2019-11-14T16:57:21-06:00 2018-12-31 061009205 BLUM SHAPIRO & COMPANY PC CPA'S ONE INTERNATIONAL PLACE 16TH FLOOR BOSTON MA 02110 990 2018-01-01 043138403 JEWISH NURSING HOME OF WESTERN MASSACHUSETTS INC JEWI 4135676211 770 CONVERSE STREET LONGMEADOW MA 011061786 RUDY D'AGOSTINO TREASURER 4135676211 2019-11-14 1 LAURA J KENNEY P00202198 6177170831 2019-11-14 64.251.63.131 2019-11-14 11:49:23 ES P F655607A01BC9414CB150F5C2D5B642F4B7C09E6 B49528270D5C596423F272EFB472E66EFBF6AFC8 2018 2020-03-31 21:24:44Z RUDY D'AGOSTINO 770 CONVERSE STREET LONGMEADOW MA 011061786 22871175 0 X WWW.JGSLIFECARE.ORG X 1992 MA TO CARE FOR THE FRAIL ELDERLY AND INFIRMED ACCORDING TO JEWISH TRADITIONS. 20 20 382 73 0 0 0 1851014 19799625 20810855 22 43 204079 209263 20003726 22871175 0 0 0 0 11765771 11591293 0 0 0 11331063 13815087 23096834 25406380 -3093108 -2535205 21917215 21042064 28210394 29870448 -6293179 -8828384 TO CARE FOR THE FRAIL ELDERLY AND INFIRMED ACCORDING TO JEWISH TRADITIONS. 0 0 19071601 21020118 THE HOME IS A NON-PROFIT ORGANIZATION WHICH OWNS AND OPERATES A 200 BED SKILLED NURSING FACILITY, WHICH INCLUDES A 24 BED SHORT STAY UNIT, AND AN ADULT DAY CARE CENTER. 19071601 1 1 0 0 0 0 0 0 1 0 1 0 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 1 0 1 382 1 0 0 0 0 0 0 0 0 0 0 0 0 X 20 20 1 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 0 0 0 MA X CHELSEA JEWISH LIFECARE JEFFREY LANDA CFO 9784715110 240 LYNNFIELD STREET PEABODY MA 01960 ERIC BERG CHAIR 1.00 5.00 X X 0 0 0 STUART ANFANG TREASURER 1.00 5.00 X X 0 0 0 JAMES GORDON CLERK 1.00 5.00 X X 0 0 0 ROBERT BAEVSKY DIRECTOR 1.00 5.00 X 0 0 0 CHRISTOPHER CARR II DIRECTOR 1.00 5.00 X 0 0 0 RICHARD CHASE DIRECTOR 1.00 5.00 X 0 0 0 ANNE CHERNICK DIRECTOR 1.00 5.00 X 0 0 0 RUDY D'AGOSTINO DIRECTOR 1.00 5.00 X 0 0 0 STEVEN DANE DIRECTOR 1.00 5.00 X 0 0 0 MARK DINDAS DIRECTOR 1.00 5.00 X 0 0 0 MICHELE FEINSTEIN DIRECTOR 1.00 5.00 X 0 0 0 MARTHA FINKEL DIRECTOR 1.00 5.00 X 0 0 0 SUSAN GOLDSMITH DIRECTOR 1.00 5.00 X 0 0 0 PETER GREENBERG DIRECTOR 1.00 5.00 X 0 0 0 RICHARD HALPERN DIRECTOR 1.00 5.00 X 0 0 0 SUSAN KLINE DIRECTOR 1.00 5.00 X 0 0 0 GERALD LAZARUS DIRECTOR 1.00 5.00 X 0 0 0 JAMES ROSENTHAL DIRECTOR 1.00 5.00 X 0 0 0 CANDACE WEINER DIRECTOR 1.00 5.00 X 0 0 0 MEYER WEISS DIRECTOR 1.00 5.00 X 0 0 0 STEPHEN MCPHERSON INTERIM CEO (TO JUNE 2018) 1.00 44.00 X 0 95812 0 KAREN PETRUCCELLI COO 1.00 44.00 X 0 212640 28841 BETH CHAGUE CFO (TO JULY 2018) 1.00 44.00 X 0 126536 11878 ELINOR RIBERIO LPN 40.00 0.00 X 129664 0 18527 SHANNON WESSON DIRECTOR OF NURSING 40.00 0.00 X 118177 0 12974 PATRICIA MESHAK LPN 40.00 0.00 X 109700 0 10663 ANN REID LPN 40.00 0.00 X 101644 0 16321 459185 434988 99204 4 0 1 0 HEALTHPRO REHABILITATION 536 OLD HOWELL ROAD GREENVILLE SC 29615 REHAB/THERAPY SERVICES 1161616 HEALTHCARE SERVICES GROUP 3220 TILLMAN DRIVE SUITE 300 BENSALEM PA 19020 HOUSEKEEPING/LAUNDRY SERVICES 677501 WORLDWIDE STAFFING 2222 SEDGWICK RD DURHAM NC 27713 NURSE STAFFING 237587 3 1851014 1851014 NURSING HOME 623000 20336609 20336609 DAY CARE REVENUE 624100 474246 474246 20810855 43 43 73200 0 73200 73200 73200 CAFE, COFFEE, BEAUTY, GIFT SHOPS 453220 76839 76839 MISC REVENUE 900099 59224 59224 136063 22871175 21020118 0 43 X 9405732 8940154 465578 1456944 246901 1210043 728617 662480 66137 2817998 49424 2768574 188891 188891 3522559 3474024 48535 525424 478743 46681 21568 925 20643 823160 813638 9522 94843 93935 908 930880 889181 41699 1439989 1439989 186062 186062 USER FEE 1167121 1167121 FOOD FUNCTIONS 770475 770475 PHARMACY 587657 587657 BAD DEBTS 569897 569897 168563 54178 114385 25406380 19071601 6334779 0 720476 450566 259638 188125 2294595 2803176 189086 173826 41598348 24171977 18453420 17426371 21917215 21042064 2346001 3971659 57227 89722 54693 73832 14998 6017 25737475 25729218 28210394 29870448 X -6293179 -8828384 -6293179 -8828384 21917215 21042064 -2535205 0 X 0 1 X 1 0 X 121000 1851014 1972014 17744387 18270873 20044973 19799625 20810855 96670713 17744387 18270873 20165973 19799625 22661869 98642727 0 0 0 98642727 73207 73233 73200 73222 73243 366105 73207 73233 73200 73222 73243 366105 182818 80356 82207 130879 136063 612323 18000412 18424462 20321380 20003726 22871175 99621155 0.99020 0.99020 0.00370 0.00440 X SCHEDULE A, PART III, LINE 12, EXPLANATION FOR OTHER INCOME: MISCELLANEOUS INCOME 2014 AMOUNT: $ 182,818 2015 AMOUNT: $ 80,356 2016 AMOUNT: $ 82,207 2017 AMOUNT: $ 130,879 2018 AMOUNT: $ 136,063 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 83562 83562 25964696 14447770 11516926 8193536 4879746 3313790 6825638 4728766 2096872 530916 115695 415221 17426371 DUE TO AFFILIATES 25644442 DUE TO THIRD PARTIES 42202 ASSET RETIREMENT OBLIGATION 42574 25729218 X 22301278 0 22301278 569897 569897 22871175 24836483 0 24836483 569897 569897 25406380 PART IV, LINE 2B: THE ORGANIZATION HOLDS FUNDS ON BEHALF OF ITS RESIDENTS TO BE USED AS DIRECTED BY THE RESIDENTS. (PERSONAL NEEDS ACCOUNT) PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE ORGANIZATION AND RECOGNIZE A TAX LIABILITY IF THE ORGANIZATION HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. MANAGEMENT BELIEVES THAT NO UNCERTAIN TAX POSITIONS EXIST AS OF DECEMBER 31, 2018. THE ORGANIZATION IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 569,897. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 569,897. 0 0 0 0 0 0 0 0 0 KAREN PETRUCCELLI COO 0 212640 0 0 0 0 0 0 0 28841 0 241481 0 0 PART I, LINE 3 THE TOP MANAGEMENT AND FINANCIAL OFFICIALS ARE COMPENSATED BY A RELATED ORGANIZATION. THE RELATED ORGANIZATION USES THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION: A COMPENSATION COMMITTEE, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR A COMPENSATION COMMITTEE. FORM 990, PART VI, SECTION A, LINE 2 THE OFFICERS LISTED IN PART VII, SECTION A (KAREN PETRUCCELLI, BETH CHAGUE, AND STEPHEN MCPHERSON), RECEIVE EMPLOYMENT COMPENSATION FROM A RELATED ORGANIZATION. A CERTAIN BOARD MEMBER OF THE FILING ORGANIZATION IS ALSO A MEMBER OF THE RELATED ORGANIZATION'S BOARD OF DIRECTORS (STUART ANFANG), THEREBY ESTABLISHING A BUSINESS RELATIONSHIP BETWEEN THE OFFICERS AND THE BOARD MEMBER. FORM 990, PART VI, SECTION A, LINE 3 EFFECTIVE SEPTEMBER 5, 2018, JEWISH NURSING HOME OF WESTERN MASSACHUSETTS, INC., ENTERED INTO A MANAGEMENT AGREEMENT WITH CHELSEA JEWISH LIFECARE, INC. UNDER THIS AGREEMENT, CHELSEA JEWISH LIFECARE WAS APPOINTED AS THE SOLE AND EXCLUSIVE BUSINESS MANAGER AND ADMINISTRATOR OF ALL BUSINESS AND ADMINISTRATIVE FUNCTIONS AND SERVICES ASSOCIATED WITH JEWISH NURSING HOME OF WESTERN MASSACHUSETTS. THE AGREEMENT HAS A TERM OF TEN (10) YEARS, WHICH WILL BE EXTENDED FOR SUBSEQUENT ONE-YEAR TERMS THEREAFTER, IN THE EVENT THAT NEITHER PARTY EXERCISES ITS RIGHT TO TERMINATE THE AGREEMENT. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS REVIEWED AND APPROVED BY MANAGEMENT BEFORE FILING, AND A COPY WAS REVIEWED BY THE BOARD MEMBERS AFTER FILING. FORM 990, PART VI, SECTION B, LINE 12C PROCESS FOR MONITORING COMPLIANCE WITH CONFLICTS OF INTEREST POLICY - THE CORPORATE COMPLIANCE OFFICER CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY THROUGH ANNUAL CORPORATE COMPLIANCE TRAINING AND CONFIRMATIONS SIGNED BY ALL EMPLOYEES AND BY OBTAINING ANNUAL WRITTEN CONFIRMATIONS FROM INDEPENDENT BOARD MEMBERS. THE POLICY STATES THAT EMPLOYEES OR DIRECTORS MUST SEEK GUIDANCE FROM APPROPRIATE MANAGEMENT PERSONNEL PRIOR TO PURSUING ANY BUSINESS OR PERSONAL ACTIVITY THAT MAY CONSTITUTE A CONFLICT OF INTEREST. ACTUAL OR POTENTIAL CONFLICTS OF INTEREST MUST BE DISCLOSED TO APPROPRIATE PERSONNEL. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION OF TOP MANAGEMENT IS PAID BY A RELATED ORGANIZATION. THE HUMAN RESOURCES COMMITTEE AND THE BOARD OF DIRECTORS OF THE RELATED ORGANIZATION REVIEW AND APPROVE COMPENSATION OF TOP MANAGEMENT. THE PROCESS INCLUDES A COMPENSATION STUDY, DELIBERATION BY THE COMMITTEE, AND FINAL APPROVAL FROM BOTH THE HUMAN RESOURCES COMMITTEE AND THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENT AVAILABLE TO THE PUBLIC. THESE DOCUMENTS ARE AVAILABLE UPON WRITTEN REQUEST TO THE ORGANIZATION. FORM 990, PART IX, LINE 11G PHYSICAL THERAPY: PROGRAM SERVICE EXPENSES 1,406,055. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,406,055. LAUNDRY AND HOUSEKEEPING: PROGRAM SERVICE EXPENSES 779,976. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 779,976. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 689,492. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 689,492. MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 300,915. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 300,915. ENGINEERING: PROGRAM SERVICE EXPENSES 216,154. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 216,154. OTHER FEES: PROGRAM SERVICE EXPENSES 81,432. MANAGEMENT AND GENERAL EXPENSES 8,374. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 89,806. ADMINISTRATIVE/BUSINESS OFFICE SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 40,161. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 40,161. JGS LIFECARE CORPORATION 770 CONVERSE STREET LONGMEADOW MA 011061786 042129128 GERIATRIC/NURSING PROVIDER MA 501(C)(3) LINE 10 0 JGS ADMINISTRATIVE SERVICES INC 770 CONVERSE STREET LONGMEADOW MA 011061786 043295014 MANAGERIAL & ADMINISTRATIVE SUPPORT MA 501(C)(3) LINE 10 JGS LIFECARE CORPORATION 0 JGS HOUSING SERVICES INC 770 CONVERSE STREET LONGMEADOW MA 011061786 043321157 ASSISTED LIVING FACILITY MA 501(C)(3) LINE 10 JGS LIFECARE CORPORATION 0 SPECTRUM HOME HEALTH AND HOSPICE CARE INC 770 CONVERSE STREET LONGMEADOW MA 011061786 043237982 PATIENT TRANSITION ASSISTANCE MA 501(C)(3) LINE 10 JGS LIFECARE CORPORATION 0 SPECTRUM HOME CARE INC 770 CONVERSE STREET LONGMEADOW MA 011061786 043399549 NON-CERTIFIED HOME HEALTH AGENCY MA 501(C)(3) LINE 10 JGS LIFECARE CORPORATION 0 GENESIS HOUSE INC 770 CONVERSE STREET LONGMEADOW MA 011061786 042817295 ELDERLY HOUSING MA 501(C)(3) LINE 10 JGS LIFECARE CORPORATION 0 GENESIS HOUSE II INC 770 CONVERSE STREET LONGMEADOW MA 011061786 222611647 ELDERLY HOUSING MA 501(C)(3) LINE 10 JGS LIFECARE CORPORATION 0 GENESIS HOUSE III INC 770 CONVERSE STREET LONGMEADOW MA 011061786 000739159 ELDERLY HOUSING MA 501(C)(3) LINE 10 JGS LIFECARE CORPORATION 0 GENESIS LIFECARE CORPORATION 770 CONVERSE STREET LONGMEADOW MA 011061786 812041419 LOW-INCOME ELDERLY HOUSING (HUD SUBSIDIZED) MA 501(C)(3) LINE 10 JGS LIFECARE CORPORATION 0 GENESIS LIFECARE III 770 CONVERSE STREET LONGMEADOW MA 011061786 LOW-INCOME ELDERLY HOUSING MA 501(C)(3) LINE 10 JGS LIFECARE CORPORATION 0 0 0 1 1 1 0 0 0 0 1 0 0 1 1 1 1 1 1 1