Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet 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.
MediumBulletGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2017
Open to Public Inspection
Name of the organization
MOUNT AUBURN HOSPITAL
 
Employer identification number

04-2103606
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 (b) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No
2
Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image$
 
3
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?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
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) 2017
Page 2
Schedule L (Form 990 or 990-EZ) 2017
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?
Yes No
(1) SUBSTANTIAL CONTRIBUTOR #3
 
SUBSTANTIAL CONTRIBUTOR 6,229,025 CAPITAL PROJECTS RENOVATION   No
(2) SUBSTANTIAL CONTRIBUTOR #5
 
SUBSTANTIAL CONTRIBUTOR 321,596 PHYSICIAN FEES   No
(3) SUBSTANTIAL CONTRIBUTOR #39
 
SUBSTANTIAL CONTRIBUTOR 817,766 CASE MANAGEMENT SERVICES, DATA WAREHOUSING, AND ACO EXPENSES   No
(4) SUBSTANTIAL CONTRIBUTOR #49
 
SUBSTANTIAL CONTRIBUTOR 1,616,472 PHYSICIAN FEES   No
(5) SUBSTANTIAL CONTRIBUTOR #89
 
SUBSTANTIAL CONTRIBUTOR 2,817,357 IT NETWORK EQUIPMENT AND SUPPORT SERVICES   No
(6) SUBSTANTIAL CONTRIBUTOR #92
 
SUBSTANTIAL CONTRIBUTOR 4,321,435 SOFTWARE LICENSE PURCHASE AND SUPPORT FEES   No
(7) M SHORTSLEEVE BUSINESS RELATIONSHIP 321,596 SERVICES   No
(8) K RAFFERTY FAMILY MEMBER OF J. RAFFERTY 119,692 SERVICES   No
Part V
Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).
Return Reference Explanation
PART IV - BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS MOUNT AUBURN HOSPITAL, MOUNT AUBURN PROFESSIONAL SERVICES AND CAREGROUP PARMENTER HOME CARE & HOSPICE MAY BE REFERRED TO IN THESE EXPLANATORY NOTES TO FORM 990 SCHEDULE L PART IV AS MAH, MAPS AND CPHCH RESPECTIVELY.DONOR #3SUBSTANTIAL CONTRIBUTORAMOUNT OF TRANSACTION: $6,229,025DESCRIPTION OF TRANSACTION: CAPITAL PROJECTS RENOVATIONDONOR #5SUBSTANTIAL CONTRIBUTORAMOUNT OF TRANSACTION: $321,596DESCRIPTION OF TRANSACTION: PHYSICIAN FEESDONOR #39SUBSTANTIAL CONTRIBUTORAMOUNT OF TRANSACTION: $817,766DESCRIPTION OF TRANSACTION: CASE MANAGEMENT SERVICES, DATA WAREHOUSING, AND ACO EXPENSESDONOR #49SUBSTANTIAL CONTRIBUTORAMOUNT OF TRANSACTION: $1,616,472DESCRIPTION OF TRANSACTION: PHYSICIAN FEESDONOR #89SUBSTANTIAL CONTRIBUTORAMOUNT OF TRANSACTION: $2,817,357DESCRIPTION OF TRANSACTION: IT NETWORK EQUIPMENT AND SUPPORT SERVICESDONOR #92SUBSTANTIAL CONTRIBUTORAMOUNT OF TRANSACTION: $4,321,435DESCRIPTION OF TRANSACTION: SOFTWARE LICENSE PURCHASE AND SUPPORT FEESMOUNT AUBURN HOSPITAL, MOUNT AUBURN PROFESSIONAL SERVICES AND CAREGROUP PARMENTER HOME CARE & HOSPICE MAY BE REFERRED TO IN THESE EXPLANATORY NOTES TO FORM 990 SCHEDULE L PART IV AS MAH, MAPS AND CPHCH RESPECTIVELY.MICHAEL SHORTSLEEVE, M.D., A MEMBER OF THE MAH BOARD OF TRUSTEES AND CHAIR OF THE DEPARTMENT OF RADIOLOGY, IS THE PRESIDENT OF SCHATZKI ASSOCIATES. SCHATZKI ASSOCIATES PROVIDED RADIOLOGY AND TEACHING SERVICES TO MAH, INCLUDING THE CHAIR OF THE DEPARTMENT OF RADIOLOGY. CHARGES FOR THOSE SERVICES DURING THE FISCAL YEAR WERE $321,596. THE FEES PAID TO SCHATZKI ASSOCIATES REFLECTED FAIR MARKET VALUE RATES. SEE FORM 990 PART VII AND SCH J FOR ADDITIONAL INFORMATION. KATHERINE RAFFERTY, COMMUNITY RELATIONS DIRECTOR AT MOUNT AUBURN HOSPITAL, IS THE SISTER OF JAMES RAFFERTY WHO IS A MAH TRUSTEE. HER SALARY AND OTHER INCOME FOR THE CALENDAR YEAR 2017 INCLUDE:BASE COMPENSATION: $97,295 INCENTIVE COMPENSATION: $225OTHER REPORTABLE COMPENSATION: $4,049DEFERRED COMPENSATION: $7,277NON-TAXABLE BENEFITS: $10,846ALL 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. MOUNT AUBURN HOSPITAL (MAH) MAINTAINS AN ACCOUNTABLE BUSINESS EXPENSE REIMBURSEMENT PLAN. FROM TIME TO TIME, MAH 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 MAH CONFLICT OF INTEREST POLICY AND REFLECT FAIR MARKET PAYMENTS AND RATES.
Schedule L (Form 990 or 990-EZ) 2017


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