2017-06-05T11:03:13-05:00 2016-09-30 061009205 BLUM SHAPIRO & COMPANY PC CPA'S 29 S MAIN STREET PO BOX 272000 WEST HARTFORD CT 061272000 990 2015-10-01 061241982 SAINT JOSEPH'S LIVING CENTER INC SAIN 8604561107 14 CLUB ROAD WINDHAM CT 062801000 LAURA NELSON ADMINISTRATOR 8604561107 2017-06-01 1 ELIZABETH SOLECKI P00235171 8605614000 2017-05-22 2015 2021-01-29 14:40:06Z LAURA NELSON 14 CLUB ROAD WINDHAM CT 06280 11387050 0 X N/A X 1987 CT LONG-TERM SKILLED NURSING CARE AND REHABILITATION SERVICES. 12 11 249 68 0 0 107210 108664 11222588 11253456 9868 8655 1920 15979 11341586 11386754 0 0 0 0 8274785 8012811 0 0 0 3672611 3610446 11947396 11623257 -605810 -236503 8967345 7115340 6204418 4781977 2762927 2333363 SAINT JOSEPH'S LIVING CENTER WAS ORGANIZED FOR THE PURPOSE OF PROVIDING LONG-TERM SKILLED NURSING CARE AND REHABILITATION SERVICES TO ITS RESIDENTS AND PATIENTS. 0 0 9656747 11253456 THE ORGANIZATION PROVIDED LONG-TERM SKILLED NURSING CARE AND REHABILITATION SERVICE TO 320 RESIDENTS AND PATIENTS DURING THE YEAR ENDED SEPTEMBER 30, 2016. 9656747 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 0 1 0 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 38 0 1 249 1 0 0 0 0 0 0 0 0 0 0 X 12 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X JOY GILL 8604561107 14 CLUB ROAD WINDHAM CT 06280 REV LAURENCE AM LAPOINTE CHAIRMAN 3.00 X X 0 0 0 SR M JACINTA ANDERSON RN DIRECTOR 0.50 X 0 0 0 BRUCE DOUGHERTY DDS DIRECTOR 0.50 X 0 0 0 MR DONALD DUBIEL SECRETARY 2.00 X X 0 0 0 MR JAMES DUFFY DIRECTOR 0.50 X 0 0 0 MS LORRAINE BROWN GALLUP DIRECTOR 2.00 X 0 0 0 MR THEODORE HINTZ SR TREASURER 2.00 X X 0 0 0 MS SUSAN LESTER HUMES DIRECTOR 0.50 X 0 0 0 MR TIMOTHY KILLEEN VICE CHAIR 2.00 X X 0 0 0 DR EDWARD SAWICKI DIRECTOR 0.50 X 0 0 0 MRS CLAIRE SHEA DIRECTOR 0.50 X 0 0 0 MRS ANNE TUCKER DIRECTOR 0.50 X 0 0 0 GERALYN HINES-IVERSON ADMINISTRATOR 40.00 X 141595 0 15001 JOY M GILL CFO 40.00 X 119794 0 4824 PATRICIA DUFFY DIRECTOR OF NURSING SERVICE 40.00 X 111499 0 27696 PAULA M HANEY DIRECTOR OF REHABILITATION 40.00 X 117267 0 14149 490155 0 61670 4 0 1 0 0 108664 108664 MEDICARE/MEDICAID PAYMENTS 623000 8199444 8199444 PATIENT SERVICE FEES 623000 3054012 3054012 11253456 8451 8451 500 296 204 204 204 MISCELLANEOUS REVENUE 900099 15979 15979 15979 11386754 11253456 0 24634 295886 295886 144847 144847 5864387 5327139 537248 138399 125334 13065 1088725 992479 96246 480567 439316 41251 18575 18575 40296 40296 54018 54018 38887 38887 652360 554493 97867 77129 70508 6621 4687 4687 120699 110338 10361 588183 537694 50489 202007 202007 PROVIDER TAX 661352 661352 CONTRACTED SERVICES 478952 478952 EQUIPMENT RENTAL & MAIN 307881 281453 26428 FOOD 298308 298308 67112 67112 11623257 9656747 1966510 0 2590127 1844350 239192 309887 1006563 870300 82131 70686 87390 92878 14327673 10480472 4347588 3847201 438161 0 176193 80038 8967345 7115340 1851852 1687358 44692 97026 4150000 2822000 157874 175593 6204418 4781977 X 2653480 2220887 109447 112476 2762927 2333363 8967345 7115340 X -236503 -193061 X 0 1 X 1 0 X 24964 20228 26293 107210 108664 287359 11483987 12027034 11848835 11222588 11253456 57835900 11508951 12047262 11875128 11329798 11362120 58123259 0 0 0 58123259 5474 4869 7361 9868 8451 36023 5474 4869 7361 9868 8451 36023 5178 4502 5937 1920 15979 33516 11519603 12056633 11888426 11341586 11386550 58192798 0.99880 0.99730 0.00060 0.00060 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 109447 9252 6223 112476 62639 60120 13312 109447 59487 17770 14618 62639 51803 16585 8901 59487 45663 19622 13482 51803 0.00000 0.00000 1.00000 0 0 1220000 1220000 10273928 8429478 1844450 2635803 2050994 584809 197942 197942 3847201 CAPITAL LEASE PAYABLE 6928 INTEREST RATE SWAP OBLIGATION 168665 175593 11151377 -235173 -235173 11386550 204 204 11386754 11580942 -204 -204 11581146 42111 42111 11623257 PART V, LINE 4: THE TERM ENDOWMENT FUNDS ARE COMPRISED OF DONATIONS THAT HAVE DONOR IMPOSED DESIGNATIONS ON THEIR INTENDED USE FROM THE DONOR. THESE DESIGNATIONS ARE COMPRISED OF HOSPICE SUITE DONATIONS, CHAPEL SERVICES, RECREATIONAL PROGRAMS AND COURTYARD UPKEEP. PART XI, LINE 2D - OTHER ADJUSTMENTS: LOSS ON DEBT REFINANCING -159,675. UNREALIZED LOSS ON INTEREST RATE SWAP -33,387. BAD DEBT EXPENSE -42,111. PART XI, LINE 4B - OTHER ADJUSTMENTS: RECLASSIFICATION OF LOSS ON FIXED ASSET DISPOSAL 204. PART XII, LINE 2D - OTHER ADJUSTMENTS: RECLASSIFICATION OF LOSS ON FIXED ASSET DISPOSAL -204. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 42,111. X X 0 0 0 0 0 0 0 0 0 GERALYN HINES-IVERSON ADMINISTRATOR 141595 0 0 0 0 0 4956 0 10045 0 156596 0 0 0 A CONNECTICUT HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 060806186 2016-06-15 2840000 2013 SERIES B REVENUE BONDS REISSUANCE 0 0 0 A 2840000 2840000 2016 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 1 1 KEY BANK 7.291666700000 0 0 0 0 1 A 1 PART II, LINE 11 - OTHER SPENT PROCEEDS: OHTER SPENT PROCEEDS WERE USED TO REFUND A PRIOR ISSUE. PATRICIA DUFFY SPOUSE OF BOARD MEMBER 118371 EMPLOYMENT 0 FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS REVIEWED BY THE ADMINISTRATOR AND THE CHIEF FINANCIAL OFFICER PRIOR TO REVIEW BY THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 12C ANNUAL CONFLICTS OF INTEREST STATEMENTS ARE REVIEWED BY THE ADMINISTRATIVE ASSISTANT AND THE ADMINISTRATOR. NONCOMPLIANCE ISSUES ARE REFERRED TO THE CHAIRMAN OF THE BOARD BY THE ADMINISTRATOR. FORM 990, PART VI, SECTION B, LINE 15A AN EVALUATION OF THE ADMINISTRATOR IS CONDUCTED BY THE EXECUTIVE COMMITTEE, WHICH IS COMPRISED OF MEMBERS INDEPENDENT OF THE ORGANIZATION. COMPARABLE COMPENSATION DATA IS UTILIZED FROM THE LEADING AGE ANNUAL SALARY SURVEY. COMPENSATION DECISIONS VOTED ON BY THE EXECUTIVE COMMITTEE ARE MADE BASED ON THE OUTCOME OF THIS PROCESS, AS WELL AS FACILITY FINANCIAL PERFORMANCE. THE DELIBERATION AND DECISION PROCESS IS DOCUMENTED. FORM 990, PART VI, SECTION C, LINE 19 ANY INQUIRIES REGARDING GOVERNING DOCUMENTS WILL BE REFERRED TO THE ADMINISTRATOR AND MADE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: LOSS ON THE REFINANCING OF DEBT -159,675. UNREALIZED LOSS ON INTEREST RATE SWAP -33,387. ROUNDING 1. NORWICH ROMAN CATHOLIC DIOCESAN CORP 213 BROADWAY NORWICH CT 06360 CHURCH SVCS CT 501(C)3 1 N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0