CHMC Anesthesia Foundation Inc Retiree Medical Benefit Trust

Address
300 Longwood Avenue
Boston, MA 02115
Contact
Phone: +1 (617) 355-7267
Nonprofit
NTEE: E11 - Single Organization Support
EIN: 26-0538595

Mission

The retiree medical plan is a welfare plan as defined by ERISA. The plan is funded entirely by CHMC Anesthesia Foundation, Inc. (the employer). Benefits reimburse qualifying medical expenses defined in IRC Sections 213(d), incurred by participants, spouses, and dependent children not reimbursed from other sources.
 20172016201520142013
Basic features of the organization
Year of formation2006
Subsection code09
PF filing required0    
Metropolitan statistical area1123
Form of organization
TrustTrue
Human resources, including compensation
Summary compensation info
Sum of reportable (W2/1099) compensation$0.00$0.00$0.00$0.00 
Number of employees0000 
Number of people compensated >$100k0000 
Number of volunteers0000 
Number of highly compensated contractors0000 
Personnel
Hickey, Paul
TitlePresident/TreasurerRMB Committee MemberRMB Committee MemberRMB Committee Member 
Name of key/compensated personPaul R Hickey MDPaul R Hickey MDPaul R Hickey MDPaul R Hickey MD 
Position of compensated person
Current individual trustee or directorTrueTrueTrueTrue 
Current officerTrue    
Average hours per week working for org1.001.001.001.00 
Reportable compensation from org$0.00$0.00$0.00$0.00 
Breakdown of reportable comp
Base reportable compensation from org$0.00$0.00$0.00$0.00 
Bonus and incentive reportable compensation$0.00$0.00$0.00$0.00 
Other reportable compensation from org$0.00$0.00$0.00$0.00 
Retirement and other deferred compensation$0.00$0.00$0.00$0.00 
Nontaxable benefits from org$0.00$0.00$0.00$0.00 
Compensation from org previously reported as deferred$0.00$0.00$0.00$0.00 
Other comp, non-reportable, from org and related orgs$159,511.00$91,113.00$189,033.00$184,279.00 
Sum of all compensation from org$0.00$0.00$0.00$0.00 
Corresponding comp from related orgs
Reportable compensation from related orgs $1,557,083.00$1,512,505.00$1,802,794.00$2,448,114.00 
Average hours per week working for related orgs59.0059.0059.0060.00 
Koka, Babu
TitleDirectorRMB Committee MemberRMB Committee Member  
Name of key/compensated personBabu Koka MDBabu Koka MDBabu Koka MD  
Position of compensated person
Current individual trustee or directorTrueTrueTrue  
Average hours per week working for org1.001.001.00  
Reportable compensation from org$0.00$0.00$0.00  
Breakdown of reportable comp
Base reportable compensation from org$0.00$0.00$0.00  
Bonus and incentive reportable compensation$0.00$0.00$0.00  
Other reportable compensation from org$0.00$0.00$0.00  
Retirement and other deferred compensation$0.00$0.00$0.00  
Nontaxable benefits from org$0.00$0.00$0.00  
Compensation from org previously reported as deferred$0.00$0.00$0.00  
Other comp, non-reportable, from org and related orgs$117,081.00$114,300.00$176,961.00  
Sum of all compensation from org$0.00$0.00$0.00  
Corresponding comp from related orgs
Reportable compensation from related orgs $427,962.00$464,121.00$481,570.00  
Average hours per week working for related orgs59.0059.0059.00  
McManus, Michael
TitleDirectorRMB Committee MemberRMB Committee MemberRMB Committee Member 
Name of key/compensated personMichael McManus MDMichael McManus MDMichael McManus MDMichael McManus MD 
Position of compensated person
Current individual trustee or directorTrueTrueTrueTrue 
Average hours per week working for org1.001.001.001.00 
Reportable compensation from org$0.00$0.00$0.00$0.00 
Breakdown of reportable comp
Base reportable compensation from org$0.00$0.00$0.00$0.00 
Bonus and incentive reportable compensation$0.00$0.00$0.00$0.00 
Other reportable compensation from org$0.00$0.00$0.00$0.00 
Retirement and other deferred compensation$0.00$0.00$0.00$0.00 
Nontaxable benefits from org$0.00$0.00$0.00$0.00 
Compensation from org previously reported as deferred$0.00$0.00$0.00$0.00 
Other comp, non-reportable, from org and related orgs$127,260.00$101,507.00$148,579.00$161,790.00 
Sum of all compensation from org$0.00$0.00$0.00$0.00 
Corresponding comp from related orgs
Reportable compensation from related orgs $577,302.00$558,389.00$913,073.00$558,423.00 
Average hours per week working for related orgs59.0059.0059.0060.00 
Nargozian, Charles
TitleDirectorRMB Committee MemberRMB Committee MemberRMB Committee Member 
Name of key/compensated personCharles Nargozian MDCharles Nargozian MDCharles Nargozian MDCharles Nargozian MD 
Position of compensated person
Current individual trustee or directorTrueTrueTrueTrue 
Average hours per week working for org1.001.001.001.00 
Reportable compensation from org$0.00$0.00$0.00$0.00 
Breakdown of reportable comp
Base reportable compensation from org$0.00$0.00$0.00$0.00 
Bonus and incentive reportable compensation$0.00$0.00$0.00$0.00 
Other reportable compensation from org$0.00$0.00$0.00$0.00 
Retirement and other deferred compensation$0.00$0.00$0.00$0.00 
Nontaxable benefits from org$0.00$0.00$0.00$0.00 
Compensation from org previously reported as deferred$0.00$0.00$0.00$0.00 
Other comp, non-reportable, from org and related orgs$121,183.00$97,629.00$168,171.00$163,889.00 
Sum of all compensation from org$0.00$0.00$0.00$0.00 
Corresponding comp from related orgs
Reportable compensation from related orgs $446,234.00$480,273.00$489,490.00$479,317.00 
Average hours per week working for related orgs59.0059.0059.0060.00 
Rockoff, Mark
TitleClerkRMB Committee MemberRMB Committee MemberRMB Committee Member 
Name of key/compensated personMark A Rockoff MDMark A Rockoff MDMark A Rockoff MDMark A Rockoff MD 
Position of compensated person
Current individual trustee or directorTrueTrueTrueTrue 
Current officerTrue    
Average hours per week working for org1.001.001.001.00 
Reportable compensation from org$0.00$0.00$0.00$0.00 
Breakdown of reportable comp
Base reportable compensation from org$0.00$0.00$0.00$0.00 
Bonus and incentive reportable compensation$0.00$0.00$0.00$0.00 
Other reportable compensation from org$0.00$0.00$0.00$0.00 
Retirement and other deferred compensation$0.00$0.00$0.00$0.00 
Nontaxable benefits from org$0.00$0.00$0.00$0.00 
Compensation from org previously reported as deferred$0.00$0.00$0.00$0.00 
Other comp, non-reportable, from org and related orgs$134,571.00$90,816.00$117,196.00$206,969.00 
Sum of all compensation from org$0.00$0.00$0.00$0.00 
Corresponding comp from related orgs
Reportable compensation from related orgs $726,631.00$938,388.00$876,885.00$933,146.00 
Average hours per week working for related orgs59.0059.0059.0060.00 
Purpose: mission, activities, & accomplishments
Mission or significant activitiesTax-exempt employee benefit trustTax-exempt employee benefit trustTax-exempt employee benefit trustTax-exempt employee benefit trust 
Programs, including revenue & expenses
Benefits to participants, spouses, and dependent children; the employer (CHMC Anesthesia Foundation, Inc.) does not charge for donated services.
Program descriptionBenefits to participants, spouses, and dependent children; the employer (CHMC Anesthesia Foundation, Inc.) does not charge for donated services.Benefits to participants, spouses, and dependent children; the employer (CHMC Anesthesia Foundation, Inc.) does not charge for donated services.Benefits to participants, spouses, and dependent children; the employer (CHMC Anesthesia Foundation, Inc.) does not charge for donated services.Benefits to participants, spouses, and dependent children; the employer (CHMC Anesthesia Foundation, Inc.) does not charge for donated services. 
Financial data
Revenue
Total revenue$632,949.00$405,691.00$1,068,514.00$1,161,414.00 
Revenue from contributions (total)  $0.00$0.00$0.00
Investment income, current yr$632,949.00$405,691.00$1,068,514.00$1,161,414.00 
Total revenue from grants, etc., current yr$0.00$0.00$0.00$0.00 
Total unrelated business revenue$0.00$0.00$0.00$0.00 
Other revenue, current yr$0.00$0.00$0.00$0.00 
Net unrelated business taxable revenue$0.00$0.00$0.00$0.00 
Program service revenue (total)  $0.00$0.00$503,829.00
Gross receipts$3,312,811.00$3,432,976.00$5,908,457.00$8,029,530.00 
Other types of revenue
Income from dividends, interest, and similar investments$321,225.00$280,640.00$291,628.00$267,228.00 
Net rental income  $0.00$0.00$0.00
Expense categories (totals)
Total functional expenses: sum of all$8,292.00$15,504.00$6,365.00$19,814.00 
Fees for services
Fundraising service fees (total)$0.00$0.00$0.00$0.00 
Investment management fees (total)$8,292.00    
Assets and liabilities
Total assets$17,810,572.00$15,650,540.00$15,909,175.00$15,363,444.00$13,045,922.00
Total assets, beginning of year$15,650,540.00$15,909,175.00$15,363,444.00$13,045,922.00 
Total liabilities$0.00$0.00$0.00$0.00$0.00
Total liabilities, beginning of year$0.00$0.00$0.00$0.00 
Net assets$17,810,572.00$15,650,540.00$15,909,175.00$15,363,444.00 
Net assets, beginning of year$15,650,540.00$15,909,175.00$15,363,444.00$13,045,922.00 
Investments: other securities   $0.00 
Investments: publicly traded securities$17,425,091.00$15,362,940.00$15,691,688.00$15,166,658.00 
Cash: non-interest bearing$385,481.00$287,600.00$217,487.00$196,786.00 
Cash: non-interest bearing, beginning of year$287,600.00$217,487.00$196,786.00$140,110.00 
Other financial variables
Revenue less expenses$624,657.00$390,187.00$1,062,149.00$1,141,600.00 
Total net assets or fund balances$17,810,572.00$15,650,540.00$15,909,175.00$15,363,444.00 
Governance and accountability
Number of voting members5554 
Number of independent voting members0000 
Cash accountingTrueTrueTrueTrue 
Tax year start date2016-07-012015-07-012014-07-012013-07-01 
Tax year end date2017-06-012016-06-012015-06-012014-06-012013-06-01
Metadata about the filing
E-return type: 990, 990EZ, or 990PF990990990990 
Date e-filing submitted2018-05-162017-09-062016-08-032015-07-16 
IRS schema version2016v3.02015v3.02014v6.02013v4.0 
Filing identifier201811169349301261201731249349300413201611339349303601201521289349301137 
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