Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and 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)
THE LOWELL GENERAL HOSPITAL |
042103590 | 3 | Yes | 0 | 0 | |
| (B)
TUFTS MEDICAL CENTER INC |
043400617 | 3 | Yes | 0 | 0 | |
| (C)
MELROSEWAKEFIELD HEALTHCARE INC |
042767880 | 3 | Yes | 0 | 0 | |
|
Total 3
|
0 | 0 | ||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 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) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (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 2019 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2019 |
(iii) Distributable Amount for 2019 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2019 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions. |
||||
| 3 Excess distributions carryover, if any, to 2019: | ||||
| a From 2014....... | ||||
| b From 2015....... | ||||
| c From 2016....... | ||||
| d From 2017....... | ||||
| e From 2018....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2019 distributable amount | ||||
|
i
Carryover from 2014 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2019 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2019 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
||||
|
6
Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
||||
|
7 Excess distributions carryover to 2020. Add lines 3j and 4c. |
||||
| 8 Breakdown of line 7: | ||||
| a Excess from 2015..... | ||||
| b Excess from 2016..... | ||||
| c Excess from 2017..... | ||||
| d Excess from 2018..... | ||||
| e Excess from 2019..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| SECTION A. ALL SUPPORTING ORGANIZATIONS | EFFECTIVE JANUARY 1, 2018 TUFTS MEDICAL CENTER PARENT, INC. AND CONSOLIDATED AFFILIATES ("TUFTS MC"), CIRCLE HEALTH, INC. AND CONSOLIDATED AFFILIATES ("CIRCLE HEALTH") AND MELROSEWAKEFIELD HEALTHCARE PARENT CORPORATION AND CONSOLIDATED AFFILIATES ("HALLMARK HEALTH"), BECAME THE FOUNDING MEMBERS OF WELLFORCE, INC. ("WELLFORCE"), WHICH IS HEREINAFTER REFERRED TO AS THE "SYSTEM." WELLFORCE WILL PROVIDE ASSISTANCE IN POPULATION HEALTH MANAGEMENT AS A SUPPORTING ORGANIZATION TO TUFTS MEDICAL CENTER, HALLMARK HEALTH, AND THE LOWELL GENERAL HOSPITAL, ALL OF WHICH ARE 501(C)(3) TAX EXEMPT ORGANIZATIONS. THIS WILL ALLOW FOR INNOVATION IN CARE MANAGEMENT MODELS, DISSEMINATION OF BEST PRACTICES, AND SHARED INFRASTRUCTURE AND INFORMATION SYSTEMS. TUFTS MC, HALLMARK HEALTH AND LGH WOULD CARRY OUT THESE ACTIVITIES ON THEIR OWN IF THEY WERE NOT PERFORMED BY WELLFORCE. WELLFORCE IS THE COMMON PARENT, INC. ("TUFTS MC PARENT") CIRCLE HEALTH, INC. ("CIRCLE HEALTH") AND HALLMARK HEALTH, ALL 501(C)(3) ORGANIZATIONS. UNTIL SEPTEMBER 30, 2020, EACH OF TUFTS MC PARENT AND CIRCLE HEALTH WILL APPOINT 7 OF THE 22 TRUSTEES OF WELLFORCE, AND THE 22ND TRUSTEE WILL BE APPOINTED BY TUFTS MC PARENT, HALLMARK HEALTH AND CIRCLE HEALTH JOINTLY. THEREAFTER, EACH OF TUFTS MC PARENT, HALLMARK HEALTH AND CIRCLE HEALTH WILL APPOINT 3 TRUSTEES OF WELLFORCE, AND THE REMAINING TRUSTEES WILL BE ELECTED BY THE TRUSTEES OF WELLFORCE THEN IN OFFICE. WHILE WELLFORCE'S GOVERNING DOCUMENTS DO NOT EXPRESSLY REQUIRE THAT A MAJORITY OF ITS GOVERNING BOARD CONSISTS OF INDIVIDUALS WHO ALSO SERVE ON THE GOVERNING BOARD(S) OF THE SUPPORTED ORGANIZATION(S), WELLFORCE BELIEVES THAT IT MEETS TEST 1 BECAUSE, DURING AN INITIAL TRANSITION PERIOD OF SIX YEARS, A MAJORITY OF ITS CURRENT GOVERNING BOARD ALSO SERVE ON THE GOVERNING BOARD(S) OF THE SUPPORTED ORGANIZATION(S), AND THE APPOINTMENT PROCESS WILL ALLOW FOR A MAJORITY OF THE GOVERNING BOARD TO CONTINUE TO CONSIST OF INDIVIDUALS WHO ALSO SERVE ON THE GOVERNING BOARD(S) OF THE SUPPORTED ORGANIZATION(S). AFTER THE INITIAL TRANSITION PERIOD, (I) THREE OF THE TRUSTEES WILL BE APPOINTED BY CIRCLE HEALTH, (II) THREE OF THE TRUSTEES WILL BE APPOINTED BY TUFTS MC PARENT, (III), THREE OF THE TRUSTEES WILL BE APPOINTED BY HALLMARK HEALTH, THE PRESIDENT AND CEO OF WELLFORCE SHALL BE AN EX OFFICIO TRUSTEE, AND (IV) THE REMAINING TRUSTEES SHALL BE ELECTED BY A MAJORITY VOTE OF THE TRUSTEES OF WELLFORCE THEN IN OFFICE. CURRENTLY, A SIGNIFICANT NUMBER OF THE WELLFORCE TRUSTEES ARE ALSO ON THE GOVERNING BOARD OF LGH, HALLMARK HEALTH AND TUFTS MC, RESULTING IN MAJORITY WHO ALSO SERVE ON THE GOVERNING BOARD(S) OF THE SUPPORTED ORGANIZATION(S), WITH ONE VACANCY. IN APPOINTING FUTURE TRUSTEES, TUFTS MC PARENT, HALLMARK HEALTH, CIRCLE HEALTH AND THE TRUSTEES OF WELLFORCE WILL ENSURE THAT A MAJORITY OF THE TRUSTEES OF WELLFORCE ALSO SERVE ON THE GOVERNING BOARD(S) OF THE SUPPORTED ORGANIZATION(S). |
| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 7A | THE BOARD OF TRUSTEES SHALL CONSIST OF TWENTY-FOUR (24) PERSONS, WHO SHALL BE DESIGNATED OR ELECTED AT THE ANNUAL MEETING, OR AT ANY REGULAR MEETING OR SPECIAL MEETING CALLED FOR THE PURPOSE AS FOLLOWS AND SHALL BE COMPOSED AS FOLLOWS DURING THE PERIOD COMMENCING ON OCTOBER 1, 2018: - FOR SO LONG AS THE CORPORATION IS THE SOLE MEMBER OF CIRCLE, SEVEN (7) OF THE TRUSTEES SHALL BE DESIGNATED BY CIRCLE. - FOR SO LONG AS THE CORPORATION IS THE SOLE MEMBER OF TUFTS, SEVEN (7) OF THE TRUSTEES SHALL BE DESIGNATED BY TUFTS. - FOR SO LONG AS THE CORPORATION IS THE SOLE MEMBER OF HALLMARK HEALTH, SEVEN (7) OF THE TRUSTEES SHALL BE DESIGNATED BY MELROSEWAKEFIELD. - FOR SO LONG AS THE CORPORATION IS THE SOLE MEMBER OF HALLMARK HEALTH, ONE (1) OF THE TRUSTEES SHALL BE DESIGNATED BY HOME HEALTH FOUNDATION. - FOR SO LONG AS THE CORPORATION IS THE SOLE MEMBER OF EACH OF THE FOUNDING MEMBERS, ONE (1) PERSON JOINTLY DESIGNATED BY THE FOUNDING MEMBERS WHO SHALL NOT BE A TRUSTEE, OFFICER, EMPLOYEE, PHYSICIAN AFFILIATED WITH CIRCLE, TUFTS, MELROSEWAKEFIELD, OR HOME HEALTH FOUNDATION OR THEIR RESPECTIVE AFFILIATES. - THE CHIEF EXECUTVE OFFICER OF THE CORPORATION. |
| FORM 990, PART VI, SECTION B, LINE 11B | WELLFORCE, INC'S 990 WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM IN ACCORDANCE WITH INFORMATION PROVIDED BY THE FINANCE DEPARTMENT. THE FINANCE DEPARTMENT REVIEWED AND MADE RECOMMENDATIONS BASED UPON THE DRAFT PRIOR TO ITS PRESENTATION TO THE FULL BOARD OF DIRECTORS. BASED UPON THIS REVIEW, THE FINANCE DEPARTMENT FORMED A RECOMMENDATION TO THE BOARD OF DIRECTORS AS TO THE ACCEPTABILITY AND CONTENT OF THE FILING. ALL MEMBERS OF THE BOARD OF DIRECTORS WERE PROVIDED A COPY OF THE COMPLETED 990 BEFORE FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | WELLFORCE, INC. FOLLOWS THE CONFLICT OF INTEREST POLICY OF LOWELL GENERAL HOSPITAL. ALL TRUSTEES, OFFICERS AND KEY EMPLOYEES SIGN AN ANNUAL CONFLICT OF INTEREST STATEMENT FOLLOWING THE POLICY OF LOWELL GENERAL HOSPITAL AS OUTLINED BELOW: ALL OFFICERS, BOARD MEMBERS, AND KEY EMPLOYEES ARE SUBJECT TO THE CONFLICT OF INTEREST POLICY. ANY ACTUAL OR POTENTIAL CONFLICTS ARE FORWARDED TO THE COMPLIANCE COMMITTEE FOR CONSIDERATION. IN THE EVENT OF AN ACTUAL OR POTENTIAL CONFLICT, THE CONFLICTED INDIVIDUAL IS PROHIBITED FROM PARTICIPATING IN DELIBERATIONS OR DECISIONS RELATING TO THE MATTER. A COMPLIANCE COMMITTEE MEETING IS HELD EVERY OTHER MONTH TO ADDRESS CONCERNS. |
| FORM 990, PART VI, SECTION B, LINE 15 | COMPENSATION FOR THE CEO AND OTHER OFFICERS FOLLOWS THE PROCESS OF LOWELL GENERAL HOSPITAL AS OUTLINED BELOW: A THIRD PARTY CONSULTANT IS HIRED FOR AN INDEPENDENT ASSESSMENT OF APPROPRIATE SALARY RANGES FOR THE OFFICERS OF THE ORGANIZATION SUCH AS THE CEO, COO, AND CFO. THIS ASSESSMENT IS REVIEWED BY THE COMPENSATION COMMITTEE AND A RECOMMENDATION IS GIVEN TO THE EXECUTIVE COMMITTEE ON SALARY INCREASES AND BONUSES. |
| FORM 990, PART VI, SECTION C, LINE 19 | WELLFORCE, INC'S FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC THROUGH THE MASSACHUSETTS'S ATTORNEY GENERAL'S WEBSITE. WELLFORCE, INC. DOES NOT MAKE ITS GOVERNING DOCUMENTS OR ITS CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. THE 990 IS AVAILABLE ON THE MASSACHUSETT'S ATTORNEY GENERAL'S WEBSITE AND WWW.GUIDESTAR.ORG. |
| FORM 990, PART IX, LINE 11G | PROFESSIONAL CONSULTING FEES: PROGRAM SERVICE EXPENSES 4,116,233. MANAGEMENT AND GENERAL EXPENSES 4,116,233. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,232,466. |
| FORM 990, PART XI, LINE 9: | INTERENTITY NET ASSET TRANSFERS 13,019,213. |
| Software ID: | |
| Software Version: |