2018-07-03T12:16:21-05:00 2016-09-30 111986323 Marcum LLP City Place II 185 Asylum Street Hartford CT 06103 990 2015-10-01 223012385 Johnson Evergreen Corporation JOHN 8606846341 114 Woodland Street MS-510358 Hartford CT 06105 Stuart E Rosenberg CEO 8606846341 2018-06-25 1 DOUGLAS FARRINGTON P00370668 8607600600 2018-06-25 2015 2018-06-14 16:35:46Z X X Evergreen Health Care Center Stuart E Rosenberg 114 Woodland Street MS-510358 Hartford CT 06105 3657435 0 X www.jmmc.com X 1989 CT To develop, operate, and maintain programs directed toward improving efficiency of utilization of health care facilities and services in the state of CT, and in Hartford and Tolland counties and surrounding areas in particular, and reducing the cost of health care to the public while maintaining a high quality of care. Evergreen is a skilled nursing facility with 120 long term care beds, a 30 bed subacute unit for patients in need of extensive therapy and care before returning home, and a 30 bed MSU. X 16 16 350 65 0 0 3551 0 16507384 3656161 0 42 56830 1232 16567765 3657435 0 0 0 0 11386159 2696721 0 0 0 6779836 1634752 18165995 4331473 -1598230 -674038 4946323 0 18363565 0 -13417242 0 X To develop, operate, and maintain programs directed toward improving efficiency of utilization of health care facilities and services in the state of CT, and in Hartford and Tolland counties and surrounding areas in particular, and reducing the cost of health care to the public while maintaining a high quality of care. Evergreen is a skilled nursing facility with 120 long term beds, a 30 bed subacute rehabilitation unit and a 30 bed MSU. Services include: 24 hour nursing care, long term care, cardiac recovery, subacute rehabilitation, dental care, hospice care, respite care, IV therapists, medically complex care, mental health services, oncology/cancer care, optometry and opthalmology care, orthopedic care, pain management, wound care, podiatry and other special services, postoperative care, pulmonary/respiratory care, social services and therapeutic recreation. 0 1 2922094 3656643 Nursing Home Care: Johnson Evergreen Corporation, DBA Evergreen Health Care Center maintains a 180 bed SNF with 24 hour skilled nursing care for residents. During FY 15 the facility maintained a high occupancy and high quality care in the facility. The cost shown represents the necessary salary, supplies, and overhead essential for caring for residents at Evergreen. (12,192 resident days) 2922094 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 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 1 29 0 1 350 1 0 0 0 0 0 0 0 0 0 0 X 16 16 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Jane Moonan 8607147009 114 Woodland Street MS510358 Hartford CT 06105 Patrick Mahon chairman 0.10 0.40 X X 0 0 0 james m makuch vice chairman 0.10 0.40 X X 0 0 0 evelyne a parizek secretary 0.10 0.40 X X 0 0 0 david o'conner treasurer 0.10 0.40 X X 0 0 0 christopher dadlez director 0.10 0.40 X 0 0 0 cathryn-jean fleming esq director 0.10 0.40 X 0 0 0 joseph ianello md director 0.10 0.40 X 0 0 0 michael p krol director 0.10 0.40 X 0 0 0 younus f masih md director 0.10 0.40 X 0 0 0 john w patton director 0.10 0.40 X 0 0 0 kevin sullivan director 0.10 0.40 X 0 0 0 r christopher hartley director 0.10 0.40 X 0 0 0 john rodis md director 0.10 0.40 X 0 0 0 phil tartsinis director 0.10 0.40 X 0 0 0 david bittner director 0.10 0.40 X 0 0 0 john p kearney director 0.10 0.40 X 0 0 0 stuart e rosenberg president/ceo 0.00 50.00 X 0 0 0 john grish chief financial officer 0.00 50.00 X 0 298520 18890 damien eilerman nursing supervisor 40.00 0.00 X 113463 0 29084 jennifer bessette pt manager 40.00 0.00 X 103929 0 29164 mary denunzio director of nursing 40.00 0.00 X 101654 0 16999 319046 298520 94137 3 0 1 1 0 resident revenues 623000 3656161 3656161 3656161 42 42 miscellaneous revenue 900099 1232 482 750 1232 3657435 3656643 0 792 2028757 1795125 233632 505004 446848 58156 162960 144193 18767 48938 48938 118192 118192 12597 12597 97450 58817 38633 25093 25093 204837 70426 134411 1392 1392 75015 75015 25614 25614 Provider Tax Expense 346551 346551 medical/surgical suppli 275606 275606 Administrative Services 248619 248619 food 82627 82627 72221 48452 23769 4331473 2922094 1409379 0 300 0 0 0 1580143 0 0 0 0 26625 0 250948 0 0 0 2766856 0 0 0 0 0 321451 0 4946323 0 3212641 0 14213697 0 937227 0 18363565 0 X -13417242 0 -13417242 0 4946323 0 X -674038 14091280 X 0 0 0 X 8629 10420 8324 3551 0 30924 16798928 16121923 16658078 16507384 3656161 69742474 16807557 16132343 16666402 16510935 3656161 69773398 0 0 0 69773398 42 42 42 42 43968 21028 53968 56830 1232 177026 16851525 16153371 16720370 16567765 3657435 69950466 0.99750 0.99660 0.00000 0.00000 X 0 0 0 0 0 0 0 0 0 john grish chief financial officer 0 278520 0 20000 0 0 0 0 0 18890 0 317410 0 0 Form 990, Part VII, Section A, Line 5: Stuart Rosenberg was paid by St Francis Hospital and Medical Center. He received the following: - $310,229 in base compensation - $36,160 in bonus & incentive compensation - $20,800 in deferred compensation - $25,375 in non-taxable benefits Accounts receivables 2015-12-29 498581 cost approximates fair market value 474559045 Stafford Springs CT SNF LLC 135 South Road Farmington CT 06032 limited liability company Allowance for Doubtful Accounts 2015-12-29 -242466 cost approximates fair market value 474559045 Stafford Springs CT SNF LLC 135 South Road Farmington CT 06032 limited liability company Inventory 2015-12-29 26625 cost approximates fair market value 474559045 Stafford Springs CT SNF LLC 135 South Road Farmington CT 06032 limited liability company Property Plant & Equipment (net of accumulated depreciation) 2015-12-29 2692810 cost approximates fair market value 474559045 Stafford Springs CT SNF LLC 135 South Road Farmington CT 06032 limited liability company Accounts payable 2015-12-29 -905688 cost approximates fair market value 474559045 Stafford Springs CT SNF LLC 135 South Road Farmington CT 06032 limited liability company Prepaids 2015-12-29 172230 cost approximates fair market value 474559045 Stafford Springs CT SNF LLC 135 South Road Farmington CT 06032 limited liability company 0 0 0 0 0 1 1 1 0 Part I, Line 3: ON JANUARY 14, 2015, JOHNSON EVERGREEN CORPORATION FILED A VOLUNTARY JOINT PETITION FOR RELIEF UNDER CHAPTER 11 OF THE U.S. BANKRUPTCY CODE IN THE U.S. BANKRUPTCY COURT FOR THE DISTRICT OF CONNECTICUT, HARTFORD DIVISION (BANKRUPTCY COURT).On August 20, 2015, the Bankruptcy Court approved the sale of certain assets and the assumption of certain liabilities of Evergreen to Athena Stafford Springs Landlord LLC and Stafford Springs CT SNF LLC ("Athena")Effective, December 29, 2015, Evergreen was sold to Athena Health Care who will operate it as a nursing facility. As part of this sale, Athena acquired certain assets and assumed certain liabilities of Evergreen. Evergreen's mortgage debt was not assumed by the purchaser and the Corporation was ordered by the Bankruptcy Court to pay People's Bank $5 million in 2016 from the proceeds that resulted from the sale of Evergreen.PART I:THE FAIR MARKET VALUE WAS NOT AVAILABLE FOR ANY OF THE ASSETS OR LIABILITIES REPORTED IN PART I ,THEREFORE COST WAS THE METHOD UTILIZED FOR REPORTING PURPOSES. IN ADDITION, ALL ASSETS AND LIABILITIES WERE REPORTED AS DISTRIBUTED TO STAFFORD SPRINGS CT SNF,LLC SINCE A BREAKOUT BETWEEN THE TWO ENTITIES INVOLVED IN THE SALE WERE NOT AVAILABLE. Form 990, Part III, line 3 Effective December 29, 2015, Athena Stafford Springs Landlord LLC and Stafford Springs CT SNF LLC (collectively, Athena) acquired certain assets and assumed certain liabilities of Evergreen. Form 990, Part VI, Section A, line 6 Article 3 of the Johnson Memorial Medical Center Bylaws stipulates there will be not less than 30 nor more than 60 members. Form 990, Part VI, Section A, line 7a Members are elected by the Board as recommended by the Governance and Nominating Committee. Form 990, Part VI, Section B, line 11 Board policy provides that members of the Finance Committee are provided an opportunity to review and comment to executive leadership before the 990 is filed. All members of the Board have access to any copy of the Form 990 and the Chief Financial Officer provides a summary of the 990 at the Board meeting following the filing of the Form 990. Form 990, Part VI, Section B, line 12c An annual disclosure statement is required. Executives, managers, and board members are required on an annual basis to disclose interests that may give rise to a conflict of interest. Form 990, Part VI, Section B, line 15 A board committee reviews compensation for the executive team and recommends compensation for Board approval. Comparability data is reviewed and may include surveys, documented comparisons of persons holding similar positions in similar organizations, and expert compensation schedules. Form 990, Part VI, Section C, line 19 The Johnson Memorial Medical Center maintains these documents in Administration and are available for viewing upon request during normal business hours. Form 990, Part XI, line 9: debt forgiven in bankruptcy 10,004,767. assets transferred to athena in excess of liabilities assumed -2,242,092. Debt paid off in bankruptcy 6,328,605. old jmmc inc 201 chestnut hill road stafford springs CT 06076 222541974 parent corporation CT 501(c)(3) Line 11b, II N/A 0 old jmh inc 201 chestnut hill road stafford springs CT 06076 060646696 acute care hospital CT 501(c)(3) Line 3 Johnson Memorial Medical Center 0 old jhc inc 201 chestnut hill road stafford springs CT 06076 222541981 occupational medicine CT 501(c)(3) Line 9 Johnson Memorial Medical Center 0 old hchs inc 101 phoenix avenue enfield CT 06083 060646620 visiting nurse association CT 501(c)(3) Line 9 Johnson Memorial Medical Center 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0