensation is assessed, in accordance with relevant sections of the IRC and Lifespan's executive compensation philosophy.Lifespan's Chief Executive Officer works closely with the Committee to make recommendations on the above topics and keep the Committee informed about contemplated compensation changes for executives and other key employees, as well as candidates for these roles. The CEO also provides periodic updates to the Committee regarding Lifespan's performance relative to compensation-related performance objectives. The Committee's deliberations and actions are documented in minutes prepared for each meeting.PROCESS FOR DETERMINING COMPENSATION Valuation of Total Cash and Total Remuneration: No less frequently than annually, the Committee receives and reviews a total cash compensation valuation of all existing executive compensation program participants prepared by its independent compensation consultant. Annually, the Committee also receives and reviews a total remuneration valuation of all existing executive compensation participants.Base Salary Actions: The CEO recommends any salary adjustments for participants in the executive compensation program, using the results of the valuation study and his/her assessment of individual performance or other pertinent information, for the Committee's consideration.New Participants in Executive Compensation Program: With respect to compensation offers for individuals expected to participate in the executive compensation program, certain members of the Lifespan CEO's Council work with the Committee's independent compensation consultant or rely on information previously provided by the consultant to establish a range of reasonable cash compensation within which recruitment is expected to conclude with acceptance of a reasonable compensation offer.
Form 990, Part XII, Line 2: While LPG did not produce an audited financial statement as of and for the fiscal year ended September 30, 2018, it was included in Lifespan Corporation's (Lifespan) audited consolidated financial statements, in which one column is used for LPG individually. There are no regulatory or creditor stipulations which require the preparation of a separate audited financial statement for LPG.The Lifespan Audit and Compliance Committee assumes responsibility for oversight of the audit of Lifespan Corporation's consolidated financial statements and the selection of Lifespan Corporation's independent accountant.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2019


Additional Data


Software ID: 17005038
Software Version: 2017v2.2
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990.
MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047
2019
Open to Public Inspection
Name of the organization
Lifespan Physician Group Inc
 
Employer identification number

05-0389801
Part I
Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income


 		(e)
End-of-year assets


 		(f)
Direct controlling
entity










Part II
Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section


 		(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled entity?
Yes No
(1)ALC dba HSR
249 Roosevelt Avenue

Pawtucket,RI02860
05-0442015 		Housing for Elderly and Mentally Ill RI 501(c)(3) 10 Gateway Healthcare Inc
 
 
No
(2)Bayberry Courts Inc
249 Roosevelt Avenue

Pawtucket,RI02860
20-4590384 		Housing for Elderly and Mentally Ill RI 501(c)(3) 10 Gateway Healthcare Inc
 
 
No
(3)Bradley Hospital Foundation
167 Point Street

Providence,RI02903
05-0500688 		Philanthropic Activities RI 501(c)(3) 7 Lifespan Corporation
 
 
No
(4)Capital City Community Centers Inc
249 Roosevelt Avenue

Pawtucket,RI02860
05-0259090 		Daycare Services RI 501(c)(3) 7 Gateway Healthcare Inc
 
 
No
(5)Emma Pendleton Bradley Hospital
1011 Veterans Memorial Parkway

East Providence,RI02915
05-0258806 		Pediatric Psychiatric Health Care Svcs RI 501(c)(3) 3 Lifespan Corporation
 
 
No
(6)Families Reaching Into Each New Day Inc
249 Roosevelt Avenue

Pawtucket,RI02860
05-0504841 		Bereavement Services for Children RI 501(c)(3) 7 Gateway Healthcare Inc
 
 
No
(7)Gateway Foundation
249 Roosevelt Avenue

Pawtucket,RI02860
46-4002163 		Philanthropic Activities RI 501(c)(3) 7 Lifespan Corporation
 
 
No
(8)Gateway Healthcare Inc
249 Roosevelt Avenue

Pawtucket,RI02860
05-0309043 		Subst. Abuse & Psych. Health Care Svcs RI 501(c)(3) 10 Lifespan Corporation
 
 
No
(9)Hospital Properties Inc
167 Point Street

Providence,RI02903
22-2869743 		Property Management RI 501(c)(4) N/A Lifespan Corporation
 
 
No
(10)JM Apartments Inc
249 Roosevelt Avenue

Pawtucket,RI02860
05-0435537 		Housing for Elderly and Mentally Ill RI 501(c)(3) 10 Gateway Healthcare Inc
 
 
No
(11)Lifespan Corporation
167 Point Street

Providence,RI02903
22-2861978 		Holding Company/ Mgmnt Services RI 501(c)(3) 12(II) NA
 
 
No
(12)Lifespan Diversified Services Inc
167 Point Street

Providence,RI02903
05-0258935 		Holding Company/ Mgmnt Services RI 501(c)(3) 10 Lifespan Corporation
 
 
No
(13)Lifespan Foundation
167 Point Street

Providence,RI02903
05-0493219 		Philanthropic Activities RI 501(c)(3) 7 Lifespan Corporation
 
 
No
(14)Lifespan of Massachusetts Inc
c/o Archstone Law 245 Winter St

Waltham,MA02451
04-3408517 		Holding Company MA 501(c)(3) 12(I) Lifespan Corporation
 
 
No
(15)Lifespan School Solutions Inc
140 Broadway

Providence,RI02903
46-4910847 		Educational Services RI 501(c)(3) 2 Emma Pendleton Bradley Hospital
 
 
No
(16)LJR Corporation
249 Roosevelt Avenue

Pawtucket,RI02860
03-0508346 		Housing for Elderly and Mentally Ill RI 501(c)(3) 10 Gateway Healthcare Inc
 
 
No
(17)Mill River Community Housing Corporation
249 Roosevelt Avenue

Pawtucket,RI02860
05-0427152 		Housing for Elderly and Mentally Ill RI 501(c)(3) 10 Gateway Healthcare Inc
 
 
No
(18)Newport Health Care Corporation
11 Friendship Street

Newport,RI02840
22-2535537 		Holding Company/ Mgmnt Services RI 501(c)(3) 7 Lifespan Corporation
 
 
No
(19)Newport Health Property Management Inc
11 Friendship Street

Newport,RI02840
22-2335539 		Property Management RI 501(c)(3) 12(I) Newport Health Care Corporation
 
 
No
(20)Newport Hospital
11 Friendship Street

Newport,RI02840
05-0258914 		Health Care Services RI 501(c)(3) 3 Lifespan Corporation
 
 
No
(21)Newport Hospital Foundation Inc
11 Friendship Street

Newport,RI02840
22-2535533 		Philanthropic Activities RI 501(c)(3) 7 Lifespan Corporation
 
 
No
(22)NHCC Medical Associates Inc
11 Friendship Street

Newport,RI02840
05-0472268 		Health Care Services RI 501(c)(3) 10 Lifespan Corporation
 
 
No
(23)Obed Apartments Inc
249 Roosevelt Avenue

Pawtucket,RI02860
05-0422771 		Housing for Elderly and Mentally Ill RI 501(c)(3) 10 Gateway Healthcare Inc
 
 
No
(24)Pathways Inc
249 Roosevelt Avenue

Pawtucket,RI02860
05-0393004 		Housing for Elderly and Mentally Ill RI 501(c)(3) 10 Gateway Healthcare Inc
 
 
No
(25)Rhode Island Hospital
593 Eddy Street

Providence,RI02903
05-0258954 		Health Care Services RI 501(c)(3) 3 Lifespan Corporation
 
 
No
(26)Rhode Island Hospital Foundation
167 Point Street

Providence,RI02903
05-0468736 		Philanthropic Activities RI 501(c)(3) 7 Lifespan Corporation
 
 
No
(27)RIH Ventures
593 Eddy Street

Providence,RI02903
05-0448686 		Parking Facilities/Phlebotomy Services RI 501(c)(3) 10 Lifespan Corporation
 
 
No
(28)Shore Courts Inc
249 Roosevelt Avenue

Pawtucket,RI02860
05-0504003 		Housing for Elderly and Mentally Ill RI 501(c)(3) 10 Gateway Healthcare Inc
 
 
No
(29)The Autism Project
1516 Atwood Avenue

Johnston,RI02919
05-0512037 		Services for Children With Autism RI 501(c)(3) 10 Gateway Healthcare Inc
 
 
No
(30)The Miriam Hospital
164 Summit Avenue

Providence,RI02906
05-0258905 		Health Care Services RI 501(c)(3) 3 Lifespan Corporation
 
 
No
(31)The Miriam Hospital Foundation
167 Point Street

Providence,RI02903
05-0377502 		Philanthropic Activities RI 501(c)(3) 7 Lifespan Corporation
 
 
No
(32)TLR Realty
249 Roosevelt Avenue

Pawtucket,RI02860
04-3742771 		Housing for Elderly and Mentally Ill RI 501(c)(3) 10 Gateway Healthcare Inc
 
 
No
(33)Wentworth Corporation
249 Roosevelt Avenue

Pawtucket,RI02860
05-0488520 		Housing for Elderly and Mentally Ill RI 501(c)(3) 10 Gateway Healthcare Inc
 
 
No
(34)Westerly Courts Inc
249 Roosevelt Avenue

Pawtucket,RI02860
61-1439766 		Housing for Elderly and Mentally Ill RI 501(c)(3) 10 Gateway Healthcare Inc
 
 
No
(35)RI Sound Enterprises Insurance Co Ltd
65 Front Street
Hamilton   HM 12
BD
Offshore Insurance Captive BD N/A N/A Lifespan Corporation
 
 
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2019
Schedule R (Form 990) 2019
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V-UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) Lifespan Health Alliance LLC

167 Point Street
Providence,RI02903
81-2732225 		Account. Care Org. RI N/A
         No     No  












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
 		(b)
Primary activity
 		(c)
Legal
domicile
(state or foreign
country)
 		(d)
Direct controlling
entity
 		(e)
Type of entity
(C corp, S corp,
or trust) 		(f)
Share of total income
 		(g)
Share of end-of-year
assets
 		(h)
Percentage
ownership
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) Lifespan MSO Inc

167 Point Street
Providence,RI02903
05-0508717 		Mgmnt. Svcs. RI Lifespan Corp
  		C Corp         No
(2) Lifespan Risk Services Inc

167 Point Street
Providence,RI02903
05-0459767 		Risk Mgmnt. RI Lifespan Corp
  		C Corp         No
(3) VNA Technicare Inc

200 Corliss Street
Providence,RI02904
05-0472710 		DME Sales RI LDS Inc
  		C Corp         No








Schedule R (Form 990) 2019
Schedule R (Form 990) 2019
Page 3
Part V
Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................
1a
 
No
b Gift, grant, or capital contribution to related organization(s) ............................
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) ............................
1c
 
No
d Loans or loan guarantees to or for related organization(s) ............................
1d
 
No
e Loans or loan guarantees by related organization(s) ............................
1e
 
No
f Dividends from related organization(s) ............................
1f
 
No
g Sale of assets to related organization(s) ............................
1g
 
No
h Purchase of assets from related organization(s) ............................
1h
 
No
i Exchange of assets with related organization(s) ............................
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) .......................
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) ......................
1k
Yes
 
l Performance of services or membership or fundraising solicitations for related organization(s) .....................
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) .................
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................
1n
 
No
o Sharing of paid employees with related organization(s) ............................
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses ............................
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses ............................
1q
Yes
 
r Other transfer of cash or property to related organization(s) ............................
1r
 
No
s Other transfer of cash or property from related organization(s) ............................
1s
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved





Schedule R (Form 990) 2019
Schedule R (Form 990) 2019
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(e)
Are all partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V-UBI
amount in box 20
of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2019
Schedule R (Form 990) 2019
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R. (see instructions).
Return Reference Explanation
Schedule R (Form 990) 2019

Additional Data


Software ID: 17005038
Software Version: 2017v2.2