2022-11-15T07:27:00-06:00 2021-12-31 111986323 MARCUM LLP 555 LONG WHARF DRIVE NEW HAVEN CT 06511 990 2021-01-01 800687948 SOUTH COVE MANOR AT QUINCY POINT REHABILITATION CENTER INC SOUT 6174230590 288 WASHINGTON STREET QUINCY MA 02169 SIGNING OFFICER PRESIDENT & CEO 6174230590 2022-11-14 1 SIGNING OFFICER XXX-XX-XXXX MARY ANTONETTI P00431862 2037819600 0 AAL1 IAL1 2021 2022-09-23 18:48:47Z WILLIAM GRAVES 288 WASHINGTON STREET QUINCY MA 02169 16733910 0 X WWW.SOUTHCOVEMANOR.COM X 2011 MA TO PROVIDE INDIVIDUALIZED REHABILITATION AND NURSING CARE THAT REFLECTS ASIAN CULTURAL VALUES. 19 19 224 22 0 0 3658316 1319464 13802856 15413645 31592 -78314 4410 20 17497174 16654815 0 0 0 0 10772618 9762113 0 0 5108 5383854 5998446 16156472 15760559 1340702 894256 34039222 32159189 22722021 19902090 11317201 12257099 X THE ORGANIZATION'S MISSION IS TO PROVIDE INDIVIDUALIZED REHABILITATION AND NURSING CARE THAT REFLECTS ASIAN CULTURAL VALUES. THE ORGANIZATION'S CORE VALUES INCLUDE: 1. RESPECTING THE PEOPLE WE SERVE, THEIR TRADITIONS, AND THEIR PREFERENCES, (SEE SCHEDULE O)2. PROVIDING EXCELLENT LEADING EDGE CARE AND SERVICES, 3. INVESTING IN OUR EMPLOYEES, AND 4. SERVING OUR COMMUNITY. 0 0 14112974 15413665 NURSING & REHABILITATION SERVICES - THE OGRANIZATION'S MISSION IS TO PROVIDE INDIVIDUALIZED NURSING AND REHABILITATION CARE THAT REFLECTS ASIAN CULTURAL VALUES THROUGH THE OPERATION OF A 141-BED LONG-TERM CARE FACILITY IN QUINCY, MASSACHUSETTS. 14112974 1 1 0 0 0 0 0 0 1 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 7 0 1 224 1 0 0 0 0 0 0 0 0 0 0 0 0 X 19 19 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X SCOTT HANSON DIRECTOR OF FINANCE 6174230590 288 WASHINGTON STREET QUINCY MA 02169 JASON QU CHAIRMAN OF THE BOARD 2.00 1.00 X X 0 0 0 MAY CHIN VICE PRESIDENT 2.00 1.00 X X 0 0 0 CINDY LAW TREASURER 2.00 1.00 X X 0 0 0 HEMMIE CHANG CLERK 2.00 1.00 X X 0 0 0 MARIANNE BOWLER HONORABLE DIRECTOR 2.00 1.00 X 0 0 0 ALICE ROSE RN DIRECTOR 2.00 1.00 X 0 0 0 THOMAS CHIN DIRECTOR 2.00 1.00 X 0 0 0 DAVID TING DIRECTOR 2.00 1.00 X 0 0 0 LEONARD LAI MD DIRECTOR 2.00 1.00 X 0 0 0 STANLEY ELKERTON DIRECTOR 2.00 1.00 X 0 0 0 HELEN CHIN SCHLICHTE DIRECTOR 2.00 1.00 X 0 0 0 HON HOI YEE DIRECTOR 2.00 1.00 X 0 0 0 SUSAN LUO CFA DIRECTOR 2.00 1.00 X 0 0 0 EDWARD CHENG ESQ DIRECTOR 2.00 1.00 X 0 0 0 LISA MUI DIRECTOR 2.00 1.00 X 0 0 0 HEATHER O'SULLIVAN DIRECTOR 2.00 1.00 X 0 0 0 RICHARD LUI DIRECTOR 2.00 1.00 X 0 0 0 ERIC SCHLICHTE DIRECTOR 2.00 1.00 X 0 0 0 JIM HSU DIRECTOR 2.00 1.00 X 0 0 0 WILLIAM GRAVES PRESIDENT/CEO 41.00 1.00 X 254800 0 11215 SCOTT HANSON DIRECTOR OF FINANCE 41.00 1.00 X 126319 0 14909 LI CHEN ADMINISTRATOR 40.00 X 157319 0 19247 SHINJA CHOI RN 40.00 X 153283 0 7538 MARY LOU FALLETTI LPN 40.00 X 137220 0 8215 828941 0 61124 5 0 1 0 PRO EMS SOLUTIONS INC 31 SMITH PLACE CAMBRIDGE MA 02138 COVID TESTING 634875 PARAGON REHABILITATION 303 N HURSTBOURNE PKWY LOUISVILLE KY 40222 THERAPY SERIVCES 470155 US FOODS PO BOX 3115 BOSTON MA 02241 FOOD SERVICES 300831 2 1319464 1319464 NET PATIENT SERVICE REVENUE 623000 15413645 15413645 15413645 781 781 79095 -79095 -79095 -79095 OTHER INCOME 623000 20 20 20 16654815 15413665 0 -78314 421361 421361 7748492 7064890 683602 143625 124200 19425 761445 658460 102985 687190 594248 92942 14076 14076 44708 15855 28853 310241 234319 75922 24009 24009 72325 62182 10143 106099 96362 4750 4987 347792 332222 15570 10831 10768 63 18401 17593 808 550264 525631 24633 918902 877766 41136 158379 97332 61047 MEDICAL SUPPLIES AND DR 1206976 1206976 USER FEE 994032 994032 DIETARY 477423 477423 THERAPY EXPENSE 472004 472004 271984 250711 21152 121 15760559 14112974 1642477 5108 1247923 2136589 2811651 1269219 2050365 1578075 162421 205769 33857270 7108933 27565255 26748337 81362 68427 120245 152773 34039222 32159189 1151931 1065604 443902 45373 16607816 16086659 4518372 2704454 22722021 19902090 X 11317201 12257099 11317201 12257099 34039222 32159189 X 894256 45642 X X 0 1 X 1 0 X 120819 124202 38024 3658316 1319464 5260825 14602746 15036223 15279074 13802856 15413645 74134544 14723565 15160425 15317098 17461172 16733109 79395369 0 0 0 79395369 465159 463020 386612 31592 781 1347164 465159 463020 386612 31592 781 1347164 10844 11094 18419 4410 20 44787 15199568 15634539 15722129 17497174 16733910 80787320 0.98280 0.97650 0.01670 0.02290 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 47485 30333 23398 54420 0 126625 7190 60518 73297 130942 11750 6508 22575 126625 179306 7261 41103 130942 146584 67500 4475 39253 179306 166440 17500 3648 41004 146584 0.00000 0.40929 0.59071 0 1 1 2437032 2437032 28646355 5478002 23168353 675974 85154 590820 1928773 1406039 522734 169136 139738 29398 26748337 DUE TO RELATED PARTIES 2545158 DUE TO THIRD PARTY 60726 DEFERRED COMP LIABILITY 98570 2704454 X 16733910 79095 79095 16654815 0 16654815 15839654 79095 79095 15760559 0 15760559 PART IV, LINE 1B: THE ORGANIZATION HAS FIDUCIARY CONTROL OF THE PERSONAL NEEDS ACCOUNT HELD FOR THE BENEFIT OF THE RESIDENTS. PART V, LINE 4: THE ORGANIZATION'S ENDOWMENT IS HELD BY A RELATED ORGANIZATION, SOUTH COVE NURSING FACILITIES FOUNDATION, INC. IN ACCORDANCE WITH THE DONOR REQUIREMENTS, THE ENDOWMENT FUNDS ARE HELD IN PERPETUITY. ENDOWMENT RETURNS MAY BE USED FOR THE APPRECIATION EVENTS FOR THE EMPLOYEES OF THE NURSING HOME OPERATOR. PART X, LINE 2: BELOW IS AN EXCERPT FROM THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS FOR SOUTH COVE MANOR NURSING AND REHABILITATION CENTER, INC. AND SUBSIDIARIES: THE FOUNDATION, PARENT, AND QALICB ARE NONPROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND ARE EXEMPT FROM FEDERAL AND STATE INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE INVESTMENT FUND IS A SINGLE MEMBER LLC AND ANY EARNINGS OR LOSSES ARE INCLUDED ON THE PARENT'S TAX-EXEMPT TAX RETURN. THE ORGANIZATION FOLLOWS THE GUIDANCE OF ACCOUNTING STANDARDS CODIFICATION (ASC) 740, ACCOUNTING FOR INCOME TAXES, RELATED TO THE UNCERTAINTIES IN INCOME TAXES, WHICH PRESCRIBES A THRESHOLD OF MORE LIKELY THAN NOT FOR RECOGNITION AND DERECOGNITION OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. MANAGEMENT HAS EVALUATED THE TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN, IF ANY, ON ITS EXEMPT ORGANIZATION FILINGS, AND THE LIKELIHOOD THAT UPON EXAMINATION THOSE POSITIONS WOULD BE SUSTAINED. BASED ON THE RESULTS OF THIS EVALUATION, MANAGEMENT DETERMINED THERE ARE NO POSITIONS THAT NECESSITATE DISCLOSURES AND/OR ADJUSTMENTS. THERE WERE NO UNRECOGNIZED TAX BENEFITS IDENTIFIED OR RECORDED AS LIABILITIES DURING THE PERIODS COVERED BY THESE FINANCIAL STATEMENTS. THE ORGANIZATION'S TAX RETURNS COULD BE SUBJECT TO EXAMINATION BY TAXING AUTHORITIES; HOWEVER, THERE ARE CURRENTLY NO SUCH EXAMINATIONS PENDING OR IN PROGRESS. PART XI, LINE 2D - OTHER ADJUSTMENTS: LOSS FROM EARLY RETIREMENT OF HOT WATER HEATER 79,095. PART XII, LINE 2D - OTHER ADJUSTMENTS: LOSS FROM EARLY RETIREMENT OF HOT WATER HEATER 79,095. X X X X X X 0 1 0 0 0 0 0 0 0 WILLIAM GRAVES PRESIDENT/CEO 208800 0 46000 0 0 0 0 0 11215 0 266015 0 0 0 LI CHEN ADMINISTRATOR 137319 0 20000 0 0 0 8032 0 11215 0 176566 0 0 0 SHINJA CHOI RN 153283 0 0 0 0 0 3262 0 4276 0 160821 0 0 0 PART I, LINE 4B LI CHEN RECEIVED $4,011 FROM A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN. A MASS DEVELOPMENT FINANCE AGENCY 043431814 NONEAVAIL 2012-10-30 19000000 LAND ACQUISITION AND FACILITY COSTS 0 0 0 A 2913341 19000000 252483 100640 18600277 46600 2014 0 0 1 1 A 0 0 1 0 0 0 0 1 A 0 0 1 0 1 0 0 0 1 A 1 PART II, LINE 11 THE AMOUNT OF OTHER SPENT PROCEEDS ON LINE 11 REPRESENT ISSUER'S ADMINISTRATIVE FEE PART III, LINE 3A MANAGEMENT AND SERVICE CONTRACTS IN THE BOND FINANCED SPACE FALL UNDER THE SAFE HARBOR PROVIDED BY REVENUE PROCEDURE 2016-44 AND WILL NOT RESULT IN PRIVATE BUSINESS USE. PART III, LINE 3C THE ORGANIZATION HAS BOND COUNSEL WHICH IT USES TO REVIEW CONTRACTS ON AN AS NEEDED BASIS. FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE CONSISTS OF ALL VOTING DIRECTORS WHO ARE ALSO OFFIERS OR COMMITTEE CHAIRS. THE EXECUTIVE COMMITTEE HAS FULL AUTHORITY BETWEEN BOARD SESSIONS, IF NEEDED. FORM 990, PART VI, SECTION A, LINE 2 A FAMILY RELATIONSHIP EXISTS BETWEEN MAY CHIN, VICE PRESIDENT; THOMAS CHIN, DIRECTOR; AND HELEN CHIN SCHLICHTE, DIRECTOR. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION'S AUDIT COMMITTEE REVIEWS AND APPROVES THE DRAFT FORM 990. THE COMPLETE FORM 990 IS PRESENTED TO THE BOARD OF DIRECTORS BEFORE FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY IS PART OF THE ORGANIZATION'S BY-LAWS AND IS DISCUSSED BY THE BOARD OF DIRECTORS AND TOP MANAGEMENT PERSONNEL AT THE FIRST BOARD METTING EACH YEAR REGARDING ANY/ALL SIGNIFICANT TRANSACTIONS. THE CONFLICT OF INTEREST POLICY COVERS DIRECTORS, OFFICERS, AND EMPLOYEES. ANY CONFLICTS OF INTEREST ARE DISCLOSED TO THE BOARD PRIOR TO APPROVAL OR RATIFICATION OF THE CONTRACT OR TRANSACTION BY MAJORITY VOTE OF THE DISINTERESTED PERSONS. THE CEO, ADMINISTRATOR AND FINANCE DIRECTOR ARE TASKED WITH OVERSEEING THE DISBURSEMENTS AND CONTRACT MANGAEMENT FUNCTIONS AND MONITORING FOR ANY CONFLICTING RELATIONSHIP WITH THE ORGANIZATION. ALL BOARD MEMBERS ARE AWARE OF THE NEED TO NOTIFY THE BOARD AND MANAGEMENT TEAM OF ANY CONFLICTS. THE BOARD IS NOTIFIED WHEN A CONFLICT OF INTEREST MIGHT OCCUR. SHOULD AN ACTUAL OR PERCEIVED CONFLICT OF INTEREST PRESENT ITSELF, THE MANAGEMENT TEAM IS FULLY PREPARED TO ASK THE BOARD TO CONSIDER APPROPRIATE ACTION FORM 990, PART VI, SECTION B, LINE 15 THE PROCESS FOR DETERMINING THE COMPENSATION OF THE CEO AND TOP MANAGEMENT INCLUDES A COMPARABILITY STUDY, APPROVAL BY THE COMPENSATION COMMITTEE, AND DOCUMENTATION OF THE DELIBERATION OF THE DECISION DONE IN EXECUTIVE SESSION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: EQUITY TRANSFER 45,642. FORM 990, PART XII, LINE 2C: PROCESS IS UNCHANGED FROM PRIOR YEAR SOUTH COVE INVESTMENT FUND LLC 288 WASHINGTON STREET QUINCY MA 02169 461020387 NMTC FINANCING VEHICLE MA 0 0 SOUTH COVE MANOR NURSING AND REHABILITATION CENTER SOUTH COVE NURSING FACILITIES FOUNDATION INC 288 WASHINGTON STREET QUINCY MA 02169 046406242 NURSING AND CARE FACILITIES MA 501(C)(3) LINE 12A, I SOUTH COVE MANOR NURSING AND REHABILITATION 1 SOUTH COVE REALTY COMPANY LIMITED PARTNERSHIP 288 WASHINGTON STREET QUINCY MA 02169 042820700 REAL ESTATE - OPERATIONS CEASED 2014 MA SOUTH COVE NURSING FACILITIES FOUNDATION RELATED 0 0 SOUTH COVE MANOR INC 288 WASHINGTON STREET QUINCY MA 02169 042820772 NURSING HOME MA SOUTH COVE NURSING FACILITIES C 1 0 0 1 0 1 0 0 0 0 0 0 1 1 1 1 0 1 1 1 SOUTH COVE NURSING FACILITIES FOUNDATION INC C 45642 INTERCOMPANY TRANSFER SOUTH COVE NURSING FACILITIES FOUNDATION INC N 1905652 INTERCOMPANY LOAN FORM R, PART III SOUTH COVE REALTY COMPANY LIMITED PARTNERSHIP WAS DISSOLVED IN JANUARY 2021. FORM R, PART IV SOUTH COVE MANOR WAS DISOLVED IN JANUARY 2021. FORM R, PART V, LINE 1 AMOUNT REPRESENTED ON LINE 2, COLUMN B, TRANSACTION TYPE, IS THE TOTAL AMOUNT FOR LINES 1L, M, N, O, Q, R, S.