2018-11-06T12:56:28-06:00 2017-12-31 990 2017-01-01 043419625 CHS of Worcester Inc CHSO 5087534791 100 Ames Pond Drive Tewksbury MA 01876 Susan Downey Administrator 9786546363 2018-11-06 155.212.6.161 2018-11-06 13:56:22 US P A744FCA080835C7073C58A40247746B207170AF7 A744FCA080835C7073C58A40247746B207170AF7 2017 2019-02-21 02:37:17Z STMARY HEALTH CARE CENTER Susan Downey 100 Ames Pond Drive Tewksbury MA 01876 8712748 0 X covenantheath.net X 1998 MA ST. MARY HEALTH CARE CENTER, A CATHOLIC REHABILITATION AND SKILLED NURSING FACILITY, WAS ESTABLISHED AS A CONTINUING EXPRESSION OF THE VISION OF ST. MARGUERITE D'YOUVILLE, FOUNDRESS OF THE SISTERS OF CHARITY OF MONTREAL, THE "GREY NUNS". IN THE SPIRIT OF MARGUERITE, WHOSE LEGACY WE SHARE, WE SEEK TO "BRING THE MIRACLE OF LOVE TO ALL" THROUGH COMPASSIONATE CARE. ST MARY HEALTH CARE DESIRES, IN PARTNERSHIP WITH OTHERS COMMITTED TO PROVIDING HOLISITC AND INCLUSIVE CARE FOR ALL, TO DEVELOP INNOVATIVE AND CREATIVE MEANS TO ENHANCE THE PHYSICAL, EMOTIONAL, SOCIAL AND SPIRITUAL WELL-BEING OF THOSE WE SERVE. DURING 2017 THE ORGANIZATION PROVIDED 38,658 DAYS OF SERVICE OF WHICH 36,118 WERE PROVIDED TO PATIENTS RECEIVING MEDICAID. 7 7 223 0 0 0 3382 3888 8539793 8664568 6562 0 22415 44292 8572152 8712748 0 0 0 0 5471422 5655597 0 0 0 3347640 3597926 8819062 9253523 -246910 -540775 3927823 4020095 684392 1067495 3243431 2952600 X ST. MARY HEALTH CARE CENTER, A CATHOLIC REHABILITATION AND SKILLED NURSING FACILITY, WAS ESTABLISHED AS A CONTINUING EXPRESSION OF THE VISION OF ST. MARGUERITE d'YOUVILLE, FOUNDRESS OF THE SISTERS OF CHARITY OF MONTREAL, THE "GREY NUNS". IN THE SPIRIT OF MARGUERITE, WHOSE LEGACY WE SHARE, WE SEEK TO "BRING THE MIRACLE OF LOVE TO ALL" THROUGH COMPASSIONATE CARE. ST. MARY HEALTH CARE DESIRES, IN PARTNERSHIP WITH OTHERS COMMITTED TO PROVIDING HOLISTIC AND INCLUSIVE CARE FOR ALL, TO DEVELOP INNOVATIVE AND CREATIVE MEANS TO ENHANCE THE PHYSICAL, EMOTIONAL, SOCIAL AND SPIRITUAL WELL-BEING OF THOSE WE SERVE. 0 0 8879556 8664568 THE ORGANIZATION PROVIDED 38,658 DAYS OF SKILLED NURSING CARE TO ELDERLY PATIENTS FROM ALL ECONOMIC, ETHNIC AND RELIGIOUS BACKROUNDS. OF THESE DAYS THE ORGANIZATION PROVIDED 36,118 DAYS OF SKILLED SERVICES TO MEDICAID RECIPIENTS. 8879556 1 0 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 12 0 223 1 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 0 MA X X JOHN AHLE CFO 9786546363 100 AMES POND DRIVE TEWKSBURY MA 01876 RICHARD FREIJE CHAIR 1.00 X X 0 0 0 STEVEN DIORIO SECRETARY 1.00 X X 0 0 0 MELISSA BOYLE TREASURER 1.00 X X 0 0 0 KEVIN DOWD TRUSTEE 1.00 X 0 0 0 NICOLAS RODRIGUEZ TRUSTEE FROM 3/17 1.00 X 0 0 0 BRIAN MINCHOFF TRUSTEE 1.00 X 0 0 0 SR MARIE THERESE MARTIN TRUSTEE 1.00 X 0 0 0 MICHAEL ISABELLA ADMINISTRATOR TO 3/17 10.00 X 52404 0 939 SUSAN DOWNEY ADMINISTRATOR FROM 7/17 18.00 X 65956 0 6706 118360 0 7645 0 0 0 0 Performance Healthcare Services 47R River St Suite 200R Wellesley MA 02481 HOUSEKEEPING AND LAUNDRY 316764 Rehabcare Group Po Box 503534 St Louis MO 63150 REHABILITATION SERVICES 182855 Metz Culinary Management 2 Woodland Drive Dallas PA 01862 FOODSERVICE 132729 3 3888 3888 PATIENT SERVICE REVENU 623000 8664568 8664568 8664568 Miscellaneous 623000 44292 44292 44292 8712748 8664568 0 44292 118360 118360 4685846 4685846 16342 16342 482940 482940 352109 352109 172089 172089 43456 43456 66300 66300 35434 35434 58505 58505 232579 140457 92122 12924 12924 2152 2152 275099 275099 81678 81678 Purchased Services 904015 904015 Medicaid User Fee 813740 813740 Food and supplies 708071 708071 Utilities 191884 191884 9253523 8879556 373967 0 204498 316325 1070796 1201671 62429 30914 6462999 4038056 2523077 2424943 67023 46242 3927823 4020095 591382 986319 93010 81176 684392 1067495 X 3241875 2951100 1556 1500 3243431 2952600 3927823 4020095 X -540775 249944 X 0 1 X 0 0 X 2039 1950 7388 3382 3888 18647 8300349 8965201 8647688 8539793 8664568 43117599 8302388 8967151 8655076 8543175 8668456 43136246 0 0 0 43136246 2400 83 82 62 2627 2400 83 82 62 2627 8304788 8967234 8655158 8543237 8668456 43138873 0.99990 0.99990 0.00010 0.00010 X 1556 56 1500 10000 3500 11944 1556 10000 10000 31777 31777 41000 9223 31777 1.00000 0 0 176830 176830 4800647 2680211 2120436 1243510 1135267 108243 242012 222578 19434 2424943 PROFESSIONAL LIABILITY LOSS RESERVE 35434 RESIDENT FUNDS LIABILITY 45742 81176 X Part V, Line 4: FUNDS ARE USED TO PROVIDE SERVICES,SUPPLIES AND FACILITIES TO RESIDENTS & THE POOR IN THE COMMUNITY Part X, Line 2: Covenant and its member organizations are considered not-for-profit corporations as described in Section 501(c)(3) of the Internal Revenue Code and are exempt from federal income taxes on related income pursuant to Section 501(a) of the Code, except as noted below. Tax-exempt organizations could be required to record an obligation for income taxes as the result of a tax position they have historically taken on various tax exposure items including unrelated business income or tax status. Under guidance issued by the Financial Accounting Standards Board, assets and liabilities are established for uncertain tax positions taken or positions expected to be taken in income tax returns when such positions are judged to not meet the "more-likely-than-not" threshold, based upon the technical merits of the position. Estimated interest and penalties, if applicable, related to uncertain tax positions are included as a component of income tax expense. The System has evaluated the position taken on its filed tax returns. The System has concluded no uncertain income tax positions exist at December 31, 2017. Under Internal Revenue Service regulations, the System's tax years from 2014 through 2017 are open and subject to examination. X X X X 0 0 0 0 0 0 0 0 0 Part I, Line 3 Every two to three years the compensation committee of the Covenant Health's Board of Directors engages an external consultant to provide competitive market data from various survey sources, which is used to develop recommendations for changes to the compensation program. Since 2003, the compensation committee has engaged a Human Resources Consultant to conduct this analysis. Objectives are to assess the compositeness of the total cash compensation levels of the senior leadership team, develop market based competitive salary ranges for all executive positions and ensure that the annual incentive opportunities, if there are any, are competitive and reasonable. Form 990, Part VI, Section A, line 6 COVENANT HEALTH, INC. IS THE SOLE MEMBER OF THE ORGANIZATION. AS SUCH IT RETAINS CERTAIN RESERVE RIGHTS CONCERNING CORPORATE DECISIONS AND BOARD COMPOSITION. Form 990, Part VI, Section A, line 7a COVENANT HEALTH, Inc. IS THE SOLE MEMBER OF THE ORGANIZATION. AS SUCH IT RETAINS CERTAIN RESERVE RIGHTS CONCERNING CORPORATE DECISIONS AND BOARD COMPOSITION. Form 990, Part VI, Section A, line 7b COVENANT HEALTH, Inc. IS THE SOLE MEMBER OF THE ORGANIZATION. AS SUCH IT RETAINS CERTAIN RESERVE RIGHTS OVER BOARD DECISIONS AND BOARD COMPOSITION. Form 990, Part VI, Section A, line 8b COVENANT HEALTH, Inc. IS THE SOLE MEMBER OF THE ORGANIZATION. AS SUCH IT RETAINS CERTAIN RESERVE RIGHTS OVER BOARD DECISIONS AND BOARD COMPOSITION. Form 990, Part VI, Section B, line 11b THE FORM 990 IS PROVIDED TO THE BOARD FOR REVIEW PRIOR TO ITS BEING FILED. Form 990, Part VI, Section B, line 12c THE ORGANIZATION REQUIRES CONFLICT OF INTEREST STATEMENTS TO BE SIGNED BY BOARD MEMBERS AND KEY EMPLOYEES REMINDING THEM OF THE DUTIES AND OBLIGATIONS TO REPORT REAL OR POTENTIAL CONFLICTS OF INTEREST. Form 990, Part VI, Section B, line 15 EVERY TWO TO THREE YEARS THE COMPENSATION COMMITTEE OF COVENANT HEALTH'S BOARD OF DIRECTORS ENGAGES AN EXTERNAL CONSULTANT TO PROVIDE COMPETITIVE MARKET DATA FROM VARIOUS SURVEY SOURCES WHICH IS USED TO DEVELOP RECOMMENDATIONS FOR CHANGES TO THE COMPENSATION PROGRAM. SINCE 2003, THE COVENANT COMPENSATION COMMITTEE HAS ENGAGED A HUMAN RESOURCES CONSULTANT TO CONDUCT THIS ANALYSIS. OBJECTIVES ARE TO ASSESS THE COMPOSITENESS OF THE CURRENT TOTAL CASH COMPENSATION LEVELS OF THE SENIOR LEADERSHIP TEAM, DEVELOP MARKET BASED COMPETITIVE SALARY RANGES FOR ALL EXECUTIVE POSITIONS AND ENSURE THAT ANNUAL INCENTIVE OPPORTUNITIES, IF THERE ARE ANY, ARE COMPETITIVE AND REASONABLE. Form 990, Part VI, Section C, line 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, FINANCIAL STATEMENTS AND THE FORM 990 AVAILABLE TO THE PUBLIC UPON REQUEST. THE FORM 990 IS ALSO POSTED ON COVENANT HEALTH'S WEBSITE. Form 990, Part XI, line 9: CHANGE IN TEMPORARILY RESTRICTED ASSETS -56. TRANSFER AMONG AFFILIATES 250000. COVENANT HEALTH Inc 100 AMES POND DRIVE TEWKSBURY MA 01876 222484505 HEALTHCARE MANAGEMENT AND RESOURCE ORGANIZATION MA 501(c)(3) 9 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0