2018-11-15T13:23:42-06:00 2017-12-31 410746749 CLIFTONLARSONALLEN LLP 300 CROWN COLONY DRIVE SUITE 310 QUINCY MA 02169 990 2017-01-01 042200583 CHELSEA JEWISH NURSING HOME INC CHEL 6178870001 17 LAFAYETTE AVENUE CHELSEA MA 02150 BARRY BERMAN TREASURER 6178870001 2018-11-13 1 JUDY DALEY P01294075 6179848100 2018-11-13 67.137.57.251 2018-11-13 11:25:50 ES P 839A7130264BF8A4AA8E0E9B35915F0C6C2A2968 49D45E06031322FC5F433B8196F1C5D2180A31DD 2017 2019-02-21 02:37:17Z BARRY BERMAN 17 LAFAYETTE AVENUE CHELSEA MA 02150 13084462 0 X WWW.CJNH.ORG X 1975 MA THE ORGANIZATION'S MISSION IS TO PROVIDE EXCEPTIONAL SKILLED NURSING CARE FOR THEIR RESIDENTS WITH UNWAVERING COMPASSION, DIGNITY AND RESPECT. THE HIGH STANDARD OF CARE AT CHELSEA JEWISH NURSING HOME (CJNH) ENSURES RESIDENTS RECEIVE EXCELLENT ATTENTION AND SERVICE FROM A TEAM OF COMPASSIONATE AND PROFESSIONALLY TRAINED HEALTHCARE STAFF. CJNH RESPECTS EACH INDIVIDUAL AND UNDERSTANDS THE IMPORTANCE OF MAKING RESIDENTS AND THEIR FAMILIES FEEL AT HOME. 10 7 336 14 0 0 41055 94524 11834736 12967052 1714 10428 0 12458 11877505 13084462 0 0 0 0 6770226 7043242 0 0 0 5755953 6229333 12526179 13272575 -648674 -188113 20486822 20730376 18511672 18899663 1975150 1830713 X THE ORGANIZATION'S MISSION IS TO PROVIDE EXCEPTIONAL SKILLED NURSING CARE FOR THEIR RESIDENTS WITH UNWAVERING COMPASSION, DIGNITY AND RESPECT. THE HIGH STANDARD OF CARE AT CHELSEA JEWISH NURSING HOME (CJNH) ENSURES RESIDENTS RECEIVE EXCELLENT ATTENTION AND SERVICE FROM A TEAM OF COMPASSIONATE AND PROFESSIONALLY TRAINED HEALTHCARE STAFF. CJNH RESPECTS EACH INDIVIDUAL AND UNDERSTANDS THE IMPORTANCE OF MAKING RESIDENTS AND THEIR FAMILIES FEEL AT HOME. 0 0 10528379 12979510 NURSING HOME - OPERATION OF A 120-BED SKILLED NURSING FACILITY PROVIDING NURSING CARE, REHABILITATION THERAPIES AND OTHER SKILLED SERVICES TO FRAIL ELDERLY AND DISABLED. 10528379 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 14 0 336 1 0 0 0 0 0 0 0 0 0 0 X 10 7 1 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 MA X JEFFREY LANDA 9844715100 240 LYNNFIELD STREET PEABODY MA 01960 ADAM BERMAN PRESIDENT 1.00 39.00 X X 0 314049 34154 BARRY BERMAN TREASURER 1.00 39.00 X X 0 633783 31259 JOEL MAZER CHAIR 1.00 7.00 X X 0 0 0 ELIZABETH MULLEN CLERK 1.00 39.00 X X 0 209621 20349 SUSAN BRUDNICK DIRECTOR 1.00 7.00 X 0 0 0 CHARLOTTE FLORENCE DIRECTOR 1.00 7.00 X 0 0 0 SHARON FORMAN DIRECTOR 1.00 7.00 X 0 0 0 HOWARD GREENSPAN DIRECTOR 1.00 7.00 X 0 0 0 ROBERT RICHMAN DIRECTOR 1.00 7.00 X 0 0 0 JUDY WEISS DIRECTOR 1.00 7.00 X 0 0 0 EDWARD STEWART EXECUTIVE DIRECTOR 40.00 0.00 X 130081 0 21320 ELIZABETH PAGE RN 40.00 0.00 X 117698 0 24681 ROGELIO CALAUNAN RN 40.00 0.00 X 106088 0 14258 NORINE PASQUARELLO RN 40.00 0.00 X 103689 0 22010 457556 1157453 168031 4 0 1 0 0 94524 94524 PROGRAM SERVICE REVENUE 623000 12967052 12967052 12967052 10428 10428 OTHER INCOME 623000 12458 12458 12458 13084462 12979510 0 10428 151401 151401 5897892 5815693 82199 50038 48036 2002 470966 467672 3294 472945 449298 23647 788532 788532 38099 38099 50953 50953 867090 535251 331839 1213 1213 93783 395 93388 1105038 985269 119769 145517 145517 75 75 1503 1503 1044798 1043803 995 USER FEE ASSESSMENT 758026 758026 SUPPLIES & EXPENSE 515124 515124 FOOD 390712 390712 PATIENT ANCILLARY SERVI 237411 237411 191459 39715 151744 13272575 10528379 2744196 0 229799 404769 1743333 2446158 199427 179746 22861701 7970078 15734051 14891623 2580212 2808080 20486822 20730376 2531655 1190171 25675 26038 14274848 15201914 1679494 2481540 18511672 18899663 X 212767 24654 1762383 1806059 1975150 1830713 20486822 20730376 X -188113 43676 X 0 1 X 1 0 X 20000 46263 25000 41055 94524 226842 11484194 12023207 11809163 11834736 12979510 60130810 11504194 12069470 11834163 11875791 13074034 60357652 20000 98918 25000 41055 43676 228649 0 20000 98918 25000 41055 43676 228649 60129003 203 227 2254 1714 10428 14826 203 227 2254 1714 10428 14826 11504397 12069697 11836417 11877505 13084462 60372478 0.99600 0.99380 0.00020 0.00020 X 1762383 43676 1806059 1721328 41055 1762383 1750652 -29324 1721328 1698000 52652 1750652 1650000 48000 1698000 0.00000 0.00000 1.00000 1 0 13575 13575 21423620 7104423 14319197 1424506 865655 558851 14891623 SOFTWARE, NET 2488 REPLACEMENT RESERVE 179326 ESCROW AGREEMENT 820207 BENEFICIAL INTEREST IN TESTAMENTARY TRUST 1806059 2808080 DUE TO RELATED PARTIES 2481540 2481540 13084462 0 13084462 0 13084462 13272575 0 13272575 0 13272575 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. X X 0 0 0 0 0 0 0 0 0 ADAM BERMAN PRESIDENT 0 314049 0 0 0 0 0 0 0 34154 0 348203 0 0 BARRY BERMAN TREASURER 0 633783 0 0 0 0 0 0 0 31259 0 665042 0 0 ELIZABETH MULLEN CLERK 0 209621 0 0 0 0 0 0 0 20349 0 229970 0 0 EDWARD STEWART EXECUTIVE DIRECTOR 130081 0 0 0 0 0 0 0 21320 0 151401 0 0 0 LOUIS BRUDNICK (LOUIS J BRUDNICK & SONS) SUSAN BRUDNICK, SPOUSE, IS A DIRECTOR OF THE BOARD 12741 INSURANCE BROKER/AGENT 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 15A 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. 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. 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 TESTAMENT TRUST 43,676. 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 201 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 7 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