2024-02-22T16:06:05-06:00 2023-05-31 410746749 CLIFTONLARSONALLEN LLP 4 BATTERYMARCH PARK SUITE 100 QUINCY MA 02169 990 2022-06-01 042103875 BERKSHIRE RETIREMENT HOME INC BERK 4134454056 290 SOUTH STREET PITTSFIELD MA 01201 DOROTHY MARA TREASURER 4134454056 2024-02-20 1 DOROTHY MARA 999009999 0 KATARZYNA O PADZIK P02268641 7819821001 2024-02-20 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z BERKSHIRE PLACE NELSON FURLANO 290 SOUTH STREET PITTSFIELD MA 01201 6619553 0 X WWW.BERKSHIREPLACE.COM X 1890 MA TO BETTER SERVE THE HEALTHCARE NEEDS OF OUR COMMUNITY. OUR SERVICES FOCUS ON EXCEPTIONAL CARE AND SERVICES WITH AN EMPHASIS ON RETAINING A PERSONALIZED, HOME-LIKE ENVIRONMENT. 12 12 113 25 0 0 68540 39495 6736512 6378867 -6988 21433 -203836 179758 6594228 6619553 0 0 0 0 3419416 3393148 0 0 0 2356477 2526461 5775893 5919609 818335 699944 13020326 13156670 11739492 11377867 1280834 1778803 TO BETTER SERVE HEALTHCARE NEEDS OF OUR COMMUNITY. OUR SERVICES FOCUS ON EXCEPTIONAL CARE AND SERVICES WITH AN EMPHASIS ON RETAINING A PERSONALIZED, HOME-LIKE ENVIRONMENT. 0 0 5114065 0 6558625 BERKSHIRE PLACE PROVIDES SKILLED NURSING AND REHABILITATION CARE, LONG TERM CARE RESIDENCY, MEMORY CARE SUPPORT, PALLIATIVE CARE/COMFORT CARE, OUTPATIENT REHABILITATION AND RESPITE CARE. 210 CLIENTS WERE SERVED DURING THE YEAR. 5114065 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 3 0 113 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X EDWARD FORFA 4134454056 290 SOUTH STREET PITTSFIELD MA 01201 EDWARD A FORFA EXECUTIVE DIRECTOR 20.00 20.00 X 0 256462 13175 TERRIE CHOQUETTE ADMINISTRATOR 40.00 X 119072 0 4910 PATRICIA MEADER CERTIFIED NURSING ASSISTANT 40.00 X 112963 0 0 ELIZABETH SHEPARD REGISTERED NURSE 40.00 X 106607 0 0 NELSON FURLANO PRESIDENT 0.50 0.50 X X 0 0 0 JOHN MURPHY VICE-PRESIDENT 0.50 0.50 X X 0 0 0 DOROTHY MARA TREASURER 0.50 0.50 X X 0 0 0 MARK GILLIGAN SECRETARY/CLERK 0.50 0.50 X X 0 0 0 RICHARD HERRICK MEMBER - IMMEDIATE PAST PRESIDENT 0.50 0.50 X 0 0 0 KEVIN BISACCIO MEMBER 0.50 X 0 0 0 ELIZABETH KIRBY MEMBER 0.50 X 0 0 0 SHELLEY GUYETTE MEMBER 0.50 X 0 0 0 CRAIG KAHN MEMBER 0.50 X 0 0 0 VINCENT MARINARO MEMBER 0.50 X 0 0 0 JACQUELINE MCNINCH MEMBER 0.50 X 0 0 0 RICHARD PATTERSON MEMBER 0.50 X 0 0 0 338642 256462 18085 3 0 1 0 PREFERRED THERAPY SOLUTIONS 850 SILAS DEANE HWY 2 WETHERSFIELD CT 06109 PHYSICAL THERAPY 312107 INTELYCARE INC 1250 HANCOCK ST 501N QUINCY MA 02169 NURSING AGENCY 227975 2 39495 39495 PATIENT SERVICE REVENUE 623000 6304314 6304314 USER FEE 623000 60799 60799 MISCELLANEOUS INCOME 623000 13754 13754 6378867 21433 21433 CHANGE IN FUTURE SERVICE OBLIGATI 900099 179758 179758 179758 6619553 6558625 0 21433 134819 134819 2779118 2491760 287358 40183 33703 6480 219206 184502 34704 219822 112579 107243 100 100 46533 46533 11475 11475 30326 30326 74406 74406 125851 122948 2903 359528 351045 8483 335589 327670 7919 151954 148724 3230 NURSING SERVICES 607371 607371 ANCILLARIES 388172 388172 DIETARY EXPENSE 166258 166258 PLANT OPERATIONS 79541 78019 1522 149357 101314 48043 5919609 5114065 805544 0 348477 204773 638946 371450 312572 205468 329 14139022 3406810 11067803 10732212 1008683 652528 633755 13020326 13156670 306287 330159 10908661 10702921 524544 344787 11739492 11377867 X 1236832 1739341 44002 39462 1280834 1778803 13020326 13156670 X 699944 -1975 -200000 X 0 1 X 1 1 1 X 16883 19723 841764 68540 39495 986405 7157957 6782022 6654519 6736512 6378867 33709877 7174840 6801745 7496283 6805052 6418362 34696282 1200 1950 3150 1462930 1688195 1095949 1904533 2079471 8231078 1462930 1688195 1095949 1905733 2081421 8234228 26462054 19662 25425 7553 -6988 21434 67086 19662 25425 7553 -6988 21434 67086 328972 -203836 179757 304893 7194502 7156142 7503836 6594228 6619553 35068261 0.75460 0.76870 0.00190 0.00510 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 264543 264543 13281621 2826394 10455227 592858 580416 12442 10732212 RESERVE FOR OBLIGATION TO PROVIDE FUTURE SERVICES 344787 344787 X PART X, LINE 2: BERKSHIRE RETIREMENT HOME, INC. AND 89 SOUTH CARE SUPPORT, INC. ARE EXEMPT FROM FEDERAL TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC) AND STATE TAXES UNDER APPLICABLE STATE LAW. IN ADDITION, 89 SOUTH CARE SUPPORT, INC. QUALIFIES FOR THE CHARITABLE CONTRIBUTION DEDUCTION UNDER SECTION 509(A)(3) AND HAS BEEN CLASSIFIED AS AN ORGANIZATION THAT IS NOT A PRIVATE FOUNDATION. AT HOME WITH BERKSHIRE PLACE, LLC HAS BEEN ORGANIZED AS A LIMITED LIABILITY COMPANY AND A PASS-THROUGH ENTITY AND IS INCLUDED WITHIN THE CONSOLIDATED TAX RETURN OF 89 SOUTH CARE SUPPORT, INC. MANAGEMENT HAS EVALUATED SIGNIFICANT TAX POSITIONS AGAINST THE CRITERIA ESTABLISHED BY PROFESSIONAL STANDARDS AND BELIEVES THERE ARE NO SUCH TAX POSITIONS REQUIRING ACCOUNTING RECOGNITION. GENERALLY, THE ORGANIZATION'S TAX RETURNS ARE SUBJECT TO EXAMINATION BY TAXING AUTHORITIES FOR THE PRIOR THREE FILING YEARS. THERE ARE CURRENTLY NO EXAMINATIONS PENDING OR IN PROGRESS. 0 0 0 0 0 0 0 0 0 EDWARD A FORFA EXECUTIVE DIRECTOR 0 206462 0 50000 0 0 0 10258 0 2917 0 269637 0 0 PART I, LINE 3 THE ORGANIZATION'S EXECUTIVE DIRECTOR IS PAID BY A RELATED ORGANIZATION. THE ORGANIZATION USED THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S EXECUTIVE DIRECTOR: 1) FORM 990 OF OTHER ORGANIZATIONS AND 2) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM AND IS PROVIDED TO THE AUDIT COMMITTEE AND THEN TO THE BOARD OF DIRECTORS FOR AUTHORIZATION. FORM 990, PART VI, SECTION B, LINE 12C A QUESTIONNAIRE MUST BE COMPLETED ANNUALLY BY OFFICERS, DIRECTORS AND KEY EMPLOYEES DISCLOSING ANY RELATIONSHIPS PRESENTING POTENTIAL CONFLICT OF INTEREST. ALL MEMBERS OF THE BOARD, TRUSTEES AND OFFICERS THAT ARE MAKING PURCHASES OR FUTURE RELATED PARTY TRANSACTIONS, MUST EXECUTE A CONFLICT OF INTEREST DISCLOSURE FORM. CONFLICTS OF INTEREST ARE MONITORED BY THE EXECUTIVE DIRECTOR AND ARE REVIEWED AND ENFORCED BY THE BOARD OF DIRECTORS. THE PERSON WITH THE CONFLICT MUST BE ABSTAIN FROM ANY DISCUSSION REGARDING THE TRANSACTION. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION'S EXECUTIVE DIRECTOR IS PAID BY A RELATED ORGANIZATION, 89 SOUTH CARE SUPPORT, INC. AND A PORTION OF THE EXECUTIVE DIRECTOR'S SALARY AND BENEFITS IS ALLOCATED TO THIS ORGANIZATION. ANNUALLY, THE PRESIDENT, VICE PRESIDENT, COMMITTEE CHAIR, TREASURER AND SECRETARY REVIEW COMPENSATION BASED UPON GOALS, RESULTS, ACCOMPLISHMENTS AND COMPARABLE WAGE/BENEFITS DATA. THE PROCESS WAS COMPLETED MOST RECENTLY IN 2022. FORM 990, PART VI, SECTION C, LINE 18 THE FORM 990 IS AVAILABLE UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION PROVIDES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS UPON REQUEST. FORM 990, PART XI, LINE 9: NET ASSET TRANSFER TO 89 SOUTH CARE SUPPORT, INC. -200,000. AT HOME WITH BERKSHIRE PLACE 89 SOUTH STREET PITTSFIELD MA 01201 274015376 HOME CARE AND OTHER SERVICES MA 94131 285276 89 SOUTH CARE SUPPORT INC 89 SOUTH CARE SUPPORT INC 89 SOUTH STREET PITTSFIELD MA 01201 823380934 SUPPORTIVE RESIDENTIAL AND HEALTHCARE SERVICES TO OLDER ADULTS MA 501(C)(3) LINE 12A, I BERKSHIRE RETIREMENT HOME INC 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 89 SOUTH CARE SUPPORT INC O 134819 FMV 89 SOUTH CARE SUPPORT INC R 200000 FMV