2018-07-26T11:28:03-05:00 2017-12-31 410746749 CLIFTONLARSONALLEN LLP 300 CROWN COLONY DRIVE SUITE 310 QUINCY MA 02169 990 2017-01-01 043455405 ALLIANCE HEALTH OF BROCKTON INC ALLI 6173323366 144 TURNPIKE ROAD SOUTHBOROUGH MA 01772 PAUL KEMP TREASURER & CFO 6173323366 2018-07-19 1 DOUGLAS FIEBELKORN P00173341 6179848100 2017 2022-09-23 18:48:47Z FRANCIS J GRADY 144 TURNPIKE ROAD SOUTHBOROUGH MA 01772 8878914 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. 10 9 230 10 0 0 0 0 10545193 8859355 540 1651 9465 17908 10555198 8878914 0 0 0 0 6032340 5508338 0 0 0 4440515 4436664 10472855 9945002 82343 -1066088 9286756 13434683 9870026 15029284 -583270 -1594601 THE COMPANY SHALL PROMOTE AND PROVIDE SAFE, HEALTHY, QUALITY SERVICES AND LIVING ENVIRONMENTS FOR THE ELDERS WHO CANNOT CARE FOR THEMSELVES. 0 0 8819364 8877263 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. 8819364 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 X 10 9 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 153 CORDAVILLE ROAD SUITE 320 SOUTHBOROUGH MA 01772 FRANCIS J GRADY DIRECTOR AND PRESIDENT 1.00 40.00 X X 0 344282 25807 MICHAEL O JENNINGS ESQ DIRECTOR 1.00 1.00 X 0 0 0 REV JEROME J JANISKO DIRECTOR 1.00 1.00 X 0 0 0 WILLIAM P MCDERMOTT ESQ DIRECTOR 1.00 1.00 X 0 0 0 CHRISTOPHER ROBBINS DIRECTOR 1.00 1.00 X 0 0 0 JAMES BRUCE RILEY CPA DIRECTOR 1.00 1.00 X 0 0 0 LINDA CORRIDAN RN CHAIRMAN 1.00 1.00 X 0 0 0 ARTHUR MOURTZINOS MD DIRECTOR 1.00 1.00 X 0 0 0 JANICE HOCKENSMITH DIRECTOR 1.00 1.00 X 0 0 0 PETE ZAMPINE DIRECTOR 1.00 1.00 X 0 0 0 ANDREW CALKINS DIRECTOR 1.00 1.00 X 0 0 0 PAUL KEMP TREASURER AND CFO 1.00 40.00 X 0 298476 25807 THOMAS LAVALLEE CLERK AND COO 1.00 40.00 X 0 273186 25807 MICHAEL DODOS CONTROLLER 1.00 40.00 X 0 227937 263 RICHARD CANTY VICE PRESIDENT 1.00 40.00 X 0 173862 25916 DORIS DAVILA VICE PRESIDENT 0.00 40.00 X 0 178786 1355 DAN MITCHELL EXECUTIVE DIRECTOR 0.00 40.00 X 0 176357 25920 MARY KILCOMMONS DIRECTOR OF OPERATIONS 1.00 40.00 X 0 170026 9612 PAUL MAHONEY EXECUTIVE DIRECTOR 0.00 40.00 X 0 162193 0 JACQUELINE AKINYL LPN 1.00 40.00 X 0 138855 0 LINDA CAMERON DIRECTOR OF HUMAN RESOURCES 1.00 40.00 X 0 142555 0 ELAINE HANSEN DIRECTOR OF CLINICAL SERVICES 0.00 40.00 X 0 155863 0 CLAIRE CUDDY GUETER SPEECH THERAPIST 0.00 40.00 X 0 132945 0 0 2575323 140487 0 0 1 0 CUTLER ASSOCIATES INC 43 HARVARD STREET WORCESTER MA 01609 DESIGN & CONSTRUCTION CONTRACTOR 4824683 PERFORMANCE HEALTHCARE SERVICES INC 47R RIVER STREET WELLESLEY MA 02481 HOUSEKEEPING & LAUNDRY SERVICE 323926 2 PATIENT SERVICE REVENUE 623000 8859355 8859355 8859355 1651 1651 OTHER INCOME 623000 17908 17908 17908 8878914 8877263 0 1651 4748802 4591349 157453 5457 5278 179 395039 386866 8173 359040 346387 12653 490176 490176 30252 30252 19200 19200 686366 533317 153049 14570 14570 89768 3185 86583 324223 324223 2443 2443 3898 3898 371382 371382 372967 372967 120160 120160 STATE ASSESSMENT FEE 661953 661953 ANCILLARY EXPENSES 310174 310174 MISCELLANEOUS 274425 274425 FOOD 264776 264776 399931 252922 147009 9945002 8819364 1125638 0 1475377 1062313 1589682 1413450 35427 34205 8793547 5374450 3429658 3419097 2756612 7505618 9286756 13434683 1097126 2184952 8437 17966 8721169 12785955 43294 40411 9870026 15029284 X -583270 -1594601 -583270 -1594601 9286756 13434683 X -1066088 54757 X 0 1 X 1 0 X 11177808 11090462 10662862 10545193 8859355 52335680 11177808 11090462 10662862 10545193 8859355 52335680 0 0 0 52335680 46633 28219 397 540 1651 77440 46633 28219 397 540 1651 77440 6571 35407 9465 17908 69351 11224441 11125252 10698666 10555198 8878914 52482471 0.99720 0.99700 0.00150 0.00210 X SCHEDULE A, PART III, SECTION B, LINE 12: MISCELLANEOUS OTHER PROGRAM INCOME - $17,908. 300000 300000 6321000 3851058 2469942 339119 123797 215322 1833428 1399595 433833 3419097 DEPOSITS 21161 GOODWILL, NET 907350 INTEREST RATE SWAP 334488 CONSTRUCTION IN PROGRESS 6220079 DUE FROM AFFILIATE 22316 SOFTWARE, NET 154 PROJECT FUNDS 70 7505618 PAYROLL TAXES PAYABLE 40411 40411 X 8878914 0 8878914 0 8878914 9945002 0 9945002 0 9945002 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 ORGANIZATION FILES AS A TAX-EXEMPT ORGANIZATION. SHOULD THAT STATUS BE CHALLENGED IN THE FUTURE, THE ORGANIZATION'S RETURNS ARE OPEN FOR EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES FOR THREE YEARS AFTER FILING. 0 0 0 0 0 0 0 0 0 FRANCIS J GRADY DIRECTOR AND PRESIDENT 0 302837 0 38000 0 3445 0 0 0 25807 0 370089 0 0 PAUL KEMP TREASURER AND CFO 0 251615 0 45000 0 1861 0 0 0 25807 0 324283 0 0 THOMAS LAVALLEE CLERK AND COO 0 228325 0 43000 0 1861 0 0 0 25807 0 298993 0 0 MICHAEL DODOS CONTROLLER 0 188974 0 30000 0 8963 0 0 0 263 0 228200 0 0 RICHARD CANTY VICE PRESIDENT 0 160344 0 12000 0 1518 0 0 0 25916 0 199778 0 0 DORIS DAVILA VICE PRESIDENT 0 164836 0 12000 0 1950 0 0 0 1355 0 180141 0 0 DAN MITCHELL EXECUTIVE DIRECTOR 0 149826 0 25000 0 1531 0 0 0 25920 0 202277 0 0 MARY KILCOMMONS DIRECTOR OF OPERATIONS 0 148051 0 20000 0 1975 0 0 0 9612 0 179638 0 0 PAUL MAHONEY EXECUTIVE DIRECTOR 0 146882 0 0 0 15311 0 0 0 0 0 162193 0 0 ELAINE HANSEN DIRECTOR OF CLINICAL SERVICES 0 141694 0 0 0 14169 0 0 0 0 0 155863 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 153 CORDAVILLE ROAD, SUITE 320, 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 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 54,757. ALLIANCE HEALTH INC 144 TURNPIKE ROAD SOUTHBOROUGH MA 01772 043468274 SUPPORTING ORGANIZATION MA 501(C)(3) LINE 12A, I 0 ALLIANCE HEALTH MANAGEMENT SERVICES LLC 144 TURNPIKE ROAD SOUTHBOROUGH MA 01772 364639819 SUPPORTING ORGANIZATION MA 501(C)(3) LINE 12B, II ALLIANCE HEALTH INC 1 ALLIANCE HEALTH OF BRAINTREE INC 144 TURNPIKE ROAD SOUTHBOROUGH MA 01772 651310230 SKILLED NURSING CORPORATION MA 501(C)(3) LINE 10 ALLIANCE HEALTH INC 1 ALLIANCE HEALTH OF CENTERVILLE INC 144 TURNPIKE ROAD SOUTHBOROUGH MA 01772 800249886 SKILLED NURSING CORPORATION MA 501(C)(3) LINE 10 ALLIANCE HEALTH INC 1 ALLIANCE HEALTH OF MARBLEHEAD INC 144 TURNPIKE ROAD SOUTHBOROUGH MA 01772 800249854 SKILLED NURSING CORPORATION MA 501(C)(3) LINE 10 ALLIANCE HEALTH INC 1 ALLIANCE HEALTH OF EAST PROVIDENCE INC 144 TURNPIKE ROAD SOUTHBOROUGH MA 01772 800249896 SKILLED NURSING CORPORATION MA 501(C)(3) LINE 10 ALLIANCE HEALTH INC 1 ALLIANCE HEALTH OF LYNN INC 144 TURNPIKE ROAD SOUTHBOROUGH MA 01772 800249859 SKILLED NURSING CORPORATION MA 501(C)(3) LINE 10 ALLIANCE HEALTH INC 1 ALLIANCE HEALTH OF MASSACHUSETTS INC 144 TURNPIKE ROAD SOUTHBOROUGH MA 01772 311712039 SKILLED NURSING CORPORATION MA 501(C)(3) LINE 10 ALLIANCE HEALTH INC 1 ALLIANCE HEALTH OF PLYMOUTH INC 144 TURNPIKE ROAD SOUTHBOROUGH MA 01772 800249891 SKILLED NURSING CORPORATION MA 501(C)(3) LINE 10 ALLIANCE HEALTH INC 1 ALLIANCE HEALTH OF PROVIDENCE INC 144 TURNPIKE ROAD SOUTHBOROUGH MA 01772 800249901 SKILLED NURSING CORPORATION MA 501(C)(3) LINE 10 ALLIANCE HEALTH INC 1 ALLIANCE HEALTH OF QUINCY INC 144 TURNPIKE ROAD SOUTHBOROUGH MA 01772 043468149 SKILLED NURSING CORPORATION MA 501(C)(3) LINE 10 ALLIANCE HEALTH INC 1 ALLIANCE HEALTH OF SANDWICH INC 144 TURNPIKE ROAD SOUTHBOROUGH MA 01772 800249868 SKILLED NURSING CORPORATION MA 501(C)(3) LINE 10 ALLIANCE HEALTH INC 1 ALLIANCE HEALTH OF SOUTHBRIDGE INC 144 TURNPIKE ROAD 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 ROAD SOUTHBOROUGH MA 01772 043582078 SKILLED NURSING CORPORATION MA 501(C)(3) LINE 10 ALLIANCE HEALTH INC 1 ALLIANCE HEALTH OF WORCESTER INC 144 TURNPIKE ROAD SOUTHBOROUGH MA 01772 800249850 SKILLED NURSING CORPORATION MA 501(C)(3) LINE 10 ALLIANCE HEALTH INC 1 ALLIANCE HUMAN SERVICES INC 144 TURNPIKE ROAD 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 ROAD SOUTHBOROUGH MA 01772 010672105 FOSTER CARE CORPORATION MA 501(C)(3) LINE 10 ALLIANCE HEALTH INC 1 ALLIANCE SPECIALITY HOSPITAL INC 144 TURNPIKE ROAD SOUTHBOROUGH MA 01772 800249832 HOSPITAL CORPORATION MA 501(C)(3) LINE 3 ALLIANCE HEALTH INC 1 DEPOT POND VILLAGE INC 144 TURNPIKE ROAD 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 ROAD SOUTHBOROUGH MA 01772 042104323 SKILLED NURSING CORPORATION MA 501(C)(3) LINE 10 ALLIANCE HEALTH INC 1 0 0 0 1 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0