2017-07-26T13:56:31-05:00 2016-12-31 410746749 CLIFTONLARSONALLEN LLP 300 CROWN COLONY DRIVE SUITE 310 QUINCY MA 02169 990 2016-01-01 043455405 ALLIANCE HEALTH OF BROCKTON INC ALLI 6173323366 134 RUMFORD AVENUE NO 306 NEWTON MA 02466 PAUL KEMP TREASURER & CFO 6173323366 2017-07-12 1 JUDY DALEY P01294075 6179848100 2017-07-12 67.137.57.251 2017-07-12 15:33:12 ED P 7D3B43D73E5FFEB45C47E4D6E75F3D8DFD573443 3905FB583EB2AC04B8E06D147EE1A9B7E683F127 2016 2021-01-29 14:40:06Z FRANCIS J GRADY 134 RUMFORD AVENUE NO 306 NEWTON MA 02466 10555198 0 X WWW.ALLIANCEHHS.ORG X 1999 MA THE COMPANY SHALL PROMOTE AND PROVIDE SAFE, HEALTHY, QUALITY SERVICES AND LIVING ENVIRONMENTS FOR THE ELDERS WHO CANNOT CARE FOR THEMSELVES. 10 9 259 9 0 0 0 0 10662862 10545193 397 540 35407 9465 10698666 10555198 0 0 0 0 6363001 6032340 0 0 0 4526371 4440515 10889372 10472855 -190706 82343 6879180 9286756 7723608 9870026 -844428 -583270 THE COMPANY SHALL PROMOTE AND PROVIDE SAFE, HEALTHY, QUALITY SERVICES AND LIVING ENVIRONMENTS FOR THE ELDERS WHO CANNOT CARE FOR THEMSELVES. 0 0 9244757 10554658 OUR SKILLED NURSING AND REHABILITATION FACILITY PROVIDES A WIDE RANGE OF MEDICAL AND REHABILITATIVE SERVICES, INCLUDING POST ACUTE CARE, SHORT-TERM REHABILITATION, RESPITE CARE, HOSPICE CARE, AND LONG-TERM CARE. WORKING DIRECTLY WITH EACH RESIDENT AND THEIR FAMILY MEMBERS, OUR STAFF WILL CUSTOMIZE A COMPREHENSIVE PLAN OF CARE DESIGNED TO TREAT MEDICAL COMPLICATIONS AND ACHIEVE FUNCTIONAL INDEPENDENCE. OUR FACILITY PROVIDES THE HIGHEST STANDARDS OF CARE AND RESIDENTS ENJOY AN ACTIVE AND FULFILLING LIFESTYLE IN AN ATMOSPHERE OF WARMTH, RESPECT AND UNDERSTANDING. 9244757 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 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 27 0 259 1 0 0 0 0 0 0 0 0 0 0 X 10 9 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X ALLIANCE HEALTH MANAGEMENT SERVICES LLC 7743482000 153 CORDAVILLE ROAD SUITE 320 SOUTHBOROUGH MA 01772 FRANCIS J GRADY PRESIDENT & DIRECTOR 1.00 40.00 X X 0 315776 24793 MICHAEL O JENNINGS ESQ CHAIRMAN 1.00 1.00 X 0 0 0 REV JEROME J JANISKO DIRECTOR 1.00 1.00 X 0 0 0 WILLIAM P MCDERMOTT ESQ DIRECTOR 1.00 1.00 X 0 0 0 CHRISTOPHER ROBBINS DIRECTOR 1.00 1.00 X 0 0 0 JAMES BRUCE RILEY CPA DIRECTOR 1.00 1.00 X 0 0 0 LINDA CORRIDAN RN DIRECTOR 1.00 1.00 X 0 0 0 ARTHUR MOURTZINOS MD DIRECTOR 1.00 1.00 X 0 0 0 JANICE HOCKENSMITH DIRECTOR 1.00 1.00 X 0 0 0 PETE ZAMPINE DIRECTOR 1.00 1.00 X 0 0 0 PAUL KEMP TREASURER & CFO 1.00 40.00 X 0 288899 25499 THOMAS LAVALLEE CLERK & COO 1.00 40.00 X 0 248437 25720 MICHAEL DODOS CONTROLLER 1.00 40.00 X 0 220476 250 RICHARD CANTY VICE PRESIDENT 1.00 40.00 X 0 169224 27753 DORIS DAVILA VICE PRESIDENT 1.00 40.00 X 0 172041 1314 DAN MITCHELL EXECUTIVE DIRECTOR 40.00 0.00 X 0 158680 25613 LAURA JANKOWSKI DIRECTOR OF NURSING 40.00 0.00 X 112440 0 8602 JACQUELINE SCOTT REHAB MANAGER 40.00 0.00 X 106325 0 8106 MARY A MCCARTHY PRESIDENT & DIRECTOR, FORMER 1.00 20.00 X 0 630020 104 218765 2203553 147754 2 1 1 0 PERFORMANCE HEALTHCARE SERVICES INC 47R RIVER STREET WELLESLEY MA 02481 HOUSEKEEPING & LAUNDRY SERVICE 312000 CUTLER ASSOCIATES INC 43 HARVARD STREET WORCESTER MA 01609 ARCHITECTS 136500 2 PATIENT SERVICE REVENUE 623000 10545193 10545193 10545193 540 540 OTHER INCOME 623000 9465 9465 9465 10555198 10554658 0 540 5245586 5030725 214861 9548 9158 390 372637 363385 9252 404569 386789 17780 484032 484032 9508 9508 24000 24000 615874 424415 191459 15325 15325 82047 1525 80522 322646 322646 3682 3682 1509 1509 397308 397308 419105 419105 116243 116243 STATE ASSESSMENT FEE 628003 628003 ANCILLARY EXPENSES 422331 422331 FOOD 263314 263314 NURSING SUPPLIES AND EX 225302 225302 410286 234508 175778 10472855 9244757 1228098 0 813050 1475377 1066332 1589682 80136 35427 8464800 5035142 3715215 3429658 1204447 2756612 6879180 9286756 1011114 1097126 34039 8437 6650000 8721169 28455 43294 7723608 9870026 X -844428 -583270 -844428 -583270 6879180 9286756 X 82343 -1 178816 X X 0 1 X 1 0 X 10926245 11177808 11090462 10662862 10545193 54402570 10926245 11177808 11090462 10662862 10545193 54402570 0 0 0 54402570 37105 46633 28219 397 540 112894 37105 46633 28219 397 540 112894 6571 35407 9465 51443 10963350 11224441 11125252 10698666 10555198 54566907 0.99700 0.99680 0.00210 0.00250 X SCHEDULE A, PART III, SECTION B, LINE 12: MISCELLANEOUS OTHER PROGRAM INCOME - $9,465. 300000 300000 6321000 3640362 2680638 258305 108872 149433 1585495 1285908 299587 3429658 DEPOSITS 21161 GOODWILL, NET 907350 DEFERRED FINANCE COSTS, NET 279731 CONSTRUCTION IN PROGRESS 758781 DUE FROM AFFILIATE 19260 SOFTWARE, NET 6669 PROJECT FUNDS 763660 2756612 PAYROLL TAXES PAYABLE 43294 43294 X 10555198 0 10555198 0 10555198 10472855 0 10472855 0 10472855 PART X, LINE 2: THE ORGANIZATION IS A NONPROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC) AND IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE IRC. THE ORGANIZATION FILES AS A TAX-EXEMPT ORGANIZATION. SHOULD THAT STATUS BE CHALLENGED IN THE FUTURE, THE ORGANIZATION'S RETURNS ARE OPEN FOR EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES FOR THREE YEARS AFTER FILING. 0 1 0 0 0 0 0 0 0 FRANCIS J GRADY PRESIDENT & DIRECTOR 0 285129 0 28000 0 2647 0 0 0 24793 0 340569 0 0 PAUL KEMP TREASURER & CFO 0 245133 0 42000 0 1766 0 0 0 25499 0 314398 0 0 THOMAS LAVALLEE CLERK & COO 0 208077 0 38500 0 1860 0 0 0 25720 0 274157 0 0 MICHAEL DODOS CONTROLLER 0 179807 0 28265 0 12404 0 0 0 250 0 220726 0 0 RICHARD CANTY VICE PRESIDENT 0 155764 0 12000 0 1460 0 0 0 27753 0 196977 0 0 DORIS DAVILA VICE PRESIDENT 0 160441 0 10000 0 1600 0 0 0 1314 0 173355 0 0 DAN MITCHELL EXECUTIVE DIRECTOR 0 142308 0 15000 0 1372 0 0 0 25613 0 184293 0 0 MARY A MCCARTHY PRESIDENT & DIRECTOR, FORMER 0 209559 0 24000 0 396461 0 0 0 104 0 630124 0 378804 PART I, LINE 3 THE COMPENSATION OF THE CEO IS DETERMINED AND PAID OUT BY A RELATED ORGANIZATION, ALLIANCE HEALTH, INC. ALLIANCE HEALTH, INC.'S BOARD SHALL CONDUCT A PERFORMANCE EVALUATION OF THE CHIEF EXECUTIVE OFFICER OF THE COMPANY ON AN ANNUAL BASIS. SUCH EVALUATION SHALL BE USED AS THE BASIS FOR DETERMINING COMPENSATION AND SHALL INCLUDE AN ASSESSMENT OF COMPANY GOALS AND PERFORMANCE. THE BOARD WILL REVIEW YEAR OVER YEAR PERFORMANCE AND EVALUATE COMPANY RESULTS WITH RESPECT TO FINANCIAL PERFORMANCE, ATTAINMENT OF GOALS, PROGRAM AND OPERATIONAL QUALITY AND GOVERNANCE. THE BOARD WILL ALSO CONSIDER ORGANIZATIONAL STRENGTH AND DEVELOPMENT AND BOARD-CEO RELATIONSHIP MANAGEMENT. IN MAKING A COMPENSATION DETERMINATION, THE BOARD SHALL CONSIDER CURRENT INDEPENDENT MARKET ASSESSMENT OF AND RELIABLE DATA FROM COMPARABLE ORGANIZATIONS. THE BOARD MAY FROM TIME TO TIME SPECIFICALLY ENGAGE THIRD PARTY PROFESSIONALS TO CONDUCT COMPENSATION STUDIES OR TO REVIEW AND ASSESS CURRENT PRACTICES WHEN DEEMED USEFUL TO KEEP ITS KNOWLEDGE AND INFORMATION CURRENT. ALL EXTERNAL STUDIES WILL FOLLOW THE IRS GUIDELINES FOR DETERMINING "EXCESS BENEFIT". THE BOARD SHALL APPOINT A COMPENSATION COMMITTEE WHO WILL BE RESPONSIBLE FOR LEADING THE COMPENSATION AND EVALUATION PROCESS. THE COMMITTEE WILL REPORT ITS RECOMMENDATIONS TO THE BOARD, WHICH WILL PARTICIPATE IN FULL IN THE DECISION MAKING. PART I, LINE 4B MARY A. MCCARTHY, FORMER PRESIDENT & DIRECTOR, PARTICIPATED IN A DEFERRED COMPENSATION PLAN IN PRIOR YEARS OF WHICH $378,804 WAS PAID OUT IN 2016. THIS DEFERRED COMPENSATION OF $378,804 IS REPORTED ON FORM 990, SCH.J, PART II, IN COL.B(III) AND COL.F. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION DELEGATED CONTROL OVER MANAGEMENT AND FINANCIAL DUTIES TO A RELATED ORGANIZATION, ALLIANCE HEALTH MANAGEMENT SERVICES, LLC. THE MANAGEMENT COMPANY IS A NON-PROFIT SUPPORTING ORGANIZATION WHICH ENGAGES IN THE BUSINESS OF PLANNING, DEVELOPING, CONSTRUCTING, OWNING, AND MANAGING NON-PROFIT ORGANIZATIONS WHICH PROVIDE SERVICES THAT RANGE FROM POST ACUTE CARE FACILITIES, SKILLED NURSING FACILITIES TO ASSISTED LIVING COMMUNITIES. ALLIANCE HEALTH MANAGEMENT SERVICES, LLC IS LOCATED AT 153 CORDAVILLE ROAD, SUITE 320, SOUTHBOROUGH, MA 01772. FORM 990, PART VI, SECTION B, LINE 11B THE AUDIT COMMITTEE SHALL REVIEW AND APPROVE THE IRS FORM 990 ANNUAL TAX FILINGS PRIOR TO SUBMISSION, AND THE BOARD SHALL RECEIVE A COPY AND REVIEW THE IRS FORM 990 TAX FILINGS WITHIN 30 DAYS LEADING UP TO ITS SUBMISSION. FORM 990, PART VI, SECTION B, LINE 12C EACH DIRECTOR MUST PROVIDE THE BOARD OF DIRECTORS WITH AN ANNUAL WRITTEN DISCLOSURE OF THE FOLLOWING: (I) THE DIRECTOR'S BUSINESS INVOLVEMENTS WITH THE ORGANIZATION AND RELATED ORGANIZATIONS; (II) THE DIRECTOR'S OTHER BOARD MEMBERSHIPS, WHETHER OF FOR-PROFIT OR NON-PROFIT CORPORATIONS; AND (III) THE TOTAL AMOUNT RECEIVED BY THE DIRECTOR FROM THE ORGANIZATION AND RELATED ORGANIZATIONS FOR SERVICES RENDERED AS A VENDOR OF GOODS OR SERVICES TO THE RELATED ORGANIZATIONS. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD SHALL CONDUCT A PERFORMANCE EVALUATION OF THE CHIEF EXECUTIVE OFFICER OF THE COMPANY ON AN ANNUAL BASIS. SUCH EVALUATION SHALL BE USED AS THE BASIS FOR DETERMINING COMPENSATION AND SHALL INCLUDE AN ASSESSMENT OF COMPANY GOALS AND PERFORMANCE. THE BOARD WILL REVIEW YEAR OVER YEAR PERFORMANCE AND EVALUATE COMPANY RESULTS WITH RESPECT TO FINANCIAL PERFORMANCE, ATTAINMENT OF GOALS, PROGRAM AND OPERATIONAL QUALITY AND GOVERNANCE. THE BOARD WILL ALSO CONSIDER ORGANIZATIONAL STRENGTH AND DEVELOPMENT AND BOARD-CEO RELATIONSHIP MANAGEMENT. IN MAKING A COMPENSATION DETERMINATION, THE BOARD SHALL CONSIDER CURRENT INDEPENDENT MARKET ASSESSMENT OF AND RELIABLE DATA FROM COMPARABLE ORGANIZATIONS. THE BOARD MAY FROM TIME TO TIME SPECIFICALLY ENGAGE THIRD PARTY PROFESSIONALS TO CONDUCT COMPENSATION STUDIES OR TO REVIEW AND ASSESS CURRENT PRACTICES WHEN DEEMED USEFUL TO KEEP ITS KNOWLEDGE AND INFORMATION CURRENT. ALL EXTERNAL STUDIES WILL FOLLOW THE IRS GUIDELINES FOR DETERMINING "EXCESS BENEFIT". THE BOARD SHALL APPOINT A COMPENSATION COMMITTEE WHO WILL BE RESPONSIBLE FOR LEADING THE COMPENSATION AND EVALUATION PROCESS. THE COMMITTEE WILL REPORT ITS RECOMMENDATIONS TO THE BOARD, WHICH WILL PARTICIPATE IN FULL IN THE DECISION MAKING. THE CEO SHALL CONDUCT A PERFORMANCE EVALUATION OF THE CHIEF FINANCIAL OFFICER OF THE COMPANY ON AN ANNUAL BASIS. SUCH EVALUATION SHALL BE USED AS THE BASIS FOR DETERMINING COMPENSATION AND SHALL INCLUDE AN ASSESSMENT OF COMPANY GOALS AND PERFORMANCE. THE CEO WILL REVIEW YEAR OVER YEAR PERFORMANCE AND EVALUATE COMPANY RESULTS WITH RESPECT TO FINANCIAL PERFORMANCE, ATTAINMENT OF GOALS, PROGRAM AND OPERATIONAL QUALITY AND GOVERNANCE. IN MAKING A COMPENSATION DETERMINATION, THE CEO SHALL CONSIDER CURRENT INDEPENDENT MARKET ASSESSMENT OF AND RELIABLE DATA FROM COMPARABLE ORGANIZATIONS. THE CEO WILL ADVISE THE BOARD OF THE DECISION MADE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENT 279,731. LOSS ON REFINANCING -100,915. FORM 990, PART XII, LINE 2C: THE ORGANIZATION DID NOT CHANGE EITHER ITS OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE YEAR. ALLIANCE HEALTH INC 134 RUMFORD AVENUE SUITE 306 NEWTON MA 02466 043468274 SUPPORTING ORGANIZATON MA 501(C)(3) LINE 12A, I 0 ALLIANCE HEALTH MANAGEMENT SERVICES LLC 134 RUMFORD AVENUE SUITE 306 NEWTON MA 02466 364639819 SUPPORTING ORGANIZATON MA 501(C)(3) LINE 12B, II ALLIANCE HEALTH INC 0 ALLIANCE HEALTH OF BRAINTREE INC 134 RUMFORD AVENUE SUITE 306 NEWTON MA 02466 651310230 SKILLED NURSING CORPORATION MA 501(C)(3) LINE 10 ALLIANCE HEALTH INC 0 ALLIANCE HEALTH OF CENTERVILLE INC 134 RUMFORD AVENUE SUITE 306 NEWTON MA 02466 800249886 SKILLED NURSING CORPORATION MA 501(C)(3) LINE 10 ALLIANCE HEALTH INC 0 ALLIANCE HEALTH OF DANVERS INC 134 RUMFORD AVENUE SUITE 306 NEWTON MA 02466 800249854 SKILLED NURSING CORPORATION MA 501(C)(3) LINE 10 ALLIANCE HEALTH INC 0 ALLIANCE HEALTH OF EAST PROVIDENCE INC 134 RUMFORD AVENUE SUITE 306 NEWTON MA 02466 800249896 SKILLED NURSING CORPORATION MA 501(C)(3) LINE 10 ALLIANCE HEALTH INC 0 ALLIANCE HEALTH OF LOWELL INC 134 RUMFORD AVENUE SUITE 306 NEWTON MA 02466 800249859 SKILLED NURSING CORPORATION MA 501(C)(3) LINE 10 ALLIANCE HEALTH INC 0 ALLIANCE HEALTH OF MASSACHUSETTS INC 134 RUMFORD AVENUE SUITE 306 NEWTON MA 02466 311712039 SKILLED NURSING CORPORATION MA 501(C)(3) LINE 10 ALLIANCE HEALTH INC 0 ALLIANCE HEALTH OF PLYMOUTH INC 134 RUMFORD AVENUE SUITE 306 NEWTON MA 02466 800249891 SKILLED NURSING CORPORATION MA 501(C)(3) LINE 10 ALLIANCE HEALTH INC 0 ALLIANCE HEALTH OF PROVIDENCE INC 134 RUMFORD AVENUE SUITE 306 NEWTON MA 02466 800249901 SKILLED NURSING CORPORATION MA 501(C)(3) LINE 10 ALLIANCE HEALTH INC 0 ALLIANCE HEALTH OF QUINCY INC 134 RUMFORD AVENUE SUITE 306 NEWTON MA 02466 043468149 SKILLED NURSING CORPORATION MA 501(C)(3) LINE 10 ALLIANCE HEALTH INC 0 ALLIANCE HEALTH OF SANDWICH INC 134 RUMFORD AVENUE SUITE 306 NEWTON MA 02466 800249868 SKILLED NURSING CORPORATION MA 501(C)(3) LINE 10 ALLIANCE HEALTH INC 0 ALLIANCE HEALTH OF SOUTHBRIDGE INC 134 RUMFORD AVENUE SUITE 306 NEWTON MA 02466 800249840 SKILLED NURSING CORPORATION MA 501(C)(3) LINE 10 ALLIANCE HEALTH INC 0 ALLIANCE HEALTH OF SOUTHEASTERN MASSACHUSETTS INC 134 RUMFORD AVENUE SUITE 306 NEWTON MA 02466 043582078 SKILLED NURSING CORPORATION MA 501(C)(3) LINE 10 ALLIANCE HEALTH INC 0 ALLIANCE HEALTH OF WORCESTER INC 134 RUMFORD AVENUE SUITE 306 NEWTON MA 02466 800249850 SKILLED NURSING CORPORATION MA 501(C)(3) LINE 10 ALLIANCE HEALTH INC 0 ALLIANCE HUMAN SERVICES INC 134 RUMFORD AVENUE SUITE 306 NEWTON MA 02466 043476887 FOSTER CARE CORPORATION MA 501(C)(3) LINE 10 ALLIANCE HEALTH INC 0 ALLIANCE OF THE CHESAPEAKE BAY INC 134 RUMFORD AVENUE SUITE 306 NEWTON MA 02466 010672105 FOSTER CARE CORPORATION MA 501(C)(3) LINE 10 ALLIANCE HEALTH INC 0 ALLIANCE SPECIALITY HOSPITAL INC 134 RUMFORD AVENUE SUITE 306 NEWTON MA 02466 800249832 HOSPITAL CORPORATION MA 501(C)(3) LINE 3 ALLIANCE HEALTH INC 0 DEPOT POND VILLAGE INC 134 RUMFORD AVENUE SUITE 306 NEWTON MA 02466 203883388 RESIDENTIAL FACILITY FOR ELDERLY MA 501(C)(3) LINE 10 ALLIANCE HEALTH INC 0 THE HOSPITAL COTTAGES FOR CHILDREN 134 RUMFORD AVENUE SUITE 306 NEWTON MA 02466 042104323 SKILLED NURSING CORPORATION MA 501(C)(3) LINE 10 ALLIANCE HEALTH INC 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0