2017-11-15T09:23:09-06:00 2016-12-31 410746749 CLIFTONLARSONALLEN LLP 300 CROWN COLONY DRIVE SUITE 310 QUINCY MA 02169 990 2016-01-01 271756594 CHELSEA JEWISH COMMUNITY INC CHEL 6178870001 165 CAPTAINS ROW CHELSEA MA 02150 BARRY BERMAN TREASURER 6178870001 2017-11-13 1 JUDY DALEY P01294075 6179848100 2017-11-13 67.137.57.251 2017-11-13 13:19:57 ES P 499B49BEE9E95068E93680D69C996EB6A62D8814 C1D470E4C4FD0E6018A3BDA039B2AFA75AE02954 2016 2017-02-10 21:41:12Z BARRY BERMAN 165 CAPTAINS ROW CHELSEA MA 02150 8212166 0 X WWW.CHELSEAJEWISH.ORG X 2007 MA THE ORGANIZATION'S MISSION IS TO PROVIDE MANAGEMENT AND THERAPY SERVICES TO RELATED ENTITIES WHICH SEEK TO PROVIDE THE HIGHEST LEVEL OF SKILLED NURSING AND REHABILITATION, HOME HEALTH, HOSPICE, AND PERSONAL CARE SERVICES WITHOUT REGARD OF AN INDIVIDUAL'S ABILITY TO PAY. ALSO TO PROVIDE CERTIFIED NURSING ASSISTANT TRAINING IN CERTIFICATION. 9 6 128 6 0 0 0 0 7492813 8211451 1095 715 0 0 7493908 8212166 0 0 0 0 6572801 6783423 0 0 94026 753327 858028 7326128 7641451 167780 570715 3757192 7144092 4622842 6608836 -865650 535256 X THE ORGANIZATION'S MISSION IS TO PROVIDE MANAGEMENT, CERTIFIED NURSING ASSISTANT EDUCATION, AND THERAPY SERVICES TO RELATED ENTITIES WHICH SEEK TO PROVIDE THE HIGHEST LEVEL OF SKILLED NURSING AND REHABILITATION, HOME HEALTH, HOSPICE, AND PERSONAL CARE SERVICES WITHOUT REGARD OF AN INDIVIDUAL'S ABILITY TO PAY. 0 0 1701448 4468093 MANAGEMENT SERVICES - PROVIDE MANAGEMENT SERVICES TO RELATED ENTITIES. 1187725 3119030 THERAPY SERVICES - PROVIDE THERAPY SERVICES TO RELATED ENTITIES. 237744 624328 CERTIFIED NURSING ASSISTANT EDUCATION - PROVIDE STATE APPROVED TRAINING FOR CERTIFICATION OF CERTIFIED NURSING ASSISTANTS. 3126917 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 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 9 0 1 128 1 0 0 0 0 0 0 0 0 0 0 X 9 6 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X JEFFREY M LANDA 6178870001 165 CAPTAINS ROW CHELSEA MA 01250 ADAM BERMAN PRESIDENT 1.00 39.00 X X 305651 0 27058 BARRY BERMAN TREASURER 1.00 39.00 X X 610459 0 32880 JOEL MAZER CHAIR 1.00 2.00 X X 0 0 0 ELIZABETH MULLEN CLERK 1.00 39.00 X X 206839 0 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 RONILO ANGLO EXECUTIVE 40.00 0.00 X 213095 0 17112 MATTHEW WALLEN THERAPY DIRECTOR 40.00 0.00 X 120682 0 1234 MELISSA KERSHAW EXECUTIVE 40.00 0.00 X 116136 0 2366 ELLEN SHONER AVP OF FINANCE 40.00 0.00 X 108808 0 26820 INNA SHTYRKOV BUSINESS OFFICE MANAGER 40.00 0.00 X 102430 0 13631 1784100 0 138267 8 0 1 0 FE FRENCH CONSTRUCTION INC 40 BRIGHTON STREET BELMONT MA 02479 CONSTRUCTION 308750 DONGHUE BARRETT & SINGAL PC ONE BEACON STREET BOSTON MA 02108 LEGAL 191424 EXPENSE REDUCTION ANALYSTS INC PO BOX 956251 ST LOUIS MO 63195 CONSULTANT 133457 ADP PO BOX 842875 BOSTON MA 02284 PAYROLL 118282 KTM PROPERTIES 25 SPAULDING ROAD SUITE 17-2 FREMONT NH 03044 CONSULTANT 111969 6 MANAGEMENT SERVICES 561000 4468093 4468093 THERAPY SERVICES 623000 3119030 3119030 CERTIFIED NURSING ASSISTANT EDUC. 611710 592828 592828 OTHER INCOME 561000 31500 31500 8211451 715 715 8212166 8211451 0 715 1430260 1430260 3691057 2175214 1446773 69070 251605 109831 138286 3488 680688 357493 311843 11352 729813 318580 401117 10116 187142 187142 47922 47922 55170 55170 218567 103780 114787 1 1 95127 95127 67737 67737 408 408 80256 80256 686 686 35074 35074 36029 36029 OTHER EXPENSES 7372 7372 PLANT OPERATIONS 3325 3325 THERAPY SUPPLIES & EXPE 3145 3145 20067 20067 7641451 3126917 4420508 94026 1156874 1299039 2413214 1370414 49500 6069 347385 90809 93202 256576 44402 4211994 3757192 7144092 923346 1123495 2000000 3699496 3485341 4622842 6608836 X -865650 535256 -865650 535256 3757192 7144092 X 570715 830191 X 0 1 X 1 0 X 3707 3707 11520 6610491 6800565 7492813 8211451 29126840 11520 6610491 6804272 7492813 8211451 29130547 0 0 0 29130547 654 746 1095 715 3210 654 746 1095 715 3210 96 96 11616 6611145 6805018 7493908 8212166 29133853 0.99990 0.99990 0.00010 0.00010 X 347385 90809 256576 256576 DUE FROM RELATED PARTIES 2800588 SOFTWARE, NET 11585 CONSTRUCTION IN PROCESS 1399821 4211994 DUE TO RELATED ENTITIES 3485341 3485341 X 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 X 0 0 0 0 0 0 0 0 0 ADAM BERMAN PRESIDENT 305651 0 0 0 0 0 0 0 27058 0 332709 0 0 0 BARRY BERMAN TREASURER 610459 0 0 0 0 0 0 0 32880 0 643339 0 0 0 ELIZABETH MULLEN CLERK 206839 0 0 0 0 0 0 0 17166 0 224005 0 0 0 RONILO ANGLO EXECUTIVE 213095 0 0 0 0 0 0 0 17112 0 230207 0 0 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 6 THE SOLE MEMBER OF THE CORPORATION IS A RELATED ORGANIZATION, CHELSEA JEWISH LIFECARE, INC. FORM 990, PART VI, SECTION A, LINE 7A THE APPROVAL OF THE MEMBER, CHELSEA JEWISH LIFECARE, INC., IS REQUIRED TO ELECT OR REMOVE DIRECTORS OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7B THE APPROVAL OF THE MEMBER, CHELSEA JEWISH LIFECARE, INC., IS REQUIRED BEFORE THE BOARD OF DIRECTOR'S ACTION ON ANY OF THE FOLLOWING BECOMES EFFECTIVE: (A) TO AMEND OR TO REPEAL THE ARTICLES OF ORGANIZATION OR THE BYLAWS OF THE CORPORATION; (B) TO APPROVE ALL PLANS OF MERGER, CONSOLIDATION, REORGANIZATION OR DISSOLUTION OF THE CORPORATION OR ANY SUBSIDIARY OF THE CORPORATION, OR THE SALE, LEASE, ASSIGNMENT OR TRANSFER OF SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION, OR THE PURCHASE OR ACQUISITION BY THE CORPORATION OF THE CORPORATION OF AN INTEREST IN ANY CORPORATION, PARTNERSHIP, JOINT VENTURE OR OTHER ENTITY, WHETHER NEWLY CREATED OR PREVIOUSLY EXISTING, WHICH INTEREST, IN THE CASE OF A FOR-PROFIT ENTITY, REPRESENTS TWENTY-FIVE PERCENT (25%) OR MORE OF THE VOTING POWER THEREOF OR EQUITY INTEREST THEREIN, OR, IN THE CASE OF A NON-PROFIT ENTITY, REPRESENTS TWENTY-FIVE PERCENT (25%) OR MORE OF THE VOTING POWER THEREOF OR MEMBERSHIP INTEREST THEREIN; (C) TO APPROVE ALL GIFTS, GRANTS, DONATIONS OR SIMILAR TRANSFERS OF FUNDS OF THE CORPORATION TO ANY ENTITY OTHER THAN THE MEMBER OR ITS SUBSIDIARIES; (D) TO ELECT OR REMOVE DIRECTORS OF THE CORPORATION; (E) TO APPROVE THE FORMATION OF ANY SUBSIDIARY OF THE CORPORATION; AND (F) TO APPOINT THE CORPORATION'S AUDITORS. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION'S MANAGEMENT TEAM WILL CONDUCT A REVIEW OF THE FORM 990 AFTER IT HAS BEEN FINALIZED, INCLUDING READING AND REVIEWING THE KEY INFORMATION. MANAGEMENT WILL REPORT TO THE BOARD IF THERE ARE ANY MAJOR DEVIATIONS FROM THE PROVIDED DATA. A COMPLETE COPY OF THE FORM 990 IS PROVIDED TO THE BOARD PRIOR TO 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 A RELATED ORGANIZATION'S BOARD OF DIRECTORS ARRANGES FOR A SALARY STUDY TO BE PERFORMED. THE STUDY INCLUDES THE CEO ANDEXECUTIVE SALARIES OF COMPARABLY-SIZED COMPANIES IN THE INDUSTRY. THE BOARD OF DIRECTORS THEN CONSIDERS THE FINDINGS OF THE STUDY IN SETTING THE COMPENSATION. 2014 WAS THE MOST RECENT YEAR IN WHICH THE PROCESS INCLUDED REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION. COMPENSATION FOR KEY EMPLOYEES IS DETERMINED THROUGH THE USE OF SALARY STUDIES OR OTHER DATA AND ADJUSTED BASED ON THE EMPLOYEE'S YEARS OF EXPERIENCE AND RESPONSIBILITIES BY A RELATED ORGANIZATION'S BOARD OF DIRECTORS. 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: EQUITY TRANSFER 830,191. CHELSEA JEWISH LIFECARE INC 165 CAPTAINS ROW CHELSEA MA 02150 510141617 FUNDRAISING & SUPPORT MA 501(C)(3) LINE 7 N/A 0 ADMIRAL'S HILL ASSISTED LIVING CORP II 165 CAPTAINS ROW CHELSEA MA 02150 043538833 ASSISTED LIVING MA 501(C)(3) LINE 10 CHELSEA JEWISH LIFECARE INC 0 CHELSEA JEWISH GREEN HOUSE INC 165 CAPTAINS ROW CHELSEA MA 02150 043326727 NURSING HOME, HOME CARE, HOSPICE & PERSONAL CARE AGENCY MA 501(C)(3) LINE 10 CHELSEA JEWISH LIFECARE INC 0 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 NURSING HOME INC 165 CAPTAINS ROW CHELSEA MA 02150 042200583 NURSING FACILITY MA 501(C)(3) LINE 10 CHELSEA JEWISH LIFECARE INC 0 ADMIRAL'S HILL ASSISTED LIVING LP 165 CAPTAINS ROW CHELSEA MA 02150 043255842 ASSISTED LIVING MA N/A ADMIRAL'S HILL ASSISTED LIVING II LLC 165 CAPTAINS ROW CHELSEA MA 02150 043538835 ASSISTED LIVING MA N/A ASAR ELDER SERVICES INC 165 CAPTAINS ROW CHELSEA MA 02150 043289287 MANAGEMENT COMPANY FOR ANNEMARK MA N/A C 0 ADMIRAL'S HILL ASSISTED LIVING CORP 165 CAPTAINS ROW CHELSEA MA 02150 043255840 PARTNERSHIP MEMBER OF ASSISTED LIVING FACILITY MA N/A C 0 0 0 0 1 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0