2019-10-01T13:41:58-05:00 2018-12-31 990 2018-01-01 043333609 CHS OF WALTHAM INC CHSO 7818930240 66 NEWTON STREET WALTHAM MA 02453 JOSEPH DEVEAU PRESIDENT 7818930240 2019-10-01 155.212.6.161 2019-10-01 14:41:45 US P AEC35488C4CD91AC8DD9FF49E81978A397244AF0 A744FCA080835C7073C58A40247746B207170AF7 2018 2020-01-14 16:20:31Z MARISTHILL NURSING & REHABILATION JOSEPH DEVEAU 66 NEWTON STREET WALTHAM MA 02453 11033130 0 0928 X MARISTHILL.ORG X 1996 MA MARISTHILL 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. 8 6 143 0 0 0 14115 10317 10195541 10922851 46019 73954 42155 26008 10297830 11033130 0 0 0 0 6052552 6295238 0 0 0 4818605 4771000 10871157 11066238 -573327 -33108 10887258 10605123 9361046 9260915 1526212 1344208 MARISTHILL 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 10759177 10948859 MARISTHILL NURSING AND REHABILITATION CENTER PROVIDED 35,154 DAYS OF SKILLED NURSING SERVICES DURING 2018 OF WHICH 22,593 WERE TO MEDICAID RECIPIENTS. 10759177 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 10 0 143 1 0 0 0 0 0 0 0 0 0 0 X 8 6 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X X JOSEPH DEVEAU PRESIDENT 7818930240 66 NEWTON STREET WALTHAM MA 02453 KELLY HILL CHAIR 1.00 X X 0 0 0 JUDITH ALLEN TRUSTEE 1.00 X X 0 0 0 ELLEN LEITER TRUSTEE FROM 6/18 1.00 X 0 0 0 SRJOYCE ANN EDELMANN TRUSTEE 1.00 X 0 0 0 SUSAN STRANG TRUSTEE 1.00 X 0 0 0 JOSEPH CUZZUPOLI TRUSTEE 1.00 X 0 0 0 JOSEPH DEVEAU CEO/ADMINSTRATOR 40.00 X X 140685 0 2169 DAVID BECKER DIRECTOR 1.00 39.00 X 0 176706 2778 SHIRLY YELLAMATY RN SUPERVISOR 40.00 X 130438 0 12222 MORIMA COMPERE LPN SUPERVISOR 40.00 X 108029 0 7892 LUANN DEAGLE DIRECTOR OF NURSING 40.00 X 116344 0 7556 495496 176706 32617 4 0 1 0 REHABCARE GROUP INC PO BOX 503534 ST LOUIS MO 631503534 REHABILITATION SERVICE 711449 PERFORMANCE HEALTH CARE SERVICE 47R RIVER RIVER STREET WELLESLEY MA 02481 HOUSEKEEPING 366360 OMNICARE PO BOX 7800 DETROIT MI 482781668 PHARMACY 282254 US FOOD PO BOX 3155 BOSTON MA 024413155 FOOD SERVICE 235175 MCKESSON PO BOX 630693 CINCINNATI OH 452630693 MEDICAL SUPPLIES 163495 5 10317 10317 PATIENT SERVICE REVENUE 623000 10922851 10922851 10922851 73954 73954 MISCELLANEOUS 623000 26008 26008 26008 11033130 10948859 0 73954 140685 140685 5154082 5154082 23614 23614 593467 593467 383390 383390 202848 202848 50541 50541 53672 53672 12053 12053 43132 43132 232219 232219 1834 1834 5993 5993 385575 385575 413620 413620 54098 54098 PURCHASE SERVICE 1505910 1505910 NURSING HOME SUPPLIES 828503 828503 MEDICAID USER FEE 611835 611835 UTILITIES 369167 369167 11066238 10759177 307061 0 386874 316406 907266 1082273 50017 44139 13103652 7200105 6203630 5903547 2284040 2199127 1055431 1059631 10887258 10605123 712960 658247 7989760 7950951 658326 651717 9361046 9260915 X 1520212 1344208 6000 0 1526212 1344208 10887258 10605123 X -33108 -142896 -6000 X 0 1 X 0 0 X 18820 47972 17752 14115 10317 108976 10480889 10301949 10482175 10195541 10922851 52383405 10499709 10349921 10499927 10209656 10933168 52492381 0 0 0 52492381 50454 49643 40443 46019 73954 260513 50454 49643 40443 46019 73954 260513 10550163 10399564 10540370 10255675 11007122 52752894 0.99510 0.99380 0.00490 0.00620 X 6000 6000 6000 6000 1.00000 485000 485000 8412643 3741433 4671210 3910974 3167666 743308 295035 291006 4029 5903547 RESIDENT FUNDS 13379 DEBT SERVICE RESERVE FUND 731373 DEBT SERVICE SINKING FUND (NET) 314879 1059631 DEFERRED EXPENSES 273311 MEDICAID USER FEES 153783 PROFESSIONAL LIABILITY LOSS RESERVES 29180 DUE TO AFFILIATES 174691 RESIDENTS FUNDS 20752 651717 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 REVENU CODE AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE, EXCEPT AS NOTED BELOW. 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 STANDANDS 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" THERSHOLD, 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 FILLED TAX RETURNS. THE SYSTEM HAS CONCLUDED NO UNCERTAIN INCOME TAX POSITIONS EXIST AT DECEMBER 31, 2018. UNDER INTERNAL REVENUE SERVICE REGULATIONS, THE SYSTEM'S TAX YEARS FROM 2015 THROUGH 2018 ARE OPEN AND SUBJECT TO EXAMINATION. X X X X 0 0 0 0 0 0 0 0 0 DAVID BECKER DIRECTOR 0 176706 0 0 0 0 0 1761 0 1017 0 179484 0 0 PART I, LINE 3 EVERY TWO TO THREE YEARS THE COMPENSATION COMMITTEE OF THE COVENANT HEALTH'S BOARD OF DIRECTORS ENGAGES AN EXTERNAL CONSULTANT TO PROVIDE COMPETITIVE MARKET DATA FROM VARIOUS SURVEY SOURCES, WHICH IS 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 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. A MA HEALTH & EDUCATION FACILITIES AUTHORITY 042456011 57586DBF9 2007-10-30 7221865 TO FINANCE THE PURCHASE OF YOUVILLE PLACE 1 0 0 B MA HEALTH & EDUCATION FACILITIES AUTHORITY 042456011 57584QAA4 2012-06-27 1720000 CAPITAL EQUIPMENT AND PROJECTS 0 0 0 A 7221865 712880 55862 6117244 1 1 1 1 B 1720000 54828 0 0 1 1 B 0 0 0 0 0 0 0 A 1 0 0 0 0 0 B 0 0 0 0 0 0 0 0 0 A 0 B 0 PART IV, #7 & PART V: BOTH BONDS ARE CAREFULLY AND CONSISTENTLY MONITORED FOR POTENTIAL VIOLATIONS OF FEDERAL TAX REQUIREMENTS, BUT THE PROCEDURES WERE NOT WRITTEN AS OF THE END OF THE YEAR COVERED BY THIS TAX RETURN. HOWEVER, THE ORGANIZATION IS CONSIDERING ADOPTING FORMAL POLICIES THAT SET FORTH THE ORGANIZATION'S METHODOLOGY FOR ENSURING POST-ISSUANCE COMPLIANCE WITH IRS REQUIREMENTS PERTAINING TO TAX-EXEMPT DEBT AND CONTAIN SPECIFIC LANGUAGE REGARDING ORGANIZATIONAL RESPONSIBILITY, RECORD RETENTION, PRIVATE BUSINESS USE, ARBITRAGE REBATE, AND REMEDIAL ACTION. ALTHOUGH FORMAL POLICIES ARE NOT IN PLACE IN REGARDS TO THE REMEDIATION OF OUR BONDS, THE MONITORING REQUIREMENTS OF SECTION 148, AND PROCEDURES TO ENSURE THAT VIOLATIONS ARE TIMELY IDENTIFIED AND CORRECTED, THE ORGANIZATION HAS COMPLIANCE CHECKS IN PLACE THAT SUBSTANTIATE THESE REQUIREMENTS. FORM 990, PART VI, SECTION A, LINE 6 COVENANT HEALTH IS THE SOLE MEMBER OF THE ORGANIZATION OF THE BOARD. AS SUCH IT RETAINS CERTAIN RESERVE RIGHTS OVER BOARD DECISIONS AND BOARD COMPOSITION. FORM 990, PART VI, SECTION A, LINE 7A COVENANT HEALTH IS THE SOLE MEMBER OF THE ORGANIZATION. AS SUCH IT RETAINSCERTAIN RESERVE RIGHTS OVER CORPORATE DECISIONS AND BOARD COMPOSITION. FORM 990, PART VI, SECTION A, LINE 7B COVENANT HEALTH IS THE SOLE MEMBER OF THE ORGANIZATION. AS SUCH IT RETAINS CERTAIN RESERVE RIGHTS OVER BOARD DECISIONS AND BOARD COMPOSITION. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PROVIDED TO AND REVIEWED WITH THE BOARD PRIOR TO FILING FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A FULL-TIME OPERATIONAL INTEGRITY OFFICER THAT MONITORS ALL AREAS FOR POTENTIAL CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 EVERY TWO TO THREE YEARS THE COMPENSATION COMMITTEE OF COVENANT HEALTH BOARD OF DIRECTORS ENGAGES AN EXTERNAL CONSULTANT TO PROVIDE COMPETITIVE MARKET DATA FROM VARIOUS SURVEY SOURCES, WHICH IS USED TO DEVELOP RECOMMENDATIONS FOR CHANGES TO THE COMPENSATION PROGRAM. SINCE 2003 THE COMPENSATION COMMITTEE HAS ENGAGED A HUMAN RESOURCE CONSULTANT TO CONDUCT THIS ANALYSIS. THE SPECIFIC OBJECTIVES OF THE ANALYSIS ARE TO ASSESS THE COMPETITIVENESS OF THE CURRENT TOTAL CASH COMPENSATION LEVELSFOR THE SENIOR LEADERSHIP TEAM; DEVELOP MARKET COMPETITIVE SALARY RANGES FOR ALL EXECUTIVE POSITIONS AND ENSURE THAT THE ANNUAL INCENTIVE OPPORTUNITIES, IF ANY, ARE COMPETITIVE AND REASONABLE. FORM 990, PART VI, SECTION C, LINE 19 THE FORM 990 AND GOVERNING DOCUMENTS, INCLUDING THE CONFLICT OF INTEREST POLICY, AND THE FINANCIAL STATEMNTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: RELEASE OF ASSETS WITH DONOR RESTRICTIONS -6,000. PART VI LINE 6 COVENANT HEALTH IS THE SOLE MEMBER OF THE ORGANIZATION OF THE BOARD. AS SUCH IT RETAINS CERTAIN RESERVE RIGHTS OVER BOARD DECISIONS AND BOARD COMPOSITION. COVENANT HEALTH 100 AMES POND DRIVE TEWKSBURY MA 01876 222484505 HEALTH CARE MANAGEMENT AND RESOURCE ORGANIZATION MA 501(C) 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0