MI NURSING-RESTORATIVE CENTER INC: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
MI NURSING-RESTORATIVE CENTER INC (EIN 04-2104851)
Tax period
2016-01-01 to 2016-12-31
Filed
2017-10-19
IRS object ID
201702929349300205
Schema version
2016v3.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2017-10-19T07:23:34-05:00ReturnTs
Tax Period End2016-12-31TaxPeriodEndDt
Return Type990ReturnTypeCd
Tax Period Begin2016-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN042104851EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1MI Nursing Restorative Center IncBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlMINUBusinessNameControlTxt
Phone9786856321PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1172 Lawrence StreetAddressLine1Txt
CityLawrenceCityNm
State AbbreviationMAStateAbbreviationCd
ZIP01841ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonJEANNE LEYDONPersonNm
Person TitlePRESIDENT/CEOPersonTitleTxt
Phone9786856321PhoneNum
Signature2017-10-19SignatureDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address155.212.6.161IPv4AddressTxt
FieldValueIRS element (for citing)
IP2017-10-19IPDt
IP Tm08:23:27IPTm
IP TimezoneEDIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device IdE1A65C102B06E5C9ADAF8DC78101520DB9B2CC9DAtSubmissionCreationDeviceId
At Submission Filing Device IdE1A65C102B06E5C9ADAF8DC78101520DB9B2CC9DAtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2021-01-29 14:40:06ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerJEANNE LEYDONPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1172 Lawrence StreetAddressLine1Txt
CityLawrenceCityNm
State AbbreviationMAStateAbbreviationCd
ZIP01841ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$19,880,510GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website Addressmihcs.comWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1875FormationYr
Legal Domicile StateMALegalDomicileStateCd
Activity Or MissionTHE MISSION OF MI NURSING RESTORATIVE CENTER, INC. IS TO RESPOND WITH COMPASSIONATE CARE AND DIGNITY TO THE HEALTH, SOCIAL AND SPIRITUAL NEEDS OF WELL, SICK, AND FRAIL ELDERS. MI ALSO OFFERS AND EXTENDS SUPPORTIVE PRESENCE AND PROGRAMS TO THE FAMILIES OF RESIDENTS. THE QUALITY OF OUR SERVICES ARE ACHIEVED THROUGH EMBRACING CORE VALUES THAT INCLUDE COMPASSION, COMPETENCE AND COLLABORATION.ActivityOrMissionDesc
Voting Members Governing Body14VotingMembersGoverningBodyCnt
Voting Members Independent13VotingMembersIndependentCnt
Total Employee537TotalEmployeeCnt
Total Volunteers0TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$4,771PYContributionsGrantsAmt
CY Contributions Grants$9,305CYContributionsGrantsAmt
PY Program Service Revenue$19,377,701PYProgramServiceRevenueAmt
CY Program Service Revenue$19,397,777CYProgramServiceRevenueAmt
PY Investment Income$295,640PYInvestmentIncomeAmt
CY Investment Income$363,488CYInvestmentIncomeAmt
PY Other Revenue$18,503PYOtherRevenueAmt
CY Other Revenue$95,632CYOtherRevenueAmt
PY Total Revenue$19,696,615PYTotalRevenueAmt
CY Total Revenue$19,866,202CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$12,889,110PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$13,438,654CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$5,427,599PYOtherExpensesAmt
CY Other Expenses$5,330,498CYOtherExpensesAmt
PY Total Expenses$18,316,709PYTotalExpensesAmt
CY Total Expenses$18,769,152CYTotalExpensesAmt
PY Revenues Less Expenses$1,379,906PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$1,097,050CYRevenuesLessExpensesAmt
Total Assets BOY$33,304,510TotalAssetsBOYAmt
Total Assets EOY$35,482,657TotalAssetsEOYAmt
Total Liabilities BOY$1,959,002TotalLiabilitiesBOYAmt
Total Liabilities EOY$1,941,919TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$31,345,508NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$33,540,738NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionTHE MISSION OF MI NURSING RESTORATIVE CENTER, INC. IS TO RESPOND WITH COMPASSIONATE CARE AND DIGNITY TO THE HEALTH, SOCIAL AND SPIRITUAL NEEDS OF WELL, SICK, AND FRAIL ELDERS. MI ALSO OFFERS AND EXTENDS SUPPORTIVE PRESENCE AND PROGRAMS TO THE FAMILIES OF RESIDENTS. THE QUALITY OF OUR SERVICES ARE ACHIEVED THROUGH EMBRACING CORE VALUES THAT INCLUDE COMPASSION, COMPETeNCE AND COLLABORATION.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$16,841,947ExpenseAmt
Revenue$19,493,409RevenueAmt
DescTHE PROVISION OF ELDERCARE THROUGH THE OPERATION OF A 231 BED SKILLED NURSING FACILITY, THE PROVISION OF 80,435 RESIDENT DAYS OF SKILLED NURSING CARE, REHABILIATION SERVICES, DIETARY, LAUNDRY AND HOUSEKEEPING SERVICES AND NUMEROUS SOCIAL ACTIVITIES. MEDICAID DAYS REPRESENT 66,693 OF THE 80,435 TOTAL RESIDENT DAYS.Desc
Total Program Service Expenses$16,841,947TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B Required0ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other SecYes (1)ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer EntYes (1)BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document26IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee537EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members14GoverningBodyVotingMembersCnt
Independent Voting Member13IndependentVotingMemberCnt
Family Or Business RlnYes (1)FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldMAStatesWhereCopyOfReturnIsFldCd
Other WebsiteYes (X)OtherWebsiteInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1JEANNE LEYDONBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone9786856321PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1172 LAWRENCE STREETAddressLine1Txt
CityLAWRENCECityNm
State AbbreviationMAStateAbbreviationCd
ZIP01841ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerIndAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtHighest Compensated EmployeeHighestCompensatedEmployeeInd
MARGARET SHAHEEN
CHAIRPERSON1.00Yes (X)$0$0$0
DEBORAH L TURIANOMD
VICE CHAIRPERSON1.00Yes (X)$0$0$0
KAREN MILLER
TREASURER1.00Yes (X)$0$0$0Yes (X)
KELLY SULLIVAN ESQ
CLERK1.00Yes (X)$0$0$0Yes (X)
FRED SHAHEEN
DIRECTOR1.00Yes (X)$0$0$0
GERARD J FOLEY
PRESIDENT/CEO20.00Yes (X)$241,417$0$42,093Yes (X)20.00
FR JOHN DELANEY VF
DIRECTOR1.00Yes (X)$0$0$0
ROSEMARIE A CONNOLLY
DIRECTOR1.00Yes (X)$0$0$0
ARLINE EL-ASHKAR MSN RN
DIRECTOR1.00Yes (X)$0$0$0
SR SUZANNE FORGET SGM
DIRECTOR 11/14/161.00Yes (X)$0$0$0
REV PETER GORI OSA JCD
Director1.00Yes (X)$0$0$0
MICHAEL MILLER ESQ
DIRECTOR1.00Yes (X)$0$0$0
MARY LOUISE RETELLE
DIRECTOR1.00Yes (X)$0$0$0
EFRAIN ROLON
DIRECTOR1.00Yes (X)$0$0$0
APAUL HOLLINGS
ADMINISTRATOR1.00$133,362$0$52439.00Yes (X)
JEANNE LEYDON
ADMINISTRATOR8.00$136,685$0$19,10232.00Yes (X)
NOEL SANTIAGO
CNA70.00$102,042$0$5860.00Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$613,506TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$62,305TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K4IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
REHABCARE
7733 forsyth blvd ste 2300st louisMO63105REHABILITatION SERVICES$895,447
US FOODSERVICE INC
PO BOX D 3155BOSTONMA022413155FOOD/DIETARY SUPPLIES$385,118
OMNICARE
PO BOX 78000DETROITMI482781668PHARMACEUTICALS$326,436
MCKESSON MEDICAL SURGICAL
PO BOX 630693CINCINNATIOH452630693MEDICAL SUPPLIES$282,303
SHAHEENS BROS INC
95 HAVERHILL ROADAMESBURYMA01913FOOD SERVICES$173,169
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K5CntrctRcvdGreaterThan100KCnt
All Other Contributions$9,305AllOtherContributionsAmt
Total Contributions$9,305TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescPATIENT SERVICE REVENUDesc
Business623000BusinessCd
Total Revenue Column$19,397,777TotalRevenueColumnAmt
Related Or Exempt Func Income$19,397,777RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$19,397,777TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$377,796TotalRevenueColumnAmt
Exclusion$377,796ExclusionAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Other$14,308OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Other-$14,308OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column-$14,308TotalRevenueColumnAmt
Exclusion-$14,308ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
Descmiscellaneous revenueDesc
Business623000BusinessCd
Total Revenue Column$95,632TotalRevenueColumnAmt
Related Or Exempt Func Income$95,632RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Other Revenue Total$95,632OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$19,866,202TotalRevenueColumnAmt
Related Or Exempt Func Income$19,493,409RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$363,488ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$241,417TotalAmt
Program Services$212,447ProgramServicesAmt
Management And General$28,970ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$11,084,415TotalAmt
Program Services$9,754,285ProgramServicesAmt
Management And General$1,330,130ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$73,003TotalAmt
Program Services$64,243ProgramServicesAmt
Management And General$8,760ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$1,192,309TotalAmt
Program Services$1,049,232ProgramServicesAmt
Management And General$143,077ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$847,510TotalAmt
Program Services$745,809ProgramServicesAmt
Management And General$101,701ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$239,067TotalAmt
Management And General$239,067ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$37,168TotalAmt
Management And General$37,168ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$38,332TotalAmt
Management And General$38,332ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$21,108TotalAmt
Program Services$21,108ProgramServicesAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$179,389TotalAmt
Program Services$179,389ProgramServicesAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$242,508TotalAmt
Program Services$242,508ProgramServicesAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$343,925TotalAmt
Program Services$343,925ProgramServicesAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$30,238TotalAmt
Program Services$30,238ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$601,195TotalAmt
Program Services$601,195ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$170,508TotalAmt
Program Services$170,508ProgramServicesAmt

Other Expenses OtherExpensesGrp (3 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmt
purchased services$1,723,664$1,723,664
Supplies$1,567,052$1,567,052
Medicaid User Fee$136,344$136,344

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$18,769,152TotalAmt
Program Services$16,841,947ProgramServicesAmt
Management And General$1,927,205ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$1,727,586BOYAmt
EOY$2,079,572EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$236,138BOYAmt
EOY$236,850EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$1,836,294BOYAmt
EOY$1,841,049EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$186,694BOYAmt
EOY$208,060EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$21,777,989LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$16,716,400LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$5,302,809BOYAmt
EOY$5,061,589EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$23,185,288BOYAmt
EOY$25,357,456EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$829,701BOYAmt
EOY$698,081EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$33,304,510BOYAmt
EOY$35,482,657EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$1,246,572BOYAmt
EOY$1,236,704EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$712,430BOYAmt
EOY$705,215EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$1,959,002BOYAmt
EOY$1,941,919EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$31,345,508BOYAmt
EOY$33,540,738EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$31,345,508BOYAmt
EOY$33,540,738EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$33,304,510BOYAmt
EOY$35,482,657EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$1,097,050ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$1,098,180NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit Committee0AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2Yes (X)PubliclySupportedOrg509a2Ind

Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$3,304CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$3,998CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$4,281,572CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$4,771CurrentTaxYearMinus1YearAmt
Current Tax Year$9,305CurrentTaxYearAmt
Total$4,302,950TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$19,965,465CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$19,283,914CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$19,430,361CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$19,396,204CurrentTaxYearMinus1YearAmt
Current Tax Year$19,493,409CurrentTaxYearAmt
Total$97,569,353TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$19,968,769CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$19,287,912CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$23,711,933CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$19,400,975CurrentTaxYearMinus1YearAmt
Current Tax Year$19,502,714CurrentTaxYearAmt
Total$101,872,303TotalAmt

Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Substantial Contributors Amt SubstantialContributorsAmtGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$101,872,303PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$173,627CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$202,308CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$311,045CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$295,640CurrentTaxYearMinus1YearAmt
Current Tax Year$377,796CurrentTaxYearAmt
Total$1,360,416TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$173,627CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$202,308CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$311,045CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$295,640CurrentTaxYearMinus1YearAmt
Current Tax Year$377,796CurrentTaxYearAmt
Total$1,360,416TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$20,142,396CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$19,490,220CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$24,022,978CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$19,696,615CurrentTaxYearMinus1YearAmt
Current Tax Year$19,880,510CurrentTaxYearAmt
Total$103,232,719TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.98680PublicSupportCY509Pct
Public Support PY5090.98910PublicSupportPY509Pct
Investment Income CY0.01320InvestmentIncomeCYPct
Investment Income PY0.01090InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

Schedule D IRS990ScheduleD

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$1,020BeginningYearBalanceAmt
Grants Or Scholarships$1,020GrantsOrScholarshipsAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$3,020BeginningYearBalanceAmt
Grants Or Scholarships$2,000GrantsOrScholarshipsAmt
End Year Balance$1,020EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$3,020BeginningYearBalanceAmt
End Year Balance$3,020EndYearBalanceAmt

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$104,779OtherCostOrOtherBasisAmt
Book Value$104,779BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$14,269,202OtherCostOrOtherBasisAmt
Depreciation$10,055,785DepreciationAmt
Book Value$4,213,417BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$7,404,008OtherCostOrOtherBasisAmt
Depreciation$6,660,615DepreciationAmt
Book Value$743,393BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$5,061,589TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp

FieldValueIRS element (for citing)
DescOther InvestmentsDesc
Book Value$25,357,456BookValueAmt
Method ValuationFMethodValuationCd
FieldValueIRS element (for citing)
Total Book Value Securities$25,357,456TotalBookValueSecuritiesAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)

DescDescAmtAmt
DEFERRED EXPENSES$529,776
RESIDENT FUNDS LIABILITY$62,967
PROFESSIONAL LIABILITY LOSS RESERVE$66,818
DUE TO MEDICAID$45,654
FieldValueIRS element (for citing)
Total Liability$705,215TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePart X, Line 2:FormAndLineReferenceDesc
ExplanationCovenant 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, 2016. Under Internal Revenue Service regulations, the System's tax years from 2013 through 2016 are open and subject to examination.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeYes (X)CompensationCommitteeInd
Independent ConsultantYes (X)IndependentConsultantInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsYes (1)AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (2 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
GERARD J FOLEY
PRESIDENT/CEO$201,598$0$15,819$0$24,000$0$6,753$0$35,340$0$283,510$0$0$0
JEANNE LEYDON
ADMINISTRATOR$106,406$0$9,812$0$20,467$0$3,863$0$15,239$0$155,787$0$0$0

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Part I, Line 3EVERY TWO TO THREE YEARS THE COMPENSATION COMMITTEE OF THE COVENANT HEALTH's BOARD OF DIRECTORS ENGAGES AN EXTERNAL CONSULTANT TO PROVIDE COMPETITIVE MARKETS DATA FROM VARIOUS SOURCES, WHICH IS USED TO DEVELOP RECOMMENDATIONS FOR CHANGES TO THE COMPENSATION PROGRAM. SINCE 2003, THE COMPENSATION COMMITTEE HAS ENGAGED MERCER HUMAN RESOURCES CONSULTING 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 THE ANNUAL INCENTIVE OPPORTUNITIES, IF THERE ARE ANY, ARE COMPETITIVE AND REASONABLE.
Part I, Line 7THE RELATED ORGANIZATION, COVENANT HEALTH, MAINTAINS AN INCENTIVE COMPENSATION PLAN FOR EXECUTIVES THAT IS ADMINISTERED BY THAT ORGANIZATION'S COMPENSATION COMMITTEE. THE PLAN PROVIDES EXECUTIVES WITH THE OPPORTUNITY TO EARN REASONABLE INCENTIVE COMPENSATION BASED ON THE PERFORMANCE OF THE ORGANIZATION AND THE PERFORMANCE OF THE INDIVIDUAL EXECUTIVE, AS MEASURED AGAINST GOALS ESTABLISHED AT THE BEGINNING OF THE YEAR. THE ENTITLEMENT TO AWARDS FOR A PARTICULAR YEAR IS NOT DETERMINED UNTIL EARLY THE FOLLOWING YEAR. AMOUNTS PAID UNDER THE PLAN ARE REPORTED ON SCHEDULE J, PART II, COLUMN (B)(ii).

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)

Relationship DescriptionRelationshipDescriptionTxtTransactionTransactionAmtTransactionTransactionDescSharing Of RevenuesSharingOfRevenuesInd
fred shaheen
director$173,169FOOD SUPPLIES ARE PURCHASED FROM SHAHEEN BROTHERS, INC. FRED SHAHEEN IS AN OWNER OF THE COMPANY. SHAHEEN BROTHERS, INC. IS ONE OF SEVERAL VENDORS USED BY THE ORGANIZATION AND ALL TRANSACTIONS ARE CONDUCTED AT FAIR MARKET VALUE.0
margaret shaheen
director$0MARGARET IS THE WIFE OF AN OWNER OF SHAHEEN BROTHERS, INC. SHAHEEN BROTHERS, INC. TRANSACTIONS ARE LISTED ABOVE.0

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (8 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part VI, Section A, line 2FRED SHAHEEN, director and MARGARET shaheen, director, are in laws.
Form 990, Part VI, Section A, line 6COVENANT HEALTH IS THE SOLE MEMBER OF THE ORGANIZATION. ACCORDINGLY, IT RETAINS CERTAIN RESERVE RIGHTS OVER CORPORATE DECISIONS AND BOARD COMPOSITION.
Form 990, Part VI, Section A, line 7aCOVENANT HEALTH IS THE SOLE MEMBER OF THE ORGANIZATION. aS SUCH IT RETAINS CERTAIN RESERVE RIGHTS OVER CORPORATE DECISIONS AND BOARD COMPOSITION.
Form 990, Part VI, Section A, line 7bCOVENANT HEALTH IS THE SOLE MEMBER OF THE ORGANIZATION. aCCORDINGLY IT RETAINS CERTAIN RESERVE RIGHTS OVER CORPORATE DECISIONS AND BOARD COMPOSITION.
Form 990, Part VI, Section B, line 11bFORM 990 IS PROVIDED TO THE BOARD MEMBERS AND REVIEWED AT THAT TIME.
Form 990, Part VI, Section B, line 12cTHIS PROCESS IS THE RESPONSIBILITY OF THE COMPLIANCE OFFICER. A FORM IS SUBMITTED TO ALL LEADERSHIP, BOARD MEMBERS, BOARD COMMITTEE MEMBERS, EMPLOYED PHYSICIANS, MEDICAL DIRECTORS AND CERTAIN EMPLOYEES IN KEY POSITIONS ANNUALLY TO BE COMPLETED. REMINDERS ARE SENT OUT TO MAKE CERTAIN THAT ALL CONFLICT OF INTEREST FORMS ARE RETURNED.
Form 990, Part VI, Section B, line 15EVERy TWO TO THREE YEARS THE COMPENSATION COMMITTEE OF THE COVENANT HEALTH 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 MERCER HUMAN RESOURCES CONSULTING 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 C, line 19THE ORGANIZATION PROVIDES FORM 990 AND ACCESS TO GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS UPON REQUEST. THE FORM 990 IS POSTED ON COVENANT HEALTH'S WEBSITE ALSO.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (8 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationInd
MI RESIDENTIAL COMMUNITY III INC
193 MAPLE STLAWRENCEMA01841042686043PROVIDER OF LOW INCOME HOUSING (HUD) TO ELDERLY AND disABLED RESIDENTSMA501 (C) (3)Line 10COVENANT HEALTH0
MI TRANSPORTATION INC
189 MAPLE STLAWRENCEMA01841042921889PROVIDER OF TRANSPORTATION SERVICES TO ELDERLY, SICK AND DisABLEd RESIDENTSMA501 (C) (3)Line 10COVENANT HEALTH0
COVENANT HEALTH INC
100 AMES POND SUITE 102TEWKSBURYMA01876222484505HEALTHCARE MANAGEMENT AND RESOURCE ORGANIZATIONMA501 (C) (3)Line 100
MI MANAGEMENT INC
172 LAWRENCE sTLAWRENCEMA01841042857794PROVIDER OF ASSISTED LIVING SERVICES TO THE ELDERLYMA501 (C) (3)Line 12a, ICOVENANT HEALTH0
MI ADULT DAY HEALTH CARE CENTER INC
189 MAPLE STLAWRENCEMA01841042921888ADULT DAY CARE FOR ELDERLY, SICK AND HANDICAPPEDMA501 (C) (3)Line 10COVENANT HEALTH0
MI RESIDENTIAL COMMUNITY II INC
191 MAPLE STLAWRENCEMA01841042679954PROVIDER OF LOW INCOME HOUSING (HUD) TO ELDERLY AND DISABLED RESIDENTSMA501 (C) (3)Line 10COVENANT HEALTH0
MI RESIDENTIAL COMMUNITY INC
189 MAPLE STLAWRENCEMA01841042647207PROVIDER OF ASSISTED LIVING SERVICES TO THE ELDERLYMA501 (C) (3)Line 10COVENANT HEALTH0
Mary immaculate guild inc
172 LAWRENCE sTlAWRENCEMA01841463073987provider of services to MI and affiliated organizationsMA501 (C) (3)Line 12a, IMI nursing restorative center incYes (1)
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (1)PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees Sharing0PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp

Other Organization Name OtherOrganizationName

FieldValueIRS element (for citing)
Business Name Line1MI Guild IncBusinessNameLine1Txt
FieldValueIRS element (for citing)
Transaction TypePTransactionTypeTxt
Involved$6,860InvolvedAmt
Method Of Amount DeterminationcashMethodOfAmountDeterminationTxt

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