2019-10-03T11:09:47-05:00 2018-12-31 990 2018-01-01 237090088 PENACOOK PLACE INC PENA 9783740707 150 WATER STREET HAVERHILL MA 01830 David Becker Administrator 9783740707 2019-10-03 155.212.6.161 2019-10-03 12:09:40 US P AEC35488C4CD91AC8DD9FF49E81978A397244AF0 A744FCA080835C7073C58A40247746B207170AF7 2018 2020-01-14 16:20:31Z Paula Drelick 150 Water Street Haverhill MA 01830 12580936 0 X Covenanthealth.net X 1969 MA TO PROMOTE THE HIGHEST POSSIBLE QUALITY OF LIFE FOR OUR RESIDENTS IN A CLEAN, SAFE AND ATTACTIVE ENVIROMENT. TO CARE FOR OUR RESIDENTS AS WE WOOULD WANT TO BE CARED FOR-THE GOLDEN RULE OF PENACOOK PLACE. TO MEET OR EXCEDD THE EXPECTATIONS OF OUR RESIDENTS, AS WELL AS OTHERSWITH WHOM WE COME IN CONTACT. TO SHOW HOSITALITY,COURTESY, COOPERATION AND RESPECT TO ALL RESIDENTS, FAMILY MEMBERS, FELLOW EMPLOYEES, VOLUNTEERS AND VISITORS. TO BE AN INTEGRAL, CONTRIBUTING PART OF THE GREATER HAVERHILL BUSINESS, EDUCATIONAL AND CULTURAL COMMUNITIES. 11 10 310 12 0 0 106151 70911 12483147 12474592 2193 82 3403 35351 12594894 12580936 0 0 0 0 8077061 8690709 0 0 0 4364336 4258154 12441397 12948863 153497 -367927 4986275 4553131 3884521 3797496 1101754 755635 X TO PROMOTE THE HIGHEST POSSIBLE QUALITY OF LIFE FOR OUR RESIDENTS IN A CLEAN, SAFE, AND ATTRACTIVE ENVIROMENT. TO CARE FOR OUR RESIDENTS AS WE WOULD WANT TO BE CARED FOR - THE GOLDERN RULE OF PENACOOK PLACE. TO MEET OR EXCEED THE EXPECTATIONS OF OUR RESIDENTS, AS WELL AS OTHERS WITH WHOM WE COME IN CONTACT. TO SHOW HOSPITALITY, COURTRESY, COOPERATION AND RESPECT TO ALL RESIDENTS, FAMILY MEMBERS, FELLOW EMPLOYEES, VOLUNTEERS AND VISTORS. 0 0 12037460 12509943 PENACOOK PLACE IS AN INDEPENDENT, NON-PROFIT, 160 BED HAVERHILL, MA BASED NURSING HOME AND REHABILITATION FACILITY THAT STRIVES TO OFFER THE FINEST CARE AND BEST QUALITY OF LIFE FOR ITS RESIDENTS. THE FACILITY'S TEAM OF PROFESSIONALS IS SPECIALLY TRAINED TO MEET THE MEDICAL, SOCIAL, PHYCHOLOGICAL, AND THERAPEUTIC NEEDS OF THOSE THEY SERVE. THEIR DEDICATED CAREGIVERS ARE HIGHLY TRAINED, COMPASSINATE, AND HELP MAKE PENACOOK PLACE A WARM AND WELCOMING FACILITY. 12037460 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 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 0 0 1 0 0 0 1 17 0 310 1 0 0 0 0 0 0 0 0 0 0 X 11 10 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 0 MA X X Paula Drelick 9783740707 150 Water Street Haverhill MA 01830 Scott Wheeler President & CEO to 7/2018 38.00 X X 102981 0 6869 Thomas L Mortimer Chair 2.00 X X 0 0 0 William Klueber Treasurer 2.00 X X 0 0 0 Frank Novak Clerk 2.00 X X 0 0 0 Janis Cordischi Member 2.00 X 0 0 0 Andrew Desrosiers Member 2.00 X 0 0 0 Diane Lovallo Member 2.00 X 0 0 0 John Sarro Member 2.00 X 0 0 0 Gregory Shaw Member 2.00 X 0 0 0 Dr J Soma Member from 8/17 2.00 X 0 0 0 Paula Drelick President & CEO from 11/18 38.00 X X 11026 0 800 Caitlyn Mays Member 2.00 X 0 0 0 114007 0 7669 1 0 0 0 Rehabcare 7733 Forsyth Bouevard St Louis MO 63105 Rehabilitation 840478 US Foods PO Box 3155 Boston MA 02241 Dietary Services 227769 Omnicare PO Box 78000 Detriot MI 48278 Pharmacy 213448 New Hampshire Employers Insurance Co PO Box 4131 Woburn MA 01888 Worker Comp Insurance 207587 McKesson Medical Surgical PO Box 20786 Dallas TX 75320 Medical Supplies 151326 5 70911 70911 Patient Service Revenu 623000 12474592 12474592 12474592 82 82 Other Income 623000 32523 32523 Other Income 623000 2828 2828 35351 12580936 12509943 0 82 114135 103863 10272 7072444 6435924 636520 7863 7155 708 953354 867552 85802 542913 494051 48862 39270 39270 89969 89969 15641 15641 136700 136700 108004 108004 275873 275873 6248 6248 94903 94903 275984 275984 94696 94696 Purchase Services 1392268 1392268 User Fee 866123 866123 Supplies 543192 543192 Food 315611 315611 3672 3672 12948863 12037460 911403 0 850085 832051 356869 8040 1454162 1208550 126893 135786 12562159 10210306 2089917 2351853 108349 16851 4986275 4553131 1059493 925796 2423825 2460174 401203 411526 3884521 3797496 X 1036754 671635 65000 84000 1101754 755635 4986275 4553131 X -367927 2808 19000 X 0 1 X 0 0 X 146094 51202 53378 106151 70911 427736 11170781 11486410 10526438 12483147 1247592 46914368 11316875 11537612 10579816 12589298 1318503 47342104 0 0 0 47342104 9792 15764 18149 2193 82 45980 9792 15764 18149 2193 82 45980 32536 112121 11704 3403 35351 195115 11359203 11665497 10609669 12594894 1353936 47583199 0.99490 0.99630 0.00100 0.00090 X 0 0 0 0 0 0 0 0 1 0 PArt II-B, Line 1, Lobbying Activities The organization pays dues to various membership organizations. These organizations may conduct lobbying activities on behalf of their members. However, the organization does not directly participate in these lobbying activities. 65000 84000 65000 84000 65000 65000 44784 44784 47808 30586 78394 31269 47808 31269 47808 1.00000 0 0 30859 30859 7133850 5264069 1869781 5363426 4920700 442726 34024 25537 8487 2351853 Due to third party payors 60000 Asset Retirement Obligation 66000 Professional Loss Liability Reserve 34210 Due to Medicaid 234465 Resident Funds Liability 16851 411526 X Part V, Line 4: FUNDS ARE USED TO PROVIDE SERVICES,SUPPLIES AND FACILITIES TO RESIDENTS & THE POOR IN THE COMMUNITY 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 Revenue 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 Standards 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" threshold, 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 filed 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 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 Massachusetts Development Finance Agency 043431814 2017-03-21 2530707 Redeem Bank Debt, Renovations & Improvements 0 0 0 A 2530707 80707 2223845 226155 0 0 1 1 A 0 0 0 1 0 0 0 0 0 A 0 Part IV, #7 & Part V: The bond is 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 bond, 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, INC. IS THE SOLE MEMBER OF THE ORGANIZATION. AS SUCH IT RETAINS CERTAIN RESERVE RIGHTS CONCERNING CORPORATE DECISIONS AND BOARD COMPOSITION. Form 990, Part VI, Section A, line 7a COVENANT HEALTH, Inc. IS THE SOLE MEMBER OF THE ORGANIZATION. AS SUCH IT RETAINS CERTAIN RESERVE RIGHTS CONCERNING CORPORATE DECISIONS AND BOARD COMPOSITION. Form 990, Part VI, Section A, line 7b COVENANT HEALTH, Inc. 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 A, line 8b COVENANT HEALTH, Inc. 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 THE BOARD FOR REVIEW PRIOR TO ITS BEING FILED. Form 990, Part VI, Section B, line 12c THE ORGANIZATION REQUIRES CONFLICT OF INTEREST STATEMENTS TO BE SIGNED BY BOARD MEMBERS AND KEY EMPLOYEES REMINDING THEM OF THE DUTIES AND OBLIGATIONS TO REPORT REAL OR POTENTIAL CONFLICTS OF INTEREST. Form 990, Part VI, Section B, line 15 EVERY TWO TO THREE YEARS THE COMPENSATION COMMITTEE OF 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 COVENANT COMPENSATION COMMITTEE HAS ENGAGED A HUMAN RESOURCES CONSULTANT TO CONDUCT THIS ANALYSIS. OBJECTIVES ARE TO ASSESS THE COMPOSITENESS OF THE CURRENT TOTAL CASH COMPENSATION LEVELS OF THE SENIOR LEADERSHIP TEAM, DEVELOP MARKET BASED COMPETITIVE SALARY RANGES FOR ALL EXECUTIVE POSITIONS AND ENSURE THAT ANNUAL INCENTIVE OPPORTUNITIES, IF THERE ARE ANY, ARE COMPETITIVE AND REASONABLE. Form 990, Part VI, Section C, line 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, FINANCIAL STATEMENTS AND THE FORM 990 AVAILABLE TO THE PUBLIC UPON REQUEST. THE FORM 990 IS ALSO POSTED ON COVENANT HEALTH'S WEBSITE. Form 990, Part XI, line 9: Change in Temporarily Restricted Assets 19000. COVENANT HEALTH Inc 100 AMES POND DRIVE TEWKSBURY MA 01876 222484505 HEALTHCARE MANAGEMENT AND RESOURCE ORGANIZATION MA 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0