2019-11-14T14:18:47-06:00 2018-12-31 410746749 CLIFTONLARSONALLEN LLP 300 CROWN COLONY DRIVE SUITE 310 QUINCY MA 02169 990 2018-01-01 042104321 SHERRILL HOUSE INC SHER 6177312400 135 SOUTH HUNTINGTON AVENUE BOSTON MA 02130 MARC SCHULTZ CHIEF FINANCIAL OFFICER 6177312400 2019-11-13 1 KURT BENNION 6179848100 2019-11-13 67.137.57.251 2019-11-13 16:32:19 PS P 3F92979DAE40F12078D85DA51A75D99227C616B2 ED7A213D0C8BAFBC613504E63D8DBAF6E4014801 2018 2020-03-31 21:24:44Z PATRICK STAPLETON 135 SOUTH HUNTINGTON AVENUE BOSTON MA 02130 25826845 0 X N/A X 1907 MA HIGH QUALITY MEDICAL, NURSING, AND REHABILITATION SERVICES ON AN IN-PATIENT BASIS TO MEN AND WOMEN. 15 15 315 45 0 5262 530187 688279 20057536 19885206 240520 192458 233324 289336 21061567 21055279 0 0 0 0 15300059 15966440 64000 16500 314892 7699412 7578755 23063471 23561695 -2001904 -2506416 34034525 30728553 15232946 15339322 18801579 15389231 X SHERRILL HOUSE IS A NON-PROFIT, SKILLED NURSING HOME MAINTAINED AND OPERATED BY SHERRILL HOUSE, INC. AN EXTENSION OF THE MINISTRY OF TRINITY CHURCH, COPLEY SQUARE, BOSTON, AND THE EPISCOPAL DIOCESE OF MASSACHUSETTS, ITS MISSION HAS BEEN ENHANCED WITH THE MERGER OF ASSETS OF ST. LUKE'S HOME FOR CONVALESCENTS AND THE FRANK WOOD CONVALESCENTS HOME.SHERRILL HOUSE PROVIDES HIGH-QUALITY MEDICAL, NURSING AND REHABILITATION SERVICES ON AN INPATIENT BASIS TO MEN AND WOMEN WITHOUT DISTINCTION AS TO RACE, CREED, COLOR OR NATIONAL ORIGIN. SHERRILL HOUSE HAS ESTABLISHED A REFERRAL SYSTEM WITH OTHER HEALTH CARE FACILITIES IN THE AREA TO ENSURE COMPLETE HE 0 0 18883785 0 19885206 SHERRILL HOUSE IS A NONPROFIT CORPORATION THAT OWNS AND OPERATES A 196-BED SKILLED NURSING FACILITY LOCATED IN JAMAICA PLAIN, MASSACHUSETTS. EFFECTIVE SEPTEMBER 1, 2011, EIGHT LICENSED BEDS WERE TAKEN OUT OF SERVICE. SHERRILL HOUSE HAS ESTABLISHED A REFERRAL SYSTEM WITH OTHER HEALTH CARE FACILITIES IN THE AREA TO ENSURE COMPLETE HEALTH SERVICES AT ALL LEVELS. IT OFFERS LOCAL PHYSICIANS AND HOUSE STAFF A SETTING IN WHICH TO RENDER THE BEST SKILLED CARE ON A SHORT-TERM OR LONG-TERM BASIS. IN ITS CONCERN FOR THE INDIVIDUAL, SHERRILL HOUSE AIMS TO BE AS BROAD AND DIVERSE AS THE NEEDS OF THOSE IT SERVES. 18883785 1 1 0 1 0 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 37 0 315 1 0 0 0 0 0 0 0 0 0 0 0 0 X 15 15 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 MA X MARC SCHULTZ CFO 6177312400 135 SOUTH HUNTINGTON AVENUE BOSTON MA 02130 RICHARD W BENKA ESQ PRESIDENT 2.00 X X 0 0 0 DAVID A KIRCHNER VICE PRESIDENT 1.00 X X 0 0 0 FREDERICA SEE TREASURER 2.00 X X 0 0 0 THE REV THOMAS B KENNEDY CHAIRMAN 2.00 X X 0 0 0 BARBARA BAUMAN TRUSTEE 1.00 X 0 0 0 ALEXANDER T BOK TRUSTEE 1.00 X 0 0 0 STEVE HENDRICKSON TRUSTEE 1.00 X 0 0 0 ROBERT S HULBURT JR TRUSTEE 1.00 X 0 0 0 PAUL ZINTL TRUSTEE 1.00 X 0 0 0 JOSEPH MARTIN TRUSTEE 1.00 X 0 0 0 CHERYL WHITFIELD TRUSTEE 1.00 X 0 0 0 GRACE CLARK TRUSTEE 1.00 X 0 0 0 JOHN R COOK JR TRUSTEE 1.00 X 0 0 0 LISTO FISHER TRUSTEE 1.00 X 0 0 0 ALLENE RUSSELL PIERSON TRUSTEE 1.00 X 0 0 0 PATRICK STAPLETON CEO 40.00 X 294589 0 16994 MARC SCHULTZ CFO 40.00 X 172636 0 19518 BEATRICE AWUOR RN 59.00 X 143495 0 18124 JOSEPHINE NWOSU RN 53.00 X 143042 0 14090 JAMES DAME DIRECTOR OF REHAB 55.00 X 154856 0 23114 LORENE BEGLEY DON 42.00 X 138477 0 20669 IVY LEUNG RN 69.00 X 169569 0 25130 1216664 0 137639 27 0 1 0 CLIFTONLARSONALLEN 300 CROWN COLONY DRIVE SUITE 310 QUINCY MA 02169 AUDIT AND TAX SERVICES 135350 1 688279 688279 PATIENT SERVICE REVENUE 623000 19885206 19885206 19885206 173728 173728 4790296 4771566 18730 18730 18730 289336 289336 289336 21055279 19885206 0 481794 467225 467225 13076617 11652894 1178083 245640 68580 59042 8233 1305 1334187 1148627 160167 25393 1019831 877992 122428 19411 64929 64929 74000 74000 2338 2338 16500 16500 67868 67868 423577 310146 112925 506 32798 32798 426068 73797 352141 130 631137 542931 87076 1130 30234 30234 392063 337270 54091 702 1684253 1448866 232370 3017 290498 245177 44810 511 USER FEE EXPENSE 1083498 1083498 ANCILLARY EXPENSES 1037495 1037495 FOOD EXPENSE 629669 629669 SUPPLIES 338070 338070 370260 179471 190142 647 23561695 18883785 4363018 314892 154833 246740 42203 30877 1922714 1807517 196487 168438 50223694 31846861 19555554 18376833 11408083 9413542 754651 684606 34034525 30728553 4182124 4681191 50279 26770 11000543 10631361 15232946 15339322 X 16822305 13546646 90729 69346 1888545 1773239 18801579 15389231 34034525 30728553 X -2506416 -836325 -69607 X X 0 1 X 1 0 X 899488 1258694 783171 530187 688279 4159819 20010778 19917195 20804045 20057536 19885206 100674760 20910266 21175889 21587216 20587723 20573485 104834579 367370 313046 520204 451763 377504 2029887 0 367370 313046 520204 451763 377504 2029887 102804692 660143 220444 131299 123560 173728 1309174 660143 220444 131299 123560 173728 1309174 233324 289336 522660 21570409 21396333 21718515 20944607 21036549 106666413 0.96380 0.95790 0.01230 0.01630 X SCH A PART III LINE 12 OTHER INCOME INCLUDES DIRECT CARE ADD ON REIMBURSEMENT, WORKERS COMPENSATION DIVIDENDS AND ANTENNA LEASE INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 2338 2338 0 PART II-B, LINE 1: A PERCENTAGE OF MEMBERSHIP DUES TO STATE HEALTHCARE ORGANIZATIONS ARE ASSOCIATED WITH LOBBYING. 1979274 51418 -134580 53527 1842585 2104126 21216 200141 346209 1979274 2084525 38984 69185 88568 2104126 1855533 490809 -54760 207057 2084525 1911124 54366 115031 224988 1855533 0.00000 0.96240 0.03760 0 0 860636 860636 16048704 7354327 8694377 25547162 17824647 7722515 7313606 6261026 1052580 453586 406861 46725 18376833 X 20081481 -836325 -69605 -905930 20987411 67868 67868 21055279 23493827 0 23493827 67868 67868 23561695 PART V, LINE 4: THE ORGANIZATION'S ENDOWMENT FUNDS ARE TO BE USED FOR CHAPLAINCY, VOLUNTEER, FUND FACILITY AND VARIOUS OTHER PROGRAMS. PART X, LINE 2: THE ORGANIZATION IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN BENEFICIAL INTEREST IN PERPETUAL TRUST -69,605. X X X 1 DEVELOPMENT COMMUNICATIONS ASSOCIATES 9 VERNON STREET 2ND FLOOR FRAMINGHAM MA 01701 FUNDRAISING CONSULTANT 0 0 16500 -16500 16500 -16500 MA X X X 0 0 0 0 0 0 0 0 0 PATRICK STAPLETON CEO 294589 0 0 0 0 0 2562 0 14432 0 311583 0 0 0 MARC SCHULTZ CFO 172636 0 0 0 0 0 1726 0 17792 0 192154 0 0 0 BEATRICE AWUOR RN 143495 0 0 0 0 0 0 0 18124 0 161619 0 0 0 JOSEPHINE NWOSU RN 143042 0 0 0 0 0 0 0 14090 0 157132 0 0 0 JAMES DAME DIRECTOR OF REHAB 154856 0 0 0 0 0 0 0 23114 0 177970 0 0 0 LORENE BEGLEY DON 138477 0 0 0 0 0 0 0 20669 0 159146 0 0 0 IVY LEUNG RN 169569 0 0 0 0 0 0 0 25130 0 194699 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B 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 ANNUALLY, EACH MEMBER OF THE BOARD IS PROVIDED A CONFLICT OF INTEREST QUESTIONNAIRE FORM TO BE COMPLETED, SIGNIFYING THAT THEY OBTAINED A COPY OF THE POLICY, HAVE READ AND COMPREHEND THE POLICY, AND AGREE TO COMPLY WITH THE POLICY. THE BOARD REVIEWS AND MONITORS ANY CONFLICTS DISCLOSED. ALL MEMBERS OF THE BOARD, TRUSTEES AND OFFICERS THAT ARE MAKING PURCHASES OR FUTURE RELATED PARTY TRANSACTIONS, MUST EXECUTE A CONFLICT OF INTEREST DISCLOSURE FORM. CONFLICTS MAY BE SEEN BY THE BOARD AND CONFLICTS ARE DETERMINED AND REVIEWED BY THE BOARD. THE PERSON WITH THE CONFLICT MUST BE ABSTAIN FROM ANY DISCUSSION REGARDING THE TRANSACTION. FORM 990, PART VI, SECTION B, LINE 15A A STUDY IS CONDUCTED BY AN OUTSIDE CONSULTING COMPANY, WHICH USES COMPARABILITY DATA ON SALARIES WITHIN THE INDUSTRY. USING THESE REPORTS, AS WELL AS OTHER FACTORS, THE APPROVAL OF COMPENSATION IS DISCUSSED AND VOTED ON BY THE BOARD, AND DOCUMENTED WITHIN THE BOARD MEETING MINUTES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN BENEFICIAL INTEREST -69,605. ADJUSTMENT -2. FINANCIAL STATEMENT AND REPORTING NO CHANGES HAVE BEEN MADE DURUING ITS OVERSIGHT PROCESS DURING THE TAX YEAR