2020-11-16T11:32:26-06:00 2019-12-31 410746749 CLIFTONLARSONALLEN LLP 300 CROWN COLONY DRIVE SUITE 310 QUINCY MA 02169 990 2019-01-01 042200583 CHELSEA JEWISH NURSING HOME INC CHEL 6178870001 17 LAFAYETTE AVENUE CHELSEA MA 02150 JEFFREY LANDA CFO 6178870001 2020-11-14 1 DOUGLAS FIEBELKORN P00173341 6179848100 2020-11-13 67.137.57.251 2020-11-14 06:35:39 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 DB4D876F1E865A169F112399513D375B5F212DAE 2019 2021-01-29 14:40:06Z KATZMAN FAMILY CENTER FOR LIVING ADAM BERMAN 240 LYNNFIELD STREET PEABODY MA 01960 13353340 0 X WWW.CHELSEAJEWISH.ORG X 1919 MA TO PROVIDE THE HIGHEST LEVEL OF SKILLED NURSING AND REHABILITATION SERVICES. 6 2 232 12 0 0 97290 27207 13202736 13322047 1778 811 80295 3275 13382099 13353340 0 0 0 0 6755605 7755395 0 0 70908 6993066 6122999 13748671 13878394 -366572 -525054 22322953 20848387 20472793 19386651 1850160 1461736 X THE ORGANIZATION'S MISSION IS TO PROVIDE INDIVIDUALS THROUGHOUT THE GREATER BOSTON AREA WITH THE HIGHEST LEVEL OF SKILLED NURSING, REHABILITATION AND ASSISTED LIVING SERVICES WITHOUT REGARD TO ABILITY TO PAY. THE GOAL IS TO ENSURE BOTH CLIENTS AND FAMILIES RETAIN HEALTH, INDEPENDENCE, AND WELL-BEING THROUGH OUR SERVICES. 0 0 11766158 0 13322047 NURSING HOME - OPERATION OF A 120-BED SKILLED NURSING FACILITY PROVIDING NURSING CARE, REHABILITATION THERAPIES AND OTHER SKILLED SERVICES TO FRAIL ELDERLY. 11766158 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 232 1 0 0 0 0 0 0 0 0 0 0 0 0 X 6 2 1 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X JEFFREY LANDA 9784715100 240 LYNNFIELD STREET PEABODY MA 01960 BARRY BERMAN CEO/TREASURER 1.00 39.00 X X 0 677517 75257 ADAM BERMAN PRESIDENT 1.00 39.00 X X 0 349563 51303 ELIZABETH MULLEN COO/CLERK 1.00 39.00 X X 0 229257 28058 GILDA RICHMAN CHAIR 1.00 39.00 X X 0 74333 5774 JOEL MAZER DIRECTOR 1.00 8.00 X 0 0 0 JUDY WEISS DIRECTOR 1.00 8.00 X 0 0 0 JEFFREY LANDA CFO 1.00 39.00 X 0 285500 31390 EDWARD STEWART EXECUTIVE DIRECTOR 40.00 X 134152 0 20023 ROGELIO CALAUNAN RN 40.00 X 129915 0 19749 MATT WALLEN DIRECTOR OF REHAB 40.00 X 126459 0 18803 DAVIS DOROTHY RN 40.00 X 103824 0 9967 494350 1616170 260324 4 0 1 0 0 27207 27207 PROGRAM SERVICE REVENUE 623990 13322047 13322047 13322047 811 811 OTHER INCOME 623000 3275 0 3275 3275 13353340 13322047 0 4086 6879724 6193378 615438 70908 14391 14391 339965 329367 10598 521315 521170 145 797235 737560 59675 15322 14374 948 61755 57932 3823 255933 217630 38303 1456 1420 36 112411 81177 31234 26814 26814 456690 392751 63939 144482 135187 9295 1890 1843 47 668504 618464 50040 1091888 1010156 81732 355841 332305 23536 USER FEE ASSESSMENT 812159 812159 SUPPLIES AND EXPENSE 510467 506890 3577 FOOD 395417 395417 PATIENT ANCILLARY SERVI 208563 177283 31280 206172 41854 164318 13878394 11766158 2041328 70908 1744562 1357321 2700204 2317135 210996 191746 23560438 10144575 14410697 13415863 3256494 3566322 22322953 20848387 2257685 1425538 5124 29529 16404418 16227077 1805566 1704507 20472793 19386651 X -341918 -866972 2192078 2328708 1850160 1461736 22322953 20848387 X -525054 136630 X 0 1 X 1 1 1 X 25000 41055 94524 49290 27207 237076 11809163 11834736 12979510 13283031 13319721 63226161 11834163 11875791 13074034 13332321 13346928 63463237 25000 41055 43676 48000 27207 184938 0 25000 41055 43676 48000 27207 184938 63278299 2254 1714 10428 1778 811 16985 2254 1714 10428 1778 811 16985 11836417 11877505 13084462 13334099 13347739 63480222 0.99680 0.99560 0.00030 0.00030 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2192078 163837 27207 2328708 1806059 500000 -65981 48000 2192078 1762383 43676 1806059 1721328 41055 1762383 1750652 -29324 1721328 0.00000 0.00000 1.00000 1 1 0 13575 13575 21964916 9003172 12961744 1581947 1141403 440544 13415863 SOFTWARE, NET 498 REPLACEMENT RESERVE 394109 ESCROW AGREEMENT 773231 CONSTRUCTION IN PROGRESS 69776 BENEFICIAL INTEREST IN RELATED PART 500000 BENEFICIAL INTEREST IN TESTAMENTARY TRUST 1828708 3566322 DUE TO RELATED PARTIES 1660755 DUE TO THIRD-PARTY PAYORS 43752 1704507 X 13353340 0 13353340 0 13353340 13878394 0 13878394 0 13878394 PART V, LINE 4: THE ORGANIZATION IS THE SOLE BENEFICIARY OF A CHARITABLE TESTAMENTARY TRUST THAT IS ADMINISTERED BY UNRELATED FINANCIAL INSTITUTIONS. THE UNRELATED FINANCIAL INSTITUTIONS SET FORTH THE INVESTMENT POLICIES FOR THE TRUST. THE ORGANIZATION RECEIVED INCOME GENERATED BY THE TRUST FOR GENERAL PURPOSES AND CLASSIFIED AS UNRESTRICTED NET ASSETS. GAINS AND LOSSES ARE CONSIDERED RESTRICTED. THE ORGANIZATION HAS A BENEFICIAL INTEREST IN ASSETS THAT ARE HELD BY A RECIPIENT ORGANIZATION, CHELSEA JEWISH CHARITABLE FOUNDATION (THE FOUNDATION), A RELATED PARTY, IN THE AMOUNT OF $500,000 AT DECEMBER 31, 2019 AND 2018. THE ASSETS WILL BE TRANSFERRED TO THE ORGANIZATION WITH THE APPROVAL OF THE FOUNDATION. THE DONORS DID NOT GRANT VARIANCE POWER TO THE FOUNDATION. THE ORGANIZATION'S INTEREST IN NET ASSETS OF RECIPIENT ORGANIZATION IS REPORTED AT FAIR VALUE. PART X, LINE 2: THE ORGANIZATION IS A NONPROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC) AND IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE ORGANIZATION FILES AS A TAX-EXEMPT ENTITY. SHOULD THAT STATUS BE CHALLENGED IN THE FUTURE, ITS 2016 THROUGH 2019 TAX YEARS ARE OPEN FOR EXAMINATION BY THE FEDERAL AND STATE TAXING AUTHORITIES. THE ORGANIZATION FOLLOWS THE POLICY FOR UNCERTAINTY IN INCOME TAXES TO BE RECOGNIZED IN AN ENTITY'S FINANCIAL STATEMENTS. THE POLICY PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT PRINCIPLES FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. NO UNCERTAIN INCOME TAX POSITIONS WERE IDENTIFIED FOR THE YEAR ENDED DECEMBER 31, 2019. THE ORGANIZATION EVALUATES TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN IN ITS TAX RETURNS TO DETERMINE WHETHER THE TAX POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED BY THE APPLICABLE TAX AUTHORITY. TAX POSITIONS NOT DEEMED TO MEET THE MORE LIKELY THAN NOT THRESHOLD, ALONG WITH ACCRUED INTEREST AND PENALTY THEREON WOULD BE RECORDED AS AN EXPENSE IN THE CURRENT YEAR FINANCIAL STATEMENTS. AT DECEMBER 31, 2019, MANAGEMENT BELIEVES THAT IT HAS NO UNCERTAIN TAX POSITIONS WITH ANY OF ITS OPEN TAX YEARS. X X 0 0 0 0 0 0 0 0 0 BARRY BERMAN CEO/TREASURER 0 677517 0 0 0 0 0 0 0 75257 0 752774 0 0 ADAM BERMAN PRESIDENT 0 349563 0 0 0 0 0 0 0 51303 0 400866 0 0 ELIZABETH MULLEN COO/CLERK 0 229257 0 0 0 0 0 0 0 28058 0 257315 0 0 JEFFREY LANDA CFO 0 285500 0 0 0 0 0 0 0 31390 0 316890 0 0 EDWARD STEWART EXECUTIVE DIRECTOR 134152 0 0 0 0 0 0 0 20023 0 154175 0 0 0 JEFFREY BRUDNICK (LOUIS J BRUDNICK & SONS) JEFFREY BRUDNICK IS A DIRECTOR OF THE BOARD OF CHELSEA JEWISH LIFECARE 24862 INSURANCE BROKER/AGENT 0 FORM 990, PART VI, SECTION A, LINE 2 ADAM BERMAN, PRESIDENT, AND BARRY BERMAN, TREASURER, HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION ENTERED INTO A MANAGEMENT AGREEMENT WITH CHELSEA JEWISH LIFECARE EFFECTIVE JANUARY 1, 2017. CHELSEA JEWISH LIFECARE, INC. PROVIDED MANAGEMENT SERVICES WHICH INCLUDED THE FOLLOWING RESPONSIBILITIES: 1) KEY PERSONNEL MANAGEMENT 2) PERSONNEL OVERSIGHT (EMPLOYEES & ADMINISTRATION) 3) FINANCIAL RESPONSIBILITIES 4) MANAGEMENT REPORTS 5) REGULATORY COMPLIANCE 6) QUALITY ASSURANCE 7) PURCHASING & CONTRACTING 8) BANK ACCOUNTS FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE CORPORATION IS A RELATED ORGANIZATION, CHELSEA JEWISH LIFECARE, INC. FORM 990, PART VI, SECTION A, LINE 7A THE APPROVAL OF THE MEMBER, CHELSEA JEWISH LIFECARE, INC., IS REQUIRED TO ELECT OR REMOVE DIRECTORS OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7B THE APPROVAL OF THE MEMBER, CHELSEA JEWISH LIFECARE, INC., IS REQUIRED BEFORE THE BOARD OF DIRECTOR'S ACTION ON ANY OF THE FOLLOWING BECOMES EFFECTIVE: (A) TO AMEND OR TO REPEAL THE ARTICLES OF ORGANIZATION OR THE BYLAWS OF THE CORPORATION; (B) TO APPROVE ALL PLANS OF MERGER, CONSOLIDATION, REORGANIZATION OR DISSOLUTION OF THE CORPORATION OR ANY SUBSIDIARY OF THE CORPORATION, OR THE SALE, LEASE, ASSIGNMENT OR TRANSFER OF SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION, OR THE PURCHASE OR ACQUISITION BY THE CORPORATION OF THE CORPORATION OF AN INTEREST IN ANY CORPORATION, PARTNERSHIP, JOINT VENTURE OR OTHER ENTITY, WHETHER NEWLY CREATED OR PREVIOUSLY EXISTING, WHICH INTEREST, IN THE CASE OF A FOR-PROFIT ENTITY, REPRESENTS TWENTY-FIVE PERCENT (25%) OR MORE OF THE VOTING POWER THEREOF OR EQUITY INTEREST THEREIN, OR, IN THE CASE OF A NON-PROFIT ENTITY, REPRESENTS TWENTY-FIVE PERCENT (25%) OR MORE OF THE VOTING POWER THEREOF OR MEMBERSHIP INTEREST THEREIN; (C) TO APPROVE ALL GIFTS, GRANTS, DONATIONS OR SIMILAR TRANSFERS OF FUNDS OF THE CORPORATION TO ANY ENTITY OTHER THAN THE MEMBER OR ITS SUBSIDIARIES; (D) TO ELECT OR REMOVE DIRECTORS OF THE CORPORATION; (E) TO APPROVE THE FORMATION OF ANY SUBSIDIARY OF THE CORPORATION; AND (F) TO APPOINT THE CORPORATION'S AUDITORS. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION'S MANAGEMENT TEAM WILL CONDUCT A REVIEW OF THE FORM 990 AFTER IT HAS BEEN FINALIZED, INCLUDING READING AND REVIEWING THE KEY INFORMATION. MANAGEMENT WILL REPORT TO THE BOARD IF THERE ARE ANY MAJOR DEVIATIONS FROM THE PROVIDED DATA. A COMPLETE COPY OF THE FORM 990 IS PROVIDED TO THE BOARD PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ON AN ANNUAL BASIS, ALL BOARD MEMBERS ARE INSTRUCTED TO INFORM THE REST OF THE BOARD IF ANY CONFLICT OF INTEREST EXISTS PERTAINING TO THEIR MEMBERSHIP ON THE BOARD. ANY POTENTIAL CONFLICT OF INTEREST IS THEN DISCUSSED AND ASSESSED BY THE REMAINING BOARD MEMBERS. IF A CONFLICT EXISTS, IT MUST BE DISCLOSED AND HELD TO A HIGHER LEVEL OF SCRUTINY IN ORDER TO VERIFY THAT ALL TRANSACTIONS ARE AT ARMS-LENGTH. ANY BOARD MEMBER DEEMED TO HAVE A CONFLICT OF INTEREST WILL ABSTAIN FROM PARTICIPATING IN THE BOARD'S DELIBERATIONS AND DECISIONS IN THE TRANSACTION. FORM 990, PART VI, SECTION B, LINE 15 THE CEO IS PAID FROM A RELATED ORGANIZATION. PRIOR TO MAJOR SALARY ADJUSTMENTS FOR THE CEO, A RELATED ORGANIZATION'S BOARD OF DIRECTORS ARRANGES FOR A SALARY STUDY TO BE PERFORMED. THE STUDY INCLUDES THE EXECUTIVE SALARIES OF COMPARABLY-SIZED COMPANIES IN THE INDUSTRY. THE BOARD OF DIRECTORS THEN CONSIDERS THE FINDINGS OF THE STUDY IN SETTING THE CEO'S COMPENSATION. 2019 WAS THE MOST RECENT YEAR IN WHICH THE PROCESS INCLUDED REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION. FORM 990, PART VI, SECTION B, LINE 15B: OFFICERS AND KEY EMPLOYEES ARE PAID FROM A RELATED ORGANIZATION. COMPENSATION FOR KEY EMPLOYEES IS DETERMINED THROUGH THE USE OF SALARY STUDIES OR OTHER DATA AND ADJUSTED BASED ON THE EMPLOYEE'S YEARS OF EXPERIENCE AND RESPONSIBILITIES BY A RELATED ORGANIZATION'S BOARD OF DIRECTORS. 2019 WAS THE MOST RECENT YEAR IN WHICH THE PROCESS INCLUDED REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION. 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: OTHER CHANGES IN NET ASSETS-990 -27,207. CHANGE IN BENEFICIAL INTEREST IN TESTAMENTARY TRUST 163,837. CHELSEA JEWISH LIFECARE INC 165 CAPTAINS ROW CHELSEA MA 02150 510141617 MANAGEMENT MA 501(C)(3) LINE 7 N/A 0 ADMIRAL'S HILL ASSISTED LIVING CORP II 165 CAPTAINS ROW CHELSEA MA 02150 043538833 ASSISTED LIVING MA 501(C)(3) LINE 10 CHELSEA JEWISH LIFECARE INC 0 CHELSEA JEWISH COMMUNITY INC 165 CAPTAINS ROW CHELSEA MA 02150 271756594 MANAGEMENT, HOMECARE, PERSONAL CARE, HOSPICE, THERAPY MA 501(C)(3) LINE 10 CHELSEA JEWISH LIFECARE INC 0 CHELSEA JEWISH CHARITABLE FOUNDATION INC 240 LYNNFIELD STREET PEABODY MA 01960 261244471 FUNDRAISING & SUPPORT MA 501(C)(3) LINE 12B, II CHELSEA JEWISH LIFECARE INC 0 CHELSEA JEWISH GREEN HOUSE INC 165 CAPTAINS ROW CHELSEA MA 02150 043326727 ASSISTED LIVING & NURSING HOME MA 501(C)(3) LINE 10 CHELSEA JEWISH LIFECARE INC 0 CHELSEA JEWISH NORTH SHORE ASSISTED LIVING INC 240 LYNNFIELD STREET PEABODY MA 01960 043274643 ASSISTED LIVING MA 501(C)(3) LINE 10 CHELSEA JEWISH LIFECARE INC 0 CHELSEA JEWISH NORTH SHORE FOUNDATION INC 240 LYNNFIELD STREET PEABODY MA 01960 223102199 FUNDRAISING & SUPPORT MA 501(C)(3) LINE 7 CHELSEA JEWISH LIFECARE INC 0 JEWISH REHABILITATION CENTER FOR AGED OF THE NORTH SHORE INC 240 LYNNFIELD STREET PEABODY MA 01960 042106768 SKILLED NURSING & ADH MA 501(C)(3) LINE 10 CHELSEA JEWISH LIFECARE INC 0 JGS LIFECARE CORPORATION 770 CONVERSE STREET LONGMEADOW MA 01106 042129128 GERIATRIC/NURSING PROVIDER MA 501(C)(3) LINE 7 CHELSEA JEWISH LIFECARE INC 0 JGS ADMINISTRATIVE SERVICES 770 CONVERSE STREET LONGMEADOW MA 01106 043295014 ADMIN SUPPORT TO JEWISH GERIATRIC SERVICES MA 501(C)(3) LINE 10 JGS LIFECARE CORPORATION 0 JEWISH NURSING HOME OF WESTERN MA INC 770 CONVERSE STREET LONGMEADOW MA 01106 043138403 SKILLED NURSING FACILITY MA 501(C)(3) LINE 10 JGS LIFECARE CORPORATION 0 JGS HOUSING SERVICES INC 770 CONVERSE STREET LONGMEADOW MA 01106 043321157 ASSISTED LIVING MA 501(C)(3) LINE 10 JGS LIFECARE CORPORATION 0 SPECTRUM HOME HEALTH & HOSPICE 770 CONVERSE STREET LONGMEADOW MA 01106 043237982 HOME HEALTH & HOSPICE CARE MA 501(C)(3) LINE 10 JGS LIFECARE CORPORATION 0 SPECTRUM HOME CARE INC 770 CONVERSE STREET LONGMEADOW MA 01106 043399549 NON-CERTIFIED HOME HEALTH AGENCY MA 501(C)(3) LINE 10 JGS LIFECARE CORPORATION 0 WINTHROP APARTMENTS LLC 165 CAPTAINS ROW CHELSEA MA 02150 463739775 REAL ESTATE MA N/A 0 0 0 0 1 1 0 0 0 0 0 0 0 1 0 1 0 0 1 0