2022-11-08T11:40:09-06:00 2021-12-31 010494526 Baker Newman & Noyes 650 Elm Street Suite 302 Manchester NH 03101 990 2021-01-01 222484505 Covenant Health Inc COVE 9786546363 100 Ames Pond Drive 102 Tewksbury MA 01876 Stephen W Forney Chief Financial Officer 9786546363 2022-11-03 1 Stephen Forney 999009999 Connor Smart P02285543 6036262200 2022-11-03 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z Stephen Grubbs 100 Ames Pond Drive 102 Tewksbury MA 01876 101000451 0 X covenanthealth.net X 1983 MA Covenant Health is a Catholic health care system sponsoring hospitals, nursing homes, assisted living residences, and other health and elder services throughout New England. The Organization is committed to the health of the individuals and communities it serves, and the Organization strives to offer a continuum of high quality care. Please see the Organization's website for the 2020 Covenant Health Corporate Report. 15 14 333 17 11519 9166 38830 230583 65145894 70089882 1508831 9191863 0 -5929000 66693555 73583328 2750 5051 0 0 33055216 35014239 0 0 0 35731234 37354620 68789200 72373910 -2095645 1209418 176504110 339773281 81054354 236797832 95449756 102975449 Covenant Health is an innovative Catholic health organization committed to advancing the healing ministry of Jesus. 0 0 69764691 5051 70089882 Sponsoring and operating a Catholic health care system consisting of hospitals, nursing homes, assisted living residences, and other health and elder services, as well as furthering the delivery of health and human services consistent with the teachings and law of the Roman Catholic Church. 69764691 1 1 0 1 0 0 0 0 0 1 1 1 0 1 1 1 0 1 0 0 1 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 39 0 1 333 1 1 1 1 CJ 0 0 0 0 0 0 0 0 0 0 X 15 14 0 0 0 0 0 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 0 MA X X Stephen Grubbs Chief Executive Officer 9786546363 100 Ames Pond Drive Tewksbury MA 01876 Stephen Grubbs President & CEO 40.00 5.50 X X 909317 0 36190 Lesley Adkinson E PhD RN Director 2.00 3.00 X 0 0 0 Bruce Bonnell MD MPH Director 2.00 1.00 X 0 0 0 Aisha Barlatier-Bonny Director 2.00 1.00 X 0 0 0 Kathy Connerton JD MBA Director 2.00 1.00 X 0 0 0 John Isaacson Director (end 6/2021) 2.00 1.00 X 0 0 0 Thomas Kelly Director (end 6/2021) 2.00 1.00 X 0 0 0 James F Loftus IV Director (end 6/2021) 2.00 2.00 X 0 0 0 Catherine P Lovecchio PhD RN Director 2.00 1.00 X 0 0 0 William P Lucy Director 2.00 1.50 X 0 0 0 Thomas Mortimer Director 2.00 3.00 X 0 0 0 Cherie Noe MD Director 2.00 1.00 X 0 0 0 Sr Catherine O'Connor Director 2.00 1.00 X 0 0 0 Gino J Pazzaglini Director 2.00 1.00 X 0 0 0 Louise Trottier Director 2.00 2.00 X 0 0 0 John Oliverio Chair 2.00 2.00 X X 0 0 0 Kenneth E Arnold Vice Chair 2.00 1.00 X X 0 0 0 Mark W Anthoine Sr Finance Committee Chair 2.00 2.00 X X 0 0 0 Stephen Forney SVP and Chief Financial Officer 40.00 1.60 X 568230 0 39353 Douglas Waite SVP and Chief Medical Officer 40.00 0.00 X 610794 0 38577 John Newman SVP General Counsel 40.00 1.00 X 496678 0 42287 John Emerson SVP Integrated Medical Group 40.00 0.00 X 435731 0 40290 Gerard Foley SVP & President of Post Acute Care 40.00 0.00 X 428312 0 33063 Katherine Bechtold SVP & Chief Nursing Office 40.00 0.00 X 393846 0 14258 Karen Bowling SVP & Chief Information Officer 40.00 0.00 X 399677 0 20982 James Coffey CH SVP; President, CH Foun 1.00 40.00 X 286883 0 43936 John Jurczyk SVP & President, SJH Nashua 40.00 1.00 X 540887 0 35065 Steven Jorgensen SVP & President, SMHS Lewiston 40.00 0.00 X 526409 0 33283 Mary Prybylo SVP & President, SJH Bangor 40.00 0.50 X 706461 0 44672 Richard Plamondon VP Finance 40.00 1.00 X 400983 0 33005 Timothy Juergensen VP & Chief Employee Experience Off. 40.00 0.00 X 301220 0 4970 7005428 0 459931 91 0 1 0 Ensemble RCM LLC PO Box 639076 Cincinnati OH 45263 Management and consulting services 25059004 Good Help Connections LLC 1701 Mercy Health Place Cincinnati OH 45237 Telecommunications and IT Solutions 9006832 Microsoft PO Box 842103 Dallas TX 75284 IT service and support 3025555 Logically PO Box 645994 Pittsburgh PA 15264 IT service and support 1402809 CyberNorth 15 Cottage Road Unit 2433 South Portland ME 04116 IT service and support 1340672 46 230583 10256 230583 Membership and other fees 900099 70089882 70089882 70089882 450963 11519 439444 36158023 27417123 8740900 8740900 8740900 Loss on debt extinguishment 525990 -5929000 -5929000 -5929000 73583328 70089882 11519 3251344 X 5051 5051 4838404 4548100 290304 26052348 24489207 1563141 509226 478672 30554 1664862 1564970 99892 1949399 1832435 116964 605 605 288959 288959 110700 110700 108100 108100 14500053 14500053 704318 704318 960820 960820 8569752 8569752 1003615 1003615 273126 273126 2760618 2760618 7504584 7504584 102586 102586 Recruitment/relations 431066 431066 Dietary supplies 22518 22518 MA Provider Tax 13200 13200 72373910 69764691 2609219 0 13393664 20958514 1270438 1151182 7160893 1941441 2957937 3441829 90542050 23292661 73090935 67249389 73682691 83616993 0 606360 4947552 160807573 176504110 339773281 14571416 12932086 4167 3983803 0 49360478 222987523 13138657 874056 81054354 236797832 X 95157182 102717313 292574 258136 95449756 102975449 176504110 339773281 X 1209418 6953445 -637170 X X 0 1 X 1 1 1 X 9050 10330 5922 38830 230583 294715 15213900 72129091 70423256 65145894 70089882 293002023 15222950 72139421 70429178 65184724 70320465 293296738 15000 10000 25000 0 15000 10000 25000 293271738 605729 1109845 150262 1469423 439444 3774703 18060 24690 34245 39408 11519 127922 623789 1134535 184507 1508831 450963 3902625 15846739 73273956 70613685 66693555 70771428 297199363 0.98680 0.98020 0.01310 0.01980 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 3718 0 0 1 108100 111818 0 Part II-B, Line 1: Covenant Health Inc. was a member of the Catholic Health Association of the United States. Based on Covenant Health's historic relationship with the Association, it is possible that a portion of the dues paid to the Association in 2021 was used for lobbying on behalf of Covenant Health and the other member-organizations in furtherance of their exempt purposes. At the time of this filing, the Organization estimates that, of the $98,360 in total dues paid to the Association during the tax year, $3,718 was available for lobbying purposes. Additionally, the Organization contracted with two law firms to provide lobbying and governmental services in 2021, as detailed below: - Bernstein Shur Sawyer Nelson, Inc. ($48,100) - Kozak & Gayer PA ($60,000) 292574 200327 10613 245378 258136 326059 1650 14457 49592 292574 349585 21874 45400 326059 345883 3702 349585 382841 8157 45115 345883 0.00000 0.00000 1.00000 1 1 1 42022 36473 5549 89449905 23256188 66193717 1050123 1050123 67249389 Investment in Covenant Health Investment Trust 38662030 F Investment in Covenant Health Insurance LTD 44949963 F Investment in Yankee Alliance 5000 F 83616993 Due from affiliates 160724577 Security deposits 82996 160807573 Due to affiliates 267696 Operating lease liabilities 606360 874056 X Part V, Line 4: The Organization's endowment funds are to be used to assist the needy through education and/or projects for the poor, as determined by the Vice President of Missions and approved by the President of Covenant Health. 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, except as noted below. St. Joseph Hospital Corporate Services, Inc., a wholly-owned subsidiary of Nashua, is a for-profit organization, which is subject to federal and state income taxes. St. Joseph Hospital Corporate Services, Inc. has net operating loss (NOL) carryforwards for tax purposes. The NOLs are not anticipated to be utilized so the amounts have been fully offset with a reserve. CHIL, a wholly-owned subsidiary, is domiciled in the Cayman Islands. No income taxes are levied in the Cayman Islands and CHIL has been granted an exemption for any taxes that might be introduced. Accordingly, no provision for income taxes has been made in the accompanying financial statements. 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. 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. Central America and the Caribbean - Antigua & Barbuda, Aruba, Bahamas, 0 0 Capital contributions into Cayman Islands-based insurance company. 10556894 0 0 0 0 0 0 10556894 0 10556894 1 0 1 0 0 0 Part III Accounting Method: 1 CHS of Waltham Inc 66 Newton Street Waltham MA 02453 043333609 501(c)(3) 5051 0 General operating support 1 0 Part I, Line 2: During its year ending December 31, 2021, Covenant Health, Inc. awarded grants in excess of $5,000 to one of its affiliated organizations. As Covenant Health, Inc. is the sole member and effective parent of the recipient Organization, Covenant Health is able to exercise control, substantiation, and record-keeping over any use of the funds granted. X X X X 0 0 0 0 0 0 0 1 0 Stephen Grubbs President & CEO 851411 0 30924 0 26982 0 8700 0 27490 0 945507 0 0 0 Mary Prybylo SVP & President, SJH Bangor 457173 0 241643 0 7645 0 8700 0 35972 0 751133 0 0 0 Douglas Waite SVP and Chief Medical Officer 525397 0 79500 0 5897 0 4097 0 34480 0 649371 0 0 0 Stephen Forney SVP and Chief Financial Officer 537938 0 27119 0 3173 0 5875 0 33478 0 607583 0 0 0 John Jurczyk SVP & President, SJH Nashua 516616 0 18634 0 5637 0 8700 0 26365 0 575952 0 0 0 Steven Jorgensen SVP & President, SMHS Lewiston 483808 0 18094 0 24507 0 8700 0 24583 0 559692 0 0 0 John Newman SVP General Counsel 472178 0 24500 0 0 0 8700 0 33587 0 538965 0 0 0 John Emerson SVP Integrated Medical Group 392823 0 16023 0 26885 0 6937 0 33353 0 476021 0 0 0 Gerard Foley SVP & President of Post Acute Care 404795 0 15423 0 8094 0 6102 0 26961 0 461375 0 0 0 Richard Plamondon VP Finance 383518 0 13881 0 3584 0 7949 0 25056 0 433988 0 0 0 Karen Bowling SVP & Chief Information Officer 380374 0 13260 0 6043 0 8700 0 12282 0 420659 0 0 0 Katherine Bechtold SVP & Chief Nursing Office 384086 0 0 0 9760 0 2997 0 11261 0 408104 0 0 0 James Coffey CH SVP; President, CH Foun 275110 0 10187 0 1586 0 7190 0 36746 0 330819 0 0 0 Timothy Juergensen VP & Chief Employee Experience Off. 287598 0 7930 0 5692 0 2879 0 2091 0 306190 0 0 0 Part I, Line 3 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 A Compensation Committee recommends the variable pay award that may be issued to qualifying employees and officers. The payment of the award is discretionary and is subject to meeting the pre-determined goals of the Organization. Form 990, Part VI, Section A, line 7a The directors of the Organization are elected by the members of Covenant Health, a public juridic person of pontifical right under the laws of the Roman Catholic Church (the "CHS Public Juridic Person"). Form 990, Part VI, Section A, line 7b Any change in the written statements of philosophy or mission of the organization must be approved by the Covenant Health Public Juridic Person before such change becomes effective. 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 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 B, line 16b: Although written policies were not in place as of the end of the year covered by this tax return requiring the Organization to evaluate its participation in joint venture arrangements under applicable federal law to ensure that the Organization's exempt status is protected, the Organization performed due diligence with respect to its joint venture arrangements to safeguard the Organization's exempt status. 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 at the following web address: https://www.covenanthealth.net/financial-information/financial-information Form 990, Part IX, line 11g Admin and office support: Program service expenses 9,529,158. Management and general expenses 0. Fundraising expenses 0. Total expenses 9,529,158. Management and profesional consulting: Program service expenses 4,970,895. Management and general expenses 0. Fundraising expenses 0. Total expenses 4,970,895. Form 990, Part XI, line 9: Transfers to affiliates -637,170. Form 990, Part XII, Line 2c: The audit process has not changed from the previous year. Form 990-Statement Pursuant to Regulation Section 1.351-3(a): This statement is pursuant to regulation section 1.351-3(a) by Covenant Health, Inc. (EIN 22-2484505), a significant transferor. On various dates during 2021, Covenant Health, Inc. (EIN 22-2484505) transferred the following property to Covenant Health Insurance LTD (EIN 04-3360127), a Cayman Islands-based foreign corporation: Cash-fair market value and adjusted tax basis equal to $10,556,894. No private letter ruling was received in connection with the Section 351 exchange. Additionally, Covenant Health has prepared a filed a 2021 Form 926 to report the transaction in greater detail. Alternative Health Services 360 Broadway Bangor ME 04402 010422885 Home health and hospice ME 501(c)(3) Line 10 St Joseph Healthcare Foundation 1 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 1 CHS of Worcester Inc dba St Mary Care Center 39 Queen Street Worcester MA 01610 043419625 Nursing home and restorative facility MA 501(c)(3) Line 10 Covenant Health Inc 1 Community Clinical Services PO Box 7291 Lewiston ME 04243 010409788 Physician practice ME 501(c)(3) Line 10 St Mary's Health System 1 Covenant Health Foundation Inc 100 Ames Pond Drive Tewksbury MA 01876 800199674 Charitable foundation MA 501(c)(3) Line 12a, I Covenant Health Inc 1 Covenant Health Investment Trust 420 Bedford Street Lexington MA 02420 046835128 Investment trust MA 501(c)(3) Line 12a, I Covenant Health Inc 1 Fanny Allen Corporation Inc 790 College Parkway Colchester VT 05446 222495808 Charitable foundation VT 501(c)(3) Line 12a, I Covenant Health Inc 1 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 1 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 1 M & J Company 360 Broadway Bangor ME 04402 222480150 Lease holding company ME 501(c)(2) St Joseph Healthcare Foundation 1 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 1 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 1 MI Management Inc 172 Lawrence Street Lawrence MA 01841 042857794 Assisted living services MA 501(c)(3) Line 12a, I Covenant Health Inc 1 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 1 MI Residential Community Inc 189 Maple Street Lawrence MA 01841 042647207 HUD low income housing MA 501(c)(3) Line 10 Covenant Health Inc 1 MI Transportation Inc 189 Maple Street Lawrence MA 01841 042921889 Elderly transportation services MA 501(c)(3) Line 10 Covenant Health Inc 1 Mount St Rita Health Centre 15 Sumner Brown Road Cumberland RI 02864 050342330 Nursing home RI 501(c)(3) Line 10 Covenant Health Inc 1 Neighborhood Housing Initiative PO Box 7291 Lewiston ME 04243 010539730 Affordable housing services ME 501(c)(3) Line 10 St Mary's Health System 1 Penacook Place Inc 150 Water Street Haverhill MA 01830 237090088 Nursing home MA 501(c)(3) Line 10 Covenant Health Inc 1 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 1 St Joseph Ambulatory Care Inc 360 Broadway Bangor ME 04402 222480373 Physician practice ME 501(c)(3) Line 3 St Joseph Healthcare Foundation 1 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 1 St Joseph Healthcare Foundation 360 Broadway Bangor ME 04402 222480149 Healthcare foundation ME 501(c)(3) Line 7 Covenant Health Inc 1 St Joseph Hospital 360 Broadway Bangor ME 04402 010212435 Hospital and health care facility ME 501(c)(3) Line 3 St Joseph Healthcare Foundation 1 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 1 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 1 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 1 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 1 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 1 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 1 St Mary's Villa Nursing Home Inc 675 St Marys Villa Road Moscow PA 18444 232057177 Nursing home and restorative facility PA 501(c)(3) Line 10 Covenant Health Inc 1 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 1 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 1 Youville House Inc 1573 Cambridge Street Cambridge MA 02138 043239593 Assisted living services MA 501(c)(3) Line 10 Youville Lifecare Inc 1 Youville Lifecare Inc 1575 Cambridge Street Cambridge MA 02138 042103582 Hospital and health care facility MA 501(c)(3) Line 10 Covenant Health Inc 1 Youville Place 10 Pelham Road Lexington MA 02421 043297834 Assisted living services MA 501(c)(3) Line 10 Covenant Health Inc 1 Campus Holding PO box 7291 Lewiston ME 04240 010406049 Holding company ME N/A C 1 Covenant Health Insurance LTD PO Box 69 Grand Cayman CJ KY1-1102 043360127 Self-insurance company CJ Covenant Health Inc C 10542817 73868035 1.00000 1 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 1 Strauss Incorporated 360 Broadway Bangor ME 04402 010391369 Repairs and transcriptions ME N/A C 1 0 0 0 1 1 0 0 0 0 0 0 1 0 0 0 0 0 1 0 St Joseph Hospital of Nashua L 24349991 Actual per book St Mary's Regional Medical Center L 22889904 Actual per book St Joseph Hospital of Bangor L 17552630 Actual per book MI Nursing Restorative Center Inc L 1107906 Actual per book CHS of Waltham Inc L 437969 Actual per book St Joseph Manor Health Care L 425377 Actual per book CHS of Worcester Inc L 398112 Actual per book Mount St Rita Health Centre L 381126 Actual per book Penacook Place L 421140 Actual per book Covenant Health Insurance LTD L 99000 Actual per book Fanny Allen Corporation Inc L 281000 Actual per book St Andre Health Care Center L 380128 Actual per book Youville Place L 230536 Actual per book Youville House Inc L 214852 Actual per book