TY 2018 Form 990

(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)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) BOUTON CHRISTOPHER...................................................................... TRUSTEE	1.00 ................. 0.00	X		0	0	0
(2) CAPOLUPO WAYNE...................................................................... TRUSTEE	1.00 ................. 0.00	X		0	0	0
(3) CONNOLLY GRACE...................................................................... TRUSTEE, VICE CHAIR	1.00 ................. 0.00	X	X	0	0	0
(4) COSTELLO MICHAEL...................................................................... TRUSTEE	1.00 ................. 0.00	X		0	0	0
(5) COUSINS FRANK...................................................................... TRUSTEE	1.00 ................. 0.00	X		0	0	0
(6) ELLISON GEORGE JR...................................................................... TRUSTEE	1.00 ................. 0.00	X		0	0	0
(7) ERAMO GINNY...................................................................... TRUSTEE, SECRETARY	1.00 ................. 0.00	X	X	0	0	0
(8) GHIASUDDEN MD SALMAN...................................................................... TRUSTEE	60.00 ................. 0.00	X		24,000	0	0
(9) GOLDSTEIN MARK...................................................................... TRUSTEE (EX-OFF), PRES, CEO	42.00 ................. 18.00	X	X	591,109	253,332	66,220
(10) HEERSINK BEN...................................................................... TRUSTEE	1.00 ................. 0.00	X		0	0	0
(11) KHATIB MATT...................................................................... TRUSTEE (EX-OFFICIO); CHAIR	1.00 ................. 0.00	X	X	0	0	0
(12) KIRPAS JEFF...................................................................... TRUSTEE, FINANCE CHAIR	1.00 ................. 0.00	X		0	0	0
(13) LAFLAMME DAVID...................................................................... CHAIRMAN, TRUSTEE	1.00 ................. 0.00	X	X	0	0	0
(14) MATTHEWS BYRON...................................................................... TRUSTEE	1.00 ................. 0.00	X		0	0	0
(15) NESTO MD RICHARD...................................................................... TRUSTEE (EX-OFF) CEO DESIGNEE	0.00 ................. 65.00	X		0	862,978	68,437
(16) PIENIAZEK MATT...................................................................... TRUSTEE	1.00 ................. 0.00	X		0	0	0
(17) PURSLEY MD DEWAYNE M...................................................................... TRUSTEE	1.00 ................. 65.00	X		0	735,184	87,124

(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)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) SEYMOUR PETER........................................................................ TRUSTEE	1.00 .......................0.00	X					0	0	0
(19) SHENK WILBUR........................................................................ TRUSTEE; QUALITY CHAIR	1.00 .......................0.00	X					0	0	0
(20) SWIERZEWSKI DAVID........................................................................ TTEE, PRES OF MED STAFF	5.00 .......................55.00	X					50,925	508,602	36,429
(21) TABB MD KEVIN........................................................................ TRUSTEE (EX-OFF); CEO	1.00 .......................65.00	X	X				0	1,756,953	143,704
(22) WILEY MEG........................................................................ TRUSTEE	1.00 .......................0.00	X					0	0	0
(23) FISCHER STEVEN P........................................................................ TREASURER (EX-OFFICIO)	0.00 .......................62.00		X				0	770,210	75,762
(24) KATZ JAMIE........................................................................ CLERK, EX-OFFICIO	1.00 .......................59.00		X				0	560,463	44,008
(25) KILDAY KEVIN........................................................................ CHIEF FINANCIAL OFFICER	36.00 .......................24.00		X				210,797	140,532	61,809
(26) FAYRE GAIL........................................................................ CHIEF MEDICAL OFFICER	36.00 .......................24.00			X			219,245	146,164	59,681
(27) LEE GARY........................................................................ CHIEF OPERATING OFFICER	60.00 .......................0.00			X			205,627	0	51,114
(28) MAKI RICHARD........................................................................ CHIEF NURSING OFFICER	60.00 .......................0.00			X			257,261	0	55,004
(29) ABBY-STEARNS ELIZABETH........................................................................ NURSING SUPERVISOR	60.00 .......................0.00				X		166,431	0	18,653
(30) BUCHANAN ROBERT........................................................................ DIRECTOR IS	60.00 .......................0.00				X		188,309	0	43,852
(31) PERRY DANIELLE........................................................................ VP PUBLIC RELATIONS	60.00 .......................0.00				X		192,903	0	41,239
(32) SOLDANO JOSEPH........................................................................ DIR FINANCIAL PLANNING	60.00 .......................0.00				X		152,433	0	45,207
(33) SZUKSTA WALTER........................................................................ DIR SURGICAL SVCS	60.00 .......................0.00				X		146,958	0	34,503
(34) O'CONNOR DELIA........................................................................ FORMER CHIEF EXECUTIVE OFFICER	1.00 .......................0.00					X	166,584	0	0
(35) SALVO STEPHEN........................................................................ FORMER VP HR	60.00 .......................0.00					X	175,788	0	39,874

(A) Name and business address	(B) Description of services	(C) Compensation
SEACOAST AFFILIATED GROUP PRACTICE 25 HIGHLAND AVE NEWBURYPORT,MA01950	SUBSIDY TO SUPPORT OPERATING CASH NEEDS	2,750,000
HEALTH PARTNERS OF NEW ENGLAND 85 PATTON RD DEVENS,MA01434	MGMT PEDI PSYCH	2,711,554
MERRIMACK VALLEY ANESTHESIA GROUP 690 CANTON ST STE 200 WESTWOOD,MA02090	ANESTHESIA SVC	412,500
UMS LITHOTRIPSY SVC OF EASTERN MA 1700 WEST PARK DR SUITE 410 WESTBOROUGH,MA01581	LITHOTRIPSY SERVICES	246,400
BEHAVIORAL HEALTH SERVICES 24 MORRILL PL AMESBURY,MA01913	PSYCHIATRIC SERVICES	240,667
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 20

- TIN:

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.
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Attach to Form 990 or Form 990-EZ.
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Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization

ANNA JAQUES HOSPITAL INC

Employer identification number

04-2104338

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.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


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) 2018

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv), 170(b)(1)(A)(vi), and 170(b)(1)(A)(ix)
(Complete only if you checked the box on line 5, 7, 8, or 9 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(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)		(a) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(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

Gross receipts from related activities, etc. (see instructions) ..................

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

Public support percentage for 2018 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2017 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2018. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2017. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2018. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2017. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

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) 2018

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)		(a) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

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

Public support percentage for 2018 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2017 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2018 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2017 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2018. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2017. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2018

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

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.

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).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

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.

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.

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.

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.

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.

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).

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?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

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.

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) .

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).

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.

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.

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.

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

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) 2018

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

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

A family member of a person described in (a) above?

11b

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

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.

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.

Section C. Type II Supporting Organizations

Yes

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).

Section D. All Type III Supporting Organizations

Yes

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?

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).

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.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

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.

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.

Parent of Supported Organizations. Answer (a) and (b) below.

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.

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.

Schedule A (Form 990 or 990-EZ) 2018

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	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

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2018

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 2018 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-2018	(iii) Distributable Amount for 2018
1 Distributable amount for 2018 from Section C, line 6
2 Underdistributions, if any, for years prior to 2018 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2018:
a From 2013.......
b From 2014.......
c From 2015.......
d From 2016.......
e From 2017.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2018 distributable amount
i Carryover from 2013 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2018 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2018 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2018, 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 2018. 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 2019. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2014......
b Excess from 2015.....
c Excess from 2016.....
d Excess from 2017.....
e Excess from 2018.....

Schedule A (Form 990 or 990-EZ) (2018)

Schedule A (Form 990 or 990-EZ) 2018

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) 2018

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Name of the organization

ANNA JAQUES HOSPITAL INC

Employer identification number

04-2104338

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution. An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018) Page 2

Name of organization ANNA JAQUES HOSPITAL INC

Part I	Contributors (See instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Page 3

Name of organization ANNA JAQUES HOSPITAL INC		Employer identification number 04-2104338

Part II	Noncash Property (See instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Page 4


Name of organization ANNA JAQUES HOSPITAL INC			Employer identification number 04-2104338
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

ANNA JAQUES HOSPITAL INC

Employer identification number

04-2104338

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV (see instructions for definition of “political campaign activities")

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b........... SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2018

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ...............................
c	Total lobbying expenditures (add lines 1a and 1b) ...................................................................
d	Other exempt purpose expenditures ........................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ...................................................................................................................	Yes No

4-Year Averaging Period Under section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2018

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Yes

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Yes

108,190

Total. Add lines 1c through 1i ....................................................................................................

108,190

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures (see instructions) .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
PART II-B, LINE 1:	ANNA JAQUES HOSPITAL, INC. ENGAGED IN SOME LOBBYING EFFORTS ON BEHALF OF ITSELF AND OTHER NETWORK AFFILIATES AND/OR PAYS DUES TO CERTAIN MEMBERSHIP ORGANIZATIONS OF WHICH A PORTION MAY BE USED BY SUCH ORGANIZATIONS FOR LOBBYING ACTIVITIES ON BEHALF OF THIS INSTITUTION AND OTHER SIMILARLY SITUATED ORGANIZATIONS. LOBBYING COSTS ASSOCIATED WITH THESE COMBINED LOBBYING ACTIVITIES WAS $108,190 FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2019. TOTAL LOBBYING EXPENDITURES ARE MINIMAL AND NOT SUBSTANTIAL BASED ON REVENUES.

Return Reference

Explanation

PART II-B, LINE 1:

ANNA JAQUES HOSPITAL, INC. ENGAGED IN SOME LOBBYING EFFORTS ON BEHALF OF ITSELF AND OTHER NETWORK AFFILIATES AND/OR PAYS DUES TO CERTAIN MEMBERSHIP ORGANIZATIONS OF WHICH A PORTION MAY BE USED BY SUCH ORGANIZATIONS FOR LOBBYING ACTIVITIES ON BEHALF OF THIS INSTITUTION AND OTHER SIMILARLY SITUATED ORGANIZATIONS. LOBBYING COSTS ASSOCIATED WITH THESE COMBINED LOBBYING ACTIVITIES WAS $108,190 FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2019. TOTAL LOBBYING EXPENDITURES ARE MINIMAL AND NOT SUBSTANTIAL BASED ON REVENUES.

Schedule C (Form 990 or 990EZ) 2018

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

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 the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

ANNA JAQUES HOSPITAL INC

Employer identification number

04-2104338

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 ........

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? ............

Yes No

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? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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.


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

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

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)? .............................

Yes No

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.

If the organization elected, as permitted under SFAS 116 (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.

If the organization elected, as permitted under SFAS 116 (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

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 SFAS 116 (ASC 958) relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

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) 2018

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

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):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

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?...

Yes No

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.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


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

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

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 ....	20,018,666	18,808,414	17,924,855	13,806,943	10,530,894
b	Contributions ...	0			3,228,000	3,855,649
c	Net investment earnings, gains, and losses	157,707	1,210,252	1,583,559	889,912
d	Grants or scholarships ...	0				579,600
e	Other expenditures for facilities and programs ...	95,759		700,000
f	Administrative expenses ....
g	End of year balance ......	20,080,614	20,018,666	18,808,414	17,924,855	13,806,943

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

99.400 %

Permanent endowment SchDMd Bullet

0 %

Temporarily restricted endowment SchDMd Bullet

0.600 %

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations .................

3a(i)

(ii) related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

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 .....	2,459,100		2,459,100
b	Buildings ....	22,445,745	1,948,659	20,497,086
c	Leasehold improvements	1,129,691	195,672	934,019
d	Equipment ....	13,778,415	994,373	12,784,042
e	Other .....	1,666,998		1,666,998
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				38,341,245

Schedule D (Form 990) 2018

Page 3

Part VII

InvestmentsOther 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
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram 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

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

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) INVESTMENT IN JOINT VENTURES - MRI, PET, RAD ONC				939,463
(2) PHYSICIAN INCOME GUARANTEE				135,303
(3) CSV SPLIT DOLLAR LIFE INSURANCE				867,503
(4) DEFERRED COMPENSATION - 457B				1,739,404
(5) INSURANCE RECOVERIES RECEIVABLE				1,622,914
(6) DUE FROM AFFILIATES				5,214,523
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				10,519,110

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
UNFUNDED PENSION LIABILITY	32,875,976
DEFERRED RENT	266,883
LT SPLIT DOLLAR LIFE INS PAYABLE	221,859
DEFERRED COMP PAYABLE - 457B	1,739,404
ACCRUED INSURANCE CLAIMS	1,622,914
DUE TO/(FROM) THIRD PARTIES	-599,597
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	36,127,439
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) 2018

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	3,267,670,000
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a	-438,989
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d	3,197,925,433
e	Add lines 2a through 2d .....................			2e	3,197,486,444
3	Subtract line 2e from line 1..................			3	70,183,556
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	66,765,680
c	Add lines 4a and 4b....................			4c	66,765,680
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	136,949,236

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	3,594,794,000
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	3,515,237,408
e	Add lines 2a through 2d....................			2e	3,515,237,408
3	Subtract line 2e from line 1...................			3	79,556,592
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	55,745,011
c	Add lines 4a and 4b.....................			4c	55,745,011
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	135,301,603

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 V, LINE 4:	THE BOARD DESIGNATED FUNDS ON ANNA JAQUES HOSPITAL, INC.'S BOOKS ARE UNRESTRICTED, BUT REQUIRE A BOARD VOTE TO AUTHORIZE THEIR EXPENDITURE. THE TEMPORARILY RESTRICTED ENDOWMENT FUNDS ARE RESTRICTED BY THE DONORS FOR THE PURCHASE OF PROPERTY, PLANT AND EQUIPMENT. THE FUND WILL BE RELEASED ONCE THE RESTRICTION HAS BEEN MET AND THE EQUIPMENT HAS BEEN PURCHASED.
PART X, LINE 2:	EACH ENTITY WITHIN THE BETH ISRAEL LAHEY HEALTH, INC. (BILH) SYSTEM RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING 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 JUDGEMENT OCCURS. THE SYSTEM DID NOT RECOGNIZED THE EFFECT OF ANY INCOME TAX POSITIONS IN 2019.
PART XI, LINE 2D - OTHER ADJUSTMENTS:	NET ASSETS RELEASED FROM RESTRICTIONS FOR OPERATIONS 455,550. CONSOLIDATED AFFILIATES NET OF ELIMINATIONS 3,189,020,673. UNRESTRICTED NET ASSETS UPON ACQUISITION 8,449,210.
PART XI, LINE 4B - OTHER ADJUSTMENTS:	5 MONTHS REVENUE NOT IN FINANCIAL STATEMENTS 66,765,680.
PART XII, LINE 2D - OTHER ADJUSTMENTS:	CONSOLIDATED AFFILIATES NET OF ELIMINATIONS 3,515,237,408.
PART XII, LINE 4B - OTHER ADJUSTMENTS:	5 MONTHS EXPENSES NOT IN FINANCIAL STATEMENTS 55,745,011.

Schedule D (Form 990) 2018

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

ANNA JAQUES HOSPITAL INC

Employer identification number

04-2104338

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	2,749,498	420,854	2,328,644	1.720 %
b	Medicaid (from Worksheet 3, column a) . . . . .	2,996,619	2,389,065	607,554	0.450 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	5,746,117	2,809,919	2,936,198	2.170 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	219,052	52,241	166,811	0.120 %
f	Health professions education (from Worksheet 5) . . .
g	Subsidized health services (from Worksheet 6) . . . .	2,750,000		2,750,000	2.030 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	35,827		35,827	0.030 %
j	Total. Other Benefits . .	3,004,879	52,241	2,952,638	2.180 %
k	Total. Add lines 7d and 7j .	8,750,996	2,862,160	5,888,836	4.350 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2018

Schedule H (Form 990) 2018

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

5,191,850

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

46,985,496

Enter Medicare allowable costs of care relating to payments on line 5.....

50,953,390

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-3,967,894

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2018

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	ANNA JAQUES HOSPITAL 25 HIGHLAND AVE NEWBURYPORT,MA01950 2006	X	X	X

Schedule H (Form 990) 2018

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	ANNA JAQUES HOSPITAL
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 18

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): WWW.AJH.ORG

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 18

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): SEE PART VI

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2018

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	ANNA JAQUES HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 150.000000000000% and FPG family income limit for eligibility for discounted care of 300.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

SEE PART VI

The FAP application form was widely available on a website (list url):

A plain language summary of the FAP was widely available on a website (list url):

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2018

Page 6

Part VFacility Information (continued)

Billing and Collections

	ANNA JAQUES HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs

Made a reasonable effort to orally notify individuals about the FAP and FAP application process

Processed incomplete and complete FAP applications

Made presumptive eligibility determinations

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2018

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	ANNA JAQUES HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2018

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
ANNA JAQUES HOSPITAL	PART V, SECTION B, LINE 5: PART V, SECTION B, LINE 5: FOR DISCLOSURES RELATED TO FORM 990 SCHEDULE H PART V, SECTION B PLEASE SEE SCHEDULE H PART VI SUPPLEMENTAL INFORMATION.
ANNA JAQUES HOSPITAL	PART V, SECTION B, LINE 11: PART V, SECTION B, LINE 11: FOR DISCLOSURES RELATED TO FORM 990 SCHEDULE H PART V, SECTION B PLEASE SEE SCHEDULE H PART VI SUPPLEMENTAL INFORMATION.

Schedule H (Form 990) 2018

Page 9

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?6
Name and address		Type of Facility (describe)
1	1 - ANNA JAQUES HOSPITAL 24 MORRILL PLACE AMESBURY,MA01913	IP CHILD PSYCHIATRIC UNIT
2	2 - ANNA JAQUES HOSPITAL 1 WALLACE BASHAW WAY NEWBURYPORT,MA01950	OP ONCOLOGY
3	3 - ANNA JAQUES HOSPITAL 21 HIGHLAND AVE NEWBURYPORT,MA01950	OP SERVICES
4	4 - ANNA JAQUES HOSPITAL 2 WATER ST HAVERHILL,MA01930	OP ULTRASOUND
5	5 - ANNA JAQUES HOSPITAL ONE PARK WAY HAVERHILL,MA01830	OP DIAGNOSTIC IMAGING
6	6 - ANNA JAQUES HOSPITAL STOREY AVENUE NEWBURYPORT,MA01950	OP PYHSICAL THERAPY
7
8
9
10

Schedule H (Form 990) 2018

Page 10

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
FORM 990 SCHEDULE H, SUPPLEMENTAL INFORMATION	FORM 990 SCHEDULE H PART V, SECTION C, SUPPLEMENTAL INFORMATION FOR SCHEDULE H PART V, SECTION BFINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITSCOMMUNITY HEALTH IMPROVEMENT SERVICES AND CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPSCOMMUNITY BENEFITS MISSION STATEMENT ANNA JAQUES HOSPITAL (AJH) A MEMBER OF BETH ISRAEL LAHEY HEALTH (BILH). BILH WAS ESTABLISHED WITH AN APPRECIATION FOR THE IMPORTANCE OF CARING FOR PATIENTS AND COMMUNITIES IN NEW AND BETTER WAYS. BILH BRINGS TOGETHER AN EXCEPTIONAL ARRAY OF CLINICAL ORGANIZATIONS SPANNING THE FULL CONTINUUM OF HEALTH CARE DELIVERY ACADEMIC AND TEACHING HOSPITALS, COMMUNITY HOSPITALS, AMBULATORY AND URGENT CARE CENTERS, BEHAVIORAL HEALTH PROGRAMS, AND HOME CARE IN A SHARED MISSION TO EXPAND ACCESS TO GREAT CARE AND ADVANCE THE SCIENCE AND PRACTICE OF MEDICINE THROUGH GROUNDBREAKING RESEARCH AND EDUCATION. AT THE HEART OF BILH IS THE BELIEF THAT EVERYONE DESERVES HIGH-QUALITY, AFFORDABLE HEALTH CARE AND THIS BELIEF IS WHAT DRIVES US TO WORK WITH COMMUNITY PARTNERS ACROSS THE REGION TO PROMOTE HEALTH, EXPAND ACCESS AND DELIVER THE BEST CARE IN THE COMMUNITIES BILH SERVES. BILH'S COMMUNITY BENEFITS STAFF IS COMMITTED TO WORKING COLLABORATIVELY WITH BILH'S COMMUNITIES TO ADDRESS THE LEADING HEALTH ISSUES AND CREATE A HEALTHY FUTURE FOR INDIVIDUALS, FAMILIES AND COMMUNITIES.ANNA JAQUES HOSPITAL IS A 123-BED COMMUNITY HOSPITAL SERVING CITIES AND TOWNS IN THE MERRIMACK VALLEY, NORTH SHORE AND SOUTHERN NEW HAMPSHIRE BORDER TOWNS. OUR MISSION IS TO PROVIDE THE HIGHEST QUALITY MEDICAL CARE, WELLNESS AND HEALTH EDUCATION TO OUR COMMUNITY, IN ALLIANCE WITH OUR MEDICAL STAFF. ANNA JAQUES HOSPITAL IS RECOGNIZED FOR DELIVERING HIGH QUALITY, LOW-COST COMMUNITY HEALTH CARE WITH AN EMPHASIS ON PATIENT SATISFACTION. WITH OUR MISSION AT THE HEART OF EVERYTHING WE DO, ANNA JAQUES HOSPITAL GIVES BACK TO THE COMMUNITY IN MANY WAYS. INVOLVING AJH STAFF, INCLUDING ITS LEADERSHIP AND DOZENS OF COMMUNITY PARTNERS, IN THE CHNA PROCESS AS WELL AS IN THE DEVELOPMENT, IMPLEMENTATION AND OVERSIGHT OF THE IMPLEMENTATION STRATEGY; ENGAGING RESIDENTS THROUGHOUT THE HOSPITAL'S SERVICE AREAS IN ALL ASPECTS OF THE COMMUNITY BENEFITS PROCESS, INCLUDING ASSESSMENT, PLANNING, IMPLEMENTATION AND EVALUATION. SPECIAL ATTENTION IS FOCUSED ON ENGAGING DIVERSE PERSPECTIVES, FROM THOSE, PATIENTS AND NON-PATIENTS ALIKE, WHO ARE OFTEN LEFT OUT OF SIMILAR ASSESSMENT, PLANNING AND PROGRAM IMPLEMENTATION PROCESSES; ASSESSING UNMET COMMUNITY NEED BY COLLECTING PRIMARY AND SECONDARY DATA (BOTH QUANTITATIVE AND QUALITATIVE) TO IDENTIFY UNMET HEALTH-RELATED NEEDS AND TO CHARACTERIZE THOSE IN THE COMMUNITY WHO ARE MOST VULNERABLE AND FACE DISPARITIES IN ACCESS AND OUTCOMES; IMPLEMENTING COMMUNITY HEALTH PROGRAMS AND SERVICES IN ANNA JAQUES HOSPITAL'S SERVICE AREA GEARED TOWARD IMPROVING CURRENT AND FUTURE HEALTH STATUS OF INDIVIDUALS, FAMILIES AND COMMUNITIES BY REMOVING BARRIERS TO CARE, ADDRESSING SOCIAL DETERMINANTS OF HEALTH, STRENGTHENING THE HEALTHCARE SYSTEM AND WORKING TO DECREASE THE BURDEN OF THE LEADING HEALTH ISSUES; PROMOTING HEALTH EQUITY BY ADDRESSING SOCIAL AND INSTITUTIONAL INEQUITIES, RACISM AND BIGOTRY AND ENSURING THAT ALL PATIENTS ARE WELCOMED AND RECEIVE CARE THAT IS RESPECTFUL AND CULTURALLY RESPONSIVE; AND FACILITATING COLLABORATION AND PARTNERSHIP WITHIN AND ACROSS SECTORS (E.G., STATE/LOCAL PUBLIC HEALTH AGENCIES, HEALTH CARE PROVIDERS, SOCIAL SERVICE ORGANIZATIONS, BUSINESSES, ACADEMIC INSTITUTIONS, COMMUNITY HEALTH COLLABORATIVES, AND OTHER COMMUNITY HEALTH ORGANIZATIONS) TO ADVOCATE FOR, SUPPORT AND IMPLEMENT EFFECTIVE HEALTH POLICIES, COMMUNITY PROGRAMS AND SERVICES.DURING THE FISCAL YEAR COVERED BY THIS FILING, ANNA JAQUES HOSPITAL PROVIDED COMMUNITY HEALTH IMPROVEMENT SERVICES, COMMUNITY BENEFITS OPERATIONS AND CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS OF $202,638, AS REPORTED ON THIS SCHEDULE H, PART I, LINES 7E AND 7I. COMMUNITY BENEFITS LEADERSHIP/TEAMANNA JAQUES HOSPITAL IS A MEMBER OF BILH. WHILE AJH OVERSEES LOCAL COMMUNITY BENEFITS PROGRAMMING AND COMMUNITY ENGAGEMENT EFFORTS, COMMUNITY BENEFITS IS UNDER THE PURVIEW OF THE BILH CHIEF STRATEGY OFFICER. THIS STRUCTURE ENSURES THAT COMMUNITY BENEFITS EFFORTS, PRIORITIZATION, PLANNING AND STRATEGY ALIGN AND/OR ARE INTEGRATED WITH LOCAL AND SYSTEM STRATEGIC AND REGULATORY PRIORITIES. THE AJH COMMUNITY BENEFITS PROGRAM IS LED BY A MANAGER OF COMMUNITY BENEFITS/COMMUNITY RELATIONS. THE MANAGER HAS DIRECT ACCESS AND IS ACCOUNTABLE TO THE AJH PRESIDENT AND THE BILH VICE PRESIDENT OF COMMUNITY BENEFITS/COMMUNITY RELATIONS, THE LATTER OF WHOM REPORTS DIRECTLY TO THE BILH CHIEF STRATEGY OFFICER. IT IS THE RESPONSIBILITY OF THESE SENIOR MANAGERS TO ENSURE THAT COMMUNITY BENEFITS IS ADDRESSED BY THE ENTIRE ORGANIZATION AND THAT THE NEEDS OF THE UNDERSERVED POPULATIONS ARE CONSIDERED EVERY DAY IN DISCUSSIONS ON RESOURCE ALLOCATION, POLICIES, AND PROGRAM DEVELOPMENT. MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENTINTERNAL REVENUE CODE SECTION 501(R)INTERNAL REVENUE CODE (IRC) SECTION 501(R), ENACTED AS PART OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT, REQUIRES EACH HOSPITAL TO COMPLETE A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND TO FORMALLY ADOPT AN IMPLEMENTATION STRATEGY PURSUANT TO FEDERAL GUIDELINES TO MAINTAIN ITS TAX-EXEMPT STATUS AS A HOSPITAL UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED. ANNA JAQUES HOSPITAL COMPLETED ITS MOST RECENT NEEDS ASSESSMENT IN AUGUST 2019. THAT CHNA WAS APPROVED BY THE BOARD OF TRUSTEES ON SEPTEMBER 26, 2019. THE ACCOMPANYING IMPLEMENTATION STRATEGY FOR THE MOST RECENT CHNA WAS ALSO APPROVED BY THE BOARD ON SEPTEMBER 26, 2019, WHICH IS WITHIN THE TIMELINE REQUIRED BY THE TREASURY REGULATIONS UNDER 501(R). THE MOST RECENT CHNA AND THE ASSOCIATED IMPLEMENTATION STRATEGY ARE THE CULMINATION OF SEVERAL MONTHS OF WORK AND WERE BORNE LARGELY OF AJH COMMITMENT TO BETTER UNDERSTAND AND ADDRESS THE HEALTH-RELATED NEEDS OF THOSE LIVING IN ITS COMMUNITY BENEFITS SERVICE AREA WITH AN EMPHASIS ON THOSE WHO ARE MOST DISADVANTAGED. THE PROJECT ALSO FULFILLS COMMONWEALTH ATTORNEY GENERAL'S OFFICE (AGO) AND FEDERAL INTERNAL REVENUE SERVICE (IRS) REGULATIONS THAT REQUIRE THAT AJH ASSESS COMMUNITY HEALTH NEEDS, ENGAGE THE COMMUNITY, IDENTIFY PRIORITY HEALTH ISSUES AND CREATE A COMMUNITY HEALTH STRATEGY THAT DESCRIBES HOW AJH, IN COLLABORATION WITH THE COMMUNITY AND LOCAL HEALTH DEPARTMENT, WILL ADDRESS THE NEEDS AND THE PRIORITIES IDENTIFIED BY THE CHNA.COMMUNITY HEALTH NEEDS ASSESSMENTTARGETED GEOGRAPHY AND POPULATIONSAS NOTED ABOVE, AJH COMPLETED ITS LAST ASSESSMENT IN AUGUST 2019. THE GEOGRAPHICAL FOCUS OF THE 2019 CHNA ENCOMPASSES AJH'S COMMUNITY BENEFITS SERVICE AREA (CBSA), COMPRISED OF TEN CITIES AND TOWNS INCLUDING HAVERHILL, NEWBURYPORT, AMESBURY, SALISBURY, GEORGETOWN, NEWBURY, MERRIMAC, GROVELAND, WEST NEWBURY AND ROWLEY. TARGET POPULATIONS FOR ANNA JAQUES HOSPITAL'S COMMUNITY BENEFITS INITIATIVES ARE IDENTIFIED THROUGH A COMMUNITY INPUT AND PLANNING PROCESS, COLLABORATIVE EFFORTS AND A CHNA THAT IS CONDUCTED EVERY THREE YEARS IN ACCORDANCE WITH THE REQUIREMENTS UNDER IRC SECTION 501(R). WHILE AJH IS COMMITTED TO IMPROVING THE HEALTH STATUS AND WELL-BEING OF THOSE LIVING THROUGHOUT ITS ENTIRE SERVICE AREA, PER THE COMMONWEALTH'S UPDATED COMMUNITY BENEFITS GUIDELINES, AJH'S IMPLEMENTATION STRATEGY WILL FOCUS ON POPULATIONS THAT ARE MOST AT-RISK. IN RESPONSE TO THE FY19 CHNA, AJH WILL FOCUS ITS FY20-22 IMPLEMENTATION STRATEGY ON THE FOLLOWING PRIORITY AREAS THAT ADDRESS THE BROAD RANGE OF HEALTH AND SOCIAL ISSUES FACING RESIDENTS WHO HAVE THE GREATEST HEALTH DISPARITIES:1) SUBSTANCE USE2) CANCER3) SUPPORT FOR VULNERABLE COMMUNITIES2019 COMMUNITY HEALTH NEEDS ASSESSMENTSUMMARY OF APPROACH AND METHODSTHE ASSESSMENT BEGAN IN DECEMBER 2018 AND WAS CONDUCTED IN THREE PHASES, ALLOWING FOR THE COLLECTION OF AN EXTENSIVE AMOUNT OF QUANTITATIVE AND QUALITATIVE DATA:PHASE 1 PRELIMINARY ASSESSMENT AND ENGAGEMENTPHASE 2 TARGETED ENGAGEMENTPHASE 3 STRATEGIC PLANNING AND REPORTINGINDIVIDUALS FROM ACROSS ANNA JAQUES HOSPITAL'S SERVICE AREA WERE ENGAGED IN THE ASSESSMENT AND PLANNING PROCESS, INCLUDING HEALTH AND SOCIAL SERVICES PROVIDERS, PUBLIC HEALTH OFFICIALS, PUBLIC SCHOOL NURSES AND ADMINISTRATORS, FIRST RESPONDERS, LEADERS OF FAITH BASED ORGANIZATIONS, SENIOR LEADERSHIP, STAFF, BOARD MEMBERS, AND COMMUNITY RESIDENTS. MEMBERS OF THE COMMUNITY BENEFITS ADVISORY COMMITTEE PROVIDED LEADERSHIP, DIRECTION, AND INPUT, AS WELL AS CONNECTED AJH TO AVAILABLE COMMUNITY DATA AND RESOURCES THAT REPRESENTS THE BROAD INTERESTS OF THE COMMUNITY TO DRIVE THE CONTENT OF THE CHNA.
FORM 990 SCHEDULE H, SUPPLEMENTAL INFORMATION	2019 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESSDETAIL OF APPROACH AND METHODSTHE QUANTITATIVE ASSESSMENT INCLUDED AN EXTENSIVE ANALYSIS OF DEMOGRAPHIC AND SOCIOECONOMIC DATA, HEALTH STATUS, UTILIZATION RATES, AND BEHAVIORAL RISK SURVEY DATA. DATA FROM A BROAD RANGE OF SOURCES WAS COLLECTED AND ANALYZED TO CHARACTERIZE COMMUNITIES IN ANNA JAQUES HOSPITAL'S CBSA, MEASURE HEALTH STATUS, AND INFORM A COMPREHENSIVE UNDERSTANDING OF HEALTH-RELATED ISSUES. U.S. CENSUS BUREAU, AMERICAN COMMUNITY SURVEY 5-YEAR ESTIMATES (2013-2017) MASSACHUSETTS DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION: SCHOOL AND DISTRICT PROFILES FBI UNIFORM CRIME REPORTS (2017) MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH, REGISTRY OF VITAL RECORDS AND STATISTICS (2015) MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH, BUREAU OF SUBSTANCE ABUSE SERVICES (2017) MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH, ANNUAL REPORTS ON BIRTHS (2016) MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH, OPIOID RELATED EMS INCIDENTS (2018)QUALITATIVE DATA SOURCES: TO OBTAIN TARGETED DATA AND UNDERSTAND THE CURRENT ISSUES FACING THE COMMUNITY: INTERNAL STAKEHOLDER INTERVIEWS (BOARD MEMBERS, SENIOR LEADERS AND SERVICE LINE LEADERS) EXTERNAL STAKEHOLDER INTERVIEWS 2019 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESSKEY INFORMANT INTERVIEWS WITH INTERNAL AND EXTERNAL STAKEHOLDERS (SCHEDULE H, PART V, SECTION B, LINE 5)AJH CONDUCTED KEY COMMUNITY STAKEHOLDERS, INCLUDING REPRESENTATIVES FROM HOSPITAL AND MUNICIPAL LEADERSHIP, THE BUSINESS COMMUNITY, PUBLIC HEALTH DEPARTMENTS, SOCIAL SERVICE PROVIDERS, SCHOOLS, AND COMMUNITY HEALTH COALITIONS. 2019 COMMUNITY HEATH NEEDS ASSESSMENT PROCESSFOCUS GROUPS AND COMMUNITY FORUMS (SCHEDULE H, PART V, SECTION B, LINE 5)COMMUNITY DIALOGUES AND KEY INFORMANT INTERVIEWS WERE CONDUCTED WITH INDIVIDUALS FROM ACROSS THE CITY AND TOWNS THAT COMPRISE THE AJH REGION. PARTICIPANTS REPRESENTED DIFFERENT AUDIENCES, INCLUDING LEADERS IN EMERGENCY RESPONSE, EDUCATION, HEALTH CARE AND SOCIAL SERVICE ORGANIZATIONS FOCUSING ON VULNERABLE POPULATIONS (E.G., YOUTH, SENIORS, MINORITY GROUPS AND FOREIGN-LANGUAGE SPEAKERS) (SCHEDULE H, PART V, SECTION B, QUESTIONS 3 AND 5). AJH ALSO REVIEWED PRIMARY DATA FROM THE YWCA OF NEWBURYPORT, PENNIES FOR POVERTY, OUR NEIGHBOR'S TABLE AND ESSEX COUNTY ASSET BUILDERS NETWORK TO UNDERSTAND THE POPULATIONS AND PRESSING HEALTH ISSUES. 2019 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESSREVIEWING RESULTS AND COMPILING THE COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY DOCUMENTS THE AJH COMMUNITY HEALTH IMPLEMENTATION STRATEGY WAS DEVELOPED BY A TEAM COMPRISED OF HOSPITAL LEADERSHIP, MEDICAL STAFF, COMMUNITY BENEFITS STAFF AND COMMUNITY REPRESENTATION. THE GROUP REVIEWED PROGRESS TOWARD GOALS AND OBJECTIVES OF THE PRIOR THREE-YEAR PERIOD, AS WELL AS THE CURRENT DATA COLLECTED THROUGH THE CHNA, TO HELP ENVISION AND DEFINE PRIORITY AREAS FOR THE FUTURE. THE IMPLEMENTATION STRATEGY IDENTIFIED PRIORITY AREAS AND DEFINED GOALS, ALONG WITH OBJECTIVES FOR EACH GOAL AND DRAFTED STRATEGIES TO OPERATIONALIZE THESE OBJECTIVES. COMMUNITY HEALTH NEEDS ASSESSMENTKEY FINDINGSBELOW IS A HIGH-LEVEL SUMMARY OF HEALTH-RELATED FINDINGS THAT WERE IDENTIFIED AFTER A COMPREHENSIVE REVIEW OF ALL THE QUANTITATIVE AND QUALITATIVE INFORMATION THAT WAS COLLECTED AS PART OF THE CHNA. A DETAILED AND IN-DEPTH DISCUSSION OF KEY FINDINGS IS INCLUDED IN THE FULL CHNA REPORT. CANCER. 11% OF MASSACHUSETTS ADULTS REPORTED THAT THEY HAD EVER BEEN DIAGNOSED WITH CANCER. AMONG THOSE 75 YEARS OF AGE AND OLDER, THE PREVALENCE OF CANCER SURVIVOR COMPRISES 35% OF ALL RESIDENTS. WHITE ADULTS WERE MORE LIKELY THAN HISPANIC ADULTS TO HAVE EVER BEEN DIAGNOSED WITH CANCER. ONE IN FOUR ADULTS AGES 50-74 REPORTED THEY DID NOT MEET THE US PREVENTIVE SERVICES TASK FORCE RECOMMENDATION FOR COLORECTAL CANCER SCREENING. 86% OF FEMALES AGES 50-74 REPORTED HAVING A MAMMOGRAM IN THE PREVIOUS TWO YEARS. 84% OF FEMALES AGES 21-65 WITHOUT A HYSTERECTOMY REPORTED HAVING A PAP SMEAR IN THE PREVIOUS THREE YEARS; HOWEVER, AMONG THOSE 21-24 YEARS OF AGE, THIS WAS ONLY 59%. ASIAN FEMALES WERE LESS LIKELY THAN WHITE FEMALES TO REPORT HAVING A PAP SMEAR IN THE PREVIOUS THREE YEARS. SUBSTANCE USE. AS REPORTED BY THE NATIONAL INSTITUTE ON DRUG ABUSE, MASSACHUSETTS RANKED AMONG THE TOP TEN STATES WITH THE HIGHEST RATES OF DRUG OVERDOSE DEATHS INVOLVING OPIOIDS. IN 2017, THERE WERE 1,913 DRUG OVERDOSE DEATHS INVOLVING OPIOIDS IN MASSACHUSETTSA RATE OF 28.2 DEATHS PER 100,000 PERSONS, WHICH IS TWOFOLD HIGHER THAN THE NATIONAL RATE OF 14.6 DEATHS PER 100,000 PERSONS. 311 OF THOSE DEATHS WERE IN ESSEX COUNTY. SOCIAL DETERMINANTS OF HEALTH. THE SOCIAL CONDITIONS IN WHICH PEOPLE ARE BORN, GROW, LIVE, WORK, AND AGE PLAY A KEY ROLE IN DETERMINING HEALTH OUTCOMES AND HEALTH DISPARITIES. SPECIFICALLY, THE NUMBER OF HOMELESS CHILDREN CONTINUES TO GROW ACCORDING TO SCHOOL DISTRICT DATA. POVERTY IMPACTS MANY IN OUR LOCAL COMMUNITY. DESPITE THE IMPRESSION OF AFFLUENCE IN OUR AREA, MANY ARE STRUGGLING WITH POVERTY AND MANY OF THOSE ARE CHILDREN. ACCORDING TO DATA COMPILED BY THE GREATER BOSTON FOOD BANK AND FEEDING AMERICA, THERE ARE APPROXIMATELY 6,000 PEOPLE WHO ARE FOOD INSECURE LIVING IN NORTHEASTERN ESSEX COUNTY PEOPLE WHO ARE WORRYING ABOUT RUNNING OUT OF FOOD OR ACTUALLY GOING WITHOUT. ADDITIONALLY, THE FINDINGS NOTE THE KEY BARRIERS TO OBTAINING HEALTHCARE INCLUDE TRANSPORTATION, ACCESS TO AVAILABLE RESOURCES, AFFORDABILITY, INSURANCE COVERAGES, INADEQUATE SERVICES, LACK OF HEALTHCARE PROVIDERS, AND LANGUAGE BARRIERS.COMMUNITY HEALTH NEEDS ASSESSMENT AND ACTIVITIES REPORTED IN THIS FILINGTHE CHNA THAT WAS COMPLETED DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2019, WILL INFORM AJH'S COMMUNITY BENEFITS INITIATIVES DURING THE FISCAL YEARS ENDED SEPTEMBER 30, 2020; SEPTEMBER 30, 2021; AND SEPTEMBER 30, 2022.COMMUNITY HEALTH NEEDS ASSESSMENTADDRESSING COMMUNITY HEALTH NEEDSAJH STRIVES TO ADDRESS THE PRIORITY AREAS IN ITS CHNA AND IMPLEMENTATION STRATEGY THAT ARE AVAILABLE UPON REQUEST AND ON THE HOSPITAL'S WEBSITE AT: HTTPS://WWW.AJH.ORG/COMMUNITY/COMMUNITY-BENEFITS-REPORTS/VIEW-PUBLICATION-CATEGORYIN ADDITION, THE CHNA THAT WAS PREVIOUSLY COMPLETED DURING THE FISCAL YEAR ENDED FY18 IS AVAILABLE ON THE HOSPITAL'S WEBSITE AT: HTTPS://WWW.AJH.ORG/COMMUNITY/COMMUNITY-BENEFITS-REPORTS/VIEW-PUBLICATION-CATEGORYBOTH DOCUMENTS ARE ALSO AVAILABLE UPON REQUEST (SCHEDULE H, PART V, SECTION B, LINE 7A). COMMUNITY HEALTH NEEDS ASSESSMENT AND ACTIVITIES REPORTED IN THIS FILINGTHE PREVIOUS NEEDS ASSESSMENT AND ACCOMPANYING IMPLEMENTATION PLAN WERE APPROVED BY THE AJH BOARD OF TRUSTEES ON FEBRUARY 25, 2016 AND INFORMED AJH'S COMMUNITY BENEFITS PROCESS FOR THE FISCAL YEARS ENDED SEPTEMBER 30, 2017; SEPTEMBER 30, 2018; AND SEPTEMBER 30, 2019. AS SUCH, THE ACCOMPLISHMENTS AND ACTIVITIES INCLUDED IN THIS FILING AND REPORTED BELOW RELATE TO THE DOCUMENTS APPROVED AS OF SEPTEMBER 30, 2016.
FORM 990 SCHEDULE H, SUPPLEMENTAL INFORMATION	2016 COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGYIN FY17, AJH COMPLETED THE REQUIRED TRIENNIAL COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). 2016 COMMUNITY HEALTH NEEDS ASSESSMENTTARGETED GEOGRAPHY AND POPULATIONSANNA JAQUES HOSPITAL COLLABORATED WITH THE HEALTH PARTNERSHIP (HP) OF THE LOWER MERRIMACK VALLEY AND SEACOAST (PREVIOUSLY KNOWN AS THE COMMUNITY HEALTH NETWORK AREA 12 OF GREATER HAVERHILL) THAT CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT FOR THE ELEVEN HEALTH PARTNERSHIP SERVICE AREAS: AMESBURY, BOXFORD, GEORGETOWN, GROVELAND, HAVERHILL, MERRIMAC, NEWBURY, NEWBURYPORT, ROWLEY, SALISBURY, AND WEST NEWBURY. IN 2018, AJH REVIEWED AVAILABLE PUBLIC HEALTH DATA AND COLLABORATED WITH COMMUNITY PARTNERS TO UPDATE THE ASSESSMENT AND DEVELOP A COMMUNITY HEALTH IMPLEMENTATION PLAN. KEY POPULATIONS WERE IDENTIFIED AS AT RISK WERE SUBSTANCE USERS, ELDERLY AND THE AMESBURY SENIOR CENTER.2016 COMMUNITY HEALTH NEEDS ASSESSMENTSUMMARY OF APPROACH AND METHODSTHE CHNA WAS CONDUCTED IN PHASES, ALLOWING AJH TO COMPILE AN EXTENSIVE AMOUNT OF QUANTITATIVE AND QUALITATIVE DATA, ENGAGE AND INVOLVE KEY INTERNAL AND EXTERNAL STAKEHOLDERS, DEVELOP A REPORT AND DETAILED CHIP AND COMPLY WITH ALL STATE AND FEDERAL IRS COMMUNITY BENEFITS REQUIREMENTS. DATA SOURCES INCLUDED A BROAD ARRAY OF PUBLICLY AVAILABLE SECONDARY DATA AND KEY INFORMANT INTERVIEWS.2016 COMMUNITY HEALTH NEEDS ASSESSMENTMAJOR HEALTH NEEDS AND HOW PRIORITIES WERE DETERMINEDIN RESPONSE TO THE PRIORITY HEALTH NEEDS IDENTIFIED IN THE 2016 CHNA, AJH DEVELOPED A THREE YEAR COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP). THE CHIP WAS DEVELOPED WITH INPUT FROM THE AJH COMMUNITY BENEFITS ADVISORY BOARD AND APPROVED BY THE AJH BOARD OF DIRECTORS. THE COMMUNITY BENEFITS PROGRAMS OFFERED IN FY18 WERE DESIGNED TO ADDRESS THE PRIORITY HEALTH NEEDS IDENTIFIED IN THE 2018 CHNA, ALONG WITH THE MASSACHUSETTS STATEWIDE HEALTH PRIORITIES IDENTIFIED BY THE EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES.HEALTH NEEDS IDENTIFIED IN THE 2016 CHNA: 1) SUBSTANCE USE2) CANCER3) OBESITY4) SUPPORT FOR VULNERABLE COMMUNITIES2016 COMMUNITY HEALTH NEEDS ASSESSMENTKEY FINDINGS SUBSTANCE USE. AS REPORTED BY THE NATIONAL INSTITUTE ON DRUG ABUSE, MASSACHUSETTS RANKED AMONG THE TOP TEN STATES WITH THE HIGHEST RATES OF DRUG OVERDOSE DEATHS INVOLVING OPIOIDS. IN 2017, THERE WERE 1,913 DRUG OVERDOSE DEATHS INVOLVING OPIOIDS IN MASSACHUSETTSA RATE OF 28.2 DEATHS PER 100,000 PERSONS, WHICH IS TWOFOLD HIGHER THAN THE NATIONAL RATE OF 14.6 DEATHS PER 100,000 PERSONS. 311 OF THOSE DEATHS WERE IN ESSEX COUNTY. CANCER. 11% OF MASSACHUSETTS ADULTS REPORTED THAT THEY HAD EVER BEEN DIAGNOSED WITH CANCER. AMONG THOSE 75 YEARS OF AGE AND OLDER, THE PREVALENCE OF CANCER SURVIVOR COMPRISES 35% OF ALL RESIDENTS. WHITE ADULTS WERE MORE LIKELY THAN HISPANIC ADULTS TO HAVE EVER BEEN DIAGNOSED WITH CANCER. ONE IN FOUR ADULTS AGES 50-74 REPORTED THEY DID NOT MEET THE US PREVENTIVE SERVICES TASK FORCE RECOMMENDATION FOR COLORECTAL CANCER SCREENING. 86% OF FEMALES AGES 50-74 REPORTED HAVING A MAMMOGRAM IN THE PREVIOUS TWO YEARS. 84% OF FEMALES AGES 21-65 WITHOUT A HYSTERECTOMY REPORTED HAVING A PAP SMEAR IN THE PREVIOUS THREE YEARS; HOWEVER, AMONG THOSE 21-24 YEARS OF AGE, THIS WAS ONLY 59%. ASIAN FEMALES WERE LESS LIKELY THAN WHITE FEMALES TO REPORT HAVING A PAP SMEAR IN THE PREVIOUS THREE YEARS. OBESITY. PERCENTAGE OF OVERWEIGHT ADULTS IS HIGHER THAN THE STATE AVERAGE. IN HAVERHILL, OVERWEIGHT AND OBESE CHILDREN IS OF CONCERN IN ALL GRADES. IN AMESBURY, OBESE CHILDREN IS OF CONCERN IN MIDDLE SCHOOL AND HIGH SCHOOL. SUPPORT FOR VULNERABLE COMMUNITIES. THE SOCIAL CONDITIONS IN WHICH PEOPLE ARE BORN, GROW, LIVE, WORK, AND AGE PLAY A KEY ROLE IN DETERMINING HEALTH OUTCOMES AND HEALTH DISPARITIES. SPECIFICALLY, THE NUMBER OF HOMELESS CHILDREN CONTINUES TO GROW ACCORDING TO SCHOOL DISTRICT DATA. POVERTY IMPACTS MANY IN OUR LOCAL COMMUNITY. DESPITE THE IMPRESSION OF AFFLUENCE IN OUR AREA, MANY ARE STRUGGLING WITH POVERTY AND MANY OF THOSE ARE CHILDREN. ACCORDING TO DATA COMPILED BY THE GREATER BOSTON FOOD BANK AND FEEDING AMERICA, THERE ARE APPROXIMATELY 6,000 PEOPLE WHO ARE FOOD INSECURE LIVING IN NORTHEASTERN ESSEX COUNTY PEOPLE WHO ARE WORRYING ABOUT RUNNING OUT OF FOOD OR ACTUALLY GOING WITHOUT. ADDITIONALLY, THE FINDINGS NOTE THE KEY BARRIERS TO OBTAINING HEALTHCARE INCLUDE TRANSPORTATION, ACCESS TO AVAILABLE RESOURCES, AFFORDABILITY, INSURANCE COVERAGES, INADEQUATE SERVICES, LACK OF HEALTHCARE PROVIDERS, AND LANGUAGE BARRIERS.COMMUNITY HEALTH NEEDS ASSESSMENTMAKING THE CHNA AND IMPLEMENTATION STRATEGY WIDELY AVAILABLEAJH STRIVES TO ADDRESS THE PRIORITY AREAS IN ITS CHNA AND IMPLEMENTATION STRATEGY. COPIES OF THE REPORT ARE AVAILABLE UPON REQUEST AND ON THE HOSPITAL'S WEBSITE AT: HTTPS://WWW.AJH.ORG/COMMUNITY/OUTREACH-AND-INVOLVEMENTIN ADDITION, THE MOST RECENT CHNA HAS ALSO BEEN SHARED PUBLICALLY AND COPIES ARE AVAILABLE UPON REQUEST AND ON THE HOSPITAL'S WEBSITE ATHTTPS://WWW.AJH.ORG/COMMUNITY/OUTREACH-AND-INVOLVEMENTBOTH DOCUMENTS ARE ALSO AVAILABLE UPON REQUEST (SCHEDULE H, PART V, SECTION B, LINE 7A).
FORM 990 SCHEDULE H, SUPPLEMENTAL INFORMATION	COMMUNITY HEALTH NEEDS ASSESSMENTADDRESSING COMMUNITY HEALTH NEEDS(SCHEDULE H, PART V, SECTION B, LINE 11)FY19 SCHEDULE HIMPLEMENTATION STRATEGY UPDATETHE COMMUNITY BENEFITS PROGRAMS THAT LHMC/LMCP OFFERED TO MEET THESE MOST PRESSING HEALTH CARE NEEDS INCLUDE THE FOLLOWING:FOCUS ON SUBSTANCE USETHE PERSIST PROGRAM AT ANNA JAQUES HOSPITAL (AJH) SUPPORTS WOMEN WITH SUBSTANCE USE DISORDER AND INFANTS WITH NEONATAL ABSTINENCE SYNDROME (NAS), WHICH IMPACTS ABOUT 14.5 CASES PER 1,000 BIRTHS IN MASSACHUSETTS. IN FY18, THE PERSIST PROGRAM SERVED 192 WOMEN WHO WERE IN RECOVERY AND SOUGHT ADDITIONAL SUPPORT, SUFFERED FROM TRAUMA OR ABUSE OR WERE DIAGNOSED WITH MENTAL HEALTH DISORDERS. A PATIENT CARE NAVIGATOR WORKS IN COLLABORATION WITH WOMEN'S HEALTH CARE AND THE ANNA JAQUES BIRTH CENTER & NEONATAL CARE CENTER TO CHAMPION WOMEN THROUGHOUT THEIR PREGNANCY AND FIRST YEAR OF MOTHERHOOD. PATIENTS SET TREATMENT GOALS SUCH AS MAINTAINING SOBRIETY, SECURING MENTAL HEALTH COUNSELING, OBTAINING STABLE HOUSING AND DISCONTINUING MARIJUANA USE. WOMEN ARE CONNECTED WITH RECOVERY SUPPORT SERVICES AND MENTAL HEALTH PROVIDERS TO HELP THEM ACHIEVE THEIR GOALS. THE PERSIST SUPPORT GROUP, A FREE GROUP THAT MEETS WEEKLY IN HAVERHILL, HOSTS SPEAKERS WHO SHOWCASE LOCAL RESOURCES AND USEFUL INFORMATION; TOPICS HAVE INCLUDED EMERGENCY SERVICES, HOUSING AND HEALTHY RELATIONSHIPS. IN FY18, 78% OF PATIENTS MET THEIR TREATMENT GOALS. IN FY19 THIS INCREASED TO 83% OF PATIENTS. OVERALL, THE NUMBER OF SUBSTANCE-EXPOSED BABIES STEADILY DECLINED FROM 91 IN 2017, TO 56 IN 2018 AND TO 24 IN 2019.ANNA JAQUES HOSPITAL COLLABORATED WITH NEWBURYPORT HIGH SCHOOL ON AN ANTI-VAPING CAMPAIGN TO CREATE A THREE STAGE CURRICULUM: A PRE-TEST TO COLLECT DATA FOR THE STUDENTS' PREVIOUS KNOWLEDGE, AN EDUCATIONAL VIDEO TO PROVIDE A VISUAL FOR THE HARMFUL EFFECT OF VAPING, AND A GROUP DISCUSSION ON THE NEGATIVE IMPACTS OF VAPING. THE CAMPAIGN HAS BEEN WELL RECEIVED BY STUDENTS AND SCHOOL STAFF. THE HOSPITAL ALSO WORKS CLOSELY WITH THE PETTENGILL HOUSE'S TO PROVIDE SUPPORT FOR FAMILIES STRUGGLING WITH LIFE CHALLENGES. THEY START BY HELPING TO ENSURE BASIC NEEDS SUCH AS SAFETY, SHELTER, FOOD AND CLOTHING AND THEY WORK WITH INDIVIDUALS AND FAMILIES TO PROVIDE A LONG TERM PATH TO A BRIGHTER FUTURE.ANNA JAQUES HOSPITAL WORKS WITH THE ESSEX COUNTY ASSET BUILDER (ECAB) NETWORK TO CREATE REGIONAL CONNECTIONS AND SUPPORTS FOR INDIVIDUALS, FAMILIES AND ORGANIZATIONS FROM AMESBURY, GEORGETOWN, NEWBURY, ROWLEY, SALISBURY AND NEWBURYPORT, IN USING A POSITIVE YOUTH DEVELOPMENT APPROACH TO HELP YOUTH THRIVE. BEING A PART OF THE ECAB NETWORK BRINGS LOCAL AND REGIONAL OPPORTUNITIES. LOCALLY, COMMUNITIES HAVE ACCESS TO TRAININGS, DATA, AND BEST PRACTICES, AND RECEIVE GUIDANCE ON IMPLEMENTATION AND OUTREACH STRATEGIES THAT BUILD POSITIVE YOUTH DEVELOPMENT POSSIBILITIES. COMMUNITIES ALSO GET THE BENEFIT OF REGIONALIZING EFFORTS, WHERE NETWORKING, COMBINING RESOURCES, CURRENT POLICIES, AND A SHARED VISION STRENGTHEN THE TOWNS AND CITIES AS WELL AS THE REGION. AS A COLLABORATOR OF THIS NETWORK, ANNA JAQUES HOSPITAL SUPPORTED THE ACQUISITION OF A DATABASE THAT WOULD TRACK OVERDOSES BETWEEN COMMUNITIES AND ALLOW FOR A MORE COHESIVE, MULTI-AGENCY, APPROACH TO CONNECTING INDIVIDUALS WITH THE ASSISTANCE THAT THEY NEED AND THE SERVICES AVAILABLE IN THE AREA. FOCUS ON CANCER SUPPORT SERVICESFOR MORE THAN 20 YEARS, AJH HAS HOSTED TWO MONTHLY SUPPORT GROUPS FOR COMMUNITY RESIDENTS COPING WITH A DIAGNOSIS OF CANCER OR BREAST CANCER. BOTH GROUPS ARE FACILITATED BY CLINICAL PROFESSIONALS WHO HAVE BEEN IMPACTED BY CANCER. AJH COLLABORATES WITH COMMUNITY PROGRAMS TO PROMOTE AWARENESS OF THE IMPORTANCE OF BREAST CANCER SCREENING AND TO INCREASE AWARENESS OF RESOURCES FOR PEOPLE IMPACTED BY CANCER. IN FY19 ANNA JAQUES SUPPORTED THE LAUNCH OF THE NORTH OF BOSTON CANCER RESOURCE. THE COMPREHENSIVE ONLINE GUIDE SIMPLIFIES ACCESS TO RESOURCES, EDUCATION AND SERVICES TO HELP PEOPLE WITH CANCER SURVIVE AND THRIVE THROUGH DIAGNOSIS, TREATMENT AND BEYOND. THIS RESOURCE, DEVELOPED IN COLLABORATION WITH THREE OTHER ORGANIZATIONS, BUILDS UPON THE HOSPITAL'S RELATIONSHIPS WITH COMMUNITY PARTNERS WHO PROVIDE COMPLEMENTARY SERVICES IN THE ANNA JAQUES CANCER CENTER. THE ONLINE NORTH OF BOSTON CANCER RESOURCE RECORDED 10,900 PAGE VIEWSTHE HOSPITAL FEATURED MAMMOGRAM REMINDER CARDS THROUGHOUT THE COMMUNITY DURING BREAST CANCER AWARENESS MONTH, ADVOCATING THAT THE, BEST PREVENTION IS EARLY DETECTION. THE CARDS WERE FEATURED ALL THROUGHOUT THE COMMUNITY IN LOCAL BUSINESSES AND IN DOCTOR'S OFFICES THROUGHOUT THE YEAR. IN FY19, THE HOSPITAL DISTRIBUTED 25,000 COFFEE SLEEVES TO LOCAL SHOPS AND BAKERIES IN NEWBURYPORT, SALISBURY, AMESBURY, WEST NEWBURY, GROVELAND, HAVERHILL AND MERRIMAC WITH A REMINDER TO SCHEDULE AN ANNUAL MAMMOGRAM.FOCUS ON OBESITYSOME 6,000 PEOPLE IN NORTHEASTERN ESSEX COUNTY ARE FOOD INSECURE. ANNA JAQUES HOSPITAL (AJH) PARTNERS WITH BOTH THE NEWBURYPORT AND HAVERHILL FARMERS' MARKETS TO ENSURE THAT COMMUNITIES HAVE ACCESS TO HEALTHY AFFORDABLE FOODS, ESPECIALLY FRUITS AND VEGETABLES. BOTH MARKETS INCLUDE FARMERS AND VENDORS WHO ACCEPT EBT/SNAP TO MAKE HEALTHY EATING MORE ACCESSIBLE TO EVERYONE.THE NEWBURYPORT MARKET HOSTS SOME 30-35 VENDORS THAT OFFER FRESH PRODUCE, MEATS, CHEESES AND OTHER LOCALLY MADE GOODS. THE HOSPITAL HOSTS TABLES TO OFFER HEALTHY LIVING INFORMATION; FOR EXAMPLE, THE CARDIAC REHABILITATION MANAGER ATTENDS DURING AMERICAN HEART MONTH IN FEBRUARY TO PROVIDE HEART HEALTH INFORMATION AND FREE BLOOD PRESSURE CHECKS. NEWBURYPORT MARKET, WHICH HOSTED 40 MARKETS FOR 800 TO 1,200 PARTICIPANTS WEEKLYTHE HAVERHILL FARMERS' MARKET PROMOTES HEALTHY EATING AND IS EASILY ACCESSIBLE BY PUBLIC TRANSPORTATION. DURING BREAST CANCER AWARENESS MONTH IN OCTOBER, A SURVIVOR AND AN AJH REPRESENTATIVE DISTRIBUTED MAMMOGRAM REMINDER CARDS AND AN AJH PATIENT NAVIGATOR DISTRIBUTED INFORMATION ABOUT THE HOSPITAL'S PERSIST PROGRAM. HAVERHILL MARKET, WHICH HOSTED 19 MARKETS FOR AN ESTIMATED 700 PARTICIPANTS WEEKLYANNA JAQUES HOSPITAL CONTINUED FREE WORKOUTS FOR ALL AGES/ABILITIES IN AMESBURY & NEWBURYPORT. THE HOSPITAL PARTNERED WITH THE YANKEE HOMECOMING WATERFRONT WORKOUT SERIES WHERE OVER 300 PARTICIPANTS HAD ACCESS TO SEVEN DAYS OF FREE WORKOUTS, SIXTEEN CLASSES/HOURS AT TWELVE LOCAL STUDIOS. WORKOUT HAVE ALSO EXPANDED TO AMESBURY WHERE PARTICIPANTS HAVE ACCESS TO "FITNESS BY THE FALLS" EVERY SUNDAY THROUGH THE SUMMER.
FORM 990 SCHEDULE H, SUPPLEMENTAL INFORMATION	COMMUNITY PARTNERSANNA JAQUES HOSPITAL IS COMMITTED TO IMPROVING THE HEALTH AND WELLBEING OF RESIDENTS WITHIN ITS SERVICE AREA BY COLLABORATING WITH A DIVERSE GROUP OF COMMUNITY PARTNERS. THE HOSPITAL WORKS TOGETHER WITH THESE PARTNERS TO REDUCE BARRIERS TO HEALTH, INCREASE PREVENTION AND/OR SELF-MANAGEMENT OF CHRONIC DISEASE AND INCREASE THE EARLY DETECTION OF ILLNESS. LISTED BELOW IS A LIST OF THE COMMUNITY PARTNERS WE HAVE JOINED WITH IN ASSESSING COMMUNITY NEED AS WELL AS PLANNING, EXECUTING, AND OVERSEEING OUR COMMUNITY BENEFITS IMPLEMENTATION STRATEGY: AMESBURY CHAMBER OF COMMERCE AMERICAN HEART ASSOCIATION AMESBURY COUNCIL ON AGING THE ARC OF GREATER HAVERHILL-NEWBURYPORT ATRIA AVITA THE BEACON COALITION BOSTON HEALTH CARE FOR THE HOMELESS COASTAL TRAILS COALITION COUNTRY CENTER FOR HEALTH AND REHABILITATION ELDER SERVICES OF THE MERRIMACK VALLEY/HOME HEALTH VNA GREATER HAVERHILL CHAMBER OF COMMERCE GREATER NEWBURYPORT CHAMBER OF COMMERCE GREATER NEWBURYPORT OVARIAN CANCER AWARENESS - OVATIONS FOR THE CURE HAMPTON CHAMBER OF COMMERCE HEALTH PARTNERSHIP OF THE LOWER MERRIMACK VALLEY AND SEACOAST REGION INSIGHT MEDITATION CENTER INSTITUTION FOR SAVINGS JEANNE GEIGER CRISIS CENTER LINK HOUSE LOCK YOUR MEDS CAMPAIGN MERRIMAC SENIOR CENTER & COUNCIL ON AGING MERRIMACK VALLEY HOSPICE - HOME HEALTH FOUNDATION NEWBURYPORT COUNCIL ON AGING NEWBURYPORT FARMERS' MARKET NEWBURYPORT FIVE CENTS SAVINGS BANK NEWBURYPORT LIONS CLUB NEWBURYPORT PUBLIC SCHOOLS NEWBURYPORT ROTARY CLUB NEWBURYPORT YANKEE HOMECOMING NEWBURYPORT YOUTH SOCCER ORGANIZATION NEWBURYPORT YOUTH SERVICES NEWBURYPORT ROTARY CLUB NEWBURYPORT COUNCIL ON AGING NEWBURYPORT SOCIETY FOR THE RELIEF OF AGED WOMEN NORTHERN ESSEX COMMUNITY COLLEGE NOURISHING THE NORTHSHORE OPPORTUNITY WORKS THE PETTENGILL HOUSE THE PROVIDENT BANK SALISBURY CHAMBER OF COMMERCE SALISBURY BEACH PARTNERSHIP, INC. SALISBURY PARKS & RECREATION DEPARTMENT SALISBURY SENIOR CENTER & COUNCIL ON AGING SEA FESTIVAL OF TREES TOUGH WARRIOR PRINCESSES TRITON EDUCATION FOUNDATION WNBP RADIO - THE LEGENDS YANKEE HOMECOMING YWCA OF NEWBURYPORT YWCA OF GREATER HAVERHILL/LAWRENCE AS DESCRIBED IN DETAIL IN THIS SUPPORTING NARRATIVE TO THE FORM 990 SCHEDULE H, ANNA JAQUES HOSPITAL IS DEEPLY DEDICATED TO ITS COMMUNITY BENEFITS OPERATIONS AND TO IMPROVING THE HEALTH OF ITS COMMUNITY. ANNA JAQUES HOSPITAL COMMITS DIRECT COMMUNITY HEALTH PROGRAM INVESTMENTS AND IN-KIND RESOURCES OF STAFF TIME AND MATERIALS. AS NOTED IN DETAIL ABOVE, ANNA JAQUES HOSPITAL'S PRIMARY TOOL FOR ASSESSING THE HEALTH CARE NEEDS OF THE COMMUNITIES SERVED IS THROUGH THE CHNA AND IMPLEMENTATION STRATEGY (SCHEDULE H PART VI QUESTION 2).
FORM 990 SCHEDULE H, SUPPLEMENTAL INFORMATION	FORM 990 SCHEDULE H PART VI SUPPLEMENTAL INFORMATIONTHE PURPOSE OF THIS FORM 990 SCHEDULE H NARRATIVE DISCLOSURE IS TO HELP THE READER UNDERSTAND IN MORE DETAIL HOW AJH CARES FOR ITS COMMUNITY BY PROVIDING FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS. AS DEMONSTRATED IN THIS SCHEDULE H, 4.35% OF AJHS TOTAL EXPENSES AS REPORTED ON FORM 990 PART IX, LINE 24, ARE INCURRED IN PROVIDING FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST. COMMUNITY BENEFITSANNUAL COMMUNITY BENEFITS REPORTAS PREVIOUSLY NOTED IN THIS FILING, ANNA JAQUES HOSPITAL'S MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND IMPLEMENTATION STRATEGY WERE COMPLETED AND APPROVED BY THE COMMUNITY BENEFITS ADVISORY COMMITTEE AND BOARD OF TRUSTEES DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2019, AS REQUIRED PURSUANT TO THE REGULATIONS UNDER INTERNAL REVENUE CODE SECTION 501(R). IN ADDITION, AS NOTED IN THIS FORM 990 SCHEDULE H, PART I, LINES 6A AND 6B, THE HOSPITAL PREPARES AN ANNUAL COMMUNITY BENEFITS REPORT THAT IS SUBMITTED TO THE MASSACHUSETTS ATTORNEY GENERAL (SCHEDULE H, PART VI, LINE 7). THAT FILING IS AVAILABLE FOR PUBLIC INSPECTION AT THE ATTORNEY GENERAL'S OFFICE, ON THE ATTORNEY GENERAL'S WEBSITE AND ON THE HOSPITAL WEBSITE AT:HTTPS://MASSAGO.ONBASEONLINE.COM/MASSAGO/1801CBS/ANNUALREPORT.ASPXTHERE ARE SOME DIFFERENCES BETWEEN THE MASSACHUSETTS ATTORNEY GENERAL DEFINITION OF CHARITY CARE AND COMMUNITY BENEFITS AND THE INTERNAL REVENUE SERVICE DEFINITION OF FINANCIAL ASSISTANCE AND COMMUNITY BENEFITS. AS SUCH, THERE ARE VARIANCES BETWEEN THIS SCHEDULE H DISCLOSURE AND THE REPORT THAT [INSERT HOSPITAL NAME] FILED WITH THE ATTORNEY GENERAL'S OFFICE. COMMUNITY BENEFITSEMERGENCY ROOM OPERATIONIN ADDITION, AS NOTED IN THIS FORM 990, SCHEDULE H, PART V, SECTION A, ANNA JAQUES HOSPITAL IS A GENERAL MEDICAL AND SURGICAL HOSPITAL, PROVIDING 24-HOUR EMERGENCY MEDICAL CARE TO ALL PATIENTS WITHOUT REGARD TO ABILITY TO PAY. FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITSCHARITY CARE AND MEANS TESTED GOVERNMENT PROGRAMSFINANCIAL ASSISTANCEANNA JAQUES HOSPITAL'S NET COST OF CHARITY CARE, INCLUDING CARE FOR EMERGENT SERVICES PROVIDED TO NON-PAYING PATIENTS AND INCLUDING PAYMENTS TO THE HEALTH SAFETY NET TRUST, WAS $2,328,644 FOR THE FISCAL YEAR ENDED SEPTEMBER 30, AND HAS BEEN REPORTED ON THIS SCHEDULE H, PART I, LINE 7A. OTHER UNCOMPENSATED CHARITY CAREMEDICAID AND MEDICAREIN ADDITION TO THE CHARITY CARE REPORTED ABOVE, ANNA JAQUES HOSPITAL ALSO PROVIDES CARE TO PATIENTS WHO PARTICIPATE IN OTHER PROGRAMS DESIGNED TO SUPPORT LOW-INCOME FAMILIES, INCLUDING PARTICULARLY THE MEDICAID PROGRAM, WHICH IS JOINTLY FUNDED BY FEDERAL AND STATE GOVERNMENTS. THE MASSACHUSETTS HEALTH REFORM LAW PROVIDED AN INITIATIVE FOR EXPANSION OF MEDICAID COVERAGE TO GREATER POPULATIONS AND FOR ENROLLMENT OF UNINSURED PATIENTS IN OTHER INSURANCE PROGRAMS. PAYMENTS FROM MEDICAID AND OTHER PROGRAMS THAT INSURE LOW-INCOME POPULATIONS DO NOT COVER THE COST OF SERVICES PROVIDED. MEDICAID IS A GOVERNMENT INSURANCE PROGRAM FOR INDIVIDUALS WITH LIMITED INCOME AND RESOURCES, AND ANNA JAQUES HOSPITAL PROVIDES CARE TO PATIENTS WHO PARTICIPATE IN THE MEDICAID PROGRAM. PAYMENTS TO HOSPITALS THROUGH THIS GOVERNMENT SPONSORED PROGRAM HAVE NOT KEPT PACE WITH INFLATION AND ALTHOUGH THE PROVISION OF HEALTH CARE TO THESE PATIENTS GENERATED MEDICAID REVENUE THIS WAS LESS THAN THE COST OF CARE PROVIDED BY ANNA JAQUES HOSPITAL FOR SUCH SERVICES BY $607,554 AS REPORTED ON THIS SCHEDULE H, PART I LINE 7B. DURING THE FISCAL PERIOD COVERED BY THIS FILING, 10.0% OR 20,320 OF ANNA JAQUES HOSPITAL'S PATIENT ENCOUNTERS WERE WITH MEDICAID PATIENTS. IN ADDITION, 39.6% OR 80,362 OF THE HOSPITAL'S PATIENT CASES WERE WITH MEDICARE PATIENTS. BAD DEBTSIN ADDITION TO CHARITY CARE AND SHORTFALLS IN PROVIDING SERVICES TO PATIENTS INSURED UNDER STATE AND FEDERAL PROGRAMS, ANNA JAQUES HOSPITAL ALSO INCURS LOSSES RELATED TO SELF-PAY PATIENTS WHO FAIL TO MAKE PAYMENTS FOR SERVICES OR INSURED PATIENTS WHO FAIL TO PAY COINSURANCE OR DEDUCTIBLES FOR WHICH THEY ARE RESPONSIBLE UNDER INSURANCE CONTRACTS. BAD DEBT EXPENSE IS INCLUDED IN UNCOMPENSATED CARE EXPENSE IN THE CONSOLIDATED FINANCIAL STATEMENTS AND INCLUDES THE PROVISION FOR ACCOUNTS ANTICIPATED TO BE UNCOLLECTIBLE. CHARGES FOR THOSE SERVICES DURING THE FISCAL PERIOD COVERED BY THIS FILING OF $5,191,850 AND ARE REPORTED AS BAD DEBT ON FORM 990, SCHEDULE H, PART III, LINE 2. ANNA JAQUES HOSPITAL SIMILARLY INCURS BAD DEBT LOSSES AND INCLUDES THE PROVISION FOR ACCOUNTS ANTICIPATED TO BE UNCOLLECTIBLE IN ITS FINANCIAL STATEMENTS. ANNA JAQUES HOSPITAL CHARGES FOR THOSE SERVICES WERE $5,191,850 DURING THE FISCAL PERIOD COVERED BY THIS FILING AS REPORTED IN THE FINANCIAL STATEMENTS AND AS REPORTED ON THE FORM 990, SCHEDULE H, PART III, LINE 2. AS REQUIRED BY THE INSTRUCTIONS TO THIS FORM 990 SCHEDULE H, LOSSES RELATED TO BAD DEBTS HAVE NOT BEEN INCLUDED IN THE CALCULATION OF FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS IN SCHEDULE H PART I LINE 7. RATHER THE AMOUNT HAS BEEN SEPARATELY REPORTED IN SCHEDULE H PART III AS REQUIRED. THE PERCENTAGES CALCULATED IN PART I, LINE 7, COLUMN F, WERE BASED ON EACH ITEM OF FINANCIAL ASSISTANCE AND COMMUNITY BENEFITS AS A PERCENTAGE OF TOTAL EXPENSES REPORTED IN PART IX OF THIS FORM 990. THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF THE BETH ISRAEL LAHEY HEALTH, INC. AND AFFILIATES FOR THE SEVEN MONTHS ENDED SEPTEMBER 30, 2019 INCLUDE THE ACCOUNTS OF: BETH ISRAEL DEACONESS MEDICAL CENTER, INC. (BIDMC), MOUNT AUBURN HOSPITAL (MAH), NEW ENGLAND BAPTIST HOSPITAL (NEBH), BETH ISRAEL DEACONESS HOSPITAL MILTON, INC. (MILTON), BETH ISRAEL DEACONESS HOSPITAL NEEDHAM, INC. (NEEDHAM), BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH, INC. (PLYMOUTH), LAHEY CLINIC FOUNDATION, WINCHESTER HOSPITAL (WINCHESTER), NORTHEAST HOSPITAL CORPORATION (NORTHEAST), ANNA JAQUES HOSPITAL (AJH) AND AFFILIATES. THE FINANCIAL STATEMENTS OF THE SYSTEM ALSO INCLUDE A CONTROLLED AFFILIATE, HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER, INC. (HMFP).THE BETH ISRAEL LAHEY HEALTH INC. CONSOLIDATED FINANCIAL STATEMENTS DO NOT INCLUDE A FOOTNOTE REGARDING BAD DEBT EXPENSE.
FORM 990 SCHEDULE H, SUPPLEMENTAL INFORMATION	FINANCIAL ASSISTANCE POLICYINTERNAL REVENUE CODE SECTION 501(R)(4)FINANCIAL ASSISTANCE POLICY PURPOSE ANNA JAQUES HOSPITAL IS DEDICATED TO PROVIDING FINANCIAL ASSISTANCE TO PATIENTS WHO HAVE HEALTH CARE NEEDS AND ARE UNINSURED, UNDERINSURED, INELIGIBLE FOR A GOVERNMENT PROGRAM OR OTHERWISE UNABLE TO PAY FOR MEDICALLY NECESSARY CARE BASED ON THEIR INDIVIDUAL FINANCIAL SITUATION. THIS FINANCIAL ASSISTANCE POLICY IS INTENDED TO BE IN COMPLIANCE WITH APPLICABLE FEDERAL AND STATE LAWS FOR OUR SERVICE AREA. PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE WILL RECEIVE DISCOUNTED CARE RECEIVED FROM QUALIFYING ANNA JAQUES HOSPITAL PROVIDERS.ANNA JAQUES HOSPITAL DOES NOT DISCRIMINATE BASED ON THE PATIENT'S AGE, GENDER, RACE, CREED, RELIGION, DISABILITY, SEXUAL ORIENTATION, GENDER IDENTITY, NATIONAL ORIGIN OR IMMIGRATION STATUS WHEN DETERMINING ELIGIBILITY.FINANCIAL ASSISTANCE POLICY, CREDIT AND COLLECTION POLICY AND EMERGENCY CARE POLICYAS REQUIRED BY IRC SECTION 501(R)(4) AND THE REGULATIONS PROMULGATED THEREUNDER, THE HOSPITAL MAINTAINS A WRITTEN FINANCIAL ASSISTANCE POLICY (FAP) WHICH APPLIES TO ALL EMERGENCY AND OTHER MEDICALLY NECESSARY CARE PROVIDED BY THE HOSPITAL FACILITY (SCHEDULE H PART I QUESTIONS 1A AND 1B). DETAIL RELATED TO EMERGENCY AND OTHER MEDICALLY NECESSARY CARE COVERED BY THE POLICY IS INCLUDED WITHIN THE POLICY AND THE DEFINITION OF EMERGENCY CARE MEETS THE DEFINITION OF THE EMERGENCY MEDICAL TREATMENT AND LABOR ACT (EMTALA), SECTION 1867 OF THE SOCIAL SECURITY ACT (42 USC 1395DD). (SCHEDULE H PART V SECTION B QUESTION 21). THE FAP INCLUDES A LIST OF PROVIDERS OTHER THAN THE HOSPITAL ITSELF, WHICH ARE COVERED BY THE FAP AND SPECIFIES ELIGIBILITY CRITERIA FOR BOTH FREE AND DISCOUNTED CARE. THE HOSPITAL MAINTAINS A SEPARATE CREDIT AND COLLECTION POLICY AS PERMITTED UNDER THE TREASURY REGULATIONS AND THIS CREDIT AND COLLECTION POLICY IS REFERENCED WITHIN THE FAP AS REQUIRED, ALONG WITH INFORMATION ON HOW TO OBTAIN A FREE COPY OF THE CREDIT AND COLLECTION POLICY (SCHEDULE H PART III SECTION C QUESTIONS 9A AND 9B AND PART V SECTION B QUESTION 17). FINANCIAL ASSISTANCE POLICYELIGIBILITY GUIDELINES THE HOSPITAL'S FAP USES THE FEDERAL POVERTY GUIDELINES IN DETERMINING ELIGIBILITY FOR FREE AND DISCOUNTED CARE (SCHEDULE H PART I QUESTION 3A AND 3B AND PART V SECTION B QUESTION 13). IN ADDITION, THE HOSPITAL'S FAP PROVIDES FOR FINANCIAL ASSISTANCE BASED ON MEDICAL HARDSHIP AND ASSET LEVEL (SCHEDULE H PART I QUESTIONS 3C AND 4, PART V SECTION B QUESTION 13 AND PART VI QUESTION 3). FINALLY, THE HOSPITAL UNDERSTANDS THAT NOT ALL PATIENTS ARE ABLE TO COMPLETE A FINANCIAL ASSISTANCE APPLICATION OR COMPLY WITH REQUESTS FOR DOCUMENTATION. THERE MAY BE INSTANCES UNDER WHICH A PATIENT/GUARANTOR'S QUALIFICATION FOR FINANCIAL ASSISTANCE IS ESTABLISHED WITHOUT COMPLETING THE APPLICATION FORM. OTHER INFORMATION MAY BE USED BY THE HOSPITAL TO DETERMINE WHETHER A PATIENT/GUARANTOR'S ACCOUNT IS UNCOLLECTIBLE, AND THIS INFORMATION MAY BE USED TO DETERMINE PRESUMPTIVE ELIGIBILITY AS OUTLINED IN THE HOSPITAL'S FAP (SCHEDULE H PART I QUESTIONS 3C).FINANCIAL ASSISTANCEPUBLIC ASSISTANCE PROGRAMS (SCHEDULE H PART I QUESTION 3C)IN ADDITION TO FINANCIAL ASSISTANCE ELIGIBILITY UNDER THE HOSPITAL'S FAP, FOR THOSE INDIVIDUALS WHO ARE UNINSURED OR UNDERINSURED, THE HOSPITAL WILL WORK WITH PATIENTS TO ASSIST THEM IN APPLYING FOR PUBLIC ASSISTANCE AND/OR HOSPITAL FINANCIAL ASSISTANCE PROGRAMS THAT MAY COVER SOME OR ALL OF THEIR UNPAID HOSPITAL BILLS. TO HELP UNINSURED AND UNDERINSURED INDIVIDUALS FIND AVAILABLE AND APPROPRIATE OPTIONS, THE HOSPITAL WILL PROVIDE ALL INDIVIDUALS WITH A GENERAL NOTICE OF THE AVAILABILITY OF PUBLIC ASSISTANCE AND FINANCIAL ASSISTANCE PROGRAMS DURING THE PATIENT'S INITIAL IN-PERSON REGISTRATION AT A HOSPITAL LOCATION FOR A SERVICE, IN ALL BILLING INVOICES THAT ARE SENT TO A PATIENT OR GUARANTOR, AND WHEN THE PROVIDER IS NOTIFIED OR THROUGH ITS OWN DUE DILIGENCE BECOMES AWARE OF A CHANGE IN THE PATIENT'S ELIGIBILITY STATUS FOR PUBLIC OR PRIVATE INSURANCE COVERAGE.HOSPITAL PATIENTS MAY BE ELIGIBLE FOR FREE OR REDUCED COST OF HEALTH CARE SERVICES THROUGH VARIOUS STATE PUBLIC ASSISTANCE PROGRAMS AS WELL AS THE HOSPITAL FINANCIAL ASSISTANCE PROGRAMS (INCLUDING BUT NOT LIMITED TO MASSHEALTH, THE PREMIUM ASSISTANCE PAYMENT PROGRAM OPERATED BY THE HEALTH CONNECTOR, THE CHILDREN'S MEDICAL SECURITY PROGRAM, THE HEALTH SAFETY NET, AND MEDICAL HARDSHIP). SUCH PROGRAMS ARE INTENDED TO ASSIST LOW-INCOME PATIENTS TAKING INTO ACCOUNT EACH INDIVIDUAL'S ABILITY TO CONTRIBUTE TO THE COST OF HER OR HIS CARE. FOR THOSE INDIVIDUALS THAT ARE UNINSURED OR UNDERINSURED, THE HOSPITAL WILL, WHEN REQUESTED, HELP THEM WITH APPLYING FOR EITHER COVERAGE THROUGH PUBLIC ASSISTANCE PROGRAMS OR HOSPITAL FINANCIAL ASSISTANCE PROGRAMS THAT MAY COVER ALL OR SOME OF THEIR UNPAID HOSPITAL BILLS.THE HOSPITAL IS AVAILABLE TO ASSIST PATIENTS IN ENROLLING INTO STATE HEALTH COVERAGE PROGRAMS. THESE INCLUDE MASSHEALTH, THE PREMIUM ASSISTANCE PAYMENT PROGRAM OPERATED BY THE STATE'S HEALTH CONNECTOR, AND THE CHILDREN'S MEDICAL SECURITY PLAN. FOR THESE PROGRAMS, APPLICANTS CAN SUBMIT AN APPLICATION THROUGH AN ONLINE WEBSITE (WHICH IS CENTRALLY LOCATED ON THE STATE'S HEALTH CONNECTOR WEBSITE), A PAPER APPLICATION, OR OVER THE PHONE WITH A CUSTOMER SERVICE REPRESENTATIVE LOCATED AT EITHER MASSHEALTH OR THE CONNECTOR. INDIVIDUALS MAY ALSO ASK FOR ASSISTANCE FROM HOSPITAL FINANCIAL COUNSELORS (ALSO CALLED CERTIFIED APPLICATION COUNSELORS) WITH SUBMITTING THE APPLICATION EITHER ON THE WEBSITE OR THROUGH A PAPER APPLICATION.FINANCIAL ASSISTANCE POLICYWIDELY PUBLICIZING AND AVAILABILITYCOPIES OF THE FAP, CREDIT AND COLLECTION POLICY, AND APPLICATION FOR FINANCIAL ASSISTANCE ARE ALL AVAILABLE AT THE HOSPITAL OR BY MAIL FREE OF CHARGE AND ON THE HOSPITAL'S WEBSITE AT (SCHEDULE H PART V SECTION B QUESTIONS 16A, 16D, 16E) AT HTTPS://WWW.AJH.ORG/PATIENTS-AND-VISITORS/BILLING-AND-INSURANCEIN ADDITION, THE FAP, CREDIT AND COLLECTION POLICY, AND APPLICATION FOR FINANCIAL ASSISTANCE ARE ALL AVAILABLE IN THE HOSPITAL'S EMERGENCY DEPARTMENT AND FINANCIAL COUNSELING OFFICE (SCHEDULE H PART V SECTION B QUESTION 16F AND SCHEDULE H PART VI QUESTION 3).THE HOSPITAL MAINTAINS SIGNAGE AND CONSPICUOUS PUBLIC DISPLAYS ABOUT FINANCIAL ASSISTANCE AND THE FAP DESIGNED TO ATTRACT THE ATTENTION OF PATIENTS AND VISITORS, INCLUDING BOTH THE EMERGENCY DEPARTMENT AND ADMISSIONS. IN ADDITION, FINANCIAL COUNSELING PERSONNEL ROUTINELY VISIT LOCATIONS DESIGNATED FOR SIGNAGE TO ENSURE THAT SUCH SIGNAGE REMAINS VISIBLE TO PATIENTS AND VISITORS AS ATTENDED. THE HOSPITAL PROVIDES INFORMATION ABOUT THE FAP TO PATIENTS CONSPICUOUSLY WITHIN BILLING STATEMENTS. INFORMATION PROVIDED TO PATIENTS IN THESE COMMUNICATIONS INCLUDE CONTACT INFORMATION FOR THOSE THAT CAN HELP PROVIDE ADDITIONAL INFORMATION ABOUT THE FAP, INFORMATION ON THE APPLICATION PROCESS AND THE WEBSITE WHERE THE FAP CAN BE OBTAINED. (SCHEDULE H PART V SECTION B QUESTION 16G).
FORM 990 SCHEDULE H, SUPPLEMENTAL INFORMATION	LIMITATION ON CHARGESINTERNAL REVENUE CODE SECTION 501(R)(5)LIMITATION ON CHARGESAS REQUIRED BY IRC SECTION 501(R)(5) AND THE REGULATIONS PROMULGATED THEREUNDER, THE HOSPITAL LIMITS THE AMOUNTS CHARGED FOR ANY EMERGENCY OR OTHER MEDICALLY NECESSARY CARE IT PROVIDES TO A FINANCIAL ASSISTANCE ELIGIBLE PATIENT, TO NOT MORE THAN AMOUNTS GENERALLY BILLED (AGB) AND LIMITS THE AMOUNTS CHARGED TO ANY FINANCIAL ASSISTANCE ELIGIBLE PATIENT FOR ALL OTHER MEDICAL CARE TO LESS THAN GROSS CHARGES. PATIENT REFUNDS FOR CHARGES IN EXCESS OF AMOUNTS GENERALLY BILLEDTHE HOSPITAL REGULARLY MONITORS THE FINANCIAL ACCOUNTS OF PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE. WHERE A PATIENT SUBMITS A COMPLETED APPLICATION FOR FINANCIAL ASSISTANCE AND IS DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE, THE HOSPITAL REFUNDS ANY AMOUNTS PREVIOUSLY PAID FOR CARE THAT EXCEED THE AMOUNT THAT THE PATIENT IS PERSONALLY RESPONSIBLE FOR PAYING WHERE SUCH AMOUNTS ARE EQUAL TO OR EXCEED $5.00. BILLING AND COLLECTIONS501(R)(6)EXTRAORDINARY COLLECTION ACTIVITIESTHE HOSPITAL DOES NOT ENGAGE IN ANY EXTRAORDINARY COLLECTION ACTIVITIES (ECAS) FOR FINANCIAL ASSISTANCE ELIGIBLE PATIENTS. SPECIFICALLY, THE HOSPITAL DOES NOT REPORT TO CREDIT AGENCIES, ENGAGE IN LEGAL OR JUDICIAL PROCESSES OR SELL A PATIENT'S OUTSTANDING AMOUNTS OWED FOR PATIENT CARE. IN ADDITION, THIS EXTENDS TO ANY THIRD PARTY CONTRACTED WITH THE HOSPITAL RELATED TO BILLING AND COLLECTIONS (SCHEDULE H PART V SECTION B QUESTIONS 18 AND 19).APPLICATION PERIOD PATIENTS MAY APPLY FOR FINANCIAL ASSISTANCE AT ANY TIME UP TO TWO HUNDRED AND FORTY (240) DAYS AFTER THE FIRST POST-DISCHARGE BILLING STATEMENT IS AVAILABLE. ADDITIONAL INFORMATION REGARDING PROMOTING THE HEALTH OF THE COMMUNITY (SCHEDULE H, PART VI, QUESTIONS 5 AND 6)THE HOSPITAL MAINTAINS AN OPEN MEDICAL STAFF AND AS NOTED IN THIS FORM 990 PARTS I AND VI, THE MAJORITY OF BOARD MEMBERS ARE INDEPENDENT COMMUNITY MEMBERS. ON MARCH 1, 2019, THE BETH ISRAEL LAHEY HEALTH SYSTEM WAS FORMED THROUGH THE COMBINATION OF THE HOSPITALS AND OTHER AFFILIATES OF THREE LEGACY HEALTH CARE SYSTEMS BASED PRIMARILY IN EASTERN MASSACHUSETTS, INCLUDING THE FORMER CAREGROUP HEALTH SYSTEM, THE FORMER LAHEY HEALTH SYSTEM, AND THE SEACOAST HEALTH SYSTEM. BETH ISRAEL LAHEY HEALTH, INC. (BILH) IS NOW THE SOLE MEMBER OF THE HOSPITAL AND NINE ADDITIONAL AFFILIATED HOSPITALS. EACH OF THESE ENTITIES MAY HAVE, IN TURN, SERVED AS THE SOLE MEMBER OF ADDITIONAL AFFILIATES. THE BILH HEALTH SYSTEM IS COMMITTED TO IMPROVING THE HEALTH OF THE COMMUNITIES IT SERVES.
FORM 990 SCHEDULE H, SUPPLEMENTAL INFORMATION	AFFILIATED HEALTH CARE SYSTEMAS NOTED IN VARIOUS NARRATIVE DISCLOSURES THAT SUPPORT THIS FORM 990 AND RELATED SCHEDULES FOR THE PERIOD COVERED BY THIS FILING, BILH IS A MASSACHUSETTS NON-PROFIT CORPORATION EXEMPT FROM INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED. BILH IS AN INTEGRATED HEALTH CARE SYSTEM COMMITTED TO EXPANDING ACCESS TO EXTRAORDINARY PATIENT CARE ACROSS EASTERN MASSACHUSETTS AND ADVANCING THE SCIENCE AND PRACTICE OF MEDICINE THROUGH GROUNDBREAKING RESEARCH AND EDUCATION. THE BILH SYSTEM IS COMPRISED OF ACADEMIC AND TEACHING HOSPITALS, A PREMIER ORTHOPEDICS HOSPITAL, PRIMARY CARE AND SPECIALTY CARE PROVIDERS, AMBULATORY SURGERY CENTERS, URGENT CARE CENTERS, COMMUNITY HOSPITALS, HOMECARE SERVICES, OUTPATIENT BEHAVIORAL HEALTH CENTERS, ADDICTION TREATMENT PROGRAMS. BILH'S COMMUNITY OF CLINICIANS, CAREGIVERS AND STAFF INCLUDES APPROXIMATELY 4,000 PHYSICIANS AND 35,000 EMPLOYEES. BILH SERVES AS SOLE MEMBER OF BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC), MOUNT AUBURN HOSPITAL (MAH), NEW ENGLAND BAPTIST HOSPITAL (NEBH), BETH ISRAEL DEACONESS HOSPITAL MILTON, INC. (MILTON), BETH ISRAEL DEACONESS HOSPITAL NEEDHAM, INC. (NEEDHAM), BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH, INC. (PLYMOUTH), LAHEY CLINIC FOUNDATION, LAHEY HEALTH SHARED SERVICES, WINCHESTER HOSPITAL (WINCHESTER), NORTHEAST HOSPITAL CORPORATION (NHC), NORTHEAST BEHAVIORAL HEALTH CORPORATION (NBHC) AND ANNA JAQUES HOSPITAL). LAHEY CLINIC FOUNDATION SERVES AS THE SOLE MEMBER OF LAHEY CLINIC, INC. AND LAHEY CLINIC HOSPITAL D/B/A LAHEY HOSPITAL AND MEDICAL CENTER. EACH OF THESE AFFILIATES MAY IN TURN SERVE AS MEMBER OF ADDITIONAL ENTITIES WITHIN THE NETWORK OF AFFILIATES.IRC 501(R) REPORTING UNDER REVENUE PROCEDURE 2015-21:DURING A REVIEW OF ANNA JAQUES HOSPITAL'S SECTION 501(R) COMPLIANCE IN FY19, IT WAS DETERMINED THAT CERTAIN INFORMATION IN AJH'S FINANCIAL ASSISTANCE POLICY (FAP) REQUIRED CLARIFICATION OR CORRECTION. IN ACCORDANCE WITH THE PROCEDURES SET FORTH IN REVENUE PROCEDURE 2015-21, EACH OF THOSE ITEMS IS LISTED ALONG WITH THE METHOD OF CORRECTION. CORRECTION OCCURRED BY ADOPTION OF A REVISED FAP AND A PLAIN LANGUAGE SUMMARY OF ITS FAP (PLS) AJH'S AUTHORIZED BODY PRIOR TO FILING THIS RETURN. (1) THE FAP DID NOT CLEARLY STATE THAT IT APPLIES TO ALL EMERGENCY AND OTHER MEDICALLY NECESSARY CARE PROVIDED BY AJH AND SUBSTANTIALLY-RELATED ENTITIES OF AJH. THE FAP HAS BEEN REVISED TO INCLUDE THIS INFORMATION. (2) THE FAP DID NOT CLEARLY SPECIFY THE AVAILABILITY OF FINANCIAL ASSISTANCE PROVIDED BY AJH, THE AMOUNTS TO WHICH DISCOUNTS WOULD BE APPLIED AND THE ELIGIBILITY CRITERIA FOR FINANCIAL ASSISTANCE. THE FAP ALSO DID NOT SPECIFY HOW AN INDIVIDUAL MAY APPLY FOR ASSISTANCE FROM AJH AND DID NOT SPECIFY THE INFORMATION AJH REQUIRES AS PART OF THE APPLICATION PROCESS. THE FAP HAS BEEN REVISED TO INCLUDE THIS INFORMATION. (3) THE FAP DID NOT SPECIFY THE METHODOLOGY FOR CALCULATING THE AMOUNTS GENERALLY BILLED (AGB). THE FAP ALSO DID NOT SPECIFY AGB PERCENTAGES USED BY AJH TO DETERMINE THE AGB OR A DESCRIPTION OF THE CALCULATION OF THE AGB. THE FAP HAS BEEN REVISED TO CLARIFY THAT AJH USES THE "LOOK BACK" METHOD AND NOW SPECIFIES AGB AND A DESCRIPTION OF ITS CALCULATION. (4) THE FAP DID NOT SPECIFY THAT FOLLOWING A DETERMINATION OF FAP ELIGIBILITY, A FAP-ELIGIBLE INDIVIDUAL MAY NOT BE CHARGED MORE THAN THE AGB. THE FAP HAS BEEN REVISED TO INCLUDE THIS INFORMATION. (5) THE FAP DID NOT SPECIFY THE LOCATION OF COUNSELORS WHO ARE AVAILABLE TO PROVIDE INFORMATION AND ASSISTANCE WITH THE FAP APPLICATION. THE FAP HAS BEEN REVISED TO INCLUDE THIS INFORMATION. (6) WHILE AJH HAD NOT BEEN ENGAGING IN ANY EXTRAORDINARY COLLECTION ACTIONS (ECAS), ITS FAP DID NOT INCLUDE A DESCRIPTION OF THE OFFICE, DEPARTMENT OR COMMITTEE WITH FINAL AUTHORITY FOR DETERMINING THAT REASONABLE EFFORTS HAD BEEN MADE TO DETERMINE FAP ELIGIBILITY BEFORE ENGAGING IN ANY ECAS. THE FAP HAS BEEN REVISED TO EXPLICITLY PROHIBIT AJH FROM ENGAGING IN ECAS. (7) THE LIST OF PROVIDERS OF EMERGENCY AND MEDICALLY NECESSARY CARE AT AJH DID NOT INCLUDE ALL PROVIDERS. THE LIST HAS BEEN UPDATED AND NOW REFLECTS ALL PROVIDERS. (8) THE FAP DID NOT SPECIFICALLY STATE THAT AJH WILL PROVIDE CARE FOR EMERGENCY MEDICAL CONDITIONS TO INDIVIDUALS REGARDLESS OF THEIR ELIGIBILITY UNDER THE FAP AND DID NOT SPECIFICALLY PROHIBIT AJH FROM ENGAGING IN ACTIONS THAT DISCOURAGE INDIVIDUALS FROM SEEKING EMERGENCY MEDICAL CARE. THE FAP NOW INCLUDES THIS INFORMATION. (9) AJH HAD NOT YET ADOPTED A PLS OF ITS FAP. IT HAS NOW ADOPTED A PLS THAT COMPLIES WITH THE REQUIREMENTS OF SECTION 501(R). (10) AJH HAD NOT CONSPICUOUSLY POSTED COPIES OF ITS FAP, FAP APPLICATION AND PLS, INCLUDING APPLICABLE TRANSLATIONS, ON ITS WEBSITE. AJH HAS NOW CONSPICUOUSLY POSTED ALL OF THESE DOCUMENTS. (11) AJH HAD NOT YET MADE EFFORTS TO INFORM MEMBERS OF THE COMMUNITY SERVED BY AJH ABOUT THE FAP IN A MANNER REASONABLY CALCULATED TO REACH THOSE MEMBERS WHO ARE MOST LIKELY TO REQUIRE FINANCIAL ASSISTANCE. AJH HAS SINCE MADE SUCH EFFORTS, INCLUDING BY DISTRIBUTING COPIES OF ITS FAP AND FAP APPLICATION TO REFERRING STAFF PHYSICIANS AND TO COMMUNITY HEALTH CENTERS SERVING AJH'S COMMUNITY. (12) AJH HAD NOT ENSURED THAT IT HAD TRANSLATED ITS FAP, FAP APPLICATION AND PLS INTO THE PRIMARY LANGUAGE SPOKEN BY EACH LIMITED ENGLISH PROFICIENCY GROUP IN ITS COMMUNITY. SUCH TRANSLATIONS HAVE NOW BEEN MADE.FINALLY, AJH HAS ADOPTED PROCEDURES THAT REQUIRE AJH TO REVIEW, ON A REGULAR BASIS, AJH'S POLICIES AND PROCEDURE TO ENSURE COMPLIANCE WITH THE REQUIREMENTS OF SECTION 501(R) AND THE REGULATIONS ISSUED THEREUNDER. THOSE PROCEDURES INCLUDE REVIEWING A SECTION 501(R) COMPLIANCE CHECKLIST.

Schedule H (Form 990) 2018

Additional Data

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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

2018

Open to Public
Inspection

Name of the organization
ANNA JAQUES HOSPITAL INC

Employer identification number
04-2104338

Part I

General Information on Grants and Assistance

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? ........................

Yes No

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	(h) Purpose of grant or assistance
(1) ESSEX COUNTY ASSET BUILDER (ECAB) PARENT SPEAKER SERIES NEWBURY RECREATION CENTER 40 MILK STREET NEWBURYPORT,MA01950			5,000	SUPPORT FOR FAMILY EDUCATION SERIES
(2) NEWBURYPORT FARMERS' MARKET 50 WATER ST NEWBURYPORT,MA01950			8,645	SUPPORT FOR HEALTHY FOOD IN THE COMMUNITY
(3) SEACOAST AFFILIATED GROUP PRACTICE 25 HIGHLAND AVE NEWBURYPORT,MA01950	04-3485648	501(C)(3)	58,375	TO ASSIST IN FUNDING

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2018

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

PART I, LINE 2:

AS PREVIOUSLY NOTED IN THE FILING ANNA JAQUES HOSPITAL, INC., MAINTAINS STRONG RELATIONSHIP WITH MANY PARTNERS AND ANNA JAQUES HOSPITAL, INC. WORKS WITH THOSE PARTNERS AS PART OF ITS COMMUNITY BENEFIT MISSION AND ACTIVITIES. PURSUANT TO THOSE RELATIONSHIPS, GRANTS MAY BE DISTRIBUTED TO THESE PARTNERS. ANNA JAQUES HOSPITAL, INC. ENSURES THAT FUNDS GRANTED ARE USED FOR THE INTENDED PURPOSES AS PART OF ITS ON-GOING AND CLOSE CONNECTIONS WITH THESE COMMUNITY PARTNERS.

Schedule I (Form 990) 2018

Additional Data

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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

2018

Open to Public Inspection

Name of the organization

ANNA JAQUES HOSPITAL INC

Employer identification number

04-2104338

Part I

Questions Regarding Compensation

Yes

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.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in 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 .........

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 in line 1a? ..

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.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

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:

Receive a severance payment or change-of-control payment? .............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

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.

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:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

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:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

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 ............

Yes

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 ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2018

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
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1GOLDSTEIN MARK TRUSTEE (EX-OFF), PRES, CEO	(i) (ii)	409,109 ------------- 175,332	175,000 ------------- 75,000	7,000 ------------- 3,000	22,225 ------------- 9,525	24,129 ------------- 10,341	637,463 ------------- 273,198	0 ------------- 0
2NESTO MD RICHARD TRUSTEE (EX-OFF) CEO DESIGNEE	(i) (ii)	0 ------------- 742,043	0 ------------- 0	0 ------------- 120,935	0 ------------- 36,500	0 ------------- 31,937	0 ------------- 931,415	0 ------------- 0
3PURSLEY MD DEWAYNE M TRUSTEE	(i) (ii)	0 ------------- 718,732	0 ------------- 1,100	0 ------------- 15,352	0 ------------- 55,000	0 ------------- 32,124	0 ------------- 822,308	0 ------------- 0
4SWIERZEWSKI DAVID TTEE, PRES OF MED STAFF	(i) (ii)	50,925 ------------- 417,091	0 ------------- 91,511	0 ------------- 0	0 ------------- 8,250	0 ------------- 28,179	50,925 ------------- 545,031	0 ------------- 0
5TABB MD KEVIN TRUSTEE (EX-OFF); CEO	(i) (ii)	0 ------------- 1,184,747	0 ------------- 552,000	0 ------------- 20,206	0 ------------- 93,674	0 ------------- 50,030	0 ------------- 1,900,657	0 ------------- 0
6FISCHER STEVEN P TREASURER (EX-OFFICIO)	(i) (ii)	0 ------------- 565,045	0 ------------- 151,691	0 ------------- 53,474	0 ------------- 18,750	0 ------------- 57,012	0 ------------- 845,972	0 ------------- 0
7KATZ JAMIE CLERK, EX-OFFICIO	(i) (ii)	0 ------------- 415,671	0 ------------- 111,276	0 ------------- 33,516	0 ------------- 17,792	0 ------------- 26,216	0 ------------- 604,471	0 ------------- 0
8KILDAY KEVIN CHIEF FINANCIAL OFFICER	(i) (ii)	198,797 ------------- 132,532	12,000 ------------- 8,000	0 ------------- 0	12,875 ------------- 8,583	24,211 ------------- 16,140	247,883 ------------- 165,255	0 ------------- 0
9FAYRE GAIL CHIEF MEDICAL OFFICER	(i) (ii)	203,215 ------------- 135,477	11,432 ------------- 7,621	4,598 ------------- 3,066	13,867 ------------- 9,244	21,942 ------------- 14,628	255,054 ------------- 170,036	0 ------------- 0
10LEE GARY CHIEF OPERATING OFFICER	(i) (ii)	200,170 ------------- 0	5,457 ------------- 0	0 ------------- 0	14,860 ------------- 0	36,254 ------------- 0	256,741 ------------- 0	0 ------------- 0
11MAKI RICHARD CHIEF NURSING OFFICER	(i) (ii)	236,817 ------------- 0	9,855 ------------- 0	10,589 ------------- 0	12,982 ------------- 0	42,022 ------------- 0	312,265 ------------- 0	0 ------------- 0
12ABBY-STEARNS ELIZABETH NURSING SUPERVISOR	(i) (ii)	166,431 ------------- 0	0 ------------- 0	0 ------------- 0	2,422 ------------- 0	16,231 ------------- 0	185,084 ------------- 0	0 ------------- 0
13BUCHANAN ROBERT DIRECTOR IS	(i) (ii)	186,201 ------------- 0	2,108 ------------- 0	0 ------------- 0	3,751 ------------- 0	40,101 ------------- 0	232,161 ------------- 0	0 ------------- 0
14PERRY DANIELLE VP PUBLIC RELATIONS	(i) (ii)	178,072 ------------- 0	14,831 ------------- 0	0 ------------- 0	13,976 ------------- 0	27,263 ------------- 0	234,142 ------------- 0	0 ------------- 0
15SOLDANO JOSEPH DIR FINANCIAL PLANNING	(i) (ii)	151,863 ------------- 0	570 ------------- 0	0 ------------- 0	8,065 ------------- 0	37,142 ------------- 0	197,640 ------------- 0	0 ------------- 0
16SZUKSTA WALTER DIR SURGICAL SVCS	(i) (ii)	146,388 ------------- 0	570 ------------- 0	0 ------------- 0	4,896 ------------- 0	29,607 ------------- 0	181,461 ------------- 0	0 ------------- 0
17O'CONNOR DELIA FORMER CHIEF EXECUTIVE OFFICER	(i) (ii)	0 ------------- 0	0 ------------- 0	166,584 ------------- 0	0 ------------- 0	0 ------------- 0	166,584 ------------- 0	0 ------------- 0
18SALVO STEPHEN FORMER VP HR	(i) (ii)	171,888 ------------- 0	0 ------------- 0	3,900 ------------- 0	17,680 ------------- 0	22,194 ------------- 0	215,662 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2018

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 4B	AS REQUIRED BY THIS FORM 990, SCHEDULE J, COMPENSATION INFORMATION, THE COMPENSATION DETAIL INCLUDED IN ANNA JAQUES HOSPITAL'S FORM 990 FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2019 IS CALENDAR YEAR 2018 DETAIL. DURING THE 2018 CALENDAR YEAR, ANNA JAQUES HOSPITAL WAS A PARTICIPATING EMPLOYER IN A NON-QUALIFIED DEFERRED COMPENSATION PLAN AND PURSUANT TO THE PLAN ELIGIBLE EMPLOYEES RECEIVE CERTAIN RETIREMENT BENEFITS. CONTRIBUTIONS RECEIVED BY PARTICIPANTS AND RELATED TO THESE PLANS ARE INCLUDED IN FORM 990 SCHEDULE J, PART II, COLUMN B(III), OTHER REPORTABLE COMPENSATION AND/OR FORM 990, SCHEDULE J, PART II, COLUMN C, DEFERRED COMPENSATION IN ACCORDANCE WITH THE INSTRUCTIONS TO THIS FORM 990. ADDITIONAL INFORMATION IS INCLUDED WITH THE EXPLANATORY NOTES TO SCHEDULE J BELOW.
PART I, LINE 7	THE ANNA JAQUES HOSPITAL EXECUTIVE COMPENSATION PACKAGES AND CERTAIN EMPLOYEE COMPENSATION PACKAGES INCLUDED OPPORTUNITIES TO EARN INCENTIVE COMPENSATION BASED ON A COMBINATION OF MEETING OR EXCEEDING PRE-DETERMINED GOALS. FOR THE PERIOD COVERED BY THIS FILING, THE INCENTIVE COMPENSATION FOR EACH EXECUTIVE REPORTED IN THIS FORM 990 WAS REVIEWED AND APPROVED BY THE ANNA JAQUES HOSPITAL COMPENSATION COMMITTEE , WHICH AS PREVIOUSLY NOTED, WAS FULLY STAFFED BY INDEPENDENT MEMBERS.
SCHEDULE J ADDITIONAL EXPLANATORY FOOTNOTES:	THE FILING ORGANIZATION HAS PROVIDED DETAILED NARRATIVE DISCLOSURE FOR EACH INDIVIDUAL LISTED IN PART VII. NOTE, HOWEVER, THAT THE ORDER OF THE NARRATIVE DISCLOSURE INCLUDED BELOW MAY NOT COINCIDE WITH THE ORDER OF THE INDIVIDUALS LISTED IN PART VII. REPORTABLE COMPENSATION LISTED IN FORM 990 PART VII INCLUDES BASE COMPENSATION, INCENTIVE COMPENSATION AND OTHER REPORTABLE COMPENSATION AS REPORTED IN FORM 990 SCHEDULE J. OTHER COMPENSATION LISTED IN FORM 990 PART VII INCLUDES DEFERRED COMPENSATION AND NON-TAXABLE BENEFITS AS REPORTED IN FORM 990 SCHEDULE J. BASE COMPENSATION: AMOUNTS NOT OTHERWISE SEPARATELY NOTED IN THIS RETURN BUT QUANTIFIED IN BASE COMPENSATION INCLUDE AMOUNTS FROM ONE OR MORE OF THE FOLLOWING ITEMS: REGULAR WAGES, EMPLOYEE DEFERRALS TO A 401(K) AND/OR 403(B) PLAN OTHER REPORTABLE COMPENSATION: AMOUNTS QUANTIFIED IN OTHER REPORTABLE COMPENSATION WHICH MAY NOT BE SEPARATELY NOTED IN THIS FILING INCLUDE AMOUNTS FROM ONE OR MORE OF THE FOLLOWING ITEMS: TAXABLE EMPLOYER-SUBSIDIZED PARKING; TAXABLE MOVING EXPENSES; TAXABLE LIFE, DISABILITY, OR LONG-TERM CARE INSURANCE; AMOUNTS DEFERRED BY THE EMPLOYEE (PLUS EARNINGS) UNDER FULLY VESTED 457(B) PLAN; DISTRIBUTIONS FROM A 457(B) PLAN; AMOUNTS INCLUDIBLE IN INCOME UNDER A 457(F) PLAN; INCREASE/DECREASE IN VALUE OF NONQUALIFIED RETIREMENT BENEFITS; OTHER TAXABLE RETIREMENT BENEFITS DEFERRED COMPENSATION: AMOUNTS NOT OTHERWISE SEPARATELY NOTED BUT QUANTIFIED IN DEFERRED COMPENSATION INCLUDE AMOUNTS FROM ONE OR MORE OF THE FOLLOWING ITEMS: EMPLOYER CONTRIBUTIONS TO 401K RETIREMENT PLAN, EMPLOYER CONTRIBUTIONS TO 403B RETIREMENT PLAN, EMPLOYER CONTRIBUTION TO PENSION PLAN AND/OR THE CHANGE IN ACTUARIAL VALUE OF THE PENSION PLAN BENEFIT, UNFUNDED AND UNVESTED AMOUNTS DEFERRED UNDER 457(F) PLAN NON-TAXABLE BENEFITS: AMOUNTS NOT OTHERWISE SEPARATELY NOTED BUT QUANTIFIED IN NON-TAXABLE BENEFITS INCLUDE AMOUNTS FROM ONE OR MORE OF THESE NON-TAXABLE BENEFITS: EMPLOYEE CONTRIBUTIONS TO HEALTH INSURANCE, EMPLOYER CONTRIBUTIONS TO HEALTH INSURANCE, EMPLOYEE CONTRIBUTIONS TO FLEXIBLE SPENDING ACCOUNTS FOR DEPENDENT CARE AND/OR MEDICAL REIMBURSEMENT, ADOPTION ASSISTANCE, TUITION ASSISTANCE PURSUANT TO AN EMPLOYER PLAN, GROUP TERM LIFE INSURANCE, DISABILITY INSURANCE ALL DIRECTORS/TRUSTEES SERVE WITHOUT COMPENSATION OR BENEFITS. COMPENSATION PAID TO OFFICERS, DIRECTORS/TRUSTEES OR KEY EMPLOYEES WAS EARNED FOR WORK PERFORMED IN A CAPACITY OTHER THAN THAT OF DIRECTOR/TRUSTEE, AS DENOTED BY THE LISTED TITLES. ANNA JAQUES HOSPITAL, ANNA JAQUES COMMUNITY HEALTH FOUNDATION AND SEACOAST AFFILIATED GROUP PRACTICES, INC. MAY BE REFERRED TO IN THESE EXPLANATORY NOTES TO FORM 990 PART VII AND FORM 990 SCHEDULE J AS AJH, AJCHF, AND SAGP RESPECTIVELY. GOLDSTEIN, MARK TRUSTEE (EX-OFFICIO), PRESIDENT, CEO ANNA JAQUES HOSPITAL TRUSTEE (EX-OFFICIO) ANNA JAQUES COMMUNITY HEALTH FOUNDATION TRUSTEE (EX-OFFICIO), PRESIDENT SEACOAST AFFILIATED GROUP PRACTICES, INC. MR. GOLDSTEIN PERFORMS SERVICES FOR AJH, AJCHF, AND SAGP. ALTHOUGH MR. GOLDSTEIN IS PAID DIRECTLY BY AJH, THE PORTION OF MR. GOLDSTEIN'S COMPENSATION ATTRIBUTABLE TO EACH POSITION HAS BEEN SEPARATELY REPORTED ON THIS FORM 990, AS FURTHER OUTLINED BELOW. PAYMENTS REPORTED BY AJH: BASE COMPENSATION: 409,109 INCENTIVE COMPENSATION: 175,000 OTHER REPORTABLE COMPENSATION: 7,000 DEFERRED COMPENSATION: 22,225 NON-TAXABLE BENEFITS: 24,129 PAYMENTS REPORTED BY AJCHF: BASE COMPENSATION: 58,444 INCENTIVE COMPENSATION: 25,000 OTHER REPORTABLE COMPENSATION: 1,000 DEFERRED COMPENSATION: 3,175 NON-TAXABLE BENEFITS: 3,447 PAYMENTS REPORTED BY SAGP: BASE COMPENSATION: 116,888 INCENTIVE COMPENSATION: 50,000 OTHER REPORTABLE COMPENSATION: 2,000 DEFERRED COMPENSATION: 6,350 NON-TAXABLE BENEFITS: 6,894 OTHER REPORTABLE AND DEFERRED COMPENSATION FOR DR. GOLDSTEIN INCLUDES COMBINED PAYMENTS FROM NONQUALIFIED RETIREMENT PLANS IN THE AMOUNT OF $18,000. OF THIS AMOUNT, $18,000 IS BOTH UNFUNDED AND UNVESTED.
SCHEDULE J ADDITIONAL EXPLANATORY FOOTNOTES:	KILDAY, KEVIN CHIEF FINANCIAL OFFICER ANNA JAQUES HOSPITAL TREASURER ANNA JAQUES COMMUNITY HEALTH FOUNDATION CHIEF FINANCIAL OFFICER SEACOAST AFFILIATED GROUP PRACTICES, INC. MR. KILDAY PERFORMS SERVICES FOR AJH, AJCHF, AND SAGP. ALTHOUGH MR. KILDAY IS PAID DIRECTLY BY AJH, THE PORTION OF MR. KILDAY 'S COMPENSATION ATTRIBUTABLE TO EACH POSITION HAS BEEN SEPARATELY REPORTED ON THIS FORM 990, AS FURTHER OUTLINED BELOW. PAYMENTS REPORTED BY AJH: BASE COMPENSATION: 198,797 INCENTIVE COMPENSATION: 12,000 OTHER REPORTABLE COMPENSATION: 0 DEFERRED COMPENSATION: 12,875 NON-TAXABLE BENEFITS: 24,211 PAYMENTS REPORTED BY AJCHF: BASE COMPENSATION: 33,133 INCENTIVE COMPENSATION: 2,000 OTHER REPORTABLE COMPENSATION: 0 DEFERRED COMPENSATION: 2,146 NON-TAXABLE BENEFITS: 4,035 PAYMENTS REPORTED BY SAGP: BASE COMPENSATION: 99,399 INCENTIVE COMPENSATION: 6,000 OTHER REPORTABLE COMPENSATION: 0 DEFERRED COMPENSATION: 6,437 NON-TAXABLE BENEFITS: 12,105 OTHER REPORTABLE AND DEFERRED COMPENSATION FOR DR. KILDAY INCLUDES COMBINED PAYMENTS FROM NONQUALIFIED RETIREMENT PLANS IN THE AMOUNT OF $10,458. OF THIS AMOUNT, $10,458 IS BOTH UNFUNDED AND UNVESTED. FAYRE, GAIL CHIEF MEDICAL OFFICER ANNA JAQUES HOSPITAL CHIEF MEDICAL OFFICER SEACOAST AFFILIATED GROUP PRACTICES, INC. MS. FAYRE PERFORMS SERVICES FOR AJH AND SAGP. ALTHOUGH MS. FAYRE IS PAID DIRECTLY BY AJH, THE PORTION OF MS. FAYRE'S COMPENSATION ATTRIBUTABLE TO EACH POSITION HAS BEEN SEPARATELY REPORTED ON THIS FORM 990, AS FURTHER OUTLINED BELOW. PAYMENTS REPORTED BY AJH: BASE COMPENSATION: 203,215 INCENTIVE COMPENSATION: 11,432 OTHER REPORTABLE COMPENSATION: 4,598 DEFERRED COMPENSATION: 13,867 NON-TAXABLE BENEFITS: 21,942 PAYMENTS REPORTED BY SAGP: BASE COMPENSATION: 135,477 INCENTIVE COMPENSATION: 7,621 OTHER REPORTABLE COMPENSATION: 3,066 DEFERRED COMPENSATION: 9,244 NON-TAXABLE BENEFITS: 14,628 OTHER REPORTABLE AND DEFERRED COMPENSATION FOR MS. FAYRE INCLUDES COMBINED PAYMENTS FROM NONQUALIFIED RETIREMENT PLANS IN THE AMOUNT OF $18,500. OF THIS AMOUNT, $10,836 IS BOTH UNFUNDED AND UNVESTED. O'CONNOR, DELIA FORMER CHIEF EXECUTIVE OFFICER ANNA JAQUES HOSPITAL FORMER CHIEF EXECUTIVE OFFICER ANNA JAQUES COMMUNITY HEALTH FOUNDATION FORMER CHIEF EXECUTIVE OFFICER SEACOAST AFFILIATED GROUP PRACTICES, INC. PAYMENTS REPORTED BY AJH: BASE COMPENSATION: 0 INCENTIVE COMPENSATION: 0 OTHER REPORTABLE COMPENSATION: 166,584 DEFERRED COMPENSATION: 0 NON-TAXABLE BENEFITS: 0 OTHER REPORTABLE AND DEFERRED COMPENSATION FOR MS. O'CONNOR INCLUDES COMBINED PAYMENTS FROM NONQUALIFIED RETIREMENT PLANS IN THE AMOUNT OF $105,312. SWIERZEWSKI, DAVID TRUSTEE, PRESIDENT OF MEDICAL STAFF ANNA JAQUES HOSPITAL TRUSTEE (EX-OFFICIO), PRESIDENT OF MEDICAL STAFF SEACOAST AFFILIATED GROUP PRACTICES, INC. TRUSTEE ANNA JAQUES COMMUNITY HEALTH FOUNDATION PAYMENTS REPORTED BY AJH: BASE COMPENSATION: 50,925 INCENTIVE COMPENSATION: 0 OTHER REPORTABLE COMPENSATION: 0 DEFERRED COMPENSATION: 0 NON-TAXABLE BENEFITS: 0 PAYMENTS REPORTED BY SAGP: BASE COMPENSATION: 417,091 INCENTIVE COMPENSATION: 91,511 OTHER REPORTABLE COMPENSATION: 0 DEFERRED COMPENSATION: 8,250 NON-TAXABLE BENEFITS: 28,179 PURSLEY, M.D., DEWAYNE M. PRESIDENT AND DIRECTOR (EX-OFFICIO) BETH ISRAEL DEACONESS DEPARTMENT OF NEONATOLOGY FOUNDATION DIRECTOR (EX-OFFICIO) AND CHAIR, DEPARTMENT OF NEONATOLOGY HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER CHIEF OF NEONATOLOGY BETH ISRAEL DEACONESS MEDICAL CENTER ASSOCIATE PROFESSOR OF PEDIATRICS HARVARD MEDICAL SCHOOL TRUSTEE ANNA JAQUES HOSPITAL TRUSTEE SEACOAST AFFILIATED GROUP PRACTICES, INC. DR. PURSLEY PERFORMS SERVICES FOR BOTH HMFP AND BIDMC. AS REQUIRED BY THIS FORM 990, ALTHOUGH DR. PURSLEY IS PAID DIRECTLY BY HMFP, THE PORTION OF DR. PURSLEY'S COMPENSATION ATTRIBUTABLE TO EACH POSITION HAS BEEN SEPARATELY REPORTED ON THIS FORM 990, AS FURTHER OUTLINED BELOW. PAYMENTS REPORTED BY HMFP: BASE COMPENSATION: 329,561 INCENTIVE COMPENSATION: 550 OTHER REPORTABLE COMPENSATION: 7,676 DEFERRED COMPENSATION: 27,500 NON-TAXABLE BENEFITS: 16,062 PAYMENTS REPORTED BY BIDMC: BASE COMPENSATION: 329,561 INCENTIVE COMPENSATION: 550 OTHER REPORTABLE COMPENSATION: 7,676 DEFERRED COMPENSATION: 27,500 NON-TAXABLE BENEFITS: 16,062 DR. PURSLEY ALSO PERFORMS SERVICES FOR SEACOAST AFFILIATED GROUP PRACTICES, INC. DR. PURSLEY'S COMPENSATION PAID DIRECTLY BY SEACOAST AFFILIATED GROUP PRACTICES, INC. HAS BEEN SEPARATELY REPORTED ON THIS FORM 990, AS FURTHER OUTLINED BELOW. PAYMENTS REPORTED BY SEACOAST AFFILIATED GROUP PRACTICES, INC.: BASE COMPENSATION: 59,610 INCENTIVE COMPENSATION: 0 OTHER REPORTABLE COMPENSATION:0 DEFERRED COMPENSATION: 0 NON-TAXABLE BENEFITS: 0 GHIASUDDEN, M.D., SALMAN TRUSTEE ANNA JAQUES HOSPITAL TRUSTEE SEACOAST AFFILIATED GROUP PRACTICES, INC. PAYMENTS REPORTED BY AJH: BASE COMPENSATION: 24,000 INCENTIVE COMPENSATION: 0 OTHER REPORTABLE COMPENSATION: 0 DEFERRED COMPENSATION: 0 NON-TAXABLE BENEFITS: 0 MAKI, RICHARD CHIEF NURSING OFFICER ANNA JAQUES HOSPITAL PAYMENTS REPORTED BY AJH: BASE COMPENSATION: 236,817 INCENTIVE COMPENSATION: 9,855 OTHER REPORTABLE COMPENSATION: 10,589 DEFERRED COMPENSATION: 12,982 NON-TAXABLE BENEFITS: 42,022 OTHER REPORTABLE AND DEFERRED COMPENSATION FOR DR. MAKI INCLUDES COMBINED PAYMENTS FROM NONQUALIFIED RETIREMENT PLANS IN THE AMOUNT OF $18,464. OF THIS AMOUNT, $7,875 IS BOTH UNFUNDED AND UNVESTED. SALVO, STEPHEN FORMER VP HR ANNA JAQUES HOSPITAL FORMER VP HR ANNA JAQUES COMMUNITY HEALTH FOUNDATION FORMER VP HR SEACOAST AFFILIATED GROUP PRACTICES, INC. PAYMENTS REPORTED BY AJH: BASE COMPENSATION: 171,888 INCENTIVE COMPENSATION: 0 OTHER REPORTABLE COMPENSATION: 3,900 DEFERRED COMPENSATION: 17,680 NON-TAXABLE BENEFITS: 22,194 OTHER REPORTABLE AND DEFERRED COMPENSATION FOR DR. SALVO INCLUDES COMBINED PAYMENTS FROM NONQUALIFIED RETIREMENT PLANS IN THE AMOUNT OF $17,971. OF THIS AMOUNT, $14,071 IS BOTH UNFUNDED AND UNVESTED.
SCHEDULE J ADDITIONAL EXPLANATORY FOOTNOTES:	LEE, GARY CHIEF OPERATING OFFICER ANNA JAQUES HOSPITAL PAYMENTS REPORTED BY AJH: BASE COMPENSATION: 200,170 INCENTIVE COMPENSATION: 5,457 OTHER REPORTABLE COMPENSATION: 0 DEFERRED COMPENSATION: 14,860 NON-TAXABLE BENEFITS: 36,254 OTHER REPORTABLE AND DEFERRED COMPENSATION FOR DR. LEE INCLUDES COMBINED PAYMENTS FROM NONQUALIFIED RETIREMENT PLANS IN THE AMOUNT OF $6,426. OF THIS AMOUNT, $6,426 IS BOTH UNFUNDED AND UNVESTED. LAFLAMME, DAVID TRUSTEE, CHAIRMAN ANNA JAQUES HOSPITAL TRUSTEE (EX-OFFICIO) ANNA JAQUES COMMUNITY HEALTH FOUNDATION TRUSTEE, CHAIRMAN SEACOAST AFFILIATED GROUP PRACTICES, INC. MATTHEWS, BYRON TRUSTEE ANNA JAQUES HOSPITAL TRUSTEE SEACOAST AFFILIATED GROUP PRACTICES, INC. HEERSINK, BEN TRUSTEE ANNA JAQUES HOSPITAL TRUSTEE SEACOAST AFFILIATED GROUP PRACTICES, INC. BOUTON, CHRISTOPHER TRUSTEE ANNA JAQUES HOSPITAL TRUSTEE SEACOAST AFFILIATED GROUP PRACTICES, INC. SEYMOUR, PETER TRUSTEE ANNA JAQUES HOSPITAL TRUSTEE SEACOAST AFFILIATED GROUP PRACTICES, INC. NESTO, M.D., RICHARD EFFECTIVE MARCH 1, 2019, DR. NESTO HELD THE FOLLOWING POSITIONS: CHIEF MEDICAL OFFICER, BETH ISRAEL LAHEY HEALTH TRUSTEE (EX-OFFICIO, BILH CEO DESIGNATE) ANNA JAQUES HOSPITAL TRUSTEE (EX-OFFICIO) SEACOAST AFFILIATES GROUP PRACTICE TRUSTEE (EX-OFFICIO, BILH CEO DESIGNATE) NORTHEAST HOSPITAL CORPORATION TRUSTEE (EX-OFFICIO, BILH CEO DESIGNATE) WINCHESTER HOSPITAL TRUSTEE (EX-OFFICIO) WINCHESTER HEALTHCARE MANAGEMENT, INC. DIRECTOR, WINCHESTER PHYSICIAN ASSOCIATES DIRECTOR, CONCORD SPECIALISTS, LLC DR. NESTO HELD THE FOLLOWING POSITIONS FROM OCTOBER 1, 2018 UNTIL MARCH 1, 2019: TRUSTEE (EX-OFFICIO) AND PRESIDENT LAHEY HEALTH SHARED SERVICES, INC. TRUSTEE AND PRESIDENT BETH ISRAEL LAHEY HEALTH PRIMARY CARE, INC. F/K/A LAHEY PHYSICIAN COMMUNITY ORGAIZATION I, INC. TRUSTEE (EX-OFFICIO) AND PRESIDENT ADDISON GILBERT SOCIETY, INC. TRUSTEE (EX-OFFICIO) AND PRESIDENT NORTHEAST HEALTH SYSTEM, INC. TRUSTEE AND PRESIDENT NORTHEAST PROFESSIONAL REGISTRY OF NURSES TRUSTEE (EX-OFFICIO) AND PRESIDENT NORTHEAST SENIOR HEALTH CORPORATION TRUSTEE (EX-OFFICIO) AND PRESIDENT SEACOAST NURSING & REHABILITATION CENTER, INC. TRUSTEE (EX-OFFICIO) AND PRESIDENT WINCHESTER HOSPITAL FOUNDATION, INC. TRUSTEE (EX-OFFICIO) AND PRESIDENT WINCHESTER HEALTHCARE MANAGEMENT, INC. TRUSTEE (EX-OFFICIO) AND PRESIDENT LAHEY CLINIC FOUNDATION, INC. TREASURER (EX-OFFICIO) LAHEY CLINIC, INC. TRUSTEE LAHEY CLINIC HOSPITAL, INC. D/B/A LAHEY HOSPITAL AND MEDICAL CENTER TRUSTEE (EX-OFFICIO) & PRESIDENT NORTHEAST HOSPITAL CORPORATION TRUSTEE AND PRESIDENT NORTHEAST MEDICAL PRACTICE TRUSTEE (EX-OFFICIO) AND PRESIDENT NORTHEAST BEHAVIORAL HEALTH CORPORATION TRUSTEE AND PRESIDENT CAB HEALTH & RECOVERY SERVICES, INC. TRUSTEE AND PRESIDENT HEALTH & EDUCATION HOUSING SERVICES, INC. TRUSTEE AND PRESIDENT WINCHESTER HOSPITAL TRUSTEE (EX-OFFICIO), PRESIDENT, AND CHIEF EXECUTIVE OFFICER LAHEY HEALTH SYSTEM, INC. PRESIDENT AND DIRECTOR LEDGEWOOD HEALTHCARE CORPORATION PRESIDENT AND DIRECTOR NORTHEAST PROPRIETARY CORPORATION DIRECTOR -- WINCHESTER PHYSICIAN ASSOCIATES AS NOTED IN THIS FILING, AND AS REQUIRED IN THIS FORM 990, COMPENSATION REPORTED FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2019 IS CALENDAR YEAR 2018 COMPENSATION. PAYMENTS REPORTED BY LHSI: BASE COMPENSATION: 742,043 INCENTIVE COMPENSATION: 0 OTHER REPORTABLE COMPENSATION: 120,935 DEFERRED COMPENSATION: 36,500 NON-TAXABLE BENEFITS: 31,937 OTHER REPORTABLE COMPENSATION FOR DR. NESTO INCLUDES COMBINED PAYMENTS TO, AND CHANGE IN VALUE OF, A 457(F) PLAN IN THE AMOUNT OF $83,602.
SCHEDULE J ADDITIONAL EXPLANATORY FOOTNOTES:	ELLISON, GEORGE JR. TRUSTEE ANNA JAQUES HOSPITAL TRUSTEE SEACOAST AFFILIATED GROUP PRACTICES, INC. ERAMO, GINNY TRUSTEE, SECRETARY ANNA JAQUES HOSPITAL TRUSTEE, SECRETARY SEACOAST AFFILIATED GROUP PRACTICES, INC. CONNOLLY, GRACE TRUSTEE, VICE CHAIR ANNA JAQUES HOSPITAL TRUSTEE, VICE CHAIR SEACOAST AFFILIATED GROUP PRACTICES, INC. KATZ, J.D., JAMIE EFFECTIVE MARCH 1, 2019, MR. KATZ HELD THE FOLLOWING POSITIONS: GENERAL COUNSEL AND CLERK (EX-OFFICIO) BETH ISRAEL LAHEY HEALTH, INC. CLERK (EX-OFFICIO) BETH ISRAEL DEACONESS MEDICAL CENTER, INC. DIRECTOR AND CLERK BETH ISRAEL DEACONESS MEDICAL CENTER PHARMACY, INC. CLERK (EX-OFFICIO) BETH ISRAEL DEACONESS HOSPITAL NEEDHAM CLERK (EX-OFFICIO) MOUNT AUBURN HOSPITAL CLERK (EX-OFFICIO) NEW ENGLAND BAPTIST HOSPITAL CLERK (EX-OFFICIO) BETH ISRAEL DEACONESS HOSPITAL MILTON CLERK COMMUNITY PHYSICIANS ASSOCIATION, INC. CLERK BETH ISRAEL DEACONESS MILTON PHYSICIAN ASSOCIATES F/K/A MILTON HOSPITAL FOUNDATION CLERK (EX-OFFICIO) BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH CLERK (EX-OFFICIO) JORDAN PHYSICIANS ASSOCIATES, INC. CLERK JORDAN HEALTH SYSTEMS CLERK (EX-OFFICIO) ANNA JACQUES HOSPITAL CLERK (EX-OFFICIO) SEACOAST AFFILIATED GROUP PRACTICE TRUSTEE AND CLERK LAHEY HEALTH SHARED SERVICES, INC. TRUSTEE, CHAIR, PRESIDENT AND CLERK BETH ISRAEL LAHEY HEALTH PRIMARY CARE, INC. CLERK (EX-OFFICIO) ADDISON GILBERT SOCIETY, INC. TRUSTEE (EX-OFFICIO) AND CLERK NORTHEAST HEALTH SYSTEM, INC. CLERK NORTHEAST PROFESSIONAL REGISTRY OF NURSES TRUSTEE (EX-OFFICIO) AND CLERK NORTHEAST SENIOR HEALTH CORPORATION TRUSTEE (EX-OFFICIO) AND CLERK SEACOAST NURSING & REHABILITATION CENTER, INC. CLERK (EX-OFFICIO) WINCHESTER HOSPITAL FOUNDATION, INC. CLERK WINCHESTER HEALTHCARE MANAGEMENT, INC. CLERK (EX-OFFICIO) LAHEY CLINIC FOUNDATION, INC. CLERK (EX-OFFICIO) LAHEY CLINIC, INC. CLERK (EX-OFFICIO) LAHEY CLINIC HOSPITAL, INC. D/B/A LAHEY HOSPITAL AND MEDICAL CENTER CLERK (EX-OFFICIO) NORTHEAST HOSPITAL CORPORATION TRUSTEE (EX-OFFICIO) AND CLERK NORTHEAST MEDICAL PRACTICE, INC. TRUSTEE (EX-OFFICIO) AND CLERK NORTHEAST BEHAVIORAL HEALTH CORPORATION TRUSTEE AND CLERK CAB HEALTH & RECOVERY SERVICES, INC. TRUSTEE AND CLERK HEALTH & EDUCATION HOUSING SERVICES, INC. CLERK (EX-OFFICIO) WINCHESTER HOSPITAL MR. KATZ HELD THE FOLLOWING POSITIONS FROM OCTOBER 1, 2018 UNTIL MARCH 1, 2019: SENIOR VICE PRESIDENT AND GENERAL COUNSEL BETH ISRAEL DEACONESS MEDICAL CENTER DIRECTOR AND CLERK BETH ISRAEL DEACONESS MEDICAL CENTER PHARMACY, INC. PAYMENTS REPORTED BY BIDMC: BASE COMPENSATION: 415,671 INCENTIVE COMPENSATION: 111,276 OTHER REPORTABLE COMPENSATION: 33,516 DEFERRED COMPENSATION: 17,792 NON-TAXABLE BENEFITS: 26,216 OTHER REPORTABLE COMPENSATION FOR MR. KATZ INCLUDES COMBINED PAYMENTS RELATED TO NONQUALIFIED RETIREMENT PLANS IN THE AMOUNT OF $30,123. KIRPAS, JEFF TRUSTEE, FINANCE CHAIR ANNA JAQUES HOSPITAL TRUSTEE, FINANCE CHAIR SEACOAST AFFILIATED GROUP PRACTICES, INC. TABB, M.D., KEVIN EFFECTIVE MARCH 1, 2019 DR. TABB HELD THE FOLLOWING POSITIONS: PRESIDENT, CHIEF EXECUTIVE OFFICER, AND TRUSTEE (EX-OFFICIO) BETH ISRAEL LAHEY HEALTH, INC. DIRECTOR AND CHIEF EXECUTIVE OFFICER BETH ISRAEL DEACONESS MEDICAL CENTER, INC. TRUSTEE (EX-OFFICIO) AND CHIEF EXECUTIVE OFFICER LAHEY CLINIC HOSPITAL, INC. D/B/A LAHEY HOSPITAL AND MEDICAL CENTER TRUSTEE (EX-OFFICIO) AND CHIEF EXECUTIVE OFFICER LAHEY CLINIC, INC. TRUSTEE, PRESIDENT, AND CHIEF EXECUTIVE OFFICER LAHEY HEALTH SHARED SERVICES, INC. DIRECTOR AND PRESIDENT BIDMC PHARMACY, INC. TRUSTEE (EX-OFFICIO), CHAIRMAN, AND PRESIDENT NORTHEAST HEALTH SYSTEM, INC. TRUSTEE (EX-OFFICIO), PRESIDENT, CHAIRMAN AND CHIEF EXECUTIVE OFFICER NORTHEAST SENIOR HEALTH CORPORATION TRUSTEE (EX-OFFICIO), CHAIRMAN AND PRESIDENT SEACOAST NURSING & REHABILITATION CENTER, INC. TRUSTEE (EX-OFFICIO) AND PRESIDENT WINCHESTER HOSPITAL FOUNDATION, INC. CHIEF EXECUTIVE OFFICER AND CHIEF OPERATING OFFICER WINCHESTER HEALTHCARE MANAGEMENT, INC. TRUSTEE (EX-OFFICIO), CHIEF EXECUTIVE OFFICER AND CHIEF OPERATING OFFICER LAHEY CLINIC FOUNDATION, INC. CHIEF EXECUTIVE OFFICER NORTHEAST HOSPITAL CORPORATION TRUSTEE (EX-OFFICIO) AND CHIEF EXECUTIVE OFFICER NORTHEAST BEHAVIORAL HEALTH CORPORATION TRUSTEE (EX-OFFICIO) AND CHIEF EXECUTIVE OFFICER CAB HEALTH & RECOVERY SERVICES, INC. CHIEF EXECUTIVE OFFICER BETH ISRAEL DEACONESS HOSPITAL MILTON CHIEF EXECUTIVE OFFICER MILTON HOSPITAL FOUNDATION CHIEF EXECUTIVE OFFICER COMMUNITY PHYSICIANS ASSOCIATION CHIEF EXECUTIVE OFFICER BETH ISRAEL DEACONESS HOSPITAL NEEDHAM CHIEF EXECUTIVE OFFICER BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH CHIEF EXECUTIVE OFFICER MOUNT AUBURN HOSPITAL CHIEF EXECUTIVE OFFICER NEW ENGLAND BAPTIST HOSPITAL CHIEF EXECUTIVE OFFICER JORDAN HEALTH SYSTEMS, INC. CHIEF EXECUTIVE OFFICER JORDAN PHYSICIAN ASSOCIATES, INC. TRUSTEE (EX-OFFICIO) AND CHIEF EXECUTIVE OFFICER HEALTH & EDUCATION HOUSING SERVICES, INC. PROFESSOR OF MEDICINE, HARVARD MEDICAL SCHOOL IN ADDITION TO THE POSITIONS NOTED ABOVE, EFFECTIVE MARCH 1, 2019 DR. TABB HELD THE FOLLOWING POSITIONS FOR WHICH HE WAS ENTITLED TO AND DID APPOINT A DESIGNATE: TRUSTEE (EX-OFFICIO NORTHEAST HOSPITAL CORPORATION TRUSTEE (EX-OFFICIO BETH ISRAEL DEACONESS HOSPITAL MILTON, BETH ISRAEL DEACONESS MILTON PHYSICIAN ASSOCIATES AND COMMUNITY PHYSICIANS ASSOCIATION TRUSTEE (EX-OFFICIO) BETH ISRAEL DEACONESS HOSPITAL NEEDHAM TRUSTEE (EX-OFFICIO) BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH, JORDAN HEALTH SYSTEMS, INC AND JORDAN PHYSICIAN ASSOCIATES, INC. TRUSTEE (EX-OFFICIO) MOUNT AUBURN HOSPITAL TRUSTEE (EX-OFFICIO) NEW ENGLAND BAPTIST HOSPITAL TRUSTEE (EX-OFFICIO) WINCHESTER HOSPITAL TRUSTEE (EX-OFFICIO) ANNA JACQUES HOSPITAL, INC. TRUSTEE (EX-OFFICIO) SEACOAST AFFILIATED GROUP PRACTICES, INC. DR. TABB HELD THE FOLLOWING POSITIONS FROM OCTOBER 1, 2018 UNTIL MARCH 1, 2019: DIRECTOR AND CHIEF EXECUTIVE OFFICER BETH ISRAEL DEACONESS MEDICAL CENTER, INC. DIRECTOR (EX-OFFICIO) HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER DIRECTOR BETH ISRAEL DEACONESS HOSPITAL MILTON DIRECTOR MILTON HOSPITAL FOUNDATION DIRECTOR COMMUNITY PHYSICIANS ASSOCIATES DIRECTOR JORDAN HEALTH SYSTEMS, INC. DIRECTOR JORDAN PHYSICIAN ASSOCIATES, INC. DIRECTOR BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH DIRECTOR AND PRESIDENT BIDMC PHARMACY, INC. TRUSTEE (EX-OFFICIO) AND CO-CHAIR CARL J. SHAPIRO INSTITUTE FOR EDUCATION & RESEARCH AT HARVARD MEDICAL SCHOOL & BETH ISRAEL DEACONESS MEDICAL CENTER, INC. PROFESSOR OF MEDICINE HARVARD MEDICAL SCHOOL AS NOTED IN THIS FILING, AND AS REQUIRED IN THIS FORM 990, COMPENSATION REPORTED FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2019 IS CALENDAR YEAR 2018 COMPENSATION. PAYMENTS REPORTED BY BIDMC: BASE COMPENSATION: 1,184,748 INCENTIVE COMPENSATION: 552,000 OTHER REPORTABLE COMPENSATION: 20,206 DEFERRED COMPENSATION: 93,674 NON-TAXABLE BENEFITS: 50,030 OTHER REPORTABLE AND DEFERRED COMPENSATION FOR DR. TABB INCLUDES $94,326 COMBINED PAYMENTS TO NONQUALIFIED RETIREMENT PLANS PLUS THE INCREASE/DECREASE IN VALUE OF THOSE ACCOUNTS DURING THE 2018 CALENDAR YEAR. OF THIS AMOUNT, $80,324 WAS UNVESTED AT SEPTEMBER 30, 2019.
SCHEDULE J ADDITIONAL EXPLANATORY FOOTNOTES:	KHATIB, MATT TRUSTEE (EX-OFFICIO), CHAIR ANNA JAQUES HOSPITAL TRUSTEE, CHAIR ANNA JAQUES COMMUNITY HEALTH FOUNDATION TRUSTEE (EX-OFFICIO), CHAIR/PRESIDENT, FOUNDATION SEACOAST AFFILIATED GROUP PRACTICES, INC. PIENIAZEK, MATT TRUSTEE ANNA JAQUES HOSPITAL TRUSTEE SEACOAST AFFILIATED GROUP PRACTICES, INC. WILEY, MEG TRUSTEE ANNA JAQUES HOSPITAL TRUSTEE SEACOAST AFFILIATED GROUP PRACTICES, INC. COSTELLO, MICHAEL TRUSTEE ANNA JAQUES HOSPITAL TRUSTEE SEACOAST AFFILIATED GROUP PRACTICES, INC. FISCHER, STEVEN EFFECTIVE MARCH 1, 2019 MR. FISCHER HELD THE FOLLOWING POSITIONS: EXECUTIVE VICE PRESIDENT, CHIEF FINANCIAL OFFICER AND TREASURER (EX-OFFICIO) BETH ISRAEL LAHEY HEALTH, INC. TREASURER BETH ISRAEL DEACONESS MEDICAL CENTER, INC. DIRECTOR AND TREASURER BETH ISRAEL DEACONESS MEDICAL CENTER PHARMACY, INC. TREASURER (EX-OFFICIO) NEW ENGLAND BAPTIST HOSPITAL TRUSTEE (EX-OFFICIO, CEO DESIGNATE) AND TREASURER BETH ISRAEL DEACONESS HOSPITAL MILTON TREASURER (EX-OFFICIO) BETH ISRAEL DEACONESS HOSPITAL NEEDHAM TRUSTEE (EX-OFFICIO, CEO DESIGNATE) AND TREASURER (EX-OFFICIO) BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH TRUSTEE (EX-OFFICIO) AND TREASURER BETH ISRAEL DEACONESS MILTON PHYSICIANS ASSOCIATES F/K/A MILTON HOSPITAL FOUNDATION TREASURER (EX-OFFICIO) MOUNT AUBURN HOSPITAL TREASURER (EX-OFFICIO) NEW ENGLAND BAPTIST HOSPITAL TRUSTEE AND TREASURER COMMUNITY PHYSICIANS ASSOCIATES TRUSTEE AND TREASURER JORDAN PHYSICIAN ASSOCIATES DIRECTOR AND TREASURER JORDAN HEALTH SYSTEMS, INC. TREASURER (EX-OFFICIO) ANNA JACQUES HOSPITAL TREASURER (EX-OFFICIO) SEACOAST AFFILIATED GROUP PRACTICE TRUSTEE AND TREASURER LAHEY HEALTH SHARED SERVICES, INC. TREASURER (EX-OFFICIO) BETH ISRAEL LAHEY HEALTH PRIMARY CARE, INC. F/K/A LAHEY PHYSICIAN COMMUNITY ORGANIZATION I, INC. TREASURER (EX-OFFICIO) ADDISON GILBERT SOCIETY, INC. TRUSTEE (EX-OFFICIO) AND TREASURER NORTHEAST HEALTH SYSTEM, INC. TREASURER NORTHEAST PROFESSIONAL REGISTRY OF NURSES TRUSTEE (EX-OFFICIO) AND TREASURER NORTHEAST SENIOR HEALTH CORPORATION TRUSTEE (EX-OFFICIO) AND TREASURER SEACOAST NURSING & REHABILITATION CENTER, INC. TRUSTEE (EX-OFFICIO) AND TREASURER WINCHESTER HOSPITAL FOUNDATION, INC. TREASURER WINCHESTER HEALTHCARE MANAGEMENT, INC. TREASURER (EX-OFFICIO) LAHEY CLINIC FOUNDATION, INC. TREASURER (EX-OFFICIO) LAHEY CLINIC, INC. TREASURER (EX-OFFICIO) LAHEY CLINIC HOSPITAL, INC. D/B/A LAHEY HOSPITAL AND MEDICAL CENTER TREASURER (EX-OFFICIO) NORTHEAST HOSPITAL CORPORATION TRUSTEE (EX-OFFICIO) AND TREASURER NORTHEAST MEDICAL PRACTICE, INC. TRUSTEE (EX-OFFICIO) AND TREASURER NORTHEAST BEHAVIORAL HEALTH CORPORATION TRUSTEE AND TREASURER CAB HEALTH & RECOVERY SERVICES, INC. TRUSTEE AND TREASURER HEALTH & EDUCATION HOUSING SERVICES, INC. TREASURER (EX-OFFICIO) WINCHESTER HOSPITAL ASSISTANT TREASURER MEDICAL CARE OF BOSTON MANAGEMENT CORP A/K/A AFFILIATED PHYSICIANS GROUP TREASURER LEDGEWOOD HEALTH CARE CORP. MR. FISCHER HELD THE FOLLOWING POSITIONS FROM OCTOBER 1, 2018 UNTIL MARCH 1, 2019: ASSISTANT TREASURER BETH ISRAEL DEACONESS MEDICAL CENTER, INC. DIRECTOR AND TREASURER BETH ISRAEL DEACONESS MEDICAL CENTER PHARMACY, INC. DIRECTOR BETH ISRAEL DEACONESS HOSPITAL MILTON DIRECTOR MILTON HOSPITAL FOUNDATION DIRECTOR COMMUNITY PHYSICIANS ASSOCIATES DIRECTOR BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH DIRECTOR JORDAN PHYSICIAN ASSOCIATES DIRECTOR JORDAN HEALTH SYSTEMS, INC. AS NOTED IN THIS FILING, AND AS REQUIRED IN THIS FORM 990, COMPENSATION REPORTED FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2019 IS CALENDAR YEAR 2018 COMPENSATION. PAYMENTS REPORTED BY BIDMC: BASE COMPENSATION: 565,046 INCENTIVE COMPENSATION: 151,691 OTHER REPORTABLE COMPENSATION: 53,474 DEFERRED COMPENSATION: 18,750 NON-TAXABLE BENEFITS: 57,012 OTHER REPORTABLE COMPENSATION FOR MR. FISCHER INCLUDES COMBINED PAYMENTS FROM NONQUALIFIED RETIREMENT PLANS IN THE AMOUNT OF $47,015. CAPOLUPO, WAYNE TRUSTEE ANNA JAQUES HOSPITAL TRUSTEE SEACOAST AFFILIATED GROUP PRACTICES, INC. SHENK, WILBUR TRUSTEE; QUALITY CHAIR ANNA JAQUES HOSPITAL TRUSTEE; QUALITY CHAIR SEACOAST AFFILIATED GROUP PRACTICES, INC. COUSINS, FRANK TRUSTEE ANNA JAQUES HOSPITAL TRUSTEE SEACOAST AFFILIATED GROUP PRACTICES, INC. PERRY, DANIELLE VP PUBLIC RELATIONS ANNA JAQUES HOSPITAL PAYMENTS REPORTED BY AJH: BASE COMPENSATION: 178,072 INCENTIVE COMPENSATION: 14,831 OTHER REPORTABLE COMPENSATION: 0 DEFERRED COMPENSATION: 13,976 NON-TAXABLE BENEFITS: 27,263 OTHER REPORTABLE AND DEFERRED COMPENSATION FOR DR. PERRY INCLUDES COMBINED PAYMENTS FROM NONQUALIFIED RETIREMENT PLANS IN THE AMOUNT OF $5,639. OF THIS AMOUNT, $5,639 IS BOTH UNFUNDED AND UNVESTED. BUCHANAN, ROBERT DIRECTOR IS ANNA JAQUES HOSPITAL PAYMENTS REPORTED BY AJH: BASE COMPENSATION: 186,201 INCENTIVE COMPENSATION: 2,108 OTHER REPORTABLE COMPENSATION: 0 DEFERRED COMPENSATION: 3,751 NON-TAXABLE BENEFITS: 40,101 SOLDANO, JOSEPH DIRECTOR FINANCIAL PLANNING ANNA JAQUES HOSPITAL PAYMENTS REPORTED BY AJH: BASE COMPENSATION: 151,863 INCENTIVE COMPENSATION: 570 OTHER REPORTABLE COMPENSATION: 0 DEFERRED COMPENSATION: 8,065 NON-TAXABLE BENEFITS: 37,142 ABBY-STEARNS, ELIZABETH NURSING SUPERVISOR ANNA JAQUES HOSPITAL PAYMENTS REPORTED BY AJH: BASE COMPENSATION: 166,431 INCENTIVE COMPENSATION: 0 OTHER REPORTABLE COMPENSATION: 0 DEFERRED COMPENSATION: 2,422 NON-TAXABLE BENEFITS: 16,231 SZUKSTA, WALTER DIRECTOR OF SURGICAL SERVICES ANNA JAQUES HOSPITAL PAYMENTS REPORTED BY AJH: BASE COMPENSATION: 146,388 INCENTIVE COMPENSATION: 570 OTHER REPORTABLE COMPENSATION: 0 DEFERRED COMPENSATION: 4,896 NON-TAXABLE BENEFITS: 29,607

Schedule J (Form 990) 2018

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Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization
ANNA JAQUES HOSPITAL INC

Employer identification number
04-2104338

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	MDFA - SERIES 2019K	04-3431814	57584YTK5	07-31-2019	211,922,775	SEE PART VI		X		X		X
B	MDFA - SERIES 2018J-1 J-2	04-3431814	57584YJW0	06-13-2018	479,594,374	SEE PART VI		X		X		X
C	MDFA - SERIES 2016I	04-3431814	57584XMT5	05-12-2016	257,611,877	SEE PART VI		X		X		X
D	MDFA - LAHEY SERIES F	04-2323457	NONEXXXXX	10-21-2015	262,828,878	RETIRE BONDS & CAP ACQUISITION		X		X		X
	MDFA - SERIES 2015 H-1	04-3431814	57584XDH1	09-02-2015	203,702,204	SEE PART VI		X		X		X
	MDFA - LAHEY SERIES E	04-3431814	NONEXXXXX	03-07-2013	130,000,000	POWER PLANT & CAPITAL ACQUISITION		X		X		X
	MDFA - SERIES 2012G	04-3431814	NONEXXXXX	07-11-2012	49,910,000	REFUND ISSUE DATED 02/11/1998		X		X		X
	MDFA - SERIES 2011F-1 F-2 F-3	04-3431814	NONEXXXXX	09-15-2011	120,280,000	REFUND ISSUED DATED 02/11/1998		X		X		X
	MHEFA - WINCHESTER SERIES F	04-2456011	57586CDD4	07-08-2004	30,340,000	SERIAL BOND SERIES F - ADV REFUND		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	42,965,000		77,815,000		8,805,000		28,000,000
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	211,922,775		493,298,411		257,618,370		261,009,548
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............							4,857,465
6 Proceeds in refunding escrows ...............							160,202,232
7 Issuance costs from proceeds ...............	2,931,137		4,594,374		2,515,889		1,310,144
8 Credit enhancement from proceeds .............
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............	208,991,638		114,836,435		19,006,493		64,587,388
11 Other spent proceeds .............	201,353,725				236,095,988		119,989,328
12 Other unspent proceeds .............			362,998,912				31,060,330
13 Year of substantial completion .............			2015		2016		2017
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? ....		X		X		X	X
15 Were the bonds issued as part of an advance refunding issue? .....		X		X	X		X
16 Has the final allocation of proceeds been made? ..........		X	X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X		X

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X		X		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............	X		X		X			X

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2018

Page 2

Part Ⅲ

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............	X		X		X			X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?	X		X		X
c Are there any research agreements that may result in private business use of bond-financed property? .............		X	X			X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?				X
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	0 %		0 %		0 %		0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........	0 %		0 %		0 %		0 %
6 Total of lines 4 and 5 .............	0 %		0 %		0 %		0 %
7 Does the bond issue meet the private security or payment test? ...		X		X		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X		X		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X		X		X			X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......	X		X		X		X
b Exception to rebate? ........		X		X		X		X
c No rebate due? .........		X		X		X		X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....		X		X		X		X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X		X		X
b Name of provider ..........	MORGAN STANLEY
c Term of hedge .........	2000.0000000000 %
d Was the hedge superintegrated? ......		X
e Was the hedge terminated? ........		X

Schedule K (Form 990) 2018

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X		X		X
b Name of provider ..........
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X		X			X

Part Ⅴ

Procedures To Undertake Corrective Action

---------------------------------------------------------------------------------------------------------------	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X		X		X			X

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).

Return Reference	Explanation
BOND A, ENTITY 1:	PART I, ROW A, COLUMN F, DESCRIPTION OF PURPOSE: THE ISSUE REFUNDED ISSUES DATED 06/09/2008, 11/30/2005, 6/16/2003, AND 6/4/1998.
BOND B, ENTITY 1:	PART I, ROW B, COLUMN F: THE ISSUE'S PURPOSE WAS TO FINANCE CAPITAL PROJECTS AND REFUND ISSUES DATED 6/9/2008; 7/13/2004; 2/11/1998 PART II, COLUMN B, LINE 3: THE TOTAL PROCEEDS EXCEED THE ISSUE PRICE DUE TO THE $13,704,037 OF INVESTMENT EARNINGS
BOND C, ENTITY 1:	PART I, ROW C, COLUMN F: THE ISSUE'S PURPOSE WAS TO FINANCE AN OUTPATIENT AMBULATORY CARE BUILDING, FACILITY UPGRADES, AND COMPUTER UPGRADES AT CERTAIN BIDMC AFFILIATES. PART II, COLUMN C, LINE 3: THE TOTAL PROCEEDS EXCEED THE ISSUE PRICE DUE TO THE $26,884,283 OF INVESTMENT EARNINGS PART II, COLUMN C, LINE 11: THE OTHER SPENT PROCEEDS ARE THE REFUNDING PROCEEDS OF THE ISSUE THAT ARE NO LONGER IN ESCROW
BOND D, ENTITY 1:	PART III, COLUMN D, LINE 9: AS OF FISCAL YEAR END 2019, BETH ISRAEL LAHEY HEALTH HAS PLANS TO INCLUDE BOTH LAHEY SERIES F AND LAHEY SERIES E UNDER ITS WRITTEN POLICIES AND PROCEDURES TO ENSURE THAT ALL NONQUALIFIED BONDS OF THE THESE ISSUES ARE REMEDIATED IN ACCORDANCE WITH THE REQUIREMENTS UNDER REGULATIONS SECTIONS 1.141-12 AND 1.145-2. THE DELAY IN ADOPTING UPDATED POLICIES AND PROCEDURES HAS RESULTED, IN LARGE PART, DUE TO COMPLICATIONS RESULTING FROM COVID-19. PART V, COLUMN D: AS OF FISCAL YEAR END 2019, BETH ISRAEL LAHEY HEALTH HAS PLANS TO INCLUDE BOTH LAHEY SERIES F AND LAHEY SERIES E UNDER ITS WRITTEN POLICIES AND PROCEDURES TO ENSURE VIOLATIONS OF FEDERAL TAX REQUIREMENTS ARE TIMELY IDENTIFIED AND CORRECTED THROUGH VOLUNTARY CLOSING AGREEMENT PROGRAM AND SELF-REMEDIATION ISN'T AVAILABLE. THE DELAY IN ADOPTING UPDATED POLICIES AND PROCEDURES HAS RESULTED, IN LARGE PART, DUE TO COMPLICATIONS RESULTING FROM COVID-19.
BOND A, ENTITY 2:	PART I, ROW A, COLUMN F: THE ISSUE'S PURPOSE WAS TO REFINANCE SEVERAL DIFFERENT ISSUES, FUND TERMINATION PAYMENTS, AND FUND BUILDING IMPROVEMENTS, EQUIPMENT AND LAND IMPROVEMENTS. PART IV, COLUMN A, LINE 2(C): ARBITRAGE REBATE & YIELD RESTRICTION LIABILITY CALCULATION PERFORMED ON OCTOBER 29, 2019.
BOND B, ENTITY 2:	PART I, ROW B, COLUMN F: DESCRIPTION OF PURPOSE: CONSTRUCTION & EQUIPPING OF A POWER PLANT AND ACQUISITION OF CAPITAL ASSETS. PART III, COLUMN D, LINE 9: AS OF FISCAL YEAR END 2019, BETH ISRAEL LAHEY HEALTH HAS PLANS TO INCLUDE BOTH LAHEY SERIES F AND LAHEY SERIES E UNDER ITS WRITTEN POLICIES AND PROCEDURES TO ENSURE THAT ALL NONQUALIFIED BONDS OF THE THESE ISSUES ARE REMEDIATED IN ACCORDANCE WITH THE REQUIREMENTS UNDER REGULATIONS SECTIONS 1.141-12 AND 1.145-2. THE DELAY IN ADOPTING UPDATED POLICIES AND PROCEDURES HAS RESULTED, IN LARGE PART, DUE TO COMPLICATIONS RESULTING FROM COVID-19. PART V, COLUMN B: AS OF FISCAL YEAR END 2019, BETH ISRAEL LAHEY HEALTH HAS PLANS TO INCLUDE BOTH LAHEY SERIES F AND LAHEY SERIES E UNDER ITS WRITTEN POLICIES AND PROCEDURES TO ENSURE VIOLATIONS OF FEDERAL TAX REQUIREMENTS ARE TIMELY IDENTIFIED AND CORRECTED THROUGH VOLUNTARY CLOSING AGREEMENT PROGRAM AND SELF-REMEDIATION ISN'T AVAILABLE. THE DELAY IN ADOPTING UPDATED POLICIES AND PROCEDURES HAS RESULTED, IN LARGE PART, DUE TO COMPLICATIONS RESULTING FROM COVID-19.
BOND C, ENTITY 2:	PART II, COLUMN C, LINE 11: 8,993,760 OF THE PROCEEDS LISTED WERE USED FOR TERMINATION OF THE HEDGE AGREEMENT, WITH THE REMAINDER BEING REFUNDING PROCEEDS THAT ARE NO LONGER IN ESCROW PART III, COLUMN C: THE 2012 ISSUE ARE EXEMPT FROM COMPLETING PART III AS THE ISSUE ARE REFUNDINGS OF BONDS ISSUED PRIOR TO 12/31/2002.
BOND D, ENTITY 2:	PART II, COLUMNS D, LINE 11: THE OTHER SPENT PROCEEDS ARE THE REFUNDING PROCEEDS OF THE ISSUE THAT ARE NO LONGER IN ESCROW PART III, COLUMN C: THE 2011 ISSUE ARE EXEMPT FROM COMPLETING PART III AS THE ISSUE ARE REFUNDINGS OF BONDS ISSUED PRIOR TO 12/31/2002.
BOND A, ENTITY 3:	PART III, COLUMN D, LINE 9: AS OF FISCAL YEAR END 2019, BETH ISRAEL LAHEY HEALTH HAS PLANS TO INCLUDE BOTH LAHEY SERIES F AND LAHEY SERIES E UNDER ITS WRITTEN POLICIES AND PROCEDURES TO ENSURE THAT ALL NONQUALIFIED BONDS OF THE THESE ISSUES ARE REMEDIATED IN ACCORDANCE WITH THE REQUIREMENTS UNDER REGULATIONS SECTIONS 1.141-12 AND 1.145-2. THE DELAY IN ADOPTING UPDATED POLICIES AND PROCEDURES HAS RESULTED, IN LARGE PART, DUE TO COMPLICATIONS RESULTING FROM COVID-19. PART V, COLUMN B: AS OF FISCAL YEAR END 2019, BETH ISRAEL LAHEY HEALTH HAS PLANS TO INCLUDE BOTH LAHEY SERIES F AND LAHEY SERIES E UNDER ITS WRITTEN POLICIES AND PROCEDURES TO ENSURE VIOLATIONS OF FEDERAL TAX REQUIREMENTS ARE TIMELY IDENTIFIED AND CORRECTED THROUGH VOLUNTARY CLOSING AGREEMENT PROGRAM AND SELF-REMEDIATION ISN'T AVAILABLE. THE DELAY IN ADOPTING UPDATED POLICIES AND PROCEDURES HAS RESULTED, IN LARGE PART, DUE TO COMPLICATIONS RESULTING FROM COVID-19.

Schedule K (Form 990) 2018

Additional Data

Software ID:
Software Version:

- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization
ANNA JAQUES HOSPITAL INC

Employer identification number
04-2104338

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	MDFA - SERIES 2019K	04-3431814	57584YTK5	07-31-2019	211,922,775	SEE PART VI		X		X		X
B	MDFA - SERIES 2018J-1 J-2	04-3431814	57584YJW0	06-13-2018	479,594,374	SEE PART VI		X		X		X
C	MDFA - SERIES 2016I	04-3431814	57584XMT5	05-12-2016	257,611,877	SEE PART VI		X		X		X
D	MDFA - LAHEY SERIES F	04-2323457	NONEXXXXX	10-21-2015	262,828,878	RETIRE BONDS & CAP ACQUISITION		X		X		X
	MDFA - SERIES 2015 H-1	04-3431814	57584XDH1	09-02-2015	203,702,204	SEE PART VI		X		X		X
	MDFA - LAHEY SERIES E	04-3431814	NONEXXXXX	03-07-2013	130,000,000	POWER PLANT & CAPITAL ACQUISITION		X		X		X
	MDFA - SERIES 2012G	04-3431814	NONEXXXXX	07-11-2012	49,910,000	REFUND ISSUE DATED 02/11/1998		X		X		X
	MDFA - SERIES 2011F-1 F-2 F-3	04-3431814	NONEXXXXX	09-15-2011	120,280,000	REFUND ISSUED DATED 02/11/1998		X		X		X
	MHEFA - WINCHESTER SERIES F	04-2456011	57586CDD4	07-08-2004	30,340,000	SERIAL BOND SERIES F - ADV REFUND		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	42,965,000		77,815,000		8,805,000		28,000,000
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	211,922,775		493,298,411		257,618,370		261,009,548
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............							4,857,465
6 Proceeds in refunding escrows ...............							160,202,232
7 Issuance costs from proceeds ...............	2,931,137		4,594,374		2,515,889		1,310,144
8 Credit enhancement from proceeds .............
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............	208,991,638		114,836,435		19,006,493		64,587,388
11 Other spent proceeds .............	201,353,725				236,095,988		119,989,328
12 Other unspent proceeds .............			362,998,912				31,060,330
13 Year of substantial completion .............			2015		2016		2017
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? ....		X		X		X	X
15 Were the bonds issued as part of an advance refunding issue? .....		X		X	X		X
16 Has the final allocation of proceeds been made? ..........		X	X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X		X

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X		X		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............	X		X		X			X

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2018

Page 2

Part Ⅲ

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............	X		X		X			X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?	X		X		X
c Are there any research agreements that may result in private business use of bond-financed property? .............		X	X			X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?				X
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	0 %		0 %		0 %		0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........	0 %		0 %		0 %		0 %
6 Total of lines 4 and 5 .............	0 %		0 %		0 %		0 %
7 Does the bond issue meet the private security or payment test? ...		X		X		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X		X		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X		X		X			X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......	X		X		X		X
b Exception to rebate? ........		X		X		X		X
c No rebate due? .........		X		X		X		X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....		X		X		X		X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X		X		X
b Name of provider ..........	MORGAN STANLEY
c Term of hedge .........	2000.0000000000 %
d Was the hedge superintegrated? ......		X
e Was the hedge terminated? ........		X

Schedule K (Form 990) 2018

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X		X		X
b Name of provider ..........
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X		X			X

Part Ⅴ

Procedures To Undertake Corrective Action

---------------------------------------------------------------------------------------------------------------	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X		X		X			X

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).

Return Reference	Explanation
BOND A, ENTITY 1:	PART I, ROW A, COLUMN F, DESCRIPTION OF PURPOSE: THE ISSUE REFUNDED ISSUES DATED 06/09/2008, 11/30/2005, 6/16/2003, AND 6/4/1998.
BOND B, ENTITY 1:	PART I, ROW B, COLUMN F: THE ISSUE'S PURPOSE WAS TO FINANCE CAPITAL PROJECTS AND REFUND ISSUES DATED 6/9/2008; 7/13/2004; 2/11/1998 PART II, COLUMN B, LINE 3: THE TOTAL PROCEEDS EXCEED THE ISSUE PRICE DUE TO THE $13,704,037 OF INVESTMENT EARNINGS
BOND C, ENTITY 1:	PART I, ROW C, COLUMN F: THE ISSUE'S PURPOSE WAS TO FINANCE AN OUTPATIENT AMBULATORY CARE BUILDING, FACILITY UPGRADES, AND COMPUTER UPGRADES AT CERTAIN BIDMC AFFILIATES. PART II, COLUMN C, LINE 3: THE TOTAL PROCEEDS EXCEED THE ISSUE PRICE DUE TO THE $26,884,283 OF INVESTMENT EARNINGS PART II, COLUMN C, LINE 11: THE OTHER SPENT PROCEEDS ARE THE REFUNDING PROCEEDS OF THE ISSUE THAT ARE NO LONGER IN ESCROW
BOND D, ENTITY 1:	PART III, COLUMN D, LINE 9: AS OF FISCAL YEAR END 2019, BETH ISRAEL LAHEY HEALTH HAS PLANS TO INCLUDE BOTH LAHEY SERIES F AND LAHEY SERIES E UNDER ITS WRITTEN POLICIES AND PROCEDURES TO ENSURE THAT ALL NONQUALIFIED BONDS OF THE THESE ISSUES ARE REMEDIATED IN ACCORDANCE WITH THE REQUIREMENTS UNDER REGULATIONS SECTIONS 1.141-12 AND 1.145-2. THE DELAY IN ADOPTING UPDATED POLICIES AND PROCEDURES HAS RESULTED, IN LARGE PART, DUE TO COMPLICATIONS RESULTING FROM COVID-19. PART V, COLUMN D: AS OF FISCAL YEAR END 2019, BETH ISRAEL LAHEY HEALTH HAS PLANS TO INCLUDE BOTH LAHEY SERIES F AND LAHEY SERIES E UNDER ITS WRITTEN POLICIES AND PROCEDURES TO ENSURE VIOLATIONS OF FEDERAL TAX REQUIREMENTS ARE TIMELY IDENTIFIED AND CORRECTED THROUGH VOLUNTARY CLOSING AGREEMENT PROGRAM AND SELF-REMEDIATION ISN'T AVAILABLE. THE DELAY IN ADOPTING UPDATED POLICIES AND PROCEDURES HAS RESULTED, IN LARGE PART, DUE TO COMPLICATIONS RESULTING FROM COVID-19.
BOND A, ENTITY 2:	PART I, ROW A, COLUMN F: THE ISSUE'S PURPOSE WAS TO REFINANCE SEVERAL DIFFERENT ISSUES, FUND TERMINATION PAYMENTS, AND FUND BUILDING IMPROVEMENTS, EQUIPMENT AND LAND IMPROVEMENTS. PART IV, COLUMN A, LINE 2(C): ARBITRAGE REBATE & YIELD RESTRICTION LIABILITY CALCULATION PERFORMED ON OCTOBER 29, 2019.
BOND B, ENTITY 2:	PART I, ROW B, COLUMN F: DESCRIPTION OF PURPOSE: CONSTRUCTION & EQUIPPING OF A POWER PLANT AND ACQUISITION OF CAPITAL ASSETS. PART III, COLUMN D, LINE 9: AS OF FISCAL YEAR END 2019, BETH ISRAEL LAHEY HEALTH HAS PLANS TO INCLUDE BOTH LAHEY SERIES F AND LAHEY SERIES E UNDER ITS WRITTEN POLICIES AND PROCEDURES TO ENSURE THAT ALL NONQUALIFIED BONDS OF THE THESE ISSUES ARE REMEDIATED IN ACCORDANCE WITH THE REQUIREMENTS UNDER REGULATIONS SECTIONS 1.141-12 AND 1.145-2. THE DELAY IN ADOPTING UPDATED POLICIES AND PROCEDURES HAS RESULTED, IN LARGE PART, DUE TO COMPLICATIONS RESULTING FROM COVID-19. PART V, COLUMN B: AS OF FISCAL YEAR END 2019, BETH ISRAEL LAHEY HEALTH HAS PLANS TO INCLUDE BOTH LAHEY SERIES F AND LAHEY SERIES E UNDER ITS WRITTEN POLICIES AND PROCEDURES TO ENSURE VIOLATIONS OF FEDERAL TAX REQUIREMENTS ARE TIMELY IDENTIFIED AND CORRECTED THROUGH VOLUNTARY CLOSING AGREEMENT PROGRAM AND SELF-REMEDIATION ISN'T AVAILABLE. THE DELAY IN ADOPTING UPDATED POLICIES AND PROCEDURES HAS RESULTED, IN LARGE PART, DUE TO COMPLICATIONS RESULTING FROM COVID-19.
BOND C, ENTITY 2:	PART II, COLUMN C, LINE 11: 8,993,760 OF THE PROCEEDS LISTED WERE USED FOR TERMINATION OF THE HEDGE AGREEMENT, WITH THE REMAINDER BEING REFUNDING PROCEEDS THAT ARE NO LONGER IN ESCROW PART III, COLUMN C: THE 2012 ISSUE ARE EXEMPT FROM COMPLETING PART III AS THE ISSUE ARE REFUNDINGS OF BONDS ISSUED PRIOR TO 12/31/2002.
BOND D, ENTITY 2:	PART II, COLUMNS D, LINE 11: THE OTHER SPENT PROCEEDS ARE THE REFUNDING PROCEEDS OF THE ISSUE THAT ARE NO LONGER IN ESCROW PART III, COLUMN C: THE 2011 ISSUE ARE EXEMPT FROM COMPLETING PART III AS THE ISSUE ARE REFUNDINGS OF BONDS ISSUED PRIOR TO 12/31/2002.
BOND A, ENTITY 3:	PART III, COLUMN D, LINE 9: AS OF FISCAL YEAR END 2019, BETH ISRAEL LAHEY HEALTH HAS PLANS TO INCLUDE BOTH LAHEY SERIES F AND LAHEY SERIES E UNDER ITS WRITTEN POLICIES AND PROCEDURES TO ENSURE THAT ALL NONQUALIFIED BONDS OF THE THESE ISSUES ARE REMEDIATED IN ACCORDANCE WITH THE REQUIREMENTS UNDER REGULATIONS SECTIONS 1.141-12 AND 1.145-2. THE DELAY IN ADOPTING UPDATED POLICIES AND PROCEDURES HAS RESULTED, IN LARGE PART, DUE TO COMPLICATIONS RESULTING FROM COVID-19. PART V, COLUMN B: AS OF FISCAL YEAR END 2019, BETH ISRAEL LAHEY HEALTH HAS PLANS TO INCLUDE BOTH LAHEY SERIES F AND LAHEY SERIES E UNDER ITS WRITTEN POLICIES AND PROCEDURES TO ENSURE VIOLATIONS OF FEDERAL TAX REQUIREMENTS ARE TIMELY IDENTIFIED AND CORRECTED THROUGH VOLUNTARY CLOSING AGREEMENT PROGRAM AND SELF-REMEDIATION ISN'T AVAILABLE. THE DELAY IN ADOPTING UPDATED POLICIES AND PROCEDURES HAS RESULTED, IN LARGE PART, DUE TO COMPLICATIONS RESULTING FROM COVID-19.

Schedule K (Form 990) 2018

Additional Data

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Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization
ANNA JAQUES HOSPITAL INC

Employer identification number
04-2104338

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	MDFA - SERIES 2019K	04-3431814	57584YTK5	07-31-2019	211,922,775	SEE PART VI		X		X		X
B	MDFA - SERIES 2018J-1 J-2	04-3431814	57584YJW0	06-13-2018	479,594,374	SEE PART VI		X		X		X
C	MDFA - SERIES 2016I	04-3431814	57584XMT5	05-12-2016	257,611,877	SEE PART VI		X		X		X
D	MDFA - LAHEY SERIES F	04-2323457	NONEXXXXX	10-21-2015	262,828,878	RETIRE BONDS & CAP ACQUISITION		X		X		X
	MDFA - SERIES 2015 H-1	04-3431814	57584XDH1	09-02-2015	203,702,204	SEE PART VI		X		X		X
	MDFA - LAHEY SERIES E	04-3431814	NONEXXXXX	03-07-2013	130,000,000	POWER PLANT & CAPITAL ACQUISITION		X		X		X
	MDFA - SERIES 2012G	04-3431814	NONEXXXXX	07-11-2012	49,910,000	REFUND ISSUE DATED 02/11/1998		X		X		X
	MDFA - SERIES 2011F-1 F-2 F-3	04-3431814	NONEXXXXX	09-15-2011	120,280,000	REFUND ISSUED DATED 02/11/1998		X		X		X
	MHEFA - WINCHESTER SERIES F	04-2456011	57586CDD4	07-08-2004	30,340,000	SERIAL BOND SERIES F - ADV REFUND		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	42,965,000		77,815,000		8,805,000		28,000,000
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	211,922,775		493,298,411		257,618,370		261,009,548
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............							4,857,465
6 Proceeds in refunding escrows ...............							160,202,232
7 Issuance costs from proceeds ...............	2,931,137		4,594,374		2,515,889		1,310,144
8 Credit enhancement from proceeds .............
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............	208,991,638		114,836,435		19,006,493		64,587,388
11 Other spent proceeds .............	201,353,725				236,095,988		119,989,328
12 Other unspent proceeds .............			362,998,912				31,060,330
13 Year of substantial completion .............			2015		2016		2017
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? ....		X		X		X	X
15 Were the bonds issued as part of an advance refunding issue? .....		X		X	X		X
16 Has the final allocation of proceeds been made? ..........		X	X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X		X

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X		X		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............	X		X		X			X

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2018

Page 2

Part Ⅲ

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............	X		X		X			X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?	X		X		X
c Are there any research agreements that may result in private business use of bond-financed property? .............		X	X			X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?				X
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	0 %		0 %		0 %		0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........	0 %		0 %		0 %		0 %
6 Total of lines 4 and 5 .............	0 %		0 %		0 %		0 %
7 Does the bond issue meet the private security or payment test? ...		X		X		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X		X		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X		X		X			X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......	X		X		X		X
b Exception to rebate? ........		X		X		X		X
c No rebate due? .........		X		X		X		X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....		X		X		X		X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X		X		X
b Name of provider ..........	MORGAN STANLEY
c Term of hedge .........	2000.0000000000 %
d Was the hedge superintegrated? ......		X
e Was the hedge terminated? ........		X

Schedule K (Form 990) 2018

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X		X		X
b Name of provider ..........
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X		X			X

Part Ⅴ

Procedures To Undertake Corrective Action

---------------------------------------------------------------------------------------------------------------	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X		X		X			X

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).

Return Reference	Explanation
BOND A, ENTITY 1:	PART I, ROW A, COLUMN F, DESCRIPTION OF PURPOSE: THE ISSUE REFUNDED ISSUES DATED 06/09/2008, 11/30/2005, 6/16/2003, AND 6/4/1998.
BOND B, ENTITY 1:	PART I, ROW B, COLUMN F: THE ISSUE'S PURPOSE WAS TO FINANCE CAPITAL PROJECTS AND REFUND ISSUES DATED 6/9/2008; 7/13/2004; 2/11/1998 PART II, COLUMN B, LINE 3: THE TOTAL PROCEEDS EXCEED THE ISSUE PRICE DUE TO THE $13,704,037 OF INVESTMENT EARNINGS
BOND C, ENTITY 1:	PART I, ROW C, COLUMN F: THE ISSUE'S PURPOSE WAS TO FINANCE AN OUTPATIENT AMBULATORY CARE BUILDING, FACILITY UPGRADES, AND COMPUTER UPGRADES AT CERTAIN BIDMC AFFILIATES. PART II, COLUMN C, LINE 3: THE TOTAL PROCEEDS EXCEED THE ISSUE PRICE DUE TO THE $26,884,283 OF INVESTMENT EARNINGS PART II, COLUMN C, LINE 11: THE OTHER SPENT PROCEEDS ARE THE REFUNDING PROCEEDS OF THE ISSUE THAT ARE NO LONGER IN ESCROW
BOND D, ENTITY 1:	PART III, COLUMN D, LINE 9: AS OF FISCAL YEAR END 2019, BETH ISRAEL LAHEY HEALTH HAS PLANS TO INCLUDE BOTH LAHEY SERIES F AND LAHEY SERIES E UNDER ITS WRITTEN POLICIES AND PROCEDURES TO ENSURE THAT ALL NONQUALIFIED BONDS OF THE THESE ISSUES ARE REMEDIATED IN ACCORDANCE WITH THE REQUIREMENTS UNDER REGULATIONS SECTIONS 1.141-12 AND 1.145-2. THE DELAY IN ADOPTING UPDATED POLICIES AND PROCEDURES HAS RESULTED, IN LARGE PART, DUE TO COMPLICATIONS RESULTING FROM COVID-19. PART V, COLUMN D: AS OF FISCAL YEAR END 2019, BETH ISRAEL LAHEY HEALTH HAS PLANS TO INCLUDE BOTH LAHEY SERIES F AND LAHEY SERIES E UNDER ITS WRITTEN POLICIES AND PROCEDURES TO ENSURE VIOLATIONS OF FEDERAL TAX REQUIREMENTS ARE TIMELY IDENTIFIED AND CORRECTED THROUGH VOLUNTARY CLOSING AGREEMENT PROGRAM AND SELF-REMEDIATION ISN'T AVAILABLE. THE DELAY IN ADOPTING UPDATED POLICIES AND PROCEDURES HAS RESULTED, IN LARGE PART, DUE TO COMPLICATIONS RESULTING FROM COVID-19.
BOND A, ENTITY 2:	PART I, ROW A, COLUMN F: THE ISSUE'S PURPOSE WAS TO REFINANCE SEVERAL DIFFERENT ISSUES, FUND TERMINATION PAYMENTS, AND FUND BUILDING IMPROVEMENTS, EQUIPMENT AND LAND IMPROVEMENTS. PART IV, COLUMN A, LINE 2(C): ARBITRAGE REBATE & YIELD RESTRICTION LIABILITY CALCULATION PERFORMED ON OCTOBER 29, 2019.
BOND B, ENTITY 2:	PART I, ROW B, COLUMN F: DESCRIPTION OF PURPOSE: CONSTRUCTION & EQUIPPING OF A POWER PLANT AND ACQUISITION OF CAPITAL ASSETS. PART III, COLUMN D, LINE 9: AS OF FISCAL YEAR END 2019, BETH ISRAEL LAHEY HEALTH HAS PLANS TO INCLUDE BOTH LAHEY SERIES F AND LAHEY SERIES E UNDER ITS WRITTEN POLICIES AND PROCEDURES TO ENSURE THAT ALL NONQUALIFIED BONDS OF THE THESE ISSUES ARE REMEDIATED IN ACCORDANCE WITH THE REQUIREMENTS UNDER REGULATIONS SECTIONS 1.141-12 AND 1.145-2. THE DELAY IN ADOPTING UPDATED POLICIES AND PROCEDURES HAS RESULTED, IN LARGE PART, DUE TO COMPLICATIONS RESULTING FROM COVID-19. PART V, COLUMN B: AS OF FISCAL YEAR END 2019, BETH ISRAEL LAHEY HEALTH HAS PLANS TO INCLUDE BOTH LAHEY SERIES F AND LAHEY SERIES E UNDER ITS WRITTEN POLICIES AND PROCEDURES TO ENSURE VIOLATIONS OF FEDERAL TAX REQUIREMENTS ARE TIMELY IDENTIFIED AND CORRECTED THROUGH VOLUNTARY CLOSING AGREEMENT PROGRAM AND SELF-REMEDIATION ISN'T AVAILABLE. THE DELAY IN ADOPTING UPDATED POLICIES AND PROCEDURES HAS RESULTED, IN LARGE PART, DUE TO COMPLICATIONS RESULTING FROM COVID-19.
BOND C, ENTITY 2:	PART II, COLUMN C, LINE 11: 8,993,760 OF THE PROCEEDS LISTED WERE USED FOR TERMINATION OF THE HEDGE AGREEMENT, WITH THE REMAINDER BEING REFUNDING PROCEEDS THAT ARE NO LONGER IN ESCROW PART III, COLUMN C: THE 2012 ISSUE ARE EXEMPT FROM COMPLETING PART III AS THE ISSUE ARE REFUNDINGS OF BONDS ISSUED PRIOR TO 12/31/2002.
BOND D, ENTITY 2:	PART II, COLUMNS D, LINE 11: THE OTHER SPENT PROCEEDS ARE THE REFUNDING PROCEEDS OF THE ISSUE THAT ARE NO LONGER IN ESCROW PART III, COLUMN C: THE 2011 ISSUE ARE EXEMPT FROM COMPLETING PART III AS THE ISSUE ARE REFUNDINGS OF BONDS ISSUED PRIOR TO 12/31/2002.
BOND A, ENTITY 3:	PART III, COLUMN D, LINE 9: AS OF FISCAL YEAR END 2019, BETH ISRAEL LAHEY HEALTH HAS PLANS TO INCLUDE BOTH LAHEY SERIES F AND LAHEY SERIES E UNDER ITS WRITTEN POLICIES AND PROCEDURES TO ENSURE THAT ALL NONQUALIFIED BONDS OF THE THESE ISSUES ARE REMEDIATED IN ACCORDANCE WITH THE REQUIREMENTS UNDER REGULATIONS SECTIONS 1.141-12 AND 1.145-2. THE DELAY IN ADOPTING UPDATED POLICIES AND PROCEDURES HAS RESULTED, IN LARGE PART, DUE TO COMPLICATIONS RESULTING FROM COVID-19. PART V, COLUMN B: AS OF FISCAL YEAR END 2019, BETH ISRAEL LAHEY HEALTH HAS PLANS TO INCLUDE BOTH LAHEY SERIES F AND LAHEY SERIES E UNDER ITS WRITTEN POLICIES AND PROCEDURES TO ENSURE VIOLATIONS OF FEDERAL TAX REQUIREMENTS ARE TIMELY IDENTIFIED AND CORRECTED THROUGH VOLUNTARY CLOSING AGREEMENT PROGRAM AND SELF-REMEDIATION ISN'T AVAILABLE. THE DELAY IN ADOPTING UPDATED POLICIES AND PROCEDURES HAS RESULTED, IN LARGE PART, DUE TO COMPLICATIONS RESULTING FROM COVID-19.

Schedule K (Form 990) 2018

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered "Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

ANNA JAQUES HOSPITAL INC

Employer identification number

04-2104338

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e)Original principal amount	(f)Balance due	(g) In default?		(h) Approved by board or committee?		(i)Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e)Original principal amount	(f)Balance due	Yes	No	Yes	No	Yes	No






Total ............... $

Part III

Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2018

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) JUDITH FAYRE	FAMILY MEMBER OF GAIL FAYRE	12,758	SERVICES		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference

Explanation

FORM 990,SCHEDULE L, PART IV

GAIL FAYRE, THE CHIEF MEDICAL OFFICER AT ANNA JAQUES HOSPITAL, INC. (AJH), IS THE SPOUSE OF JUDITH FAYRE WHO IS A LACTATION CONSULTANT AT AJH. HER SALARY AND OTHER INCOME FOR THE CALENDAR YEAR 2018 INCLUDE:BASE COMPENSATION: $12,758INCENTIVE COMPENSATION: $0OTHER REPORTABLE COMPENSATION: $0DEFERRED COMPENSATION: $0NON-TAXABLE BENEFITS: $0VARIOUS CURRENT AND FORMER OFFICERS, DIRECTORS/TRUSTEES AND KEY EMPLOYEES OF AJH MAY ALSO HOLD POSITIONS WITH OTHER ENTITIES WHICH MAKE CHARITABLE CONTRIBUTIONS TO AJH. SUCH CONTRIBUTIONS HAVE NOT BEEN INCLUDED IN THE DISCLOSURES ABOVE. AJH MAINTAINS AN ACCOUNTABLE BUSINESS EXPENSE REIMBURSEMENT PLAN. FROM TIME TO TIME, AJH MAY REIMBURSE ITS OFFICERS, DIRECTORS/TRUSTEES AND/OR KEY EMPLOYEES FOR EXPENSES THEY INCURRED AND WHICH ARE PROPERLY ORDINARY AND NECESSARY BUSINESS EXPENSES OF THE REPORTING ENTITY. THE POLICIES AND PROCEDURES REQUIRED BY THE ACCOUNTABLE BUSINESS PLAN MUST BE FOLLOWED IN ORDER TO RECEIVE REIMBURSEMENT FOR SUCH EXPENSES AND IT IS POSSIBLE THAT ONE OR MORE INDIVIDUALS RECEIVED NON-TAXABLE REIMBURSEMENTS WHICH TOTALED $10,000 OR MORE DURING THE FISCAL PERIOD COVERED BY THIS FILING. ALL OF THE ABOVE TRANSACTIONS WERE NEGOTIATED AT ARMS-LENGTH AND IN ACCORDANCE WITH THE AJH CONFLICT OF INTEREST POLICIES.

Schedule L (Form 990 or 990-EZ) 2018

Additional Data

Software ID:
Software Version:

- TIN:

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

2018

Open to Public
Inspection

Name of the organization

ANNA JAQUES HOSPITAL INC

Employer identification number

04-2104338

Return Reference	Explanation
FORM 990, PART I & III	THE MISSION OF ANNA JAQUES HOSPITAL (AJH OR HOSPITAL) IS TO PROVIDE THE HIGHEST QUALITY MEDICAL CARE AND IMPROVE THE HEALTH OF THE COMMUNITY IN ALLIANCE WITH THE MEDICAL STAFF. AJH IS RECOGNIZED FOR DELIVERING HIGH QUALITY COMMUNITY HEALTH CARE AT A LOWER COST, WITH AN EMPHASIS ON PATIENT SATISFACTION. AJH PROVIDES THIS CARE REGARDLESS OF THE PATIENT'S ABILITY TO PAY, RACE, COLOR, RELIGION, SEX, SEXUAL ORIENTATION, NATIONAL ORIGIN, ANCESTRY, AGE, OR DISABILITY. AJH ASPIRES TO BE AMONG THE BEST COMMUNITY HOSPITALS IN EASTERN MASSACHUSETTS. ON MARCH 1, 2019, LAHEY HEALTH SYSTEM INCLUDING THE LAHEY CLINIC AND LAHEY CLINIC HOSPITAL D/B/A LAHEY HOSPITAL AND MEDICAL CENTER, WINCHESTER HOSPITAL, NORTHEAST HOSPITAL CORPORATION D/B/A BEVERLY HOSPITAL, ADDISON GILBERT HOSPITAL AND BAYRIDGE HOSPITAL, THE BETH ISRAEL DEACONESS SYSTEM INCLUDING BETH ISRAEL DEACONESS MEDICAL CENTER, BETH ISRAEL DEACONESS MILTON, BETH ISRAEL DEACONESS NEEDHAM AND BETH ISRAEL DEACONESS PLYMOUTH, MOUNT AUBURN HOSPITAL, NEW ENGLAND BAPTIST HOSPITAL, ANNA JAQUES HOSPITAL AS WELL AS ENTITIES FOR WHICH THESE LISTED ORGANIZATIONS SERVE AS SOLE MEMBER AND ADDITIONAL AFFILIATES CAME TOGETHER TO FORM BETH ISRAEL LAHEY HEALTH (BILH). BILH IS AN INTEGRATED HEALTH CARE SYSTEM COMMITTED TO EXPANDING ACCESS TO EXTRAORDINARY PATIENT CARE ACROSS EASTERN MASSACHUSETTS AND ADVANCING THE SCIENCE AND PRACTICE OF MEDICINE THROUGH GROUNDBREAKING RESEARCH AND EDUCATION. THE BILH SYSTEM IS COMPRISED OF ACADEMIC AND TEACHING HOSPITALS, A PREMIER ORTHOPEDICS HOSPITAL, PRIMARY CARE AND SPECIALTY CARE PROVIDERS, AMBULATORY SURGERY CENTERS, URGENT CARE CENTERS, COMMUNITY HOSPITALS, HOMECARE SERVICES, OUTPATIENT BEHAVIORAL HEALTH CENTERS AND ADDICTION TREATMENT PROGRAMS. BILH'S COMMUNITY OF CLINICIANS, CAREGIVERS AND STAFF INCLUDES APPROXIMATELY 4,000 PHYSICIANS AND 35,000 EMPLOYEES. IN ADDITION TO BEING A MEMBER BETH ISRAEL LAHEY HEALTH, ANNA JAQUES HOSPITAL IS ALSO A CLINICAL AFFILIATE OF BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC OR MEDICAL CENTER), WHICH IS A NATIONALLY RECOGNIZED TERTIARY CARE ACADEMIC MEDICAL CENTER AND A TEACHING HOSPITAL OF HARVARD MEDICAL SCHOOL. BIDMC IS EXEMPT FROM INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED AND IS RECOGNIZED NATIONALLY FOR THE CLINICAL EXCELLENCE OF ITS FACULTY AND THE PATIENT CARE PROVIDED, AS WELL AS FOR THE MAGNITUDE AND BREADTH OF ITS RESEARCH AND FOR ITS COMMITMENT TO MEDICAL EDUCATION.
FORM 990, PART IV, LINE 4A	INPATIENT ANNA JAQUES HOSPITAL (AJH OR HOSPITAL), IS A 123-BED ACUTE CARE HOSPITAL THAT SERVES PATIENTS OF ALL AGES AND SERVES COMMUNITIES IN NORTHERN MASSACHUSETTS AND SOUTHERN NEW HAMPSHIRE. THE HOSPITAL PROVIDES A WIDE RANGE OF INPATIENT CARE INCLUDING MEDICAL SURGICAL SERVICES, OBSTETRICS, INTENSIVE AND CARDIAC CARE AND COMPLETE DIAGNOSTIC FACILITIES. AJH INPATIENT FACILITIES INCLUDE 63 MEDICAL/SURGICAL BEDS AND AN EIGHT-BED INTENSIVE UNIT. THE 12-BED BIRTH CENTER SEES 650 DELIVERIES ANNUALLY AND ALSO SUPPORTS MOTHERS WITH HIGH-RISK PREGNANCIES WITH THE LEVEL IIB NEONATAL CARE CENTER. THE HOSPITAL HAS A SURGICAL SUITE WITH SIX FULLY EQUIPPED OPERATING ROOMS INCLUDING A CARDIAC CATHERIZATION LABORATORY, FOUR AMBULATORY PROCEDURE ROOMS AND A POST-OPERATIVE CARE UNIT. SURGICAL SERVICES ARE AVAILABLE 24 HOURS A DAY FOR CRITICALLY ILL OR INJURED PATIENTS REQUIRING IMMEDIATE SURGICAL INTERVENTION, OR FOR OTHER PATIENTS ON A NON-EMERGENT OR ELECTIVE BASIS. AJH IS THE ONLY COMMUNITY HOSPITAL IN THE REGION TO PROVIDE INPATIENT PSYCHIATRIC SERVICES TO ADULTS, ADOLESCENTS AND CHILDREN. INPATIENT PSYCHIATRIC CARE AT ANNA JAQUES HOSPITAL PROVIDES SHORT-TERM, ACUTE INPATIENT CARE TO ADULTS AND ADOLESCENTS AGES 16 AND OLDER WITH A BROAD SPECTRUM OF PSYCHIATRIC PROBLEMS. THE INPATIENT PROGRAM IS A 20-BED ACUTE CARE CO-ED UNIT. THE ANNA JAQUES CHILD AND ADOLESCENT PSYCHIATRY PROGRAM PROVIDES STRUCTURED AND SECURE INPATIENT PSYCHIATRIC SERVICES TO CHILDREN AND ADOLESCENTS AGES 4-17. THE 12-BED PROGRAM OFFERS SHORT-TERM INPATIENT TREATMENT AND STABILIZATION. AJH'S SURGEONS PERFORM ORTHOPEDIC PROCEDURES AND IMPLANTS, PLASTIC RECONSTRUCTION, GASTROINTESTINAL, GENERAL SURGICAL (INCLUDING BREAST) GYNECOLOGICAL, OPHTHALMOLOGIC, PODIATRIC, AND UROLOGICAL PROCEDURES. PATIENTS ARE UNDER THE CARE OF THE HOSPITAL'S MEDICAL STAFF, HOSPITALISTS AND/OR GENERAL SURGEONS ALONG WITH NURSES AND PHYSICIAN ASSISTANTS WHO ARE TRAINED IN CARING FOR PATIENTS WITH COMPLEX MEDICAL NEEDS, INCLUDING INTENSIVISTS IN THE ICU. THE NURSING CARE TEAM CONSISTS OF REGISTERED NURSES, SURGICAL TECHNICIANS AND QUALIFIED ANCILLARY PERSONNEL WORKING COLLABORATIVELY WITH SURGICAL AND ANESTHESIA PHYSICIANS. DURING THE PERIOD OCTOBER 1, 2018 TO SEPTEMBER 30, 2019, ANNA JAQUES HOSPITAL HAD 7,109 INPATIENT DISCHARGES WITH 30,579 PATIENT DAYS, AND 839 TOTAL INPATIENT SURGERIES. ADULT PSYCH DAYS WERE 5,661 AND PEDI PSYCH DAYS WERE 3,723.
FORM 990, PART IV, LINE 4B	OUTPATIENT CLINICS AND SERVICES ANNA JAQUES HOSPITAL PROVIDES A COMPREHENSIVE PROGRAM OF CLINICAL SERVICES ENCOMPASSING GENERAL INTERNAL MEDICINE AND ALL THE SUBSPECIALTIES OF INTERNAL MEDICINE, COVERING THE GAMUT OF SERVICES FROM PRIMARY TO TERTIARY CARE AS WELL AS PROVIDING SURGICAL SERVICES ON AN OUTPATIENT BASIS. THE HOSPITAL'S MEDICAL STAFF BLENDS EXPERIENCED PRIMARY CARE PHYSICIANS AND SPECIALISTS IN A WIDE VARIETY OF DISCIPLINES. THE PRIMARY CARE AND SPECIALISTS AT AJH PROVIDE OUTPATIENT PRIMARY CARE AS WELL AS GASTROINTESTINAL, OPHTHALMOLOGIC, ORTHOPEDIC, CARDIAC, DERMATOLOGIC, UROLOGICAL AND PODIATRIC PROCEDURES, PAIN MANAGEMENT, CARDIAC REHABILITATION, PULMONARY REHABILITATION, DIABETES MANAGEMENT SERVICES, AND NUTRITIONAL COUNSELING. DIAGNOSTIC FACILITIES AT AJH INCLUDE A COMPLETE 24-HOUR LABORATORY AND BLOOD BANKING SERVICES AS WELL AS DIAGNOSTIC IMAGING INCLUDING CT SCANNING, ULTRASOUND, MRI, 3D MAMMOGRAPHY, ULTRASONIC CARDIOGRAPHY, BONE DENSITOMETRY, NUCLEAR MEDICINE, PLAIN FILM RADIOLOGY AND FLUOROSCOPY. THE ANNA JAQUES CANCER CENTER CANCER, AFFILIATED WITH BETH ISRAEL DEACONESS MEDICAL CENTER, PROVIDES A FULL ARRAY OF COMMUNITY-BASED CANCER SERVICES IN NEWBURYPORT AND WHEN NEEDED, ADVANCED TREATMENT OPTIONS AND SPECIALISTS AT BIDMC IN BOSTON. DURING THE FISCAL PERIOD OCTOBER 1, 2018 TO SEPTEMBER 30, 2019, ANNA JAQUES HOSPITAL HAD 258,902 OUTPATIENT ENCOUNTERS. HOSPITAL CLINICS HAD 22,807 VISITS, AND PERFORMED 4,275 ENDOSCOPY PROCEDURES. ONCOLOGY HAD 1,953 VISITS AND 3,723 INFUSIONS. IN ADDITION, AJH OUTPATIENT CARDIOLOGY PHYSICIANS AND PROFESSIONALS PERFORMED 9,063 EKG EXAMS AND ORTHOPEDISTS PERFORMED 714 OUTPATIENT PROCEDURES. AJH GENERAL RADIOLOGY PERFORMED 25,127 OUTPATIENT EXAMS, 13,409 CAT SCAN OUTPATIENT EXAMS, 16,000 OUTPATIENT ULTRASOUND PROCEDURES, OVER 6,365 MRI EXAMS AND 1,402 NUCLEAR MEDICINE TESTS. FINALLY, DURING THE PERIOD COVERED BY THIS FILING AJH PERFORMED 492,916 OUTPATIENT LAB TESTS, AND 22,607 REHABILITATION VISITS. SEE SCHEDULE H FOR ADDITIONAL INFORMATION ON CHARITY CARE AND COMMUNITY BENEFITS.
FORM 990, PART IV, LINE 4C	EMERGENCY DEPARTMENT ANNA JAQUES HOSPITAL'S EMERGENCY DEPARTMENT (ED) IS OPEN 24 HOURS A DAY, 7 DAYS A WEEK AND PROVIDES EMERGENCY CARE TO ALL PATIENTS, REGARDLESS OF ABILITY TO PAY. THE PHYSICIANS PROVIDE AROUND THE CLOCK PHYSICIAN PATIENT CARE COVERAGE AND MEDICAL DIRECTION OF THE AJH EMERGENCY DEPARTMENT. A HIGHLY TRAINED NURSING STAFF ALSO PROVIDES CARE TO PATIENTS IN THE ED. AJH OPERATES AS A LEVEL III TRAUMA CENTER AND CERTIFIED STROKE CENTER. THE HOSPITAL OPERATES A TELE-STROKE PROGRAM WITH BETH ISRAEL DEACONESS MEDICAL CENTER WHERE NEUROLOGICAL IMAGES CAN BE TRANSMITTED BETWEEN AJH AND BIDMC, MEANING THAT PATIENTS IN THE GREATER NEWBURYPORT AREA HAVE ACCESS TO THE SAME WORLD-CLASS SPECIALISTS AS PATIENTS AT BIDMC IN BOSTON. THE SYSTEM FACILITATES, WHEN NECESSARY, MULTI-DISCIPLINARY EVALUATION OF IMAGES, RESULTING IN IMPROVED TECHNICAL PERFORMANCE AND FEEDBACK AND DIAGNOSES WITH GREATER DIAGNOSTIC ACCURACY. DURING THE FISCAL PERIOD OCTOBER 1, 2018 TO SEPTEMBER 30, 2019, ANNA JAQUES HOSPITAL HAD 26,500 EMERGENCY DEPARTMENT VISITS.
FORM 990, PART IV, LINE 12	THE BOSTON, MA OFFICE OF KPMG ISSUED AN UNQUALIFIED OPINION ON THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF THE BETH ISRAEL LAHEY HEALTH, INC. AND AFFILIATES FOR FISCAL PERIOD ENDED SEPTEMBER 30, 2019. THESE STATEMENTS WERE PREPARED IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP) AND INCLUDED THE ACCOUNTS OF THE BETH ISRAEL LAHEY HEALTH, INC. (BILH), AND THE ENTITIES FOR WHICH BETH ISRAEL LAHEY HEALTH, INC. (BILH) SERVED AS SOLE MEMBER DURING THE FISCAL PERIOD COVERED BY THIS FILING, (BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC), MOUNT AUBURN HOSPITAL (MAH), NEW ENGLAND BAPTIST HOSPITAL (NEBH), BETH ISRAEL DEACONESS HOSPITAL MILTON, INC. (MILTON), BETH ISRAEL DEACONESS HOSPITAL NEEDHAM, INC. (NEEDHAM), BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH, INC. (PLYMOUTH), LAHEY CLINIC FOUNDATION, LAHEY HEALTH SHARED SERVICES, WINCHESTER HOSPITAL (WINCHESTER), NORTHEAST HOSPITAL CORPORATION (NHC), NORTHEAST BEHAVIORAL HEALTH CORPORATION (NBHC) AND ANNA JAQUES HOSPITAL). EACH OF THESE AFFILIATES MAY IN TURN SERVE AS MEMBER OF ADDITIONAL ENTITIES WITHIN THE NETWORK OF AFFILIATES, AND WHOSE ACCOUNTS ARE INCLUDED IN THE BILH AUDITED FINANCIAL STATEMENTS. THE FINANCIAL STATEMENTS ALSO INCLUDE THE ACCOUNTS OF HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER, INC. (HMFP), THE DEDICATED PHYSICIAN PRACTICE OF BETH ISRAEL DEACONESS MEDICAL CENTER AND AN ENTITY INTEGRALLY RELATED TO HELPING BIDMC ACCOMPLISH ITS CHARITABLE PURPOSES, AS WELL AS ALL ENTITIES FOR WHICH THESE ENTITIES SERVE AS MEMBER.
FORM 990, PART V, LINE 7G	ANNA JAQUES HOSPITAL, INC. DID NOT RECEIVE ANY CONTRIBUTIONS OF INTELLECTUAL PROPERTY AND AS SUCH, WAS NOT REQUIRED TO FILE FORM 8899.
FORM 990, PART V, LINE 7H	ANNA JAQUES HOSPITAL, INC. DID NOT RECEIVE ANY CONTRIBUTIONS OF CARS, BOATS, AIRPLANES OR OTHER VEHICLES AND AS SUCH, WAS NOT REQUIRED TO FILE FORM 1098-C.
FORM 990, PART VI, SECTION A, LINE 2	THE FOLLOWING ANNA JAQUES HOSPITAL, INC. OFFICERS, DIRECTOR/TRUSTEES, AND KEY EMPLOYEES HAVE BUSINESS RELATIONSHIPS: GEORGE ELLISON DAVID LAFLAMME FOR THE PERIOD COVERED BY THIS FILING, BETH ISRAEL LAHEY HEALTH, INC. SERVED AS THE SOLE MEMBER OF BETH ISRAEL DEACONESS MEDICAL CENTER, INC. (BIDMC), MOUNT AUBURN HOSPITAL (MAH), NEW ENGLAND BAPTIST HOSPITAL (NEBH), BETH ISRAEL DEACONESS HOSPITAL MILTON, INC. (MILTON), BETH ISRAEL DEACONESS HOSPITAL NEEDHAM, INC. (NEEDHAM), BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH, INC. (PLYMOUTH), LAHEY HEALTH SHARED SERVICES, LAHEY CLINIC FOUNDATION, WINCHESTER HOSPITAL (WINCHESTER), NORTHEAST HOSPITAL CORPORATION (NHC), NORTHEAST BEHAVIORAL CORPORATION (NBC), AND ANNA JAQUES HOSPITAL. THE LAHEY CLINIC FOUNDATION IN TURN SERVES AS SOLE MEMBER TO LAHEY CLINIC INC, AND LAHEY CLINIC HOSPITAL DBA LAHEY HOSPITAL AND MEDICAL CENTER (LHMC). ADDITIONAL ENTITIES LISTED HERE MAY ALSO IN TURN SERVE AS MEMBER TO OTHER NETWORK AFFILIATES. TWO OR MORE OF THE PERSONS LISTED IN THIS FORM 990 PART VII HAVE A BUSINESS RELATIONSHIP WITH EACH OTHER BY VIRTUE OF SITTING ON ONE OR MORE BOARDS OF DIRECTORS/TRUSTEES OR BY SERVING IN AN EMPLOYMENT RELATIONSHIP WITH ONE OR MORE ENTITIES WITHIN THE NETWORK OF AFFILIATED ORGANIZATIONS. ADDITIONAL DETAIL IS PROVIDED IN THE EXPLANATORY NOTES TO THIS FORM 990 SCHEDULE J.
FORM 990, PART VI, SECTION A, LINE 4	ANNA JAQUES HOSPITAL, INC. MADE CHANGES TO ITS BYLAWS DURING THE FISCAL PERIOD ENDED SEPTEMBER 30, 2019 AS PART OF THE CREATION OF THE BETH ISRAEL LAHEY HEALTH (BILH), AN INTEGRATED HEALTH CARE SYSTEM PROVIDING PATIENT CARE INFORMED BY WORLD-CLASS RESEARCH AND EDUCATION. BETH ISRAEL LAHEY HEALTH, INC. BECAME THE SOLE MEMBER OF ANNA JAQUES HOSPITAL, INC. CHANGES TO THE BYLAWS AFFECT: - FREQUENCY OF MEETINGS - MINIMUM & MAXIMUM NUMBER OF TRUSTEES - EX-OFFICIO TRUSTEES - APPOINTMENT, REAPPOINTMENT AND REMOVAL OF TRUSTEES - COMMITTEES - OFFICERS - TERMS AND TERM LIMITS
FORM 990, PART VI, SECTION A, LINE 6	EFFECTIVE MARCH 1, 2019, BETH ISRAEL LAHEY HEALTH, INC. (BILH) IS THE SOLE MEMBER OF ANNA JAQUES HOSPITAL, INC.. SEACOAST REGIONAL HEALTH SYSTEMS, WHICH MERGED INTO ANNA JAQUES HOSPITAL, INC. EFFECTIVE MARCH 1, 2019, PREVIOUSLY SERVED AS SOLE MEMBER.
FORM 990, PART VI, SECTION A, LINE 7A	THE MEMBER HAS THE EXCLUSIVE AUTHORITY TO (A) APPOINT AND REAPPOINT TRUSTEES, (B) FILL ANY VACANCIES IN THE OFFICES OF TRUSTEES, AND (C) ACTING BY VOTE OF NOT LESS THAN THREE QUARTERS (3/4) OF THE MEMBER'S TRUSTEES THEN IN OFFICE, REMOVE, WITH OR WITHOUT CAUSE, A TRUSTEE.
FORM 990, PART VI, SECTION A, LINE 7B	THE MEMBER OF ANNA JAQUES HOSPITAL, INC. HAS THE FOLLOWING RIGHTS, AS DESIGNATED IN ANNA JAQUES HOSPITAL, INC.'S BY-LAWS: SUBJECT TO THE PROVISIONS OF THE ARTICLES OF ORGANIZATION AND THESE BYLAWS, THE MEMBER SHALL HAVE THE RIGHT TO EXERCISE ALL POWERS, BOTH POSITIVE AND NEGATIVE, CONFERRED BY MASSACHUSETTS GENERAL LAWS ("M.G.L.") CHAPTER 180, AS AMENDED, ON MEMBERS OF CORPORATIONS ORGANIZED UNDER M.G.L. CHAPTER 180. IN ADDITION, EXCEPT AS ARE EXPRESSLY GRANTED TO THE BOARD OF TRUSTEES OF THE CORPORATION ("BOARD") IN THESE BYLAWS, THE MEMBER SHALL HAVE THE RIGHT TO EXERCISE ALL POWERS, POSITIVE AND NEGATIVE, CONFERRED BY M.G.L. CHAPTER 180 ON BOARDS OF CORPORATIONS ORGANIZED UNDER M.G.L. CHAPTER 180. NOTWITHSTANDING THE FOREGOING, THE MEMBER MAY NOT TAKE ANY OF THE FOLLOWING ACTIONS WITHOUT THE APPROVAL OF THE BOARD: (A) APPROVE OR REQUIRE ANY CHANGE IN, OR CONSOLIDATION OF PHILANTHROPIC GIFTS, ASSETS, AND PROGRAMS OF THE CORPORATION, WHICH SHALL REMAIN UNDER THE CORPORATION'S CONTROL AND BE USED FOR THE BENEFIT OF THE CORPORATION AND NOT FOR OTHER COMPONENTS OF THE MEMBER'S SYSTEM, EXCEPT TO THE EXTENT THAT SUCH CHANGES INVOLVE BACK-OFFICE CONSOLIDATION WITH OTHER DIRECT OR INDIRECT SUBSIDIARIES OF THE MEMBER; (B) APPROVE OR REQUIRE ANY CHANGE IN THE NAME, BRAND, OR TRADEMARK OF THE CORPORATION OR ANY OF ITS SUBSIDIARIES, EXCEPT SUCH COMPLEMENTARY CHANGES AS THE MEMBER MAY DETERMINE ARE REASONABLY APPROPRIATE IN ESTABLISHING A SYSTEM-WIDE IDENTITY FOR THE AFFILIATED ENTITIES; OR (C) AMEND OR RESTATE THESE BYLAWS TO CHANGE OR ELIMINATE EITHER OF THE FOREGOING LIMITATIONS ON ITS POWERS. FOR THE PERIOD ENDING ON THE THIRD ANNIVERSARY OF THE DATE THE MEMBER BECOMES THE SOLE CORPORATE MEMBER OF THE CORPORATION, THE MEMBER'S AUTHORITY TO CHANGE THE MEDICAL SCHOOL AFFILIATION OF THE CORPORATION OR ANY OF ITS SUBSIDIARIES IS SUBJECT TO THE REQUIREMENT THAT IT OBTAIN THE UNANIMOUS CONSENT OF THE CORPORATION'S DESIGNATED TRUSTEES (AS DEFINED IN THE BYLAWS OF THE MEMBER) AND THE APPROVAL OF THE MEMBER'S BOARD OF TRUSTEES (THE "MEMBER'S BOARD"). THE MEMBER MAY NOT CAUSE THE CORPORATION TO CEASE OPERATING A SEPARATELY LICENSED HOSPITAL FACILITY, OR CLOSE ANY ESSENTIAL SERVICE OF SUCH HOSPITAL FACILITY, WITHOUT CONSULTING WITH THE BOARD PRIOR TO TAKING SUCH ACTION. THE POWERS AND RESPONSIBILITIES OF THE BOARD INCLUDE THE FOLLOWING: (A) PROVIDING RECOMMENDATIONS TO THE MEMBER REGARDING (I) APPOINTMENT, REAPPOINTMENT AND REMOVAL OF TRUSTEES, (II) THE ESTABLISHMENT OF THE CORPORATION'S POLICIES, (III) THE MAINTENANCE OF PATIENT CARE QUALITY, AND (IV) THE PROVISION OF CLINICAL SERVICES AND COMMUNITY SERVICE PLANNING IN A MANNER RESPONSIVE TO LOCAL COMMUNITY NEEDS; (B) ENSURING COMPLIANCE WITH ALL LICENSURE AND ACCREDITATION REQUIREMENTS, INCLUDING CREDENTIALING AND OTHER MEDICAL STAFF MATTERS; (C) PROVIDING OVERSIGHT FOR INSTITUTIONAL PLANNING, MAKING RECOMMENDATIONS FOR NEW CLINICAL SERVICES, AND PARTICIPATING IN AN ANNUAL REVIEW OF THE CORPORATION'S STRATEGIC AND FINANCIAL PLAN AND GOALS; (D) REVIEWING AND RECOMMENDING APPROVAL OF OPERATING AND CAPITAL BUDGETS AS WELL AS MAKING RECOMMENDATIONS WITH RESPECT TO CAPITAL EXPENDITURES; (E) MAKING RECOMMENDATIONS WITH RESPECT TO QUALITY ASSESSMENT AND IMPROVEMENT PROGRAMS; (F) PROVIDING OVERSIGHT OF RISK MANAGEMENT PROGRAMS RELATING TO PATIENT CARE AND SAFETY; (G) REVIEWING DISASTER PLANS THAT DEAL WITH BOTH INTERNAL (E.G., FIRE) AND EXTERNAL DISASTERS; AND (H) EVALUATING RECRUITMENT NEEDS TO ENSURE ADEQUATE MEDICAL STAFF CAPACITY TO CONTINUE TO MEET COMMUNITY NEEDS. EXCEPT AS OTHERWISE PROVIDED IN THESE BYLAWS, THE BOARD SHALL ACT IN AN ADVISORY CAPACITY AND CONSISTENT THEREWITH SHALL HAVE ONLY THE FOLLOWING POWERS: (A) POWERS EXPRESSLY GRANTED BY THE MEMBER FROM TIME TO TIME; (B) POWER TO EXERCISE ITS AUTHORITY AS A MEMBER OF OTHER CORPORATIONS; (C) POWER TO ENFORCE ANY RIGHTS VESTED IN THE CORPORATION UNDER THE BYLAWS OF THE MEMBER (AS DEFINED UNDER THE BYLAWS OF THE MEMBER) OR UNDER THESE BYLAWS WITH RESPECT TO THE MEMBER; AND (D) POWERS TO ENFORCE ANY RIGHTS VESTED IN THE CORPORATION UNDER THAT AGREEMENT DATED JUNE 30, 2017 BY AND AMONG LAHEY HEALTH SYSTEM, INC., BETH ISRAEL DEACONESS MEDICAL CENTER, INC., NEW ENGLAND BAPTIST HOSPITAL, INC., MOUNT AUBURN HOSPITAL, CAREGROUP, INC., AND SEACOAST REGIONAL HEALTH SYSTEMS, INC. THE POWERS OF THE BOARD IN CLAUSES (A) AND (B) OF THE PRECEDING SENTENCE SHALL BE SUBJECT TO THE RESERVED POWERS OF THE MEMBER AS NOTED ABOVE. THE POWERS OF THE BOARD IN CLAUSE (C) AND (D) OF THE FIRST SENTENCE OF THIS PARAGRAPH SHALL BE INDEPENDENT OF THE MEMBER AND NOT SUBJECT TO THE RESERVED POWERS OF THE MEMBER AS NOTED ABOVE. NOTWITHSTANDING CLAUSE (B) ABOVE, THE POWER OF THE CORPORATION TO EXERCISE ITS AUTHORITY AS A MEMBER OF ANOTHER CORPORATION SHALL BE SUBJECT TO THE FOLLOWING LIMITATIONS: (X) ALL STATUTORY POWERS THAT RESIDE IN THE CORPORATION AS A MEMBER OF ANOTHER CORPORATION UNDER MASSACHUSETTS LAW MAY BE EXERCISED BY THE CORPORATION ONLY AT THE EXPRESS AND EXPLICIT DIRECTION OF, AND WITH THE APPROVAL OF, THE MEMBER; (Y) ALL STATUTORY POWERS THAT RESIDE IN THE CORPORATION AS A MEMBER OF ANOTHER CORPORATION UNDER MASSACHUSETTS LAW MAY BE EXERCISED DIRECTLY BY THE MEMBER AFTER CONSULTATION WITH THE CHAIR BUT OTHERWISE WITHOUT THE APPROVAL OR PARTICIPATION OF THE CORPORATION; AND (Z) OTHER THAN STATUTORY POWERS, THE CORPORATION SHALL HAVE ONLY THOSE POWERS AND AUTHORITIES OVER AND WITH RESPECT TO THE CORPORATIONS OF WHICH IT IS A MEMBER AS ARE EXPRESSLY AND EXPLICITLY DELEGATED OR DIRECTED TO THE CORPORATION BY ACTION OF THE MEMBER'S BOARD.
FORM 990, PART VI, SECTION B, LINE 11B	AS NOTED IN VARIOUS DISCLOSURES THROUGHOUT THIS FILING, EFFECTIVE MARCH 1, 2019, BETH ISRAEL LAHEY HEALTH, INC. (BILH) BECAME THE SOLE MEMBER OF ANNA JAQUES HOSPITAL, INC.. THIS FORM 990 IS REVIEWED BY THE CHIEF FINANCIAL OFFICER OF ANNA JAQUES HOSPITAL, INC., THE TAX DIRECTOR OF BILH AND DELOITTE TAX, LLP. A COPY OF THE COMPLETE RETURN IS THEN PROVIDED TO EACH MEMBER OF THE ANNA JAQUES HOSPITAL, INC. BOARD PRIOR TO SUBMISSION TO THE INTERNAL REVENUE SERVICE.
FORM 990, PART VI, SECTION B, LINE 12C	ANNA JAQUES HOSPITAL HAS A WRITTEN, CONFLICT OF INTEREST POLICY. TRUSTEES AND SENIOR EXECUTIVES REVIEW THE CONFLICT OF INTEREST POLICY ANNUALLY AND EACH IS ASKED TO COMPLETE AN ANNUAL CONFLICT OF INTEREST FORM TO DISCLOSE POSSIBLE CONFLICTS. RESPONSES ARE REVIEWED BY THE BOARD CHAIR TO DETERMINE IF ANY CONFLICT EXISTS. ANY INDIVIDUAL WITH A CONFLICT IS ASKED TO ABSTAIN FROM VOTING ON A RELATED MATTER. THE BOARD CHAIR AND/OR SECRETARY MONITOR SURVEYS TO ENSURE COMPLIANCE.
FORM 990, PART VI, SECTION B, LINE 15	AS NOTED THROUGHOUT THIS FILING, ANNA JAQUES HOSPITAL AND SEACOAST AFFILIATED GROUP PRACTICE (AJH AND SAGP RESPECTIVELY) ALONG WITH THEIR OTHER RELATED ENTITIES BECAME MEMBERS OF THE BETH ISRAEL LAHEY HEALTH NETWORK OF AFFILIATES WITH BILH SERVING AS AJH'S SOLE MEMBER AND AJH, IN TURN SERVING AS SAGP'S SOLE MEMBER, EFFECTIVE MARCH 1, 2019. PRIOR TO THAT DATE, SEACOAST REGIONAL HEALTH SYSTEMS, INC.(SRHS) WHICH WAS ALSO AN ENTITY EXEMPT FROM INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED, SERVED AS THE SOLE MEMBER OF BOTH AJH AND SAGP AND MAINTAINED A COMPENSATION COMMITTEE THAT WAS COMPOSED OF MEMBERS OF THE BOARD OF TRUSTEES. ALL MEMBERS WERE INDEPENDENT. AS REQUIRED BY THIS FORM 990 FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2019, COMPENSATION REPORTED HEREIN IS CALENDAR YEAR 2018 COMPENSATION. AS SUCH, COMPENSATION REPORTED IN THIS FORM 990 FOR AJH AND SAGP OFFICERS, TRUSTEES AND KEY EMPLOYEES WAS SET BY THE SRHS COMPENSATION COMMITTEE AND GUIDED BY THE COMMITTEE'S PROCESS AS OUTLINED BELOW. THE COMPENSATION OF THE SENIOR EXECUTIVE TEAM WAS REVIEWED ANNUALLY BY AN INDEPENDENT COMMITTEE OF THE PARENT'S (SRHS) BOARD. THE COMMITTEE USED DATA RECEIVED FROM AN INDEPENDENT COMPENSATION CONSULTING FIRM TO DETERMINE THE FAIRNESS AND OVERALL COMPARABILITY OF EACH EXECUTIVE'S COMPENSATION PACKAGE INCLUDING POTENTIAL INCENTIVE COMPENSATION. THE COMMITTEE RELIED ON THE SALARY SURVEY DATA TO INFORM WHETHER ANY CHANGES TO AN EXECUTIVE'S COMPENSATION WAS APPROPRIATE. IN ADDITION, THE COMMITTEE AGREED ON AND SET BENCHMARKS FOR EXECUTIVE INCENTIVE PAYMENTS AT THE START OF EACH YEAR, AND REVIEWED PROGRESS RELATED TO THOSE BENCHMARKS AT THE CONCLUSION OF THE YEAR TO DETERMINE WHETHER INCENTIVES WOULD BE PAID AND IF SO, AT WHAT LEVEL.
FORM 990, PART VI, SECTION C, LINE 19	ANNA JAQUES HOSPITAL, INC.'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST AT THE FOLLOWING LOCATION: BETH ISRAEL LAHEY HEALTH TAX DEPARTMENT 109 BROOKLINE AVENUE, SUITE 300 BOSTON, MA 02215
FORM 990, PART XI, LINE 9:	PURCHASE ACCOUNTING ADJUSTMENT 7,881,326. LOSS ON EXT OF DEBT -99,132. CHANGE IN MIN PENSION LIAB -18,176,448. TRANSFERS TO AFFILIATES -2,717,486. CHANGE IN VALUE OF SWAP MK TO MKT -646,437. CHANGE IN VALUE OF LIFE INS -24,333.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2018

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

ANNA JAQUES HOSPITAL INC

Employer identification number

04-2104338

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?
(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	Yes	No
(1)ADDISON GILBERT SOCIETY INC 41 MALL ROAD BURLINGTON,MA01805 46-4371382	SUPPORT	MA	501(C)(3)	7	LAHEY HEALTH SHARED SERVICES INC	Yes
(2)ANNA JAQUES COMMUNITY HEALTH FOUNDATION 25 HIGHLAND AVE NEWBURYPORT,MA01950 04-3318952	FUNDRSG ORG	MA	501(C)(3)	12A, I	ANNA JAQUES HOSPITAL INC	Yes
(3)ASSOC PHYS HARVARD MED FAC PHY AT BIDMC 375 LONGWOOD AVE BOSTON,MA02215 32-0058309	TO PROVIDE EMERGENCY MEDICAL SERVICES	MA	501(C)(3)	12A, I	HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER	Yes
(4)BAIM INSTITUTE OF CLINICAL RESEARCH INC FKA HCRI 930 COMMONWEALTH AVE BOSTON,MA02215 04-3521077	SCIENTIFIC & MEDICAL RESEARCH	MA	501(C)(3)	7	N/A	Yes
(5)BETH ISRAEL DEACONESS HOSPITAL - MILTON INC 199 REEDSDALE RD MILTON,MA02186 04-2103604	HOSPITAL FOR THE TREATMENT, CARE AND RELIEF OF SICK AND SUFFERING PERSONS.	MA	501(C)(3)	3	BETH ISRAEL LAHEY HEALTH INC	Yes
(6)BETH ISRAEL DEACONESS HOSPITAL - NEEDHAM INC 148 CHESTNUT ST NEEDHAM,MA02492 04-3229679	HOSPITAL FOR THE TREATMENT, CARE AND RELIEF OF SICK AND SUFFERING PERSONS.	MA	501(C)(3)	3	BETH ISRAEL LAHEY HEALTH INC	Yes
(7)BETH ISRAEL DEACONESS HOSPITAL - PLYMOUTH INC 275 SANDWICH ST PLYMOUTH,MA02360 22-2667354	HOSPITAL FOR THE TREATMENT, CARE AND RELIEF OF SICK AND SUFFERING PERSONS.	MA	501(C)(3)	3	BETH ISRAEL LAHEY HEALTH INC	Yes
(8)BETH ISRAEL DEACONESS MEDICAL CENTER 330 BROOKLINE AVE BOSTON,MA02215 04-2103881	THE OPERATION OF A WORLD CLASS ACADEMIC MEDICAL CENTER IN BOSTON, MA	MA	501(C)(3)	3	BETH ISRAEL LAHEY HEALTH INC	Yes
(9)BETH ISRAEL LAHEY HEALTH PRIMARY CARE FKA LPCO 41 MALL ROAD BURLINGTON,MA01805 47-2248298	HEALTHCARE	MA	501(C)(3)	10	LAHEY HEALTH SHARED SERVICES INC	Yes
(10)BETH ISRAEL LAHEY HEALTH INC 20 UNIVERSITY ROAD CAMBRIDGE,MA02138 83-2671600	SUPPORT	MA	501(C)(3)	12A, I	N/A	Yes
(11)BI ANAESTHESIA FOUNDATION INC 330 BROOKLINE AVE BOSTON,MA02215 04-2997215	SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HFMP AND HMS	MA	501(C)(3)	12A, I	HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER	Yes
(12)BI COMMUNITY FOUNDATION INC 330 BROOKLINE AVE STE 300 BOSTON,MA02215 04-2776678	INACTIVE CORPORATION	MA	501(C)(3)	7	N/A	Yes
(13)BI DEACONESS DEPARTMENT OF EMERGENCY MEDICINE FOUNDATION INC 330 BROOKLINE AVE W/CC-2 BOSTON,MA02215 36-4803234	SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HFMP AND HMS	MA	501(C)(3)	12A, I	HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER	Yes
(14)BI DEACONESS DEPARTMENT OF MEDICINE FOUNDATION INC 330 BROOKLINE AVE BOSTON,MA02215 04-3079630	SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HFMP AND HMS	MA	501(C)(3)	12A, I	HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER	Yes
(15)BI DEACONESS DEPARTMENT OF NEONATOLOGY FOUNDATION INC 330 BROOKLINE AVE BOSTON,MA02215 20-8253452	SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HFMP AND HMS	MA	501(C)(3)	12A, I	HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER	Yes
(16)BI DEACONESS DEPARTMENT OF NEUROLOGY FOUNDATION INC 330 BROOKLINE AVE BOSTON,MA02215 04-3030397	SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HFMP AND HMS	MA	501(C)(3)	12A, I	HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER	Yes
(17)BI DEACONESS DEPARTMENT OF ORTHOPAEDIC SURGERY FOUNDATION INC 330 BROOKLINE AVE BOSTON,MA02215 20-4974585	SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HFMP AND HMS	MA	501(C)(3)	12A, I	HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER	Yes
(18)BI DEACONESS DEPARTMENT OF SURGERY FOUNDATION INC 330 BROOKLINE AVE BOSTON,MA02215 02-0671240	SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HFMP AND HMS	MA	501(C)(3)	12A, I	HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER	Yes
(19)BI DERMATOLOGY FOUNDATION INC 330 BROOKLINE AVE BOSTON,MA02215 04-3117601	SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HFMP AND HMS	MA	501(C)(3)	12A, I	HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER	Yes
(20)BIDMC AND CHILDREN'S HOSPITAL MEDICAL CARE CORP 482 BEDFORD STREET LEXINGTON,MA02420 04-3200113	SUPPORT	MA	501(C)(3)	12A, I	N/A		No
(21)BIDMC OBSTETRICS AND GYNECOLOGY FOUNDATION INC 330 BROOKLINE AVE BOSTON,MA02215 04-2794855	SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HFMP AND HMS	MA	501(C)(3)	12A, I	HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER	Yes
(22)BIDMC PHARMACY INC 330 BROOKLINE AVE BOSTON,MA02215 82-2526816	OPERATE A SPECIALTY PHARMACY	MA	501(C)(3)	12A, I	BETH ISRAEL DEACONESS MEDICAL CENTER	Yes
(23)BID-MILTON PHYSICIAN ASSOCIATES INC FKA MHF 199 REEDSDALE RD MILTON,MA02186 22-2566792	PROMOTE HEALTHCARE	MA	501(C)(3)	12A, I	BETH ISRAEL DEACONESS HOSPITAL - MILTON	Yes
(24)BIH PATHOLOGY FOUNDATION INC 330 BROOKLINE AVE BOSTON,MA02215 22-2548374	SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HFMP AND HMS	MA	501(C)(3)	12A, I	HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER	Yes
(25)BIH RADIOLOGIC FOUNDATION INC 330 BROOKLINE AVE BOSTON,MA02215 04-2571853	SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HFMP AND HMS	MA	501(C)(3)	12A, I	HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER	Yes
(26)CAB HEALTH AND RECOVERY SERVICES INC 199 ROSEWOOD DRIVE SUITE 250 DANVERS,MA01923 04-2400270	SUBSTANCE ABUSE	MA	501(C)(3)	10	NORTHEAST BEHAVIORAL HEALTH CORPORATION	Yes
(27)CAREGROUP PARMENTER HOME CARE & HOSPICE INC 330 MOUNT AUBURN ST CAMBRIDGE,MA02138 47-3111453	HOME CARE & HOSPICE	MA	501(C)(3)	12A, I	MOUNT AUBURN HOSPITAL	Yes
(28)CAREGROUP INC 109 BROOKLINE AVE STE 300 BOSTON,MA02215 22-2629185	OVERSEE FINANCIAL HEALTH OF AFFILIATES	MA	501(C)(3)	12C, III-FI	N/A		No
(29)CARL J SHAPIRO INSTITUTE FOR EDUCATION AND RESEARCH 330 BROOKLINE AVE BOSTON,MA02215 04-3326928	DEVELOP INNOVATIVE PROG AND MODELS FOR TEACHING AND RESEARCH	MA	501(C)(3)	12A, I	N/A		No
(30)COMMUNITY PHYSICIAN ASSOCIATES INC 199 REEDSDALE RD MILTON,MA02186 04-3243146	OUTPATIENT AND PRIMARY CARE SERVICES	MA	501(C)(3)	3	MILTON HOSPITAL FOUNDATION	Yes
(31)CONTINUING EDU PROGRAM DBA BID DEPT OF PSYCH FDN 185 PILGRIM ROAD BOSTON,MA02215 04-3242952	SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HFMP AND HMS	MA	501(C)(3)	12A, I	HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER	Yes
(32)HARVARD MEDICAL FACULTY PHYSICIANS AT BIDMC INC 375 LONGWOOD AVE BOSTON,MA02215 22-2768204	GENERAL AND SPECIALIZED MEDICAL SERVICES TO THE PATIENTS OF BIDMC AND OTHERS	MA	501(C)(3)	10	BETH ISRAEL DEACONESS MEDICAL CENTER	Yes
(33)HEALTH AND EDUCATION HOUSING SERVICES 199 ROSEWOOD DRIVE DANVERS,MA01923 22-3232914	HUD HOUSING	MA	501(C)(3)	10	NORTHEAST BEHAVIORAL HEALTH CORPORATION	Yes
(34)JORDAN HEALTH SYSTEMS INC 275 SANDWICH ST PLYMOUTH,MA02360 04-2103805	PROMOTE HEALTHCARE	MA	501(C)(3)	7	BETH ISRAEL DEACONESS MEDICAL CENTER	Yes
(35)JORDAN PHYSICIANS ASSOCIATES INC 275 SANDWICH ST PLYMOUTH,MA02360 04-3228556	OUTPATIENT AND PRIMARY CARE SERVICES	MA	501(C)(3)	10	JORDAN HEALTH SYSTEMS INC	Yes
(36)LAHEY CLINIC CANADIAN FOUNDATION 130 KING STREET WEST TORONTO CA	FUNDRSG ORG	CA	NON-US		N/A		No
(37)LAHEY CLINIC FOUNDATION INC 41 MALL ROAD BURLINGTON,MA01805 04-2323457	SUPPORT	MA	501(C)(3)	7	BETH ISRAEL LAHEY HEALTH INC	Yes
(38)LAHEY CLINIC HOSPITAL INC 41 MALL ROAD BURLINGTON,MA018050001 04-2704686	HEALTHCARE	MA	501(C)(3)	3	LAHEY CLINIC FOUNDATION INC	Yes
(39)LAHEY CLINIC INC 41 MALL ROAD BURLINGTON,MA018050001 04-2704683	HEALTHCARE	MA	501(C)(3)	10	LAHEY CLINIC FOUNDATION INC	Yes
(40)LAHEY HEALTH SHARED SERVICES INC 41 MALL ROAD BURLINGTON,MA01805 04-3178972	ADMINISTRATION	MA	501(C)(3)	10	BETH ISRAEL LAHEY HEALTH INC	Yes
(41)LAHEY HEALTH SYSTEMS INC 41 MALL ROAD BURLINGTON,MA01805 61-1665701	SUPPORT	MA	501(C)(3)	12C, III-FI	N/A		No
(42)LONGWOOD MEDICAL ENERGY COLLABORATIVE 160 LONGWOOD AVENUE BOSTON,MA02215 04-3476764	COORDINATE AND PROVIDE STATEGIC PLANNING OPP FOR HMS	MA	501(C)(3)	12A, I	N/A	Yes
(43)LONGWOOD MEDICAL INTL FOUNDATION 375 LONGWOOD AVENUE BOSTON,MA02215 04-3208878	INACTIVE CORPORATION	MA	501(C)(3)	12A, I	HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER	Yes
(44)MED CARE OF BOSTON MGMT CORP DBA BID HEALTHCARE 400 HUNNEWELL ST NEEDHAM,MA02494 04-2810972	OUTPATIENT, PRIMARY CARE AND SPECIALTY SERVICES	MA	501(C)(3)	10	BETH ISRAEL DEACONESS MEDICAL CENTER	Yes
(45)MOUNT AUBURN HOSPITAL 330 MOUNT AUBURN ST CAMBRIDGE,MA02138 04-2103606	HOSPITAL FOR THE TREATMENT, CARE AND RELIEF OF SICK AND SUFFERING PERSONS	MA	501(C)(3)	3	BETH ISRAEL LAHEY HEALTH INC	Yes
(46)MOUNT AUBURN PROFESSIONAL SERVICES INC 330 MOUNT AUBURN ST CAMBRIDGE,MA02138 04-3026897	OFFERING MEDICAL CARE IN GENERAL AND SPECIALIZED PRACTICES	MA	501(C)(3)	12A, I	MOUNT AUBURN HOSPITAL	Yes
(47)NEW ENGLAND BAPTIST HOSPITAL 125 PARKER HILL AVE BOSTON,MA02120 04-2103612	ORTHOPEDIC SPECIALTY HOSPITAL	MA	501(C)(3)	3	BETH ISRAEL LAHEY HEALTH INC	Yes
(48)NEW ENGLAND BAPTIST MEDICAL ASSOCIATES INC 125 PARKER HILL AVE BOSTON,MA02120 04-3235796	OUTPATIENT MEDICAL SERVICES TO THE VARIOUS COMMUNITIES SERVICED BY NEBH	MA	501(C)(3)	3	NEW ENGLAND BAPTIST HOSPITAL	Yes
(49)NORTHEAST BEHAVIORAL HEALTH CORPORATION 199 ROSEWOOD DRIVE DANVERS,MA01923 04-2777145	HEALTHCARE	MA	501(C)(3)	10	BETH ISRAEL LAHEY HEALTH INC	Yes
(50)NORTHEAST HEALTH SYSTEM INC 85 HERRICK ST BEVERLY,MA01915 04-3240453	SUPPORT	MA	501(C)(3)	12A, I	LAHEY HEALTH SHARED SERVICES INC	Yes
(51)NORTHEAST HOSPITAL CORPORATION 85 HERRICK STREET BEVERLY,MA01915 04-2121317	HEALTHCARE	MA	501(C)(3)	3	BETH ISRAEL LAHEY HEALTH INC	Yes
(52)NORTHEAST MEDICAL PRACTICE INC 85 HERRICK ST BEVERLY,MA01915 04-3201853	HEALTHCARE	MA	501(C)(3)	10	NORTHEAST HOSPITAL CORPORATION	Yes
(53)NORTHEAST PROFESSIONAL REGISTRY OF NURSE 800NCUMMINGS CENTER BEVERLY,MA01915 20-1287349	HEALTHCARE	MA	501(C)(3)	10	NORTHEAST SENIOR HEALTH CORPORATION	Yes
(54)NORTHEAST SENIOR HEALTH CORPORATION 85 HERRICK STREET BEVERLY,MA01915 04-2731137	HEALTHCARE	MA	501(C)(3)	10	LAHEY HEALTH SHARED SERVICES INC	Yes
(55)SEACOAST AFFILIATED GROUP PRACTICES INC 25 HIGHLAND AVE NEWBURYPORT,MA01915 04-3485648	PHYSICIAN GROUP	MA	501(C)(3)	10	ANNA JAQUES HOSPITAL INC	Yes
(56)SEACOAST NURSING AND REHABILITION CENTER 300 WASHINGTON ST GLOUCESTER,MA01930 04-1305001	HEALTHCARE	MA	501(C)(3)	10	LAHEY HEALTH SHARED SERVICES INC	Yes
(57)SEACOAST REGIONAL HEALTH SYSTEMS INC 25 HIGHLAND AVE NEWBURYPORT,MA01915 22-2814214	SUPPORT ORG	MA	501(C)(3)	12A, I	N/A		No
(58)SEACOAST REGIONAL MRI INC 25 HIGHLAND AVE NEWBURYPORT,MA01915 32-0443663	HEALTH SVCS	MA	501(C)(3)	10	N/A		No
(59)WINCHESTER COMMUNITY ACCOUNTABLE CARE ORGANIZATION INC 41 HIGHLAND AVENUE WINCHESTER,MA01890 22-3137856	ACO	MA	501(C)(3)	12A, I	WINCHESTER HEALTHCARE MANAGEMENT INC	Yes
(60)WINCHESTER HEALTHCARE MANAGEMENT INC 41 HIGHLAND AVENUE WINCHESTER,MA01890 22-2701817	MANAGEMENT	MA	501(C)(3)	12A, I	LAHEY HEALTH SHARED SERVICES INC	Yes
(61)WINCHESTER HOSPITAL 41 HIGHLAND AVENUE WINCHESTER,MA018900000 04-2104434	HEALTHCARE	MA	501(C)(3)	3	BETH ISRAEL LAHEY HEALTH INC	Yes
(62)WINCHESTER HOSPITAL FOUNDATION INC 41 HIGHLAND AVENUE WINCHESTER,MA01890 04-3399570	SUPPORT	MA	501(C)(3)	12A, I	WINCHESTER HEALTHCARE MANAGEMENT INC	Yes

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2018

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
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) BIDCO HOSPITAL LLC ONE UNIVERSITY AVE NORTH ENTRANCE WESTWOOD,MA02090 46-1589743	COORDINATED, SAFE AND COST EFFECTIVE PATIENT CARE AT BIDMC	MA		EXCLUDED	-844,603	140,809		No			No	8.700 %
(2) BIDCO PHYSICIAN LLC 247 STATION DRIVE NORTHWEST 1 WESTWOOD,MA02090 46-1643790	COORDINATED, SAFE AND COST EFFECTIVE PATIENT CARE AT BIDMC	MA	N/A
(3) CAREGROUP CLINICAL RESEARCH LLC 109 BROOKLINE AVENUE BOSTON,MA02215 30-0228711	TO PARTICIPATE IN A CLINICAL RESEARCH PARTNERSHIP	MA	N/A
(4) CAREGROUP INVESTMENT PARTNERSHIP LLP 109 BROOKLINE AVENUE BOSTON,MA02215 04-3278109	INVESTMENT PARTNERSHIP	MA	N/A
(5) PHYSICIAN PROFESSIONAL SERVICES LLP 10 CABOT ROAD MEDFORD,MA02215 04-3275078	TO PROVIDE MEDICAL BILLING SERVICES	MA	N/A
(6) NEW ENGLAND BAPTIST ORTHOPEDIC NETWORK LLC 125 PARKER HILL AVE BOSTON,MA02120 46-5120176	TO PROVIDE ORTHOPEDIC MEDICAL SERVICES	MA	N/A
(7) WINCHESTER HOSPITALSHIELDS MRI LLC 700 CONGRESS ST QUINCY,MA02169 46-2523117	MRI SERVICES	MA	N/A
(8) SHIELDS IMAGING AT ANNA JAQUES HOSPITAL LLC 700 CONGRESS ST STE 204 QUINCY,MA02169 38-3989358	MRI SERVICES	MA	ANNA JAQUES HOSPITAL INC	EXCLUDED	1,024,524	1,866,880		No			No	68.740 %
(9) HAVERHILL MOB LLC 50 CHESTNUT ST NEEDHAM,MA02492 81-2856118	MEDICAL OFFICE BUILDING	MA	ANNA JAQUES HOSPITAL INC	EXCLUDED	3,209,857	344,263		No			No	60.000 %

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	(i) Section 512(b)(13) controlled entity?
(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	Yes	No
(1) JORDAN COMMUNITY ACO INC 275 SANDWICH ST PLYMOUTH,MA02360 45-4047430	COORDINATED, SAFE AND COST EFFECTIVE PATIENT CARE AT BID-PLYMOUTH	MA	N/A	C			Yes
(2) GREATER NEWBURYPORT MANAGEMENT SERVICES ORGANIZATION INC 25 HIGHLAND AVE NEWBURYPORT,MA01950 16-1744477	MANAGEMENT SERVICES	MA	N/A	C			Yes
(3) LAHEY CLINIC INSURANCE CO LTD CRAIG APPIN HOUSE PO BOX HM 2450 HAMILTON BD	INSURANCE	BD	N/A	C			Yes
(4) LEDGEWOOD HEALTHCARE CORPORATION 680 SOUTH FOURTH STREET LOUISVILLE,KY40202 04-2855189	NURSING HOME	KY	N/A	C			Yes
(5) NORTHEAST PROPRIETARY CORP 85 HERRICK STREET BEVERLY,MA01915 04-2855191	MEDICAL SERVICES	MA	N/A	C			Yes
(6) WINCHESTER PHYSICIAN ASSOCIATES INC 41 HIGHLAND AVE WINCHESTER,MA01890 04-3262963	MANAGEMENT SERVICES	MA	N/A	C			Yes
(7) WINCHESTER HEALTHCARE ENTERPRISES INC 41 HIGHLAND AVE WINCHESTER,MA01890 04-2932059	MANAGEMENT SERVICES	MA	N/A	C			Yes
(8) WINCHESTER PHYSICIAN HOSPITAL ORGANIZATION INC 41 HIGHLAND AVE WINCHESTER,MA01890 47-2646454	PHYS HOSP ORG	MA	N/A	C			Yes
(9) NORTHEAST HEALTH SYSTEMS PHYSICIAN HOSPITAL ORGANIZATION INC 500 CUMMINGS CENTER STE 6500 BEVERLY,MA01915 04-3258053	MEDICAL SERVICES	MA	N/A	C			Yes
(10) NORTHEAST PHYSICIAN PRACTICE 85 HERRICK STREET BEVERLY,MA01915 04-3285837	PHYSICIAN OFFICE	MA	N/A	C			Yes
(11) NPP SUPPORT SERVICES 85 HERRICK STREET BEVERLY,MA01915 04-2721511	PHYSICIAN OFFICE	MA	N/A	C			Yes

Schedule R (Form 990) 2018

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

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 .....................

Yes

b Gift, grant, or capital contribution to related organization(s) ............................

Yes

c Gift, grant, or capital contribution from related organization(s) ............................

Yes

d Loans or loan guarantees to or for related organization(s) ............................

Yes

e Loans or loan guarantees by related organization(s) ............................

Yes

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

Yes

k Lease of facilities, equipment, or other assets from related organization(s) ......................

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

m Performance of services or membership or fundraising solicitations by related organization(s) .................

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

Yes

q Reimbursement paid by related organization(s) for expenses ............................

Yes

r Other transfer of cash or property to related organization(s) ............................

Yes

s Other transfer of cash or property from related organization(s) ............................

Yes

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
(1) MED CARE OF BOSTON MGMT CORP DBA BID HEALTHCARE	P	439,852	FMV
(2) ANNA JAQUES COMMUNITY HEALTH FOUNDATION	C	1,256,919	FMV
(3) SEACOAST AFFILIATED GROUP PRACTICES INC	B	59,375	FMV
(4) SEACOAST AFFILIATED GROUP PRACTICES INC	P	2,750,000	FMV
(5) SEACOAST AFFILIATED GROUP PRACTICES INC	A	68,255	FMV
(6) BETH ISRAEL LAHEY HEALTH INC	R	202,933	FMV
(7) BIDCO HOSPITAL LLC	P	1,330,144	FMV

Schedule R (Form 990) 2018

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)	(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?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2018

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference

Explanation

PART I - V:

AS NOTED THROUGHOUT THIS FILING, ON MARCH 1, 2019, BETH ISRAEL LAHEY HEALTH (BILH) BECAME SOLE MEMBER OF BETH ISRAEL DEACONESS MEDICAL CENTER, INC. (BIDMC), MOUNT AUBURN HOSPITAL (MAH), NEW ENGLAND BAPTIST HOSPITAL (NEBH), BETH ISRAEL DEACONESS HOSPITAL MILTON, INC. (MILTON), BETH ISRAEL DEACONESS HOSPITAL NEEDHAM, INC. (NEEDHAM), BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH, INC. (PLYMOUTH), LAHEY HEALTH SHARED SERVICES, LAHEY CLINIC FOUNDATION, WINCHESTER HOSPITAL (WINCHESTER), NORTHEAST HOSPITAL CORPORATION (NHC), NORTHEAST BEHAVIORAL CORPORATION (NBC), AND ANNA JAQUES HOSPITAL. THE LAHEY CLINIC FOUNDATION IN TURN SERVES AS SOLE MEMBER TO LAHEY CLINIC INC, AND LAHEY CLINIC HOSPITAL DBA LAHEY HOSPITAL AND MEDICAL CENTER (LHMC). ADDITIONAL ENTITIES LISTED HERE MAY ALSO IN TURN SERVE AS MEMBER TO OTHER NETWORK AFFILIATES. BY-LAW CHANGES WERE MADE TO REFLECT THE CENTRALIZATION OF THE SYSTEM, AND AS SUCH, AFFILIATES WITHIN THE BILH SYSTEM ARE CONSIDERED CONTROLLED ENTITIES UNDER IRC SECTION 512(B)(13), AS EACH AFFILIATE IS UNDER COMMON GOVERNANCE CONTROL, AS DESCRIBED IN TREAS. REGS. 1.512(B)-1(L)(4). UNDER IRC SEC. 512, CONTROL MEANS THAT MORE THAN 50 PERCENT OF THE DIRECTORS OR TRUSTEES OF AN ORGANIZATION ARE EITHER REPRESENTATIVES OF, OR DIRECTLY OR INDIRECTLY CONTROLLED, BY AN EXEMPT ORGANIZATION. A TRUSTEE OR DIRECTOR IS A REPRESENTATIVE OF AN EXEMPT ORGANIZATION IF THEY ARE A TRUSTEE, DIRECTOR, AGENT, OR EMPLOYEE OF SUCH EXEMPT ORGANIZATION. UNDER THIS DEFINITION, HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER, INC. AND AFFILIATES ARE INCLUDED IN ANNA JAQUES HOSPITAL, INC.'S FORM 990, SCHEDULE R FOR THE CURRENT TAX YEAR.

Schedule R (Form 990) 2018

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: SEE SCHEDULE O
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	22
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	16
5	Total number of individuals employed in calendar year 2018 (Part V, line 2a) ......	5	1,291
6	Total number of volunteers (estimate if necessary) .............	6	200
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	1,194,085
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	-17,322

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	1,510,550	1,680,621
9	Program service revenue (Part VIII, line 2g) .........	126,905,168	131,456,775
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	667,382	710,044
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	2,670,395	3,101,796
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	131,753,495	136,949,236
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	22,270	72,020
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	73,298,719	73,336,848
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	57,305,422	61,892,735
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	130,626,411	135,301,603
19	Revenue less expenses. Subtract line 18 from line 12.......	1,127,084	1,647,633
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	88,866,592	92,319,549
21	Total liabilities (Part X, line 26).............	55,320,917	71,344,600
22	Net assets or fund balances. Subtract line 21 from line 20.....	33,545,675	20,974,949

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 54,646,079 including grants of $ 72,020 ) (Revenue $ 58,187,438 )
	SEE SCHEDULE O

4b	(Code: ) (Expenses $ 57,005,399 including grants of $ ) (Revenue $ 60,699,655 )
	SEE SCHEDULE O

4c	(Code: ) (Expenses $ 12,498,909 including grants of $ ) (Revenue $ 13,308,718 )
	SEE SCHEDULE O

4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses124,150,387

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	2,748,370	5,734,418	972,620

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	1,256,919
e	Government grants (contributions)		1e	423,702

f	All other contributions, gifts, grants, and similar amounts not included above		1f

g	Noncash contributions included in lines 1a - 1f:$
h Total. Add lines 1a-1f.......		1,680,621

		Business Code
2a	HOSPITAL PATIENT REVEN	621400	130,262,690	130,262,690
b	NONPATIENT LAB REVENUE	621500	1,194,085		1,194,085
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f ....		131,456,775

3 Investment income (including dividends, interest, and othersimilar amounts) ......			84,438			84,438
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		308,454
b	Less: rental expenses		0
c	Rental income or (loss)		308,454
d	Net rental income or (loss)......			308,454			308,454
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	38,730	594,447
b	Less: cost or other basis and sales expenses	0	7,571
c	Gain or (loss)	38,730	586,876
d	Net gain or (loss).....			625,606			625,606
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	MRI/PET/RAD JV REVENUE		621400	1,029,768	1,029,768
b	HAVERHILL MOB JV REV		621400	860,221			860,221
c	CAFETERIA REVENUE		900099	699,397	699,397
d	All other revenue ....			203,956	203,956
e	Total. Add lines 11a–11d ......			2,793,342
12	Total revenue. See Instructions......			136,949,236	132,195,811	1,194,085	1,878,719

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	72,020	72,020
2	Grants and other assistance to domestic individuals. See Part IV, line 22
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, line 15 and 16.
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....	2,066,355	1,896,087	170,268
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....
7	Other salaries and wages	55,507,515	51,016,164	4,491,351
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	2,406,270	2,211,440	194,830
9	Other employee benefits .......	9,278,888	8,527,599	751,289
10	Payroll taxes ...........	4,077,820	3,806,116	271,704
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	179,665		179,665
c	Accounting ...........	61,667		61,667
d	Lobbying ...........	108,190	3,246	104,944
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	11,450,489	9,202,756	2,247,733
12	Advertising and promotion ....	321,472		321,472
13	Office expenses .......	38,450,203	37,509,210	940,993
14	Information technology ......
15	Royalties ..
16	Occupancy ...........	3,790,852	2,854,552	936,300
17	Travel ............
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	105,116	77,989	27,127
20	Interest ...........	715,054	715,054
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	5,061,091	5,061,091
23	Insurance ...	628,310	628,310
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	REPAIRS	487,296	485,495	1,801
b	DUES	259,845	8,092	251,753
c	COLLECTION/RECRUITING	155,074		155,074
d	LICENSES	118,411	75,166	43,245
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	135,301,603	124,150,387	11,151,216	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 if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........				1
2	Savings and temporary cash investments .........			5,766,883	2	2,482,224
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			15,201,756	4	14,877,451
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L .............
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L ..............
					6
7	Notes and loans receivable, net ....			166,083	7	0
8	Inventories for sale or use ........			4,188,070	8	4,758,305
9	Prepaid expenses and deferred charges ......			1,123,168	9	1,260,600
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	41,479,949
b	Less: accumulated depreciation	10b	3,138,704	29,316,378	10c	38,341,245
11	Investments—publicly traded securities .			20,018,666	11	20,080,614
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			13,085,588	15	10,519,110
16	Total assets. Add lines 1 through 15 (must equal line 34)...			88,866,592	16	92,319,549

17	Accounts payable and accrued expenses .....	11,600,321	17	11,728,625
18	Grants payable ...		18
19	Deferred revenue .........	769,425	19	512,001
20	Tax-exempt bond liabilities .........	18,902,667	20	22,814,704
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..		22
23	Secured mortgages and notes payable to unrelated third parties ..	3,303,315	23	161,831
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	20,745,189	25	36,127,439
26	Total liabilities. Add lines 17 through 25..	55,320,917	26	71,344,600

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	33,364,391	27	20,822,373
28	Temporarily restricted net assets ...........	181,284	28	152,576
29	Permanently restricted net assets		29
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund ...		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	33,545,675	33	20,974,949
34	Total liabilities and net assets/fund balances ........	88,866,592	34	92,319,549