2022-11-08T08:31:55-06:00 2021-12-31 010494526 Baker Newman & Noyes PO Box 507 Portland ME 04112 990 2021-01-01 232057177 St Mary's Villa Nursing Home STMA 5708427621 516 St Marys Villa Road Elmhurst Township PA 18444 Nancy Newcomb Chief Executive Officer 5708427621 2022-11-07 1 Nancy Newcomb 999009999 Connor Smart P02285543 2078792100 2022-11-07 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z Nancy Newcomb 516 St Marys Villa Road Elmhurst Township PA 18444 15268064 0 X stmarysvilla.com X 1967 PA We are a Catholic Health Ministry, providing healing and care for the whole person, in service to all in our communities. 14 13 280 16 0 0 1392369 349065 12251786 11395223 785503 3508086 151 -4448 14429809 15247926 0 27200 0 0 8686821 8402733 0 0 0 4799395 4718891 13486216 13148824 943593 2099102 28070373 28652554 6245733 5951819 21824640 22700735 X Our Judeo-Christian tradition compels us to promote Gospel values in all of our endeavors. (continued on Schedule O)We commit to honor these core values: (1) Compassion - we show respect, caring, and sensitivity toward all, and therefore honor the dignity of each person, especialy the poor, vulnerable, and suffering.(2) Integrity - we promote justice and ethical behavior, and we responsibily steward our human, financial and environment resources.(3) Collaboration - we work in partnership, diaglogue and shared purpose to create healthy communities.(4) Excellence - we deliver all services with the higest level of quality, while seeking creative innovation. 0 0 9453662 0 8648980 St. Mary's Villa provides care to the elderly with the operation of a 112 bed skilled nursing facility. 31,591 resident days of service were provided in 2021. St. Mary's admits a number of residents who lack the resources to pay the full cost of services as well as residents whose care is funded under the state Medicaid program. In 2021, both benevolent care and contractual allowances were provided to residents in the skilled nursing facility. 1986510 0 2746243 St. Mary's Villa also provides care to the elderly through the operation of a 64 bed personal care facility. 15,807 resident days of service were provided in 2021. This operation provides a cost based alternative to skilled nursing services. 27200 27200 0 In the spirit of the Covenant Health and the Poor Sisters of Jesus Crucified and keeping with our mission, St. Mary's Villa continues to respond to the needs of the poor and underserved in our community. Under the guidance of the mission committee, St. Mary's Villa Campus donated a total of $27,200 in dollars, goods, and services to the community. 11467372 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 11 0 1 280 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 14 13 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 PA X X Ulysses S Arnold II Regional Controller 5708427621 516 St Marys Villa Road Elmhurst Township PA 18444 Nancy Newcomb President & CEO 50.00 0.00 X X 172007 0 13072 Christina Byron Director 1.00 0.00 X 0 0 0 Lori Chieffallo Director 1.00 0.00 X 0 0 0 Sr Mary Ruth Dauginikas CJC Director 1.00 0.00 X 0 0 0 Renee Loftus Director (end 5/2021) 1.00 0.00 X 0 0 0 James F Loftus IV Director 1.00 0.00 X 0 0 0 Catherine Lovecchio PhD RN Director 1.00 0.00 X 0 0 0 John P Sanderson III Esq Director 1.00 0.00 X 0 0 0 Sr Mary Valliere CJC Director 1.00 0.00 X 0 0 0 Cristen M Walker Director 1.00 0.00 X 0 0 0 Cynthia Timko Director 1.00 0.00 X 0 0 0 Jerome Musheno RPh Esq Chair 1.00 0.00 X X 0 0 0 Frank P Castellano Vice Chair 1.00 0.00 X X 0 0 0 Ellen Burkley Treasurer 1.00 0.00 X X 0 0 0 Peter Kanton Treasurer (end 5/2021) 1.00 0.00 X X 0 0 0 Antoinette Cisowski Secretary (end 5/2021) 1.00 0.00 X X 0 0 0 Dominick Gianuzzi Secretary 1.00 0.00 X X 0 0 0 Brian Beppler CFO & Regional Controller 40.00 0.00 X 115023 0 2417 Catherine Scanlon Director of Nursing 40.00 0.00 X 120113 0 13688 407143 0 29177 3 0 1 0 Covenant Health Inc 100 Ames Pond Drive Suite 102 Tewksbury MA 01876 Management services 495737 1 17900 166897 164268 349065 Patient services 623000 11329530 11329530 Residential and assisted living 623000 59988 59988 Dining and nutrition 722514 5705 5705 11395223 232493 232493 3275422 171 0 0 3275422 171 3275593 3275593 13260 17900 19379 -6119 -6119 2430 759 1671 1671 15247926 11395223 0 3503638 27200 27200 302519 278163 24356 6507828 5987202 520626 91536 83298 8238 994546 905037 89509 506304 460737 45567 495737 495737 38404 38404 117755 117755 970114 970114 154160 154160 268891 268891 280826 280826 289359 289359 25589 25589 7399 7399 203672 187378 16294 700934 644859 56075 261993 261993 Food and dining 345112 345112 PA Provider Tax 302412 302412 Drugs/medical supplies 117722 117722 Provision for bad debts 57750 57750 81062 81062 13148824 11467372 1681452 0 3603088 2530950 296815 982462 844184 16311 16311 120642 56676 21413590 12979976 8931001 8433614 14276839 16373182 45678 10140 94352 90682 28070373 28652554 993821 1258690 297738 204138 2070918 2199418 2883256 2289573 6245733 5951819 X 21258560 22146234 566080 554501 21824640 22700735 28070373 28652554 2099102 -1223007 0 X X 0 1 X 1 1 1 X 36650 6836 184752 1392369 190299 1810906 13830165 14103339 14409108 12251786 11395223 65989621 13866815 14110175 14593860 13644155 11585522 67800527 0 0 0 67800527 169374 304900 1054283 785503 231410 2545470 169374 304900 1054283 785503 231410 2545470 17011 19300 1120 151 0 37582 14053200 14434375 15649263 14429809 11816932 70383579 0.96330 0.96520 0.03620 0.03400 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 1094 0 0 0 1094 0 Part II-B, Line 1: The Nursing Home was a member of LeadingAge Pennsylvania, a healthcare association, as well as a member of the LeadingAge National Association in the year ended December 31, 2021. A portion of the dues paid to these associations was available for lobbying expenditures on behalf of the Nursing Home and the other member organizations in furtherance of their exempt purposes. The dues paid by the Nursing Home to each association during 2021, and the portion of those dues that was available for lobbying, is detailed below: LeadingAge PA: - Total dues: $7,864 - Dues available for lobbying: $977 LeadingAge National: - Total dues: $4,000 - Dues available for lobbying: 117 566080 158766 -30023 140322 554501 475311 100330 51905 61466 566080 347684 163577 14483 50433 475311 329912 50778 3370 36376 347684 323097 69214 6574 68973 329912 0.00000 0.00000 1.00000 0 0 170398 170398 7761415 3839048 3922367 8774465 5093151 3681314 4531842 4047777 484065 175470 175470 8433614 Investment in Covenant Health Investment Trust 16373182 F 16373182 Resident trust funds 13571 Due to affiliates 1900954 Deferred expense liabilities (FIN 47) 313300 Professional liability reserve 57474 Estimated third-party payor settlements 4274 2289573 X Part V, Line 4: The Nursing Home's Endowment Funds are maintained and used to produce a revenue source until they are released from donor-imposed restrictions. Revenues generated from the Endowment Funds, as well as any funds released from restrictions, are used to advance the Villa's exempt mission of providing elder-care and housing solutions. Part X, Line 2: Covenant and its member organizations are considered not-for-profit corporations as described in Section 501(c)(3) of the Internal Revenue Code and are exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. Tax-exempt organizations could be required to record an obligation for income taxes as the result of a tax position they have historically taken on various tax exposure items including unrelated business income or tax status. Under guidance issued by the Financial Accounting Standards Board, assets and liabilities are established for uncertain tax positions taken or positions expected to be taken in income tax returns when such positions are judged to not meet the "more-likely-than-not" threshold, based upon the technical merits of the position. Estimated interest and penalties, if applicable, related to uncertain tax positions are included as a component of income tax expense. The System has evaluated the position taken on its filed tax returns. The System has concluded no uncertain income tax positions exist at December 31, 2021. Annual Golf Tournament 31160 17900 13260 16544 682 2153 31160 17900 13260 16544 682 2153 19379 -6119 1 St Catherine's Church 220 Church Street Moscow PA 18444 501(c)(3) 20000 0 North Pocono Food Pantry 1 0 Part I, Line 2: In the tax period covered by this return, the Organization allocated funds for the support of various food pantry and food relief programs in its community. The funds were provided to food pantries operated by or through government agencies or qualified 501(c)(3) public charities. 0 0 0 0 0 0 0 1 0 Nancy Newcomb President & CEO 163570 0 7052 0 1385 0 3682 0 9390 0 185079 0 0 0 Part I, Line 3 Any compensation paid to the trustees, directors, officers or key employees of the Organization is subject to the oversight and decisions of Covenant Health, a related tax-exempt organization. Every two-to-three years the Compensation Committee of the Covenant Health Board of Directors engages an external consultant to provide competitive market data from various survey sources, which is then used to develop recommendations for changes to the compensation program. Since 2003, the Compensation Committee has engaged a human resources consultant to conduct this analysis. Objectives of the analysis are to assess the compositeness of the total cash compensation levels of the senior leadership team, develop market based competitive salary ranges for all executive positions, and ensure that the annual incentive opportunities, if there are any, are competitive and reasonable. Part I, Line 7 Every year, the Villa provides all of its employees an annual holiday bonus, which is awarded based on the recipient-employee's annual performance, job description, and total years of experience. Dominick Gianuzzi Director Dominick Gianuzzi served on the Nursing Home's Board of Directors during the year ended December 31, 2021. Gianuzzi is also an officer with Peoples Security Bank and Trust Company. The Nursing Home maintains multiple cash accounts with the Bank, as well as one loan under standard market terms. Transactions between the Nursing Home and the Bank in 2021 were in excess of $10,000. An exact figure cannot be stated due to daily account activity and balance changes. The accounts were active prior to Gianuzzi's joining the Board, and all transactions with the Bank are at fair market value. Gianuzzi has therefore been classified as an independent Director. 0 Form 990, Part VI, Section A, line 2 James F. Loftus IV and Renee Loftus, who both served on the Villa's Board of Directors during the year ended December 31, 2021, share a family relationship. Form 990, Part VI, Section A, line 6 St. Mary's Villa Nursing Home ("the Corporation") has two classes of Members: the Class A Members and the Class B Member. The Class A Members are persons who, from time to time, serve as General Superior and Council of the Poor Sisters of Jesus Crucified and the Sorrowful Mother ("the Congregation"), and the Class B Member shall be Covenant Health Systems, Inc., a Massachusetts non-profit corporation. The Class A Members shall hold office for so long as she serves as the General Superior or member of the Council of the Congregation. The Class B Member shall serve without limitation unless it shall be removed as such through the amendment of the Corporation's Bylaws. Form 990, Part VI, Section A, line 7a Covenant Health Inc., the Class B Member of the Nursing Home ("the Corporation"), retains the right to elect the Directors of the Corporation and to remove them with or without cause, to increase or decrease the number of Directors, and to fill any vacancy in the Board of Directors. Form 990, Part VI, Section A, line 7b St. Mary's Villa Nursing Home ("the Corporation") has two distinct classes of members: Class A Members and the Class B Member. Both classes of membership retain different rights and powers over the Corporation's governance decisions. Rights and powers retained by the Class A Members over the Corporation's governance decisions are as follows: 1. To approve any change in the written statements of philosophy and mission of the Corporation; 2. To amend and to repeal the Articles of Incorporation and the Bylaws of the Corporation; 3. To approve all plans of merger, consolidation, reorganization or dissolution of the Corporation; 4. To approve the Board approved acquisition, sale or encumbrance by the Corporation of any real estate valued in excess of the amount set by the Class A Member; 5. To approve all debt of the Corporation, not part of the approved budget, in excess of limits set by the Class A Members; and, 6. To ratify the appointment and the removal of the Chief Executive Officer. Rights and powers retained by the Class B Member over the Corporation's governance decisions are as follows: 1. To elect the Board of Directors of the Organization and to remove them with or without cause; 2. To appoint and to remove the Chief Executive Officer; 3. To ratify the Board of Directors' election of the chairperson; 4. To approve all Board-approved long-range strategic plans of the Corporation before their implementation; 5. To approve all Board-approved capital budgets of the Corporation and non-budgeted expenses which are in excess of the amount set by the Class B Member, and to approve all Board-approved operating budgets; and 6. To appoint the Corporation's auditors. Additionally, both classes of membership shall have the right to vote with respect to all matters which by law, by the Corporation's Articles of Incorporation, or by the Corporation's Bylaws require action by the Members, and the Corporation shall not affect any such matters without the approval of both classes of Members. Form 990, Part VI, Section B, line 11b The Form 990 is provided to the governing body for their review and approval prior to filing. Form 990, Part VI, Section B, line 12c This process is the responsibility of the Compliance Officer. A conflict of interest disclosure form is submitted to all leadership, board members, board committee members, employed physicians, medical directors and certain employees in key positions annually to be completed. Reminders are sent to all persons of interest to ensure that all conflict of interest disclosure forms are completed and collected. Form 990, Part VI, Section B, line 15 Any compensation paid to the trustees, directors, officers or key employees of the Organization is subject to the oversight and decisions of Covenant Health, a related tax-exempt organization. Every two-to-three years the Compensation Committee of the Covenant Health Board of Directors engages an external consultant to provide competitive market data from various survey sources, which is then used to develop recommendations for changes to the compensation program. Since 2003, the Compensation Committee has engaged a human resources consultant to conduct this analysis. Objectives of the analysis are to assess the compositeness of the total cash compensation levels of the senior leadership team, develop market based competitive salary ranges for all executive positions, and ensure that the annual incentive opportunities, if there are any, are competitive and reasonable. Form 990, Part VI, Section C, line 19 The Organization's Form 990, governing documents, conflict of interest policy, and financial statements are made available to the public upon request. The Organization's Form 990 is also made available on the website of its parent organization, Covenant Health, at the following web address: https://www.covenanthealth.net/financial-information/financial-information Form 990, Part XII, Line 2c: The audit process has not changed from the previous year. Alternative Health Services 360 Broadway Bangor ME 04402 010422885 Home health and hospice ME 501(c)(3) Line 10 St Joseph Healthcare Foundation 0 CHS of Waltham Inc dba Maristhill Nursing & Rehab Center 66 Newton Street Waltham MA 02453 043333609 Nursing home and restorative facility MA 501(c)(3) Line 10 Covenant Health Inc 0 CHS of Worcester Inc dba St Mary Care Center 39 Queen Street Worchester MA 01610 043419625 Nursing home and restorative facility MA 501(c)(3) Line 10 Covenant Health Inc 0 Community Clinical Services PO Box 7291 Lewiston ME 04243 010409788 Physician practice ME 501(c)(3) Line 10 St Mary's Health System 0 Covenant Health Foundation Inc 100 Ames Pond Drive Tewksbury MA 01876 800199674 Charitable foundation MA 501(c)(3) Line 12a, I Covenant Health Inc 0 Covenant Health Investment Trust 420 Bedford Street Lexington MA 02420 046835128 Investment trust MA 501(c)(3) Line 12a, I Covenant Health Inc 0 Covenant Health Inc 100 Ames Pond Drive Tewksbury MA 01876 222484505 Health care management and resource organization MA 501(c)(3) Line 10 N/A 0 Fanny Allen Corporation Inc 790 College Parkway Colchester VT 05446 222495808 Charitable foundation VT 501(c)(3) Line 12a, I Covenant Health Inc 0 Fanny Allen Holdings Inc 790 College Parkway Colchester VT 05446 030181052 Real estate holding company VT 501(c)(3) Line 12a, I Covenant Health Inc 0 Helping Hands of St Marguerite Inc 799 Concord Avenue Cambridge MA 02138 800199674 Private home-care health services MA 501(c)(3) Line 10 Covenant Health Inc 0 M & J Company 360 Broadway Bangor ME 04402 222480150 Lease holding company ME 501(c)(2) St Joseph Healthcare Foundation 0 Mary Immaculate Guild Inc 172 Lawrence Street Lawrence MA 01841 463073987 Supporting grants and donations MA 501(c)(3) Line 12a, I Covenant Health Inc 0 MI Adult Day Health Care Center Inc 189 Maple Street Lawrence MA 01841 042921888 Adult day care services MA 501(c)(3) Line 10 Covenant Health Inc 0 MI Management Inc 172 Lawrence Street Lawrence MA 01841 042857794 Assisted living services MA 501(c)(3) Line 12a, I Covenant Health Inc 0 MI Nursing Restorative Center Inc 172 Lawrence Street Lawrence MA 01841 042104851 Nursing home and restorative facility MA 501(c)(3) Line 10 Covenant Health Inc 0 MI Residential Community II Inc 189 Maple Street Lawrence MA 01841 042679954 HUD low income housing MA 501(c)(3) Line 10 Covenant Health Inc 0 MI Residential Community III Inc 189 Maple Street Lawrence MA 01841 042186043 HUD low income housing MA 501(c)(3) Line 10 Covenant Health Inc 0 MI Residential Community Inc 189 Maple Street Lawrence MA 01841 042647207 HUD low income housing MA 501(c)(3) Line 10 Covenant Health Inc 0 MI Transportation Inc 189 Maple Street Lawrence MA 01841 042921889 Elderly transportation services MA 501(c)(3) Line 10 Covenant Health Inc 0 Mount St Rita Health Centre 15 Sumner Brown Road Cumberland RI 02864 050342330 Nursing home RI 501(c)(3) Line 10 Covenant Health Inc 0 Neighborhood Housing Initiative PO Box 7291 Lewiston ME 04243 010539730 Affordable housing services ME 501(c)(3) Line 10 St Mary's Health System 0 Penacook Place Inc 150 Water Street Haverhill MA 01830 237090088 Nursing home MA 501(c)(3) Line 10 Covenant Health Inc 0 Souhegan Nursing Association 24 North River Road Milford NH 03055 020222795 Home health and hospice NH 501(c)(3) Line 10 St Joseph Hospital of Nashua NH Inc 0 St Joseph Ambulatory Care Inc 360 Broadway Bangor ME 04402 222480373 Physician practice ME 501(c)(3) Line 10 St Joseph Healthcare Foundation 0 St Andre Health Care 407 Pool Street Biddeford ME 04005 010342399 Nursing home and restorative facility ME 501(c)(3) Line 10 Covenant Health Inc 0 St Joseph Healthcare Foundation 360 Broadway Bangor ME 04402 222480149 Healthcare foundation ME 501(c)(3) Line 10 Covenant Health Inc 0 St Joseph Hospital 360 Broadway Bangor ME 04402 010212435 Hospital and health care facility ME 501(c)(3) Line 3 St Joseph Healthcare Foundation 0 St Joseph Manor Health Care 215 Thatcher Street Brockton MA 02302 042565937 Nursing home and restorative facility MA 501(c)(3) Line 10 Covenant Health Inc 0 St Joseph's Hospital of Nashua NH Inc 172 Kinsley Street Nashua NH 03061 020222215 Hospital and health care facility NH 501(c)(3) Line 3 Covenant Health Inc 0 St Mary's D'Youville Pavilion PO Box 7291 Lewiston ME 04243 010211558 Nursing home and restorative facility ME 501(c)(3) Line 10 St Mary's Health System 0 St Mary's Health System PO Box 7291 Lewiston ME 04243 222504349 Hospital and health care facility ME 501(c)(3) Line 12a, I Covenant Health Inc 0 St Mary's Regional Medical Center PO Box 7291 Lewiston ME 04243 010211551 Hospital and health care facility ME 501(c)(3) Line 3 St Mary's Health System 0 St Mary's Residences PO Box 7291 Lewiston ME 04243 222504356 Low income housing ME 501(c)(3) Line 10 St Mary's Health System 0 The Surgicenter at St Joseph Hospital Inc 172 Kinsley Street Nashua NH 03061 020222215 Healthcare and surgery center NH 501(c)(3) Line 10 St Joseph Hospital of Nashua NH Inc 0 Youville Hospital and Rehabilitation Center Inc 1575 Cambridge Street Cambridge MA 02138 043239563 Hospital and health care facility MA 501(c)(3) Line 10 Youville Lifecare Inc 0 Youville House Inc 1573 Cambridge Street Cambridge MA 02138 043239593 Assisted living services MA 501(c)(3) Line 10 Youville Lifecare Inc 0 Youville Lifecare Inc 1575 Cambridge Street Cambridge MA 02138 042103582 Hospital and health care facility MA 501(c)(3) Line 10 Covenant Health Inc 0 Youville Place 10 Pelham Road Lexington MA 02421 043297834 Assisted living services MA 501(c)(3) Line 10 Covenant Health Inc 0 Campus Holding PO Box 7291 Lewiston ME 04240 010406049 Holding company ME N/A C 0 Covenant Health Insurance LTD PO Box 69 Grand Cayman CJ KY1-1102 043360127 Self-insurance company CJ N/A C 0 GNM Corporation 172 Kinsley Street Nashua NH 03060 020400550 Real estate holding company NH N/A C 0 SJ Physicians Services 172 Kinsley Street Nashua NH 03060 020522234 Physician practice NH N/A C 0 St Joseph Corporate Services Inc 172 Kinsley Street Nashua NH 03060 020405197 Holding company NH N/A C 0 Strauss Incorporated 360 Broadway Bangor ME 04402 010391369 Repairs and transcriptions ME N/A C 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0