2018-11-13T13:21:13-06:00 2017-12-31 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2017-01-01 020325847 Salemhaven Inc SALE 6038935586 23 Geremonty Drive Salem NH 03079 Sonny Tylus President 6038935586 2018-10-23 1 Barbara J McGuan CPA P00219457 2077752387 2018-10-23 69.49.157.66 2018-10-23 11:39:52 ED P F16D9AD9942503E83504FB1C99E208F021A42564 E262D3C9A45A77A46A0A2832CF74466488750570 2017 2019-02-21 02:37:17Z Sonny Tylus 23 Geremonty Drive Salem NH 03079 13223670 0 X salemhaven.com X 1977 NH Healthcare services for the elderly 14 14 231 62 0 0 7772 15332 11564571 11398001 65683 122752 0 0 11638026 11536085 0 0 0 0 7233658 7443627 0 0 0 4620961 4615050 11854619 12058677 -216593 -522592 11686204 10887018 4558283 4138293 7127921 6748725 X In February, 1972, a group of Salem, NH residents founded the organization with the goal of developing a facility to provide health care and related services for the community's elderly population. 0 0 10055682 11398001 The Salemhaven complex provides comprehensive healthcare services, resources and accomodations (110 bed facility) for senior citizens, including the operation of a medical day care service. Salemhaven services include providing long term care, rehabilitation including PT, OT Speech, social services for residents and families, meeting of Spiritual needs, activities, supporting many local charities and community services, hospice services and respite care. We employ over 150 workers from the local area, we subsidized Medicaid over 1 million dollars annually, and we are a participant in the local and state emergency planning programs.Silverthorne Adult Medical Day Center provides to participants: Health care monitoring, Social services, Therapeutic and recreational activities, Health Care Education to participants, families and the community. We also provide respite care for caregivers and a Caregiver Support Group monthly for families and community members. 10055682 1 1 0 1 0 0 0 0 1 0 1 0 0 0 0 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 0 0 1 42 0 1 231 1 0 0 0 0 0 0 0 0 0 0 X 14 14 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 1 0 0 NH X Ray Milliard Administrator 6038935586 23 Geremonty Drive Salem NH 03079 Rev David Yasenka Board Member 1.00 X 0 0 0 Thomas Lynch Board Member 1.00 X 0 0 0 Michael Collins Board Treasurer 1.00 X X 0 0 0 Beverly Collins Board Vice President 1.00 X X 0 0 0 Frank Monteiro Board Member 1.00 X 0 0 0 Jeffrey Scionti Board Member 1.00 X 0 0 0 Robert Slein Board Member 1.00 X 0 0 0 Sonny Tylus Board President 1.00 X X 0 0 0 Amy White Board Member 1.00 X 0 0 0 Jamie Santo Board Member 1.00 X 0 0 0 Michael Carney Jr Board Member 1.00 X 0 0 0 Dwight Feeney Board Member 1.00 X 0 0 0 Ralph Glynn Board Member 1.00 X 0 0 0 Philip Cammarata Board Member 1.00 X 0 0 0 Raymond Milliard Administrator 40.00 X 133094 0 33283 133094 0 33283 1 0 1 1 Rehabcare Group Inc PO Box 277365 Atlanta GA 30384 Rehab Services 767740 PharMerica 38 Locke Road Concord NH 03301 Pharmacy Services 399034 Covenant Health Inc 100 Ames Pond Rd Suite 102 Tewksbury MA 01876 Management Services 229439 Sysco Food Service 1390 Enclave Parkway Houston TX 770772099 Food Services 228089 Brightstar Care of Bedford 602 Riverway Place Suite B Bedford NH 03110 Care Services 153419 5 15332 15332 Net Long-Term Care Services 623000 11167448 11167448 Adult Daycare Services 623000 220881 220881 Miscellaneous Income 623000 8539 8539 Guest Meals 623000 1133 1133 11398001 59157 59157 1751180 1687585 63595 63595 63595 11536085 11398001 0 122752 166377 166377 6095229 5686606 408623 32000 29489 2511 738847 680872 57975 411174 378911 32263 25374 25374 3601 3601 102612 61 102551 82027 80647 1380 54780 269 54511 203102 139235 63867 99085 769 98316 330566 290827 39739 11231 7582 3649 155047 155047 515147 515147 310133 195387 114746 Food/Drug/Med. Supplies 1032634 1032634 Purchased Services 897864 852900 44964 New Hampshire Quality A 573796 573796 Bad Debt Expense 182263 182263 35788 9299 26489 12058677 10055682 2002995 0 31724 40350 2796442 2845946 1198526 1029700 39462 41469 223942 202566 10954552 6507747 4847872 4446805 2260157 1995201 288079 284981 11686204 10887018 983300 943438 21707 12747 3553276 3182108 4558283 4138293 X 7127921 6748725 7127921 6748725 11686204 10887018 -522592 143396 0 X 0 1 X 1 0 X 19029 13170 10686 7772 15332 65989 10521957 11322961 11977869 11564571 11398001 56785359 10540986 11336131 11988555 11572343 11413333 56851348 100 100 11469 76376 149219 237064 100 11469 76376 149219 237164 56614184 51075 56238 54254 57913 59157 278637 51075 56238 54254 57913 59157 278637 10592061 11392369 12042809 11630256 11472490 57129985 0.99100 0.99340 0.00490 0.00500 X 0 0 0 0 0 0 0 0 1 1918 1918 0 Form 990, Schedule C, Part II-B, Line 1i Lobbying portion of NHHCA Dues 15%; Lobbying portion of American Health Care Association Dues 25% 0 1 X 41189 41189 9313468 5335359 3978109 1359124 1037919 321205 240771 134469 106302 4446805 11678241 143396 143396 11534845 1240 1240 11536085 12057437 0 12057437 1240 1240 12058677 Part IV, Line 2b: The Organization holds funds for residents and provides these funds to the resident, as needed, for various common expenses. Part XI, Line 4b - Other Adjustments: Loss on abandoment of fixed assets 1,240. Part XII, Line 4b - Other Adjustments: Loss on abandoment of fixed assets 1,240. X X X 0 0 0 0 0 0 0 0 0 Raymond Milliard Administrator 131130 0 1964 0 0 0 0 0 33283 0 166377 0 0 0 Form 990, Part VI, Section A, line 3 Covenant Health Systems, Inc., an unrelated organization, provided management services to Salemhaven, Inc. through June 30, 2017. Effective July 1, 2017, Ray Milliard, the administrator, became an employee of Salemhaven, Inc. Form 990, Part VI, Section B, line 11b The 990 is sent to all board members and reviewed at a board meeting. If necessary the auditors that prepared the 990 are requested to give a presentation. Form 990, Part VI, Section B, line 12c Board members fill out a disclosure form and are given a policy regarding disclosure and conflicts of interest. The administrator and business office monitor for potential conflicts and then report findings to the board of directors. Part of the annual financial audit is a review of potential conflicts and findings that are reported to the board. Form 990, Part VI, Section B, line 15a Ray Milliard, Administrator, worked for Covenant Health Systems, as an independent contractor through June 30, 2017. They pulled demographic reports and surveys for the Board to review and decide on compensation. When Ray became an employee of Salemhaven they continued with his compensation level. 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 X, Line 10: Land, Buildings, and Equipment Section 1.263(a)-3(n) Election: Salemhaven, Inc. 23 Geremonty, Salem, NH 03079 EIN 02-0325847 Salemhaven, Inc. is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n).