2021-11-10T14:08:14-06:00 2020-12-31 010494526 BAKER NEWMAN & NOYES LLC 650 ELM STREET SUITE 302 MANCHESTER NH 03101 990 2020-01-01 050342330 Mount St Rita Health Centre MOUN 4013336352 15 Sumner Brown Road Cumberland RI 02864 William Fleming President 4013336352 2021-11-01 1 William Fleming 999009999 Nicholas E Porto P01310283 8002447444 2021-11-01 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z William Fleming 15 Sumner Brown Road Cumberland RI 02864 9368413 0 X MountStRita.org X 1990 RI Mount Saint Rita is a Catholic skilled nursing and rehabilitation facility that continues the healing ministry of Christ by providing health care services that foster each individual's physical, spiritual, emotional and intellectual well-being. 9 8 195 14 0 0 70848 1070442 9254567 8278861 4765 19110 0 0 9330180 9368413 0 1365 0 0 5353791 4968761 0 0 0 3739569 3882500 9093360 8852626 236820 515787 5710411 6649804 892191 1278377 4818220 5371427 Mount Saint Rita is a Catholic skilled nursing and rehabilitation facility that continues the healing ministry of Christ by providing health care services that foster each individual's physical, spiritual, emotional and intellectual well-being. 0 0 7398246 1365 9140304 Mount Saint Rita Health Centre provided 26,950 days of skilled nursing services during 2020, and 20,785 days of skilled services to Medicaid recipients. 7398246 1 1 0 1 0 0 0 0 0 1 1 1 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 0 0 1 29 0 1 195 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 RI X X Samuel Bowden 4013336352 15 Sumner Brown Road Cumberland RI 02864 William Fleming President 40.00 0.00 X X 150078 0 9468 Josh Bruck RN 62.00 0.00 X 121623 0 33161 Diana Stamatelatos Director of Nursing 40.00 0.00 X 122912 0 23907 Xiao Zhong RN Manager 51.00 0.00 X 125693 0 9700 Tina Medeiros MDS Coordinator 49.00 0.00 X 118791 0 14279 Laurette Bradley Trustee (end 7/2020) 2.00 0.00 X 0 0 0 Sr Mary Costello RSM Trustee 2.00 0.00 X 0 0 0 Donald Houde Trustee 2.00 0.00 X 0 0 0 Dr Boyd Peter King Trustee 2.00 0.00 X 0 0 0 Sr Rose Angela McLellan RSM Trustee 2.00 0.00 X 0 0 0 Patricia Vieira APR Chair 2.00 0.00 X X 0 0 0 Debra Servello Vice Chair 2.00 0.00 X X 0 0 0 Peter Keenan Treasurer 2.00 0.00 X X 0 0 0 Joseph Malley Secretary 2.00 0.00 X X 0 0 0 639097 0 90515 5 0 1 0 Rehab Care Group Inc PO Box 503534 St Louis MO 63150 Rehabilitation services 444689 Performance Healthcare Services Inc 47 R River Street Wellesley MA 02481 Laundry and housekeeping 341897 2 861443 208999 1070442 Patient services 623000 8278861 8278861 8278861 19110 19110 9368413 8278861 0 19110 X 1365 1365 159546 142739 16807 3717267 3345540 371727 151627 122818 28809 637592 516450 121142 302729 245210 57519 165870 165870 100960 100960 1180086 613645 566441 49638 49638 155615 140054 15561 170539 170539 340175 340175 4165 4165 380 380 307466 307466 94626 94626 RI Provider Tax 468343 468343 Drugs/medical supplies 425465 425465 Food and nutrition 189066 189066 Provision for bad debts 134667 134667 95439 85895 9544 8852626 7398246 1454380 0 1335280 1642412 14126 143451 391503 272063 15553 76058 9564241 6200400 3493544 3363841 404003 1060529 31544 56402 59906 5710411 6649804 756296 985557 135895 292820 892191 1278377 X 4799454 5227976 18766 143451 4818220 5371427 5710411 6649804 515787 37420 0 X X 0 1 X 1 0 X 80659 68153 123597 70848 1070442 1413699 9041072 8827978 8759765 9254567 8278861 44162243 9121731 8896131 8883362 9325415 9349303 45575942 0 0 0 45575942 38 89 87 4765 19110 24089 38 89 87 4765 19110 24089 9121769 8896220 8883449 9330180 9368413 45600031 0.99950 0.99990 0.00050 0.00010 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 10897 0 0 0 10897 0 Part II-B, Line 1: Mount St. Rita Health Centre (the Organization) was a member of LeadingAge Rhode Island, a nonprofit professional association, in the year ended December 31, 2020. This membership requires the Organization to pay dues to the Association. The Association disclosed to its members that a portion of membership dues may be used for lobbying expenditures in furtherance the members' exempt purposes. However, the Association did not specifically disclose to the Organization what amount or percentage of dues paid in 2020 was ultimately used for lobbying purposes. For transparency purposes, the Organization is disclosing the total amount of dues paid to the trade association, a portion of which may have been used for lobbying expenditures, on Schedule C, Page 3, Part II-B, Line 1f. 18766 199719 75034 143451 11843 18399 11476 18766 14039 7409 9606 11843 12591 8233 6785 14039 5755 12835 5999 12591 0.00000 0.00000 1.00000 0 0 446015 446015 8142127 5535271 2606856 858839 665129 193710 117260 117260 3363841 Investment in Covenant Health Investment Trust 1060529 F 1060529 Professional loss reserves 104283 Tenant security deposits 31167 Medicaid obligations 157370 292820 X 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, 2020. X X X X 0 0 0 0 0 0 0 0 0 William Fleming President 144385 0 5693 0 0 0 8181 0 1287 0 159546 0 0 0 Josh Bruck RN 105490 0 1643 0 14490 0 4641 0 28520 0 154784 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. Form 990, Part VI, Section A, line 6 Covenant Health, Inc. is the sole corporate member of the Organization. Form 990, Part VI, Section A, line 7a As the sole corporate member of the Organization, Covenant Health, Inc. retains the ability to elect and remove the Organization's board of directors with or without cause. Form 990, Part VI, Section A, line 7b As the sole corporate member of the Organization, Covenant Health, Inc. has the following powers and rights over the Organization and its subsidiaries as outlined in the Organization's bylaws: 1. To approve any change in the written statements of philosophy and mission; 2. To amend and to repeal the organizing and governing documents; 3. To elect the Board of Directors or remove them with or without cause; 4. To appoint and remove the president; 5. To ratify the Board of Director's election of the Chair of the Board; 6. To approve all plans of merger, consolidation, reorganization, dissolution, or the sale, lease assignment, or transfer of substantially all of the assets, or the purchase or acquisition of an interest in any corporation, partnership, joint venture, or other entity; 7. To approve all long-range strategic plans before implementation; 8. To approve the acquisition, sale, or encumberance of any real estate valued in excess of an amount set by the Member in writing; 9. To approve all capital budgets and non-budgeted expeness in excess of an amount set by the Member in writing; 10. To approve all debt in excess of limits set by the Member in writing; 11. To appoint the auditors; 12. To approve the sale, assignment, or transfer of any equity interest or membership interest in any subsidiary; 13. To approve any reclassification or other change of any capital stock or other equity security; and, 14. To approve the issuance of, or the creation of any obligation to issue, any equity security. 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 IX, line 11g Medical Services: Program service expenses 515,226. Management and general expenses 0. Fundraising expenses 0. Total expenses 515,226. Consulting: Program service expenses 0. Management and general expenses 208. Fundraising expenses 0. Total expenses 208. Purchased and administrative services: Program service expenses 98,419. Management and general expenses 566,233. Fundraising expenses 0. Total expenses 664,652. Form 990, Part XII, Line 2c: The audit process has not changed from the previous year. 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 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 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 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 Youville Place 10 Pelham Road Lexington MA 02421 043297834 Assisted living services MA 501(c)(3) Line 10 Covenant Health Inc 0 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 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 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 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 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 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 Covenant Health Investment Trust 420 Bedford Street Lexington MA 02420 046835128 Investment trust MA 501(c)(3) Line 12a, I Covenant Health Inc 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 Youville House Inc 1573 Cambridge Street Cambridge MA 02138 043239593 Assisted living services MA 501(c)(3) Line 10 Youville Lifecare 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 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 Community Clinical Services PO Box 7291 Lewiston ME 04243 010409788 Physician practice ME 501(c)(3) Line 10 St Mary's Health System 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 Residences PO Box 7291 Lewiston ME 04243 222504356 Low income housing ME 501(c)(3) Line 10 St Mary's Health System 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 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 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 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 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 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 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 Transportation Inc 189 Maple Street Lawrence MA 01841 042921889 Elderly transportation services MA 501(c)(3) Line 10 Covenant Health Inc 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 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 M & J Company 360 Broadway Bangor ME 04402 222480150 Lease holding company ME 501(c)(2) St Joseph Healthcare Foundation 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 Alternative Health Services 360 Broadway Bangor ME 04402 010422885 Home health and hospice ME 501(c)(3) Line 10 St Joseph Healthcare Foundation 0 Penacook Place Inc 150 Water Street Haverhill MA 01830 237090088 Nursing home MA 501(c)(3) Line 10 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 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 Insurance LTD PO Box 69 Grand Cayman CJ KY1-1102 043360127 Self-insurance company CJ N/A C 0 Campus Holding PO Box 7291 Lewiston ME 04240 010406049 Holding company ME 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 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 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0