2019-11-15T08:53:18-06:00 2018-12-31 410746749 CLIFTONLARSONALLEN LLP 300 CROWN COLONY DRIVE SUITE 310 QUINCY MA 02169 990 2018-01-01 042200583 CHELSEA JEWISH NURSING HOME INC CHEL 6178870001 17 LAFAYETTE AVENUE CHELSEA MA 02150 JEFFREY LANDA CFO 6178870001 2019-11-12 1 DOUGLAS FIEBELKORN P00173341 6179848100 2019-11-12 67.137.57.251 2019-11-12 10:39:17 ES P FBF91E9F6601ABEAE195131D925EE83266DF73FD EAD1050B096A5AD20989DB7D26358B2771A7DE8D 2018 2020-03-31 21:24:44Z ADAM BERMAN 240 LYNNFIELD STREET PEABODY MA 01960 13382099 0 X WWW.CHELSEAJEWISH.ORG X 1919 MA 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. 10 6 215 12 0 0 94524 97290 12967052 13202736 10428 1778 12458 80295 13084462 13382099 0 0 0 0 7043242 6755605 0 0 58249 6229333 6993066 13272575 13748671 -188113 -366572 20730376 22322953 18899663 20472793 1830713 1850160 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 11642926 0 13202736 NURSING HOME - OPERATION OF A 120-BED SKILLED NURSING FACILITY PROVIDING NURSING CARE, REHABILITATION THERAPIES AND OTHER SKILLED SERVICES TO FRAIL ELDERLY AND DISABLED. 11642926 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 1 0 0 0 0 1 0 0 0 1 2 0 215 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 6 1 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X JEFFREY LANDA 9844715100 240 LYNNFIELD STREET PEABODY MA 01960 ADAM BERMAN PRESIDENT 1.00 39.00 X X 0 344889 53739 BARRY BERMAN TREASURER 1.00 39.00 X X 0 667074 71732 JOEL MAZER CHAIR 1.00 8.00 X X 0 0 0 ELIZABETH MULLEN CLERK 1.00 39.00 X X 0 230583 23481 SUSAN BRUDNICK DIRECTOR 1.00 8.00 X 0 0 0 CHARLOTTE FLORENCE DIRECTOR 1.00 8.00 X 0 0 0 SHARON FORMAN DIRECTOR 1.00 8.00 X 0 0 0 HOWARD GREENSPAN DIRECTOR 1.00 8.00 X 0 0 0 ROBERT RICHMAN 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 286005 34952 EDWARD STEWART EXECUTIVE DIRECTOR 40.00 0.00 X 130000 0 16169 ROGELIO CALAUNAN RN 40.00 0.00 X 133675 0 18737 NORINE PASQUARELLO RN 40.00 0.00 X 101335 0 17266 365010 1528551 236076 3 0 1 0 0 48000 49290 49290 97290 PROGRAM SERVICE REVENUE 623990 13202736 13202736 13202736 1778 1778 OTHER INCOME 623000 80295 0 80295 80295 13382099 13202736 0 82073 6244625 5664161 522215 58249 23864 22387 1477 9279 8763 516 477837 448259 29578 792177 792177 18535 18535 47500 47500 889816 705887 183929 474 474 150482 141897 8585 375414 352495 22919 144298 140426 3872 2921 2921 679700 628822 50878 1084600 1003414 81186 645233 615803 29430 USER FEE ASSESSMENT 789194 789194 SUPPLIES & EXPENSE 494223 494223 FOOD 360663 360663 PATIENT ANCILLARY SERVI 228546 228546 289290 37986 251304 13748671 11642926 2047496 58249 404769 1744562 2446158 2700204 179746 210996 23464380 9053683 14891623 14410697 2808080 3256494 20730376 22322953 1190171 2257685 26038 5124 15201914 16404418 2481540 1805566 18899663 20472793 X 24654 -341918 1806059 2192078 1830713 1850160 20730376 22322953 X -366572 386019 X 0 1 X 1 1 1 X 46263 25000 41055 94524 49290 256132 12023207 11809163 11834736 12979510 13283031 61929647 12069470 11834163 11875791 13074034 13332321 62185779 98918 25000 41055 43676 48000 256649 0 98918 25000 41055 43676 48000 256649 61929130 227 2254 1714 10428 1778 16401 227 2254 1714 10428 1778 16401 12069697 11836417 11877505 13084462 13334099 62202180 0.99560 0.99600 0.00030 0.00020 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1806059 500000 -65981 48000 2192078 1762383 43676 1806059 1721328 41055 1762383 1750652 -29324 1721328 1698000 52652 1750652 0.00000 0.00000 1.00000 1 1 0 13575 13575 21894265 8051596 13842669 1556540 1002087 554453 14410697 SOFTWARE, NET 1493 REPLACEMENT RESERVE 286673 ESCROW AGREEMENT 764647 BENEFICIAL INTEREST IN TESTAMENTARY TRUST 1692078 CONSTRUCTION IN PROGRESS 8859 BENEFICIAL INTEREST IN RELATED PART 500000 DUE FROM RELATED PARTIES 2744 3256494 DUE TO RELATED PARTIES 1765290 DUE TO THIRD-PARTY PAYORS 40276 1805566 X 13382099 0 13382099 0 13382099 13748671 0 13748671 0 13748671 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, 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 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 2015 THROUGH 2018 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, 2018. X X 0 0 0 0 0 0 0 0 0 ADAM BERMAN PRESIDENT 0 344889 0 0 0 0 0 0 0 53739 0 398628 0 0 BARRY BERMAN TREASURER 0 667074 0 0 0 0 0 0 0 71732 0 738806 0 0 ELIZABETH MULLEN CLERK 0 230583 0 0 0 0 0 0 0 23481 0 254064 0 0 JEFFREY LANDA CFO 0 286005 0 0 0 0 0 0 0 34952 0 320957 0 0 ROGELIO CALAUNAN RN 133675 0 0 0 0 0 0 0 18737 0 152412 0 0 0 JEFFREY BRUDNICK (LOUIS J BRUDNICK & SONS) SUSAN BRUDNICK, SPOUSE, IS A DIRECTOR OF THE BOARD 5450 INSURANCE BROKER/AGENT 0 X BUILDING IMPROVEMENTS - LIGHTING UPGRADE 1 49290 COST PER CONTRACT 0 0 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 CHELSEA JEWISH LIFECARE, INC., THE PARENT ORGANIZATION, PERFORMS THE ORGANIZATION'S MANAGEMENT DUTIES. 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. 2014 WAS THE MOST RECENT YEAR IN WHICH THE PROCESS INCLUDED REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION. THIS PROCESS WILL BE COMPLETED AGAIN IN 2019. 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. 2014 WAS THE MOST RECENT YEAR IN WHICH THE PROCESS INCLUDED REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION. THIS PROCESS WILL BE COMPLETED AGAIN IN 2019. 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: CHANGE IN BENEFICIAL INTEREST IN TESTAMENTARY TRUST -113,981. CHANGE IN BENEFICIAL INTEREST IN RECIPIENT ORGANIZATION 500,000. 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 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 1 0 1 1 1 1 0 0 0