2017-11-15T09:25:46-06:00 2016-12-31 410746749 CLIFTONLARSONALLEN LLP 300 CROWN COLONY DRIVE SUITE 310 QUINCY MA 02169 990 2016-01-01 042106768 JEWISH REHABILITATION CENTER FOR THE AGED OF THE NORTH SHORE INC JEWI 9784715100 240 LYNNFIELD STREET PEABODY MA 01960 BARRY BERMAN TREASURER 9784715100 2017-11-13 1 JUDY DALEY P01294075 6179848100 2017-11-13 67.137.57.251 2017-11-13 16:35:24 ES P 499B49BEE9E95068E93680D69C996EB6A62D8814 A78F1062FA74E90C671D16910DB17AD2D08C9BAB 2016 2017-02-10 21:41:12Z JEFFREY & SUSAN BRUDNICK CENTER FOR LIVING BARRY BERMAN 240 LYNNFIELD STREET PEABODY MA 01960 18953377 0 X WWW.CHELSEAJEWISH.ORG X 1944 MA THE ORGANIZATION'S MISSION IS TO ENRICH THE LIFE OF EACH OF OUR RESIDENTS AND PROGRAM PARTICIPANTS, SO THAT EACH CAN CONTINUE TO LIVE HIS OR HER LIFE WITH A SENSE OF MEANING AND PURPOSE THROUGH THE OPERATION OF A 180-BED NURSING HOME WITH AN ADULT DAY CARE CENTER. 9 6 384 33 0 0 0 0 18620499 18953045 494 0 576 332 18621569 18953377 0 0 0 0 11283865 11790936 0 0 0 8621212 9198792 19905077 20989728 -1283508 -2036351 36014222 34027445 42694834 28879175 -6680612 5148270 THE ORGANIZATION'S MISSION IS TO ENRICH THE LIFE OF EACH OF OUR RESIDENTS AND PROGRAM PARTICIPANTS, SO THAT EACH CAN CONTINUE TO LIVE HIS OR HER LIFE WITH A SENSE OF MEANING AND PURPOSE THROUGH THE OPERATION OF A 180-BED NURSING HOME WITH AN ADULT DAY CARE CENTER. 0 0 18053465 18953377 NURSING HOME - PROVIDE QUALITY SKILLED NURSING CARE & REHABILITATIVE THERAPY FOR UP TO 144 ELDERLY RESIDENTS OF A NURSING HOME.ADULT DAY CARE - PROVIDE SUPPORTIVE CARE TO PATIENTS OF THE ADULT DAY CARE FACILITY. 18053465 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 13 0 1 384 1 0 0 0 0 0 0 0 0 0 0 X 9 6 1 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 MA X JEFFREY M LANDA CFO 9784715100 240 LYNNFIELD STREET PEABODY MA 01960 ADAM BERMAN PRESIDENT 1.00 39.00 X X 0 305651 27058 BARRY BERMAN TREASURER 1.00 39.00 X X 0 610459 32880 JOEL MAZER CHAIR 1.00 3.00 X X 0 0 0 ELIZABETH MULLEN CLERK 1.00 39.00 X X 0 206839 17166 SUSAN BRUDNICK DIRECTOR 1.00 3.00 X 0 0 0 CHARLOTTE FLORENCE DIRECTOR 1.00 3.00 X 0 0 0 SHARON FORMAN DIRECTOR 1.00 3.00 X 0 0 0 SHELLY KATZ DIRECTOR 1.00 3.00 X 0 0 0 ROBERT RICHMAN DIRECTOR 1.00 3.00 X 0 0 0 KIM JOYCE CFO (UNTIL 05/31/16) 1.00 39.00 X 0 210415 15936 ESTHER KAIRU LPN 40.00 0.00 X 108004 0 22374 JEFF GOPEN ED, FORMER 0.00 0.00 X 150000 0 0 258004 1333364 115414 2 1 1 0 CLIFTONLARSONALLEN LLP 300 CROWN COLONY DRIVE QUINCY MA 02169 ACCOUNTING & TAX SERVICES 106620 1 PROGRAM SERVICE INCOME 623000 18881586 18881586 OTHER INCOME 624100 71459 71459 18953045 332 0 332 332 18953377 18953377 0 0 10133236 9816025 317211 84458 81814 2644 785580 760988 24592 787662 763005 24657 2294624 2294624 68778 68778 69138 69138 543390 408771 134619 14331 14331 134157 134157 578109 578109 169415 169415 18723 18723 805615 805615 1653709 1653709 38646 38646 USER FEE 740027 740027 ANCILLARIES 663805 663805 SUPPLIES 583308 583308 FOOD 437214 437214 385803 385803 20989728 18053465 2936263 0 1304963 1101298 2151427 2681097 183265 149641 37090976 7017222 31467483 30073754 907084 21655 36014222 34027445 1386696 1636590 100311 18397 26556574 23751983 57775 56435 14593478 3415770 42694834 28879175 X -6680612 5148270 -6680612 5148270 36014222 34027445 X -2036351 13865233 X 0 1 X 1 0 X 15224807 17113013 17528364 18621075 18953377 87440636 15224807 17113013 17528364 18621075 18953377 87440636 0 0 0 87440636 138 135 1185 494 0 1952 138 135 1185 494 1952 -406566 2086763 1680197 14818379 17113148 19616312 18621569 18953377 89122785 0.98110 0.95290 0.00000 0.01040 X X RELIGIOUS CEREMONIES 31536865 3556951 27979914 5452118 3457496 1994622 101993 2775 99218 30073754 DUE TO RELATED PARTIES 1378959 FAIR VALUE OF INTEREST RATE SWAPS 187508 SECURITY DEPOSITS 19107 DEFERRED MANAGEMENT FEES - RELATED PARTY 1830196 3415770 X PART III, LINE 4: TORAH - USED FOR JEWISH RELIGIOUS CEREMONIES FOR RESIDENTS. PART X, LINE 2: THE ORGANIZATION IS A NONPROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE ORGANIZATION FILES AS A TAX-EXEMPT ORGANIZATION. X X X 1 0 0 0 0 0 0 0 0 ADAM BERMAN PRESIDENT 0 305651 0 0 0 0 0 0 0 27058 0 332709 0 0 BARRY BERMAN TREASURER 0 610459 0 0 0 0 0 0 0 32880 0 643339 0 0 ELIZABETH MULLEN CLERK 0 206839 0 0 0 0 0 0 0 17166 0 224005 0 0 KIM JOYCE CFO (UNTIL 05/31/16) 0 85915 0 0 0 124500 0 0 0 15936 0 226351 0 0 JEFF GOPEN ED, FORMER 0 0 0 0 150000 0 0 0 0 0 150000 0 0 0 PART I, LINE 4A KIM JOYCE, CFO (UNTIL 05/31/2016), RECEIVED A SEVERANCE PAYMENT OF $124,500 FROM THE ORGANIZATION IN 2016. JEFF GOPEN, FORMER EXECUTIVE DIRECTOR, RECEIVED A SEVERANCE PAYMENT OF $150,000 IN 2016. A MASS DEVELOPMENT FINANCE AGENCY 043431814 57583UBR8 2011-04-29 34553888 TO REFUND OLD BONDS AND REPLACE EXISTING FACILITY. 0 0 0 A 9838631 34553888 1314672 1601175 690823 529178 30418040 2012 1 0 1 1 A 0 0 0 0 0 0 0 A 0 1 0 0 1 1 M&T BANK 5.000000000000 0 0 0 0 0 A 0 SCHEDULE K SUPPLENTAL INFORMATION THIS ORGANIZATION IS REPORTING THEIR RESPECTIVE SHARE OF THE $50M BOND ISSUED ON 04/29/11. SEE CHELSEA JEWISH NORTH SHORE ASSISTED LIVING, INC. (FKA AVIV ASSISTED LIVING, INC.) (EIN 04-3274643) FOR THE REMAINING PORTION. JEFFREY BRUDNICK LOUIS J BRUDNICK SPOUSE ON THE BOARD OF DIRECTORS. 34881 INSURANCE BROKER/AGENT OF THE ORGANIZATION'S INSURANCE COMPANY. 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 THE ORGANIZATION ENTERED INTO A MANAGEMENT AGREEMENT WITH CHELSEA JEWISH COMMUNITY, INC., A SUBSIDIARY OF CHELSEA JEWISH LIFECARE, INC., EFFECTIVE DECEMBER 1, 2014. CHELSEA JEWISH COMMUNITY, INC. PROVIDED MANAGEMENT SERVICES WHICH INCLUDED THE FOLLOWING RESPONSIBILITIES: 1) KEY PERSONNEL MANAGEMENT 2) PERSONNEL OVERSIGHT (EMPLOYEES & ADMINISTRATION) 3) FINANCIAL RESPONSIBILITIES 4) MANAGEMENT REPORTS 5) REGULATORY COMPLIANCE 6) QUALITY ASSURANCE 7) PURCHASING & CONTRACTING 8) BANK ACCOUNTS FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION'S MANAGEMENT REVIEWS THE CPA-PREPARED FORM 990 PRIOR TO ITS 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 15 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. 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 FAIR VALUE OF INTEREST RATE SWAPS 118,455. EQUITY TRANSFER WITH RELATED PARTY 13,746,778. CHELSEA JEWISH NORTH SHORE INC 240 LYNNFIELD STREET PEABODY MA 01960 261244471 MANAGEMENT MA 501(C)(3) LINE 12B, II 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 NORTH SHORE INC 0 CHELSEA JEWISH NORTH SHORE FOUNDATION INC 240 LYNNFIELD STREET PEABODY MA 01960 223102199 FUNDRAISING MA 501(C)(3) LINE 7 CHELSEA JEWISH NORTH SHORE INC 0 CHELSEA JEWISH LIFECARE INC 165 CAPTAINS ROW CHELSEA MA 02150 510141617 FUNDRAISING MA 501(C)(3) LINE 7 N/A 0 0 0 0 1 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0