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 | |||||
|
Total |
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Calendar year
(or fiscal year beginning in)
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(a) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (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)
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(a) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (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) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (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) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (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 on 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) |
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| 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) |
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| 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): |
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| 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 0.015 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 0.035 | 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 | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2022 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2022 |
(iii) Distributable Amount for 2022 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2022 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2022 (reasonable cause required-- explain in Part VI).
See instructions. |
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| 3 Excess distributions carryover, if any, to 2022: | ||||
| a From 2017....... | ||||
| b From 2018....... | ||||
| c From 2019....... | ||||
| d From 2020....... | ||||
| e From 2021....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2022 distributable amount | ||||
|
i
Carryover from 2017 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2022 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2022 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2022, 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 2022. 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 2023. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2018..... | ||||
| b Excess from 2019..... | ||||
| c Excess from 2020..... | ||||
| d Excess from 2021..... | ||||
| e Excess from 2022..... | ||||
| 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 |
|---|---|
| FORM 990, PART V, LINE 2A: | EMPLOYEES REPORTED ON FORM W-3 STURDY MEMORIAL HOSPITAL, INC. IS THE COMMON PAYMASTER FOR STURDY HEALTH, INC. AND STURDY HEALTH FOUNDATION, INC. F/K/A STURDY MEMORIAL FOUNDATION, INC. THE TOTAL NUMBER OF EMPLOYEES LISTED ON PART V, LINE 2A REPRESENTS HOSPITAL EMPLOYEES INCLUDED UNDER THE COMMON PAYMASTER FILING. |
| FORM 990, PART VI, SECTION A, LINE 1A | VOTING RIGHTS OF GOVERNING BODY THE BYLAWS OF STURDY MEMORIAL HOSPITAL, INC. STATE THAT "THE EXECUTIVE COMMITTEE SHALL HAVE THE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE HOSPITAL DURING THE INTERIM BETWEEN THE MEETINGS OF THE BOARD OF MANAGERS EXCEPT FOR SUCH MATTERS AS ARE SPECIFIED IN SECTION 55 OF THE [MASSACHUSETTS] GENERAL LAWS, CHAPTER 156B." THE EXECUTIVE COMMITTEE CONSISTS ONLY OF MEMBERS OF THE BOARD OF MANAGERS OF STURDY MEMORIAL HOSPITAL. |
| FORM 990, PART VI, SECTION A, LINE 2 | BUSINESS RELATIONSHIPS WITH GOVERNING BODY PAUL HEROUX AND LAURA GIGNAC-BUSINESS RELATIONSHIP. IN ADDITION, OTHER PERSONS LISTED IN PART VII HAVE A "BUSINESS RELATIONSHIP" WITH ONE ANOTHER DUE TO THE OVERLAPPING BOARD STRUCTURE OF STURDY HEALTH FOUNDATION AND ITS AFFILIATES. |
| FORM 990, PART VI, SECTION A, LINE 6 | MEMBERS OR STOCKHOLDERS STURDY HEALTH FOUNDATION, INC., A MASSACHUSETTS CHARITABLE CORPORATION, ACTING THROUGH ITS BOARD OF DIRECTORS, IS THE SOLE MEMBER OF STURDY MEMORIAL HOSPITAL, INC. |
| FORM 990, PART VI, SECTION A, LINE 7A | MEMBERS OR STOCKHOLDERS WHO MAY ELECT MEMBERS OF GOVERNING BODY THE BOARD OF MANAGERS OF STURDY MEMORIAL HOSPITAL, INC. CONSISTS OF THOSE PERSONS WHO SERVE AS THE DIRECTORS OF STURDY HEALTH FOUNDATION, INC. FOUNDATION MEMBERS ARE ELIGIBLE TO ATTEND ALL MEETINGS OF THE CORPORATION AND TO HOLD OFFICE. NEW MEMBERS ARE ELECTED TO MEMBERSHIP BY THE EXISTING MEMBERS FOR THREE YEAR TERMS. |
| FORM 990, PART VI, SECTION B, LINE 11B | FORM 990 REVIEW PROCESS FORM 990 IS PREPARED BY STURDY MEMORIAL'S TAX PROVIDERS, GRANT THORNTON, USING INFORMATION PROVIDED BY MANAGEMENT UPON COMPLETION OF THE ANNUAL INDEPENDENT AUDIT. THE INFORMATION PROVIDED IS THE RESPONSIBILITY OF THE CFO AND STURDY'S FISCAL SERVICES DEPARTMENT. THE RETURN IS REVIEWED BY GRANT THORNTON, THE CONTROLLER AND CFO, AND COMPENSATION AND BENEFIT SECTIONS ARE SPECIFICALLY REVIEWED BY THE CHIEF HUMAN RESOURCES OFFICER FOR STURDY MEMORIAL HOSPITAL, INC. FORM 990 IS THEN PRESENTED TO THE AUDIT COMMITTEE FOR REVIEW AND RECOMMENDATION OF APPROVAL. EVERY BOARD MEMBER RECEIVES FORM 990 AND ALL SCHEDULES PRIOR TO FILING THE RETURN WITH THE INTERNAL REVENUE SERVICE. |
| FORM 990, PART VI, SECTION B, LINE 12C | CONFLICT OF INTEREST POLICY MONITORING & ENFORCEMENT ALL HOSPITAL 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 EMPLOYEES, OFFICERS AND DIRECTORS OF THE HOSPITAL, SO THAT THEY UNDERSTAND WHAT CONSTITUTES AN INAPPROPRIATE BUSINESS ACTIVITY. GIFTS THAT CREATE A CONFLICT OF INTEREST 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. |
| FORM 990, PART VI, SECTION B, LINE 15 | PROCESS FOR DETERMINING COMPENSATION COMPENSATION DECISIONS FOR THE ORGANIZATION'S CEO, CFO AND SENIOR MANAGEMENT (KEY EMPLOYEES) ARE MADE THROUGH ITS EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE CONSISTS SOLELY OF MEMBERS WHO DO NOT HAVE A CONFLICT OF INTEREST WITH REGARDS TO COMPENSATION MATTERS. THE BOARD UTILIZES AN INDEPENDENT OUTSIDE CONSULTANT TO DETERMINE EXECUTIVE COMPENSATION. THE CONSULTANT PRESENTS NATIONAL AND REGIONAL COMPARABILITY DATA FOR SIMILAR ORGANIZATIONS. THE DATA INCLUDES COMPREHENSIVE SALARY AND BENEFITS INFORMATION FOR THE CEO, CFO AND KEY EMPLOYEES INCLUDING COMPARISON OF BASE PAY, INCENTIVE PAY, BENEFITS AND TOTAL COMPENSATION. THE EXECUTIVE COMMITTEE REVIEWS THE COMPARATIVE DATA FOR THE CEO AND CFO AND VOTES TO APPROVE THEIR COMPENSATION. THE CEO USES COMPARATIVE MARKET DATA TO DETERMINE PROPOSED BASE PAY COMPENSATION INCREASES AND POTENTIAL INCENTIVE PAY FOR ALL OTHER SENIOR MANAGERS AND PRESENTS THIS TO THE EXECUTIVE COMMITTEE FOR THEIR CONSIDERATION. THE EXECUTIVE COMMITTEE REVIEWS ALL RELEVANT INFORMATION AND VOTES TO ACCEPT THE RECOMMENDATIONS OF THE CEO FOR SENIOR MANAGER PAY. ALL DATA PRESENTED, AS WELL AS COMPENSATION DELIBERATIONS AND VOTES, ARE DOCUMENTED IN THE EXECUTIVE COMMITTEE MINUTES. THE MOST RECENT COMPENSATION STUDY WAS PERFORMED IN SEPTEMBER 2022. FORM 990, PART VI, SECTION B, LINE 16B: PARTICIPATION IN JOINT VENTURE ARRANGEMENTS STURDY MEMORIAL HOSPITAL HAS A POLICY REQUIRING EVALUATION OF ITS PARTICIPATION IN JOINT VENTURE ARRANGEMENTS UNDER APPLICABLE FEDERAL AND STATE LAW. THE HOSPITAL REQUIRES THAT ANY VENTURE OR ARRANGEMENT WITH THIRD PARTIES NOT ENGAGE IN ANY ACTIVITIES THAT WOULD JEOPARDIZE THE HOSPITAL'S EXEMPTION, SUCH AS POLITICAL ACTIVITIES, SUBSTANTIAL LOBBYING, PRIVATE INUREMENT OR SUBSTANTIAL NONEXEMPT ACTIVITIES. THE HOSPITAL SHALL MAINTAIN CONTROL, PRIORITIZE ITS EXEMPT PURPOSES, ENTER CONTRACTS AT ARMS-LENGTH, REQUIRE TRANSPARENT REPORTING, AND ENSURE ANY VENTURE COMPLY WITH INTERNAL REVENUE CODE SECTION 501(R). THE HOSPITAL'S MANAGEMENT SHALL NEGOTIATE ANY VENTURES OR ARRANGEMENTS WITH THE ASSISTANCE OF LEGAL COUNSEL, IF NECESSARY, AND THE HOSPITAL'S BOARD OF MANAGERS APPROVES ANY VENTURE OR ARRANGEMENT. THE HOSPITAL CURRENTLY PARTICIPATES IN SEVERAL VENTURES, ALL RELATED TO HEALTH CARE OPERATIONS. |
| FORM 990, PART VI, SECTION C, LINE 19 | HOW DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC THE HOSPITAL MAKES AVAILABLE COPIES OF ITS BY-LAWS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS TO THE GENERAL PUBLIC UPON REQUEST. |
| FORM 990, PART XI, LINE 9: | PENSION ADJUSTMENT 32,070,600. NET ASSETS RELEASED FROM RESTRICTIONS 643,075. |
| Software ID: | |
| Software Version: |