2018-11-15T09:42:51-06:00 2017-12-31 061009205 BLUM SHAPIRO & COMPANY PC CPA'S ONE INTERNATIONAL PLACE 16TH FLOOR BOSTON MA 02110 990 2017-01-01 043138403 JEWISH NURSING HOME OF WESTERN MASSACHUSETTS INC JEWI 4135676211 770 CONVERSE STREET LONGMEADOW MA 011061786 RUDY D'AGOSTINO TREASURER 4135676211 2018-11-14 1 LAURA J KENNEY P00202198 6172211944 2018-11-14 64.251.63.131 2018-11-14 14:18:56 ES P AE4F84C66CF7EFD26554BEC15325CB8203138E58 32C2B15C8AAF7E27428FAF8181EC4CA1A501E391 2017 2019-02-21 02:37:17Z RUDY D'AGOSTINO 770 CONVERSE STREET LONGMEADOW MA 011061786 20003726 0 X WWW.JGSLIFECARE.ORG X 1992 MA TO CARE FOR THE FRAIL ELDERLY AND INFIRMED ACCORDING TO JEWISH TRADITIONS. 4 3 381 132 0 0 121000 0 20044973 19799625 0 22 155407 204079 20321380 20003726 0 0 0 0 10563401 11765771 0 0 0 10217591 11331063 20780992 23096834 -459612 -3093108 22538744 21917215 25738815 28210394 -3200071 -6293179 TO CARE FOR THE FRAIL ELDERLY AND INFIRMED ACCORDING TO JEWISH TRADITIONS. 0 0 18605765 20003704 THE HOME IS A NON-PROFIT ORGANIZATION WHICH OWNS AND OPERATES A 176 BED SKILLED NURSING FACILITY, AN ADULT DAY CARE CENTER, AND A SHORT-TERM 24 BED REHABILITATION CENTER. 18605765 1 0 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 17 0 1 381 1 0 0 0 0 0 0 0 0 0 0 X 4 3 1 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 0 0 0 MA X JGS LIFECARE CORPORATION ROBIN MADNICK SR ACCOUNTANT 4135675211 770 CONVERSE STREET LONGMEADOW MA 011061786 STUART ANFANG BOARD MEMBER 1.00 3.00 X 0 0 0 MARTIN BAICKER PRESIDENT & CEO (TO 9/15/17) 1.00 44.00 X X 0 223792 0 ERIC BERG BOARD MEMBER 1.00 2.00 X 0 0 0 JAMES GORDON BOARD MEMBER 1.00 1.00 X 0 0 0 BETH CHAGUE CFO 1.00 44.00 X 0 184460 5630 STEPHEN MCPHERSON INTERIM CEO (AS OF 9/7/17) 1.00 44.00 X 0 52432 0 PRESLEY EZE FORMER LPN 32.00 0.00 X 134200 0 5591 MARCIA PORTER FORMER DIR. OF NURSING 40.00 0.00 X 106829 0 0 ANDREW STEINER EXEC. DIRECTOR (TO 10/31/17) 40.00 0.00 X 154434 0 0 395463 460684 11221 3 0 1 0 HEALTHPRO REHABILITATION 536 OLD HOWELL ROAD GREENVILLE SC 29615 THERAPY 1216072 HEALTHCARE SERVICES GROUP 3220 TILLMAN DRIVE SUITE 300 BENSALEM PA 19020 HOUSEKEEPING/LAUNDRY SERVICES 693616 EXPERT STAFFING 120 STAFFORD STREET 202 WORCESTER MA 01603 NURSING STAFFING SERVICES 172137 LONGONOT TRANSPORTATION 49 BISSELL STREET SPRINGFIELD MA 01119 DAYCARE TRANSPORTATION SERVICES 117628 4 NURSING HOME 623000 19243990 19243990 DAY CARE REVENUE 624100 555635 555635 19799625 22 22 73200 0 73200 73200 73200 MISC REVENUE 900099 95050 95050 CAFE, COFFEE, BEAUTY, GIFT SHOPS 453220 35829 35829 130879 20003726 20003704 0 22 X 9600693 9020304 580389 154441 145248 9193 1288453 1138111 150342 722184 666926 55258 1997876 72734 1925142 52724 52724 2631924 2555106 76818 484523 438138 46385 2820 2405 415 715429 708854 6575 121860 117684 4176 757657 739621 18036 1433215 1433215 172994 172994 USER FEE 1178081 0 1178081 FOOD FUNCTIONS 679896 679896 PHARMACY 434842 434842 BAD DEBTS 404499 404499 262723 48182 214541 23096834 18605765 4491069 0 1067041 720476 259638 2014370 2294595 28754 189086 41185408 22731988 19427079 18453420 1500 0 22538744 21917215 3195745 2346001 89250 57227 69442 54693 57243 14998 22327135 25737475 25738815 28210394 X -3200071 -6293179 -3200071 -6293179 22538744 21917215 -3093108 0 X 0 1 X 1 0 X 121000 121000 18731232 17744387 18270873 20044973 19799625 94591090 18731232 17744387 18270873 20165973 19799625 94712090 0 0 0 94712090 129206 73207 73233 73200 73222 422068 129206 73207 73233 73200 73222 422068 41044 182818 80356 82207 130879 517304 18901482 18000412 18424462 20321380 20003726 95651462 0.99020 0.99220 0.00440 0.00370 X SCHEDULE A, PART III, LINE 12, EXPLANATION FOR OTHER INCOME: MISCELLANEOUS INCOME 2013 AMOUNT: $ 41,044 2014 AMOUNT: $ 182,818 2015 AMOUNT: $ 80,356 2016 AMOUNT: $ 82,207 2017 AMOUNT: $ 130,879 0 69442 427504 442253 54693 1 X 83562 83562 25964696 13694777 12269919 8176106 4433618 3742488 6585221 4493760 2091461 375823 109833 265990 18453420 DUE TO AFFILIATES 25652699 DUE TO THIRD PARTIES 42202 ASSET RETIREMENT OBLIGATION 42574 25737475 X 19599227 -404499 -404499 20003726 0 20003726 22692335 0 22692335 404499 404499 23096834 PART IV, LINE 2B: THE ORGANIZATION HOLDS FUNDS ON BEHALF OF ITS RESIDENTS TO BE USED AS DIRECTED BY THE RESIDENTS. 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, 2017. 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 2D - OTHER ADJUSTMENTS: BAD DEBT EXPENSE -404,499. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 404,499. 1 0 0 0 0 0 0 0 0 MARTIN BAICKER PRESIDENT & CEO (TO 9/15/17) 0 223792 0 0 0 0 0 0 0 0 0 223792 0 0 BETH CHAGUE CFO 0 184460 0 0 0 0 0 0 0 5630 0 190090 0 0 ANDREW STEINER EXEC. DIRECTOR (TO 10/31/17) 143280 0 0 0 11154 0 0 0 0 0 154434 0 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. PART I, LINE 4A ANDREW STEINER - TOTAL SEVERANCE OF $25,097 (PAID OVER 9 WEEKS, BEGINNING 12/3/2017) FORM 990, PART VI, SECTION A, LINE 2 THE OFFICERS LISTED IN PART VII, SECTION A (MARTIN BAICKER, 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 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 AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G PHYSICAL THERAPY: PROGRAM SERVICE EXPENSES 1,065,064. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,065,064. LAUNDRY AND HOUSEKEEPING: PROGRAM SERVICE EXPENSES 764,615. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 764,615. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 224,573. MANAGEMENT AND GENERAL EXPENSES 24,012. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 248,585. MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 253,432. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 253,432. ENGINEERING: PROGRAM SERVICE EXPENSES 177,755. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 177,755. OTHER FEES: PROGRAM SERVICE EXPENSES 69,667. MANAGEMENT AND GENERAL EXPENSES 9,725. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 79,392. ADMINISTRATIVE/BUSINESS OFFICE SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 43,081. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 43,081. 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 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0