Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| (A)
STURDY MEMORIAL HOSPITAL INC |
042768252 | 3 | Yes | 0 | 0 | |
|
Total 1
|
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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. | ||||||
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 | ||||||
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.) | ||||||
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.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
|||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 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 |
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|
2
Underdistributions, if any, for years prior to 2018 (reasonable cause required-- explain in Part VI). See instructions. |
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| 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) |
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| 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. |
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|
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. |
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7 Excess distributions carryover to 2019. Add lines 3j and 4c. |
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| 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..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| EMPLOYEES REPORTED ON FORM W-3 | FORM 990, PART V, LINE 2A STURDY MEMORIAL HOSPITAL IS THE COMMON PAYMASTER FOR STURDY MEMORIAL ASSOCIATES. FORM W-3 IS FILED UNDER STURDY MEMORIAL HOSPITAL'S EMPLOYEE IDENTIFICATION NUMBER, THEREFORE STURDY MEMORIAL ASSOCIATES DOES NOT FILE A W-3. THE TOTAL NUMBER OF STURDY MEMORIAL ASSOCIATES EMPLOYEES IS 493, WHICH IS LISTED ON LINE 2. |
| MEMBERS OR STOCKHOLDERS | FORM 990, PART VI, SECTION A, LINE 6 STURDY MEMORIAL FOUNDATION, INC., A MASSACHUSETTS CHARITABLE CORPORATION, ACTING THROUGH ITS BOARD OF DIRECTORS, IS THE SOLE MEMBER OF STURDY MEMORIAL ASSOCIATES, INC. |
| MEMBERS OR STOCKHOLDERS WHO MAY ELECT MEMBERS OF GOVERNING BODY | FORM 990, PART VI, SECTION A, LINE 7A THE TRUSTEES SHALL BE ELECTED BY THE MEMBER AT THE ANNUAL MEETING OF THE CORPORATION. THE TERM OF OFFICE FOR EACH SUCH TRUSTEE SHALL BE ONE (1) YEAR. ANY VACANCY CAUSED BY THE RESIGNATION OR REMOVAL OF A TRUSTEE SHALL BE FILLED BY THE MEMBER. |
| DECISIONS SUBJECT TO APPROVAL | FORM 990, PART VI, SECTION A, LINE 7B ALL MATTERS INVOLVING REAL PROPERTY, INCLUDING WITHOUT NECESSARY LIMITATION, SALES, LEASES AND PURCHASES, SHALL FIRST REQUIRE APPROVAL OF THE MEMBER ACTING THROUGH THE BOARD OF DIRECTORS OF STURDY MEMORIAL FOUNDATION, INC. |
| FORM 990 REVIEW PROCESS | FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY STURDY MEMORIALS TAX PROVIDERS, GRANT THORNTON LLP, USING INFORMATION PROVIDED BY MANAGEMENT UPON COMPLETION OF THE ANNUAL INDEPENDENT AUDIT. THE INFORMATION PROVIDED IS THE RESPONSIBILITY OF THE CFO AND THE STURDY FISCAL SERVICES DEPARTMENT. THE RETURN IS REVIEWED BY GRANT THORNTON LLP, THE CONTROLLER AND CFO. PRIOR TO FILING THE FORM 990 WITH THE INTERNAL REVENUE SERVICE, THE COMPLETE FORM AND ALL SCHEDULES ARE PROVIDED TO EVERY BOARD MEMBER AND ANY QUESTIONS ARE ANSWERED. |
| CONFLICT OF INTEREST POLICY MONITORING AND ENFORCEMENT | FORM 990, PART VI, SECTION B, LINE 12C STURDY MEMORIAL ASSOCIATES, INC. IS AN AFFILIATE OF STURDY MEMORIAL HOSPITAL, INC. AND FOLLOWS THE HOSPITAL'S CONFLICT OF INTEREST POLICY. ALL LEADERSHIP AND BOARD MEMBERS COMPLETE AND SIGN AN ANNUAL CONFLICT OF INTEREST DISCLOSURE STATEMENT. THE STATEMENT REQUIRES DISCLOSURE OF ANY OUTSIDE INTERESTS IN ANY BUSINESS, OUTSIDE ACTIVITY, GIFTS, OR ENTERTAINMENT THAT MAY HAVE INFLUENCED THE RESPONDENT. IN ADDITION, THESE SIGNED STATEMENTS ARE REVIEWED BY THE INTEGRITY OFFICER AND ANY POTENTIAL CONFLICTS ARE ADDRESSED AND RESOLVED. THE INTEGRITY OFFICER DISCUSSES DISCLOSED POTENTIAL CONFLICTS WITH EMPLOYEE AND OR OFFICER OF THE CORPORATION, SO THAT THEY UNDERSTAND WHAT CONSTITUTES AN INAPPROPRIATE BUSINESS ACTIVITY. ANY GIFTS RECEIVED THAT CREATE A CONFLICT OR ARE IN VIOLATION OF THE CONFLICT OF INTEREST POLICY MUST BE RETURNED. INDIVIDUALS WITH DOCUMENTED CONFLICTS MUST ABSTAIN FROM ANY DECISION MAKING SPECIFIC TO THE IDENTIFIED AREA. AN ANNUAL REPORT IS PREPARED AND PROVIDED TO THE HOSPITAL'S PRESIDENT AND CEO AS WELL AS BOARD OF MANAGERS; THIS COMPREHENSIVE REPORT INCLUDES ALL INTEGRITY COMPLIANCE ISSUES AS WELL AS ANY NEWLY IDENTIFIED CONFLICTS OF INTEREST. |
| PROCESS FOR DETERMINING COMPENSATION | FORM 990, PART VI, SECTION B, LINE 15 THE CEO AND SENIOR MANAGERS, AS WELL AS ALL OTHER HOSPITAL EMPLOYEES, ARE COMPENSATED ON A MERIT SYSTEM. THE CEO AND SENIOR MANAGERS PREPARE GOALS AT THE START OF EACH FISCAL YEAR AND ARE EVALUATED FOR MERIT INCREASES BASED ON THOSE GOALS AND THEIR ACCOMPLISHMENTS RELATIVE TO THE GOALS. THE CEO'S EVALUATION EXTENDS TO HIS RESPONSIBILITIES AS THE CHIEF EXECUTIVE OF STURDY MEMORIAL ASSOCIATES AS WELL AS HIS RESPONSIBILITIES AT THE REMAINING AFFILIATED CORPORATIONS. THE CEOS COMPENSATION IS PAID ENTIRELY BY THE HOSPITAL (THERE IS NO ADDITIONAL COMPENSATION FROM THE RELATED ORGANIZATIONS). SEVERAL OF THE OTHER SENIOR MANAGERS HAVE RESPONSIBILITIES THAT EXTEND TO THE AFFILIATED CORPORATIONS AND THEIR COMPENSATION IS PAID ENTIRELY BY THE HOSPITAL AS WELL (THERE IS NO ADDITIONAL COMPENSATION FROM RELATED ORGANIZATIONS). THE CEO'S ACCOMPLISHMENTS (RELATIVE TO THE ESTABLISHED GOALS) ARE DOCUMENTED IN AN ANNUAL REPORT WHICH IS SUBMITTED TO THE EXECUTIVE COMMITTEE OF THE BOARD. THE EXECUTIVE COMMITTEE IS PROVIDED WITH COMPARATIVE MARKET DATA, OBTAINED THROUGH COMPENSATION SURVEYS PREPARED BY AN INDEPENDENT COMPENSATION CONSULTANT SPECIALIZING IN SUCH MATTERS. THE COMPARATIVE MARKET DATA CONSISTS OF NATIONAL AND REGIONAL PEER GROUPS COMPRISED OF HOSPITALS SIMILAR IN SIZE AND COMPLEXITY TO SMH. THE DATA INCLUDES COMPREHENSIVE SALARY AND BENEFITS INFORMATION FOR CEOS AND SENIOR MANAGERS (KEY EMPLOYEES) INCLUDING COMPARISON OF CASH COMPENSATION AS WELL AS TOTAL COMPENSATION INCLUDING BENEFITS. THE CONSULTANT MEETS IN PERSON OR BY PHONE WITH THE EXECUTIVE COMMITTEE TO REVIEW THE METHODOLOGY USED TO COMPLETE THE ASSESSMENT OF COMPENSATION AND TO REVIEW THE RESULTS. THE VICE PRESIDENT OF HUMAN RESOURCES PROVIDES THE CHAIRMAN WITH THE CEO'S CURRENT ACTUAL SALARY AND BENEFITS. THE CHAIRMAN OF THE BOARD OF MANAGERS PROVIDES THE ABOVE INFORMATION ALONG WITH THE ANNUAL REPORT OF THE CEO'S ACCOMPLISHMENTS (RELATIVE TO ESTABLISHED GOALS) AND A HISTORY OF THE CEO'S COMPENSATION TO THE EXECUTIVE COMMITTEE, WHICH SERVES AS THE COMPENSATION COMMITTEE FOR THIS PURPOSE. THE EXECUTIVE COMMITTEE REVIEWS THE COMPARATIVE DATA FOR CEO CASH COMPENSATION AND TOTAL COMPENSATION INCLUDING BENEFITS. BASED ON THE GOALS ACHIEVED AND THE COMPARATIVE DATA PROVIDED, THE EXECUTIVE COMMITTEE VOTES TO APPROVE THE SALARY AND BONUS OF THE CEO. A SUMMARY OF THE DISCUSSION AND THE DECISION OF THE EXECUTIVE COMMITTEE ARE REFLECTED IN THE MEETING MINUTES. THE CHAIRMAN OF THE BOARD OF MANAGERS COMMUNICATES THE DECISION REGARDING COMPENSATION CHANGES IN A LETTER TO THE VICE PRESIDENT OF HUMAN RESOURCES TO EXECUTE THE CHANGE. THE CEO USES COMPARATIVE MARKET DATA, OBTAINED FROM AN INDEPENDENT COMPENSATION CONSULTANT, FOR THE HOSPITAL SENIOR MANAGERS (KEY EMPLOYEES). THE CEO COMPARES THE SENIOR MANAGERS' CURRENT CASH COMPENSATION AND TOTAL COMPENSATION INCLUDING BENEFITS TO THE SURVEY DATA. THE SENIOR MANAGERS' PERFORMANCE IS EVALUATED BASED ON THE GOALS ESTABLISHED AT THE START OF THE YEAR. THE CEO DETERMINES THE BASE PAY AMOUNT AND BONUS FOR EACH SENIOR MANAGER BASED ON PERFORMANCE AND THE COMPENSATION SURVEY. BASE SALARY AND BONUS PAYMENTS FOR EACH SENIOR MANAGER, INCLUDING SURVEY INFORMATION, AS WELL AS AN OVERVIEW OF SENIOR MANAGEMENT PERFORMANCE RELATIVE TO THEIR GOALS, ARE REVIEWED WITH THE EXECUTIVE COMMITTEE BY THE CEO. THE EXECUTIVE COMMITTEE VOTES TO ACCEPT THE RECOMMENDATIONS OF THE CEO EXCEPT FOR THE CFO, THE EXECUTIVE COMMITTEE VOTES TO APPROVE THE CFO'S COMPENSATION. |
| HOW DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC | FORM 990, PART VI, SECTION C, LINE 19 STURDY MEMORIAL ASSOCIATES, INC. MAKES AVAILABLE COPIES OF ITS BY-LAWS, THE CONFLICT OF INTEREST POLICY OF STURDY MEMORIAL HOSPITAL, INC. AND FINANCIAL STATEMENTS TO THE PUBLIC UPON REQUEST. |
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