2021-11-10T18:50:23-06:00 2020-12-31 410746749 CLIFTONLARSONALLEN LLP 4 BATTERYMARCH PARK SUITE 100 QUINCY MA 02169 990 2020-01-01 042104414 ODD FELLOWS HOME OF MASSACHUSETTS INC ODDF 5088536687 104 RANDOLPH ROAD WORCESTER MA 01606 CLARENCE PLANT CEO AND BOARD SECRETARY 5088536687 2021-11-10 1 CLARENCE PLANT 999009999 JONATHAN LANGFIELD P00562148 7819821001 2021-11-08 0 AAL1 IAL1 2020 2022-09-23 18:48:47Z CLARENCE PLANT 104 RANDOLPH ROAD WORCESTER MA 01606 9260237 0 X WWW.ODDFELLOWSHOMEMA.COM X 1898 MA TO PROVIDE OUR RESIDENTS WITH THE FINEST SKILLED NURSING AND REHABILITATIVE SERVICES. 13 12 203 12 0 0 67502 1813660 7873924 7401216 47266 27623 -6573 11488 7982119 9253987 0 0 0 0 5326446 5823712 0 0 0 2566974 2710534 7893420 8534246 88699 719741 3187478 4980295 2082001 2780175 1105477 2200120 TO PROVIDE OUR RESIDENTS WITH THE FINEST SKILLED NURSING AND REHABILITATIVE SERVICES. DEDICATED TO THE BASIC TENENTS OF FRIENDSHIP, LOVE AND TRUTH, OUR HIGHLY TRAINED STAFF PROVIDES COMPASSIONATE CARE IN A COMFORTABLE, SECURE ENVIRONMENT. 0 0 7359755 0 7401216 PROVIDE QUALITY SKILLED NURSING CARE AND THERAPY FOR 100 ELDERLY RESIDENTS. 7359755 1 1 0 0 0 0 0 0 1 1 1 0 0 1 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 14 0 203 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 13 12 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 MA X CLARENCE PLANT 5088536687 104 RANDOLPH ROAD WORCESTER MA 01606 DAVID JASINISKI ADMINISTRATOR 40.00 X 133165 0 11412 PETER NDEGWA LPN 60.00 X 108117 0 11109 LIZZIE MAINA RN SUPERVISOR 40.00 X 108106 0 11297 MARGARET AKESE LPN 54.00 X 104980 0 12910 SUSAN CUSSON ACCOUNTANT 30.00 X 100375 0 8515 CLARENCE PLANT CEO AND SECRETARY 40.00 X X 78818 0 6777 WENDY E BAKER PRESIDENT 1.00 X X 0 0 0 RUTH GARCIA VICE PRESIDENT 1.00 X X 0 0 0 DAVID L LABONTE TREASURER 1.00 X X 0 0 0 DWIGHT L CROW TRUSTEE 1.00 X 0 0 0 DONNA FIFE TRUSTEE 1.00 X 0 0 0 GERARD GILMORE JR TRUSTEE 1.00 X 0 0 0 WAYNE LEBLANC TRUSTEE 1.00 X 0 0 0 GEORGE E SHAW TRUSTEE 1.00 X 0 0 0 DOREEN A SLANEY TRUSTEE 1.00 X 0 0 0 JOHN G SLANEY TRUSTEE 1.00 X 0 0 0 MARY G VITIELLO TRUSTEE 1.00 X 0 0 0 ROBERT E WALSH TRUSTEE 1.00 X 0 0 0 633561 0 62020 5 0 0 0 0 15524 1798136 1813660 PROGRAM SERVICE REVENUE 623000 7397088 7397088 CABLE/TV/PHONE/MISC 900099 4128 4128 7401216 26656 26656 967 0 967 967 967 17738 15524 6250 11488 11488 9253987 7401216 0 39111 85595 85595 4947290 4349223 598067 342732 296929 45803 448095 386473 61622 26767 26767 41250 41250 168225 121091 47134 27511 27511 34268 34268 32050 32050 253105 218367 34738 660 350 310 1809 1809 28995 28995 164615 142254 22361 102052 88018 14034 USER FEE ASSESSMENT 607495 607495 COVID EXPENSES (PPE & T 286499 286499 ANCILLARY EXPENSES 279692 279692 DIETARY EXPENSE 262464 262464 393077 320900 72177 8534246 7359755 1174491 0 777335 659872 1486273 766284 935718 2700 60595 73292 6112020 4721018 1532693 1391002 25897 26315 24674 405123 3187478 4980295 747776 706873 623993 45812 86075 486575 460771 801838 39555 0 862908 2082001 2780175 X 1079580 1799320 25897 400800 1105477 2200120 3187478 4980295 X 719741 418 374484 X 0 1 X 1 0 X 15939 9717 5032 17537 1813660 1861885 7861330 7414524 7589045 7873924 7401216 38140039 7877269 7424241 7594077 7891461 9214876 40001924 0 0 0 40001924 51976 47048 48389 47266 26656 221335 51976 47048 48389 47266 26656 221335 7929245 7471289 7642466 7938727 9241532 40223259 0.99450 0.99370 0.00550 0.00630 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 25897 345878 28606 25897 374484 24967 930 25897 25199 -232 24967 25106 93 25199 25199 -93 25106 1.00000 0 0 45080 45080 4058124 3073945 984179 872205 661048 211157 1039640 890441 149199 96971 95584 1387 1391002 SELF-FUNDED INSURANCE RECEIVABLE 24674 OTHER RECEIVABLES 5965 BENEFICIAL INTEREST IN PERPETUAL TRUST 374484 405123 ACCRUED INTEREST - RELATED PARTIES 111970 NOTES PAYABLE - RELATED PARTIES 750938 862908 X 9283011 418 28606 29024 9253987 0 9253987 8534246 0 8534246 0 8534246 PART IV, LINE 2B: DURING 2020, IT WAS DETERMINED THAT THE AMOUNTS REPORTED IN PRIOR YEARS CONSIST OF DONOR RESTRICTED FUNDS AND DO NOT REPRESENT EITHER TERM OR PERMANENT ENDOWMENTS. THEREFORE, THESE FUNDS ARE NOT REQUIRED TO BE REPORTED IN SCHEDULE D, PART V AND THE BALANCE AS OF DECEMBER 31, 2020 WAS REDUCED BY THESE AMOUNTS. DURING 2020, IT WAS ALSO DETERMINED THAT THE ORGANIZATION HAS A BENEFICIAL INTEREST IN A PERPETUAL TRUST. THIS HAS BEEN AS A 2020 CONTRIBUTION IN PART V. THIS ENDOWMENT FUND WAS ESTABLISHED TO PROVIDE INCOME TO THE ORGANIZATION OVER TIME. PART V, LINE 4: THE ENDOWMENT FUNDS WERE ESTABLISHED TO PROVIDE INCOME TO THE ORGANIZATION OVER TIME. PART X, LINE 2: THE FINANCIAL STATEMENTS DO NOT INCLUDE A PROVISION FOR INCOME TAXES BECAUSE THE ORGANIZATION HAS BEEN GRANTED EXEMPT STATUS RELATIVE TO FEDERAL AND STATE CORPORATE INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND APPLICABLE STATE CODES. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS OR AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAXES. TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES IN ACCORDANCE WITH PRESCRIBED STATUTES. THE ORGANIZATION HAS NOT BEEN EXAMINED FOR ANY OPEN YEARS. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN BENEFICIAL INTEREST IN PERPETUAL TRUST 28,606. GOLF TOURNAMENT 16637 7549 9088 1515 468 3079 BLACK TIE GALA 16625 7975 8650 1188 33262 15524 17738 1515 468 4267 6250 11488 CLARENCE PLANT CEO AND BOARD SECRETARY EMPLOYEE LOAN X 2700 2700 0 1 1 2700 FORM 990, PART VI, SECTION A, LINE 1 THE GOVERNING BODY DELEGATES AUTHORITY TO THE EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE PRESIDENT, VICE PRESIDENT, SECRETARY AND TREASURER AND THREE (3) DIRECTORS ELECTED BY THE BOARD AT THE ANNUAL MEETING. THE EXECUTIVE COMMITTEE HAVE AND MAY EXERCISE, WHEN THE BOARD IS NOT IN SESSION, ALL OF THE POWERS OF THE BOARD OF DIRECTORS IN THE MANAGEMENT OF THE ORGANIZATION EXCEPT THE AUTHORITY TO AMEND THE BYLAWS; ADOPT A PLAN OF MERGER OR CONSOLIDATION; SELL, LEASE, EXCHANGE, MORTGAGE, PLEDGE OR MAKE ANY OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE PROPERTY AND ASSETS OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 2 TRUSTEES JOHN SLANEY AND DOREEN SLANEY ARE MARRIED. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM. THE CEO AND EXECUTIVE DIRECTOR OF ODD FELLOWS HOME OF MASSACHUSETTS, INC. REVIEW THE DRAFT FORM 990. PRIOR TO FILING WITH THE IRS, A COMPLETE COPY OF THE FINAL FORM 990 IS PROVIDED TO EACH BOARD MEMBER VIA ELECTRONIC COMMUNICATION. FORM 990, PART VI, SECTION B, LINE 12C TRUSTEES SHALL NOT HAVE ANY UNDISCLOSED CONFLICTS OF INTEREST WITH THE CORPORATION. ANY CONFLICT OF INTEREST ON THE PART OF ANY TRUSTEE SHALL BE DISCLOSED TO THE OTHER TRUSTEES AND MADE A MATTER OF RECORD WHEN ANY MATTER TO WHICH THE INTEREST RELATES BECOMES THE SUBJECT OF ACTION BY THE BOARD. THE CONFLICT OF INTEREST DISCLOSURE FORM IS SIGNED OFF EVERY YEAR BY ALL BOARD MEMBERS, A PROCESS FOR WHICH THE BOARD SECRETARY ACTIVELY LEADS AND MONITORS. FORM 990, PART VI, SECTION B, LINE 15A THE EXECUTIVE COMMITTEE HOLDS AN ANNUAL MEETING WITH THE BOARD OF TRUSTEES TO DISCUSS THE COMPENSATION. THE COMMITTEE REVIEWS DUTIES, PERFORMANCE, COMPARATIVE WAGE AND BENEFIT DATA, AND DOCUMENTS ALL COMPENSATION DELIBERATIONS AND DECISIONS IN THE MEETING MINUTES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: ADJUSTMENT FOR BENEFICIAL INTEREST IN PERPETUAL TRUST 345,878. CHANGE IN BENEFICIAL INTEREST IN PERPETUAL TRUST 28,606. GRAND LODGE OF THE INDEPENDENT ORDER OF ODD FELLOWS 104 RANDOLPH ROAD WORCESTER MA 01606 041383604 FRATERNAL ORGANIZATION MA 501(C)(8) & (C)(10) 0 INDEPENDENT ORDER OF ODD FELLOWS WORCESTER LODGE #56 104 RANDOLPH ROAD WORCESTER MA 01606 237144681 FRATERNAL ORGANIZATION MA 501(C)(8) & (C)(10) 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 GRAND LODGE OF THE INDEPENDENT ORDER OF ODD FELLOWS E 517519 LOAN DOCUMENT INDEPENDENT ORDER OF ODD FELLOWS WORCESTER LODGE #56 E 233419 LOAN DOCUMENT