2019-08-02T11:20:28-05:00 2018-12-31 410746749 CLIFTONLARSONALLEN LLP 300 CROWN COLONY DRIVE SUITE 310 QUINCY MA 02169 990 2018-01-01 043455405 ALLIANCE HEALTH OF BROCKTON INC ALLI 6173323366 144 TURNPIKE ROAD NO 220 SOUTHBOROUGH MA 01772 PAUL KEMP TREASURER & CFO 6173323366 2019-07-16 1 JUDY DALEY P01294075 6179848100 67.137.57.251 2019-07-16 09:16:31 ED P 1A53DBAE8AE3BFC29E9AECF52760C2CD4F90396B 3EEEC8B090C07D7EECF61F1A8A191FC1967D2E7A 2018 2019-02-21 02:37:17Z FRANCIS J GRADY 144 TURNPIKE ROAD NO 220 SOUTHBOROUGH MA 01772 10124319 0 X WWW.ALLIANCEHHS.ORG X 1999 MA THE COMPANY SHALL PROMOTE AND PROVIDE SAFE, HEALTHY, QUALITY SERVICES AND LIVING ENVIRONMENTS FOR THE ELDERS WHO CANNOT CARE FOR THEMSELVES. 11 10 230 10 0 0 0 0 8859355 10104355 1651 616 17908 19348 8878914 10124319 0 0 0 0 5508338 5798059 0 0 0 4436664 4781798 9945002 10579857 -1066088 -455538 13434683 15686447 15029284 17685467 -1594601 -1999020 THE COMPANY SHALL PROMOTE AND PROVIDE SAFE, HEALTHY, QUALITY SERVICES AND LIVING ENVIRONMENTS FOR THE ELDERS WHO CANNOT CARE FOR THEMSELVES. 0 0 7607215 10123703 OUR SKILLED NURSING AND REHABILITATION FACILITY PROVIDES A WIDE RANGE OF MEDICAL AND REHABILITATIVE SERVICES, INCLUDING POST-ACUTE CARE, SHORT-TERM REHABILITATION, RESPITE CARE, HOSPICE CARE, AND LONG-TERM CARE. WORKING DIRECTLY WITH EACH RESIDENT AND THEIR FAMILY MEMBERS, OUR STAFF WILL CUSTOMIZE A COMPREHENSIVE PLAN OF CARE DESIGNED TO TREAT MEDICAL COMPLICATIONS AND ACHIEVE FUNCTIONAL INDEPENDENCE. OUR FACILITY PROVIDES THE HIGHEST STANDARDS OF CARE AND RESIDENTS ENJOY AN ACTIVE AND FULFILLING LIFESTYLE IN AN ATMOSPHERE OF WARMTH, RESPECT AND UNDERSTANDING. 7607215 1 0 0 0 0 0 0 0 0 0 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 0 0 0 0 0 0 0 1 0 0 0 1 33 0 230 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 10 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X X ALLIANCE HEALTH MANAGEMENT SERVICES LLC 7743482000 144 TURNPIKE ROAD STE 220 SOUTHBOROUGH MA 01772 FRANCIS J GRADY PRESIDENT & DIRECTOR 1.00 40.00 X X 0 433818 15500 LINDA CORRIDAN RN CHAIRMAN 1.00 1.00 X 0 0 0 ANDREW CALKINS DIRECTOR 1.00 1.00 X 0 0 0 JANICE HOCKENSMITH DIRECTOR 1.00 1.00 X 0 0 0 REV JEROME J JANISKO DIRECTOR 1.00 1.00 X 0 0 0 MICHAEL O JENNINGS ESQ DIRECTOR 1.00 1.00 X 0 0 0 ERIK M JONES DIRECTOR 1.00 1.00 X 0 0 0 ARTHUR MOURTZINOS MD DIRECTOR 1.00 1.00 X 0 0 0 JAMES BRUCE RILEY CPA DIRECTOR 1.00 1.00 X 0 0 0 CHRISTOPHER ROBBINS DIRECTOR 1.00 1.00 X 0 0 0 PETE ZAMPINE DIRECTOR 1.00 1.00 X 0 0 0 PAUL KEMP TREASURER & CFO 1.00 40.00 X 0 326272 15500 THOMAS LAVALLEE CLERK & COO 1.00 40.00 X 0 326272 15500 MICHAEL DODOS CONTROLLER 1.00 40.00 X 0 236906 0 RICHARD CANTY VICE PRESIDENT 1.00 40.00 X 0 184444 15500 WILLIAM FARINA DIRECTOR OF REHAB. SERVICES 0.00 40.00 X 0 180783 0 MARY KILCOMMONS DIRECTOR OF OPERATIONS 0.00 40.00 X 0 171163 4500 ELAINE HANSEN DIRECTOR OF CLINICAL SERVICES 0.00 40.00 X 0 156623 11750 DAN MITCHELL ADMINISTRATOR 40.00 0.00 X 0 177366 15500 MARIE GABRIEL LPN 50.00 0.00 X 112426 0 16864 JACQUELINE SCOTT REHAB MANAGER 40.00 0.00 X 110619 0 16593 223045 2193647 127207 2 0 1 0 CUTLER ASSOCIATES INC 43 HARVARD STREET WORCESTER MA 01609 DESIGN & CONSTRUCTION CONTRACTOR 2296447 PERFORMANCE HEALTHCARE SERVICES INC 47 RIVER STREET WELLESLEY MA 02481 HOUSEKEEPING & LAUNDRY SERVICE 292926 2 PROGRAM SERVICE REVENUE 623000 10104355 10104355 10104355 616 616 OTHER INCOME 623000 19348 19348 19348 10124319 10123703 0 616 4953211 4222153 731058 5017 4277 740 457709 390153 67556 382122 325724 56398 636804 636804 33431 33431 19200 19200 701387 521549 179838 39016 39016 88260 2522 85738 365393 365393 1883 1883 3951 3951 491320 435696 55624 449789 398866 50923 100015 88692 11323 STATE ASSESSMENT FEE 620584 620584 FOOD 280915 280915 ANCILLARY EXPENSES 232359 232359 NURSING SUPPLIES AND EX 149926 149926 567565 188990 378575 10579857 7607215 2972642 0 1062313 1123963 1413450 1308622 34205 34744 17491664 5823564 3419097 11668100 7505618 1551018 13434683 15686447 2184952 2340602 17966 0 12785955 15294761 40411 50104 15029284 17685467 X -1594601 -1999020 -1594601 -1999020 13434683 15686447 X -455538 51119 X 0 1 X 1 0 X 11090462 10662862 10545193 8859355 10104355 51262227 11090462 10662862 10545193 8859355 10104355 51262227 0 0 0 51262227 28219 397 540 1651 616 31423 28219 397 540 1651 616 31423 6571 35407 9465 17908 19348 88699 11125252 10698666 10555198 8878914 10124319 51382349 0.99770 0.99720 0.00060 0.00150 X SCHEDULE A, PART III, SECTION B, LINE 12: MISCELLANEOUS OTHER PROGRAM INCOME - $19,348 300000 300000 6321000 4061754 2259246 8622303 218771 8403532 2248361 1543039 705322 11668100 DEPOSITS 4550 GOODWILL, NET 907350 FAIR VALUE OF INTEREST RATE SWAP 385607 CONSTRUCTION IN PROGRESS 251928 DUE FROM AFFILIATES 400 SOFTWARE, NET 1183 1551018 PAYROLL TAXES PAYABLE 46924 DUE TO AFFILIATES 3180 50104 X 10124319 0 10124319 0 10124319 10579857 0 10579857 0 10579857 PART X, LINE 2: THE ORGANIZATION IS A NONPROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC) AND IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE IRC. THE FINANCIAL STATEMENTS DO NOT INCLUDE A PROVISION FOR INCOME TAXES BECAUSE THE ORGANIZATION IS A TAX-EXEMPT ORGANIZATION. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS OR AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAXES. TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE AND LOCAL AUTHORITIES IN ACCORDANCE WITH PRESCRIBED STATUTES. THE ORGANIZATION HAS NOT BEEN EXAMINED FOR ANY OPEN YEARS. 0 0 0 0 0 0 0 0 0 FRANCIS J GRADY PRESIDENT & DIRECTOR 0 352037 0 81781 0 0 0 0 0 15500 0 449318 0 0 PAUL KEMP TREASURER & CFO 0 261422 0 64850 0 0 0 0 0 15500 0 341772 0 0 THOMAS LAVALLEE CLERK & COO 0 261422 0 64850 0 0 0 0 0 15500 0 341772 0 0 MICHAEL DODOS CONTROLLER 0 197476 0 33500 0 5930 0 0 0 0 0 236906 0 0 RICHARD CANTY VICE PRESIDENT 0 169444 0 15000 0 0 0 0 0 15500 0 199944 0 0 WILLIAM FARINA DIRECTOR OF REHAB. SERVICES 0 150692 0 28325 0 1766 0 0 0 0 0 180783 0 0 MARY KILCOMMONS DIRECTOR OF OPERATIONS 0 156163 0 15000 0 0 0 0 0 4500 0 175663 0 0 ELAINE HANSEN DIRECTOR OF CLINICAL SERVICES 0 143623 0 13000 0 0 0 0 0 11750 0 168373 0 0 DAN MITCHELL ADMINISTRATOR 0 155366 0 22000 0 0 0 0 0 15500 0 192866 0 0 PART I, LINE 3 THE COMPENSATION OF THE CEO IS DETERMINED AND PAID OUT BY A RELATED ORGANIZATION, ALLIANCE HEALTH, INC. ALLIANCE HEALTH, INC.'S BOARD SHALL CONDUCT A PERFORMANCE EVALUATION OF THE CHIEF EXECUTIVE OFFICER OF THE COMPANY ON AN ANNUAL BASIS. SUCH EVALUATION SHALL BE USED AS THE BASIS FOR DETERMINING COMPENSATION AND SHALL INCLUDE AN ASSESSMENT OF COMPANY GOALS AND PERFORMANCE. THE BOARD WILL REVIEW YEAR OVER YEAR PERFORMANCE AND EVALUATE COMPANY RESULTS WITH RESPECT TO FINANCIAL PERFORMANCE, ATTAINMENT OF GOALS, PROGRAM AND OPERATIONAL QUALITY AND GOVERNANCE. THE BOARD WILL ALSO CONSIDER ORGANIZATIONAL STRENGTH AND DEVELOPMENT AND BOARD-CEO RELATIONSHIP MANAGEMENT. IN MAKING A COMPENSATION DETERMINATION, THE BOARD SHALL CONSIDER CURRENT INDEPENDENT MARKET ASSESSMENT OF AND RELIABLE DATA FROM COMPARABLE ORGANIZATIONS. THE BOARD MAY FROM TIME TO TIME SPECIFICALLY ENGAGE THIRD PARTY PROFESSIONALS TO CONDUCT COMPENSATION STUDIES OR TO REVIEW AND ASSESS CURRENT PRACTICES WHEN DEEMED USEFUL TO KEEP ITS KNOWLEDGE AND INFORMATION CURRENT. ALL EXTERNAL STUDIES WILL FOLLOW THE IRS GUIDELINES FOR DETERMINING "EXCESS BENEFIT". THE BOARD SHALL APPOINT A COMPENSATION COMMITTEE WHO WILL BE RESPONSIBLE FOR LEADING THE COMPENSATION AND EVALUATION PROCESS. THE COMMITTEE WILL REPORT ITS RECOMMENDATIONS TO THE BOARD, WHICH WILL PARTICIPATE IN FULL IN THE DECISION MAKING. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION DELEGATED CONTROL OVER MANAGEMENT AND FINANCIAL DUTIES TO A RELATED ORGANIZATION, ALLIANCE HEALTH MANAGEMENT SERVICES, LLC. THE MANAGEMENT COMPANY IS A NON-PROFIT SUPPORTING ORGANIZATION WHICH ENGAGES IN THE BUSINESS OF PLANNING, DEVELOPING, CONSTRUCTING, OWNING, AND MANAGING NON-PROFIT ORGANIZATIONS WHICH PROVIDE SERVICES THAT RANGE FROM POST-ACUTE CARE FACILITIES, SKILLED NURSING FACILITIES TO ASSISTED LIVING COMMUNITIES. ALLIANCE HEALTH MANAGEMENT SERVICES, LLC IS LOCATED AT 144 TURNPIKE ROAD, SUITE 220, SOUTHBOROUGH, MA 01772. FORM 990, PART VI, SECTION B, LINE 11B THE AUDIT COMMITTEE SHALL REVIEW AND APPROVE THE IRS FORM 990 ANNUAL TAX FILINGS PRIOR TO SUBMISSION, AND THE BOARD SHALL RECEIVE A COPY AND REVIEW THE IRS FORM 990 TAX FILINGS WITHIN 30 DAYS LEADING UP TO ITS SUBMISSION. FORM 990, PART VI, SECTION B, LINE 12C EACH DIRECTOR MUST PROVIDE THE BOARD OF DIRECTORS WITH AN ANNUAL WRITTEN DISCLOSURE OF THE FOLLOWING: (I) THE DIRECTOR'S BUSINESS INVOLVEMENTS WITH THE ORGANIZATION AND RELATED ORGANIZATIONS; (II) THE DIRECTOR'S OTHER BOARD MEMBERSHIPS, WHETHER OF FOR-PROFIT OR NON-PROFIT CORPORATIONS; AND (III) THE TOTAL AMOUNT RECEIVED BY THE DIRECTOR FROM THE ORGANIZATION AND RELATED ORGANIZATIONS FOR SERVICES RENDERED AS A VENDOR OF GOODS OR SERVICES TO THE RELATED ORGANIZATIONS. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD SHALL CONDUCT A PERFORMANCE EVALUATION OF THE CHIEF EXECUTIVE OFFICER OF THE COMPANY ON AN ANNUAL BASIS. SUCH EVALUATION SHALL BE USED AS THE BASIS FOR DETERMINING COMPENSATION AND SHALL INCLUDE AN ASSESSMENT OF COMPANY GOALS AND PERFORMANCE. THE BOARD WILL REVIEW YEAR OVER YEAR PERFORMANCE AND EVALUATE COMPANY RESULTS WITH RESPECT TO FINANCIAL PERFORMANCE, ATTAINMENT OF GOALS, PROGRAM AND OPERATIONAL QUALITY AND GOVERNANCE. THE BOARD WILL ALSO CONSIDER ORGANIZATIONAL STRENGTH AND DEVELOPMENT AND BOARD-CEO RELATIONSHIP MANAGEMENT. IN MAKING A COMPENSATION DETERMINATION, THE BOARD SHALL CONSIDER CURRENT INDEPENDENT MARKET ASSESSMENT OF AND RELIABLE DATA FROM COMPARABLE ORGANIZATIONS. THE BOARD MAY FROM TIME TO TIME SPECIFICALLY ENGAGE THIRD PARTY PROFESSIONALS TO CONDUCT COMPENSATION STUDIES OR TO REVIEW AND ASSESS CURRENT PRACTICES WHEN DEEMED USEFUL TO KEEP ITS KNOWLEDGE AND INFORMATION CURRENT. ALL EXTERNAL STUDIES WILL FOLLOW THE IRS GUIDELINES FOR DETERMINING "EXCESS BENEFIT". THE BOARD SHALL APPOINT A COMPENSATION COMMITTEE WHO WILL BE RESPONSIBLE FOR LEADING THE COMPENSATION AND EVALUATION PROCESS. THE COMMITTEE WILL REPORT ITS RECOMMENDATIONS TO THE BOARD, WHICH WILL PARTICIPATE IN FULL IN THE DECISION MAKING. THE CEO SHALL CONDUCT A PERFORMANCE EVALUATION OF THE CHIEF FINANCIAL OFFICER OF THE COMPANY ON AN ANNUAL BASIS. SUCH EVALUATION SHALL BE USED AS THE BASIS FOR DETERMINING COMPENSATION AND SHALL INCLUDE AN ASSESSMENT OF COMPANY GOALS AND PERFORMANCE. THE CEO WILL REVIEW YEAR OVER YEAR PERFORMANCE AND EVALUATE COMPANY RESULTS WITH RESPECT TO FINANCIAL PERFORMANCE, ATTAINMENT OF GOALS, PROGRAM AND OPERATIONAL QUALITY AND GOVERNANCE. IN MAKING A COMPENSATION DETERMINATION, THE CEO SHALL CONSIDER CURRENT INDEPENDENT MARKET ASSESSMENT OF AND RELIABLE DATA FROM COMPARABLE ORGANIZATIONS. THE CEO WILL ADVISE THE BOARD OF THE DECISION MADE. FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATION'S FORM 990 CAN ALSO BE FOUND ON GUIDESTAR.ORG AND THE MASSACHUSETTS AGO'S WEBSITE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENT 51,119. ALLIANCE HEALTH INC 144 TURNPIKE RD STE 220 SOUTHBOROUGH MA 01772 043468274 SUPPORTING ORGANIZATION MA 501(C)(3) LINE 12B, II N/A 0 ALLIANCE HEALTH MANAGEMENT SERVICES LLC 144 TURNPIKE RD STE 220 SOUTHBOROUGH MA 01772 364639819 SUPPORTING ORGANIZATION MA 501(C)(3) LINE 12B, II ALLIANCE HEALTH INC 1 ALLIANCE HEALTH OF BRAINTREE INC 144 TURNPIKE RD STE 220 SOUTHBOROUGH MA 01772 651310230 SKILLED NURSING CORPORATION MA 501(C)(3) LINE 10 ALLIANCE HEALTH INC 1 ALLIANCE HEALTH OF CENTERVILLE INC 144 TURNPIKE RD STE 220 SOUTHBOROUGH MA 01772 800249886 SKILLED NURSING CORPORATION MA 501(C)(3) LINE 10 ALLIANCE HEALTH INC 1 ALLIANCE HEALTH OF EAST PROVIDENCE INC 144 TURNPIKE RD STE 220 SOUTHBOROUGH MA 01772 800249896 SKILLED NURSING CORPORATION MA 501(C)(3) LINE 10 ALLIANCE HEALTH INC 1 ALLIANCE HEALTH OF LYNN INC 144 TURNPIKE RD STE 220 SOUTHBOROUGH MA 01772 800249859 SKILLED NURSING CORPORATION MA 501(C)(3) LINE 10 ALLIANCE HEALTH INC 1 ALLIANCE HEALTH OF MARBLEHEAD INC 144 TURNPIKE RD STE 220 SOUTHBOROUGH MA 01772 800249854 SKILLED NURSING CORPORATION MA 501(C)(3) LINE 10 ALLIANCE HEALTH INC 1 ALLIANCE HEALTH OF MASSACHUSETTS INC 144 TURNPIKE RD STE 220 SOUTHBOROUGH MA 01772 311712039 SKILLED NURSING CORPORATION MA 501(C)(3) LINE 10 ALLIANCE HEALTH INC 1 ALLIANCE HEALTH OF PLYMOUTH INC 144 TURNPIKE RD STE 220 SOUTHBOROUGH MA 01772 800249891 SKILLED NURSING CORPORATION MA 501(C)(3) LINE 10 ALLIANCE HEALTH INC 1 ALLIANCE HEALTH OF PROVIDENCE INC 144 TURNPIKE RD STE 220 SOUTHBOROUGH MA 01772 800249901 SKILLED NURSING CORPORATION MA 501(C)(3) LINE 10 ALLIANCE HEALTH INC 1 ALLIANCE HEALTH OF QUINCY INC 144 TURNPIKE RD STE 220 SOUTHBOROUGH MA 01772 043468149 SKILLED NURSING CORPORATION MA 501(C)(3) LINE 10 ALLIANCE HEALTH INC 1 ALLIANCE HEALTH OF SANDWICH INC 144 TURNPIKE RD STE 220 SOUTHBOROUGH MA 01772 800249868 SKILLED NURSING CORPORATION MA 501(C)(3) LINE 10 ALLIANCE HEALTH INC 1 ALLIANCE HEALTH OF SOUTHBRIDGE INC 144 TURNPIKE RD STE 220 SOUTHBOROUGH MA 01772 800249840 SKILLED NURSING CORPORATION MA 501(C)(3) LINE 10 ALLIANCE HEALTH INC 1 ALLIANCE HEALTH OF SOUTHEASTERN MASSACHUSETTS INC 144 TURNPIKE RD STE 220 SOUTHBOROUGH MA 01772 043582078 SKILLED NURSING CORPORATION MA 501(C)(3) LINE 10 ALLIANCE HEALTH INC 1 ALLIANCE HEALTH OF WORCESTER INC 144 TURNPIKE RD STE 220 SOUTHBOROUGH MA 01772 800249850 SKILLED NURSING CORPORATION MA 501(C)(3) LINE 10 ALLIANCE HEALTH INC 1 ALLIANCE HUMAN SERVICES INC 144 TURNPIKE RD STE 220 SOUTHBOROUGH MA 01772 043476887 FOSTER CARE CORPORATION MA 501(C)(3) LINE 10 ALLIANCE HEALTH INC 1 ALLIANCE OF THE CHESAPEAKE BAY INC 144 TURNPIKE RD STE 220 SOUTHBOROUGH MA 01772 010672105 FOSTER CARE CORPORATION MA 501(C)(3) LINE 10 ALLIANCE HEALTH INC 1 ALLIANCE SPECIALITY HOSPITAL INC 144 TURNPIKE RD STE 220 SOUTHBOROUGH MA 01772 800249832 HOSPITAL CORPORATION MA 501(C)(3) LINE 3 ALLIANCE HEALTH INC 1 DEPOT POND VILLAGE INC 144 TURNPIKE RD STE 220 SOUTHBOROUGH MA 01772 203883388 RESIDENTIAL FACILITY FOR ELDERLY MA 501(C)(3) LINE 10 ALLIANCE HEALTH INC 1 THE HOSPITAL COTTAGES FOR CHILDREN 144 TURNPIKE RD STE 220 SOUTHBOROUGH MA 01772 042104323 SKILLED NURSING CORPORATION MA 501(C)(3) LINE 10 ALLIANCE HEALTH INC 1 0 0 0 0 1 0 0 0 0 0 0 0 1 0 1 1 0 0 0