CHS OF WORCESTER INC: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
CHS OF WORCESTER INC (EIN 04-3419625)
Tax period
2016-01-01 to 2016-12-31
Filed
2017-10-19
IRS object ID
201722929349300507
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)
Return2017-10-19T08:06:03-05:00ReturnTs
Tax Period End2016-12-31TaxPeriodEndDt
Return Type990ReturnTypeCd
Tax Period Begin2016-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN043419625EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1CHS of Worcester IncBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlCHSOBusinessNameControlTxt
Phone5087534375PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1100 Ames Pond DriveAddressLine1Txt
CityTewksburyCityNm
State AbbreviationMAStateAbbreviationCd
ZIP01876ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonSusan DowneyPersonNm
Person TitleAdministratorPersonTitleTxt
Phone9786546363PhoneNum
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 Tm09:05:56IPTm
IP TimezoneEDIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device Id7EA5F91826FDEC39AFBB39687538FEB01BFA2691AtSubmissionCreationDeviceId
At Submission Filing Device IdE1A65C102B06E5C9ADAF8DC78101520DB9B2CC9DAtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2021-01-29 14:40:06ZBuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1STMARY HEALTH CARE CENTERBusinessNameLine1Txt
FieldValueIRS element (for citing)
Principal OfficerSusan DowneyPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1100 Ames Pond DriveAddressLine1Txt
CityTewksburyCityNm
State AbbreviationMAStateAbbreviationCd
ZIP01876ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$8,572,152GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Group Exemption0928GroupExemptionNum
Organization501c3Yes (X)Organization501c3Ind
Website Addresscovenanths.orgWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1998FormationYr
Legal Domicile StateMALegalDomicileStateCd
Activity Or MissionST. MARY HEALTH CARE CENTER, A CATHOLIC REHABILITATION AND SKILLED NURSING FACILITY, WAS ESTABLISHED AS A CONTINUING EXPRESSION OF THE VISION OF ST. MARGUERITE D'YOUVILLE, FOUNDRESS OF THE SISTERS OF CHARITY OF MONTREAL, THE "GREY NUNS". IN THE SPIRIT OF MARGUERITE, WHOSE LEGACY WE SHARE, WE SEEK TO "BRING THE MIRACLE OF LOVE TO ALL" THROUGH COMPASSIONATE CARE. ST MARY HEALTH CARE DESIRES, IN PARTNERSHIP WITH OTHERS COMMITTED TO PROVIDING HOLISITC AND INCLUSIVE CARE FOR ALL, TO DEVELOP INNOVATIVE AND CREATIVE MEANS TO ENHANCE THE PHYSICAL, EMOTIONAL, SOCIAL AND SPIRITUAL WELL-BEING OF THOSE WE SERVE. DURING 2016 THE ORGANIZATION PROVIDED 39,392 DAYS OF SERVICE OF WHICH 36,819 WERE PROVIDED TO PATIENTS RECEIVING MEDICAID.ActivityOrMissionDesc
Voting Members Governing Body5VotingMembersGoverningBodyCnt
Voting Members Independent5VotingMembersIndependentCnt
Total Employee221TotalEmployeeCnt
Total Volunteers0TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$7,388PYContributionsGrantsAmt
CY Contributions Grants$3,382CYContributionsGrantsAmt
PY Program Service Revenue$8,634,808PYProgramServiceRevenueAmt
CY Program Service Revenue$8,539,793CYProgramServiceRevenueAmt
PY Investment Income$82PYInvestmentIncomeAmt
CY Investment Income$6,562CYInvestmentIncomeAmt
PY Other Revenue$12,879PYOtherRevenueAmt
CY Other Revenue$22,415CYOtherRevenueAmt
PY Total Revenue$8,655,157PYTotalRevenueAmt
CY Total Revenue$8,572,152CYTotalRevenueAmt
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$5,424,487PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$5,471,422CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$3,259,393PYOtherExpensesAmt
CY Other Expenses$3,347,640CYOtherExpensesAmt
PY Total Expenses$8,683,880PYTotalExpensesAmt
CY Total Expenses$8,819,062CYTotalExpensesAmt
PY Revenues Less Expenses-$28,723PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$246,910CYRevenuesLessExpensesAmt
Total Assets BOY$4,121,226TotalAssetsBOYAmt
Total Assets EOY$3,927,823TotalAssetsEOYAmt
Total Liabilities BOY$622,441TotalLiabilitiesBOYAmt
Total Liabilities EOY$684,392TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$3,498,785NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$3,243,431NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionST. MARY HEALTH CARE CENTER, A CATHOLIC REHABILITATION AND SKILLED NURSING FACILITY, WAS ESTABLISHED AS A CONTINUING EXPRESSION OF THE VISION OF ST. MARGUERITE d'YOUVILLE, FOUNDRESS OF THE SISTERS OF CHARITY OF MONTREAL, THE "GREY NUNS". IN THE SPIRIT OF MARGUERITE, WHOSE LEGACY WE SHARE, WE SEEK TO "BRING THE MIRACLE OF LOVE TO ALL" THROUGH COMPASSIONATE CARE. ST. MARY HEALTH CARE DESIRES, IN PARTNERSHIP WITH OTHERS COMMITTED TO PROVIDING HOLISTIC AND INCLUSIVE CARE FOR ALL, TO DEVELOP INNOVATIVE AND CREATIVE MEANS TO ENHANCE THE PHYSICAL, EMOTIONAL, SOCIAL AND SPIRITUAL WELL-BEING OF THOSE WE SERVE.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$8,612,027ExpenseAmt
Revenue$8,539,793RevenueAmt
DescTHE ORGANIZATION PROVIDED 39,392 DAYS OF SKILLED NURSING CARE TO ELDERLY PATIENTS FROM ALL ECONOMIC, ETHNIC AND RELIGIOUS BACKROUNDS. OF THESE DAYS THE ORGANIZATION PROVIDED 36,819 DAYS OF SKILLED SERVICES TO MEDICAID RECIPIENTS.Desc
Total Program Service Expenses$8,612,027TotalProgramServiceExpensesAmt
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 EndowmentsYes (1)TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
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 Required0ScheduleJRequiredInd
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 Ent0BusinessRlnWithOfficerEntInd
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 Document11IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee221EmployeeCnt
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 Members5GoverningBodyVotingMembersCnt
Independent Voting Member5IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
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 Committees0MinutesOfCommitteesInd
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 Line1JOHN AHLE CFOBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone9786546363PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1100 AMES POND DRIVEAddressLine1Txt
CityTEWKSBURYCityNm
State AbbreviationMAStateAbbreviationCd
ZIP01876ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (6 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
RICHARD FREIJE
CHAIR1.00Yes (X)Yes (X)$0$0$0
STEVEN DIORIO
SECRETARY1.00Yes (X)Yes (X)$0$0$0
MELISSA BOYLE
TREASURER1.00Yes (X)Yes (X)$0$0$0
KEVIN DOWD
TRUSTEE1.00Yes (X)$0$0$0
RAUL SOCHA
TRUSTEE1.00Yes (X)$0$0$0
MICHAEL ISABELLA
ADMINISTRATOR40.00Yes (X)$131,405$0$0
FieldValueIRS element (for citing)
Total Reportable Comp From Org$131,405TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$0TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K1IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K0TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (3 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
Performance Healthcare Services
47R River St Suite 200RWellesleyMA02481HOUSEKEEPING AND LAUNDRY$328,741
Rehabcare Group
Po Box 503534St LouisMO63150REHABILITATION SERVICES$172,852
WinXnet
1600 Osgood StreetAndoverMA01845IT CONSULTING$104,066
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K3CntrctRcvdGreaterThan100KCnt
All Other Contributions$3,382AllOtherContributionsAmt
Total Contributions$3,382TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescPATIENT SERVICE REVENUDesc
Business623000BusinessCd
Total Revenue Column$8,539,793TotalRevenueColumnAmt
Related Or Exempt Func Income$8,539,793RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$8,539,793TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$62TotalRevenueColumnAmt
Exclusion$62ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Other$6,500OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Other$0OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Other$6,500OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$6,500TotalRevenueColumnAmt
Related Or Exempt Func Income$6,500RelatedOrExemptFuncIncomeAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescMiscellaneousDesc
Business623000BusinessCd
Total Revenue Column$22,415TotalRevenueColumnAmt
Exclusion$22,415ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$22,415OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$8,572,152TotalRevenueColumnAmt
Related Or Exempt Func Income$8,546,293RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$22,477ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$124,380TotalAmt
Program Services$124,380ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$4,651,460TotalAmt
Program Services$4,651,460ProgramServicesAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$19,046TotalAmt
Program Services$19,046ProgramServicesAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$324,959TotalAmt
Program Services$324,959ProgramServicesAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$351,577TotalAmt
Program Services$351,577ProgramServicesAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$107,316TotalAmt
Management And General$107,316ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$14,380TotalAmt
Management And General$14,380ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$85,339TotalAmt
Management And General$85,339ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$33,198TotalAmt
Program Services$33,198ProgramServicesAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$65,465TotalAmt
Program Services$65,465ProgramServicesAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$183,480TotalAmt
Program Services$183,480ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$19,523TotalAmt
Program Services$19,523ProgramServicesAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$3,465TotalAmt
Program Services$3,465ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$286,997TotalAmt
Program Services$286,997ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$115,779TotalAmt
Program Services$115,779ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmt
Purchased Services$837,095$837,095
Medicaid User Fee$747,432$747,432
Food and supplies$690,333$690,333
Utilities$157,838$157,838

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$8,819,062TotalAmt
Program Services$8,612,027ProgramServicesAmt
Management And General$207,035ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$299,300BOYAmt
EOY$204,498EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$1,053,093BOYAmt
EOY$1,070,796EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$9,905BOYAmt
EOY$62,429EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$6,309,628LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$3,786,551LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$2,691,197BOYAmt
EOY$2,523,077EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$67,731BOYAmt
EOY$67,023EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$4,121,226BOYAmt
EOY$3,927,823EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$524,702BOYAmt
EOY$591,382EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$97,739BOYAmt
EOY$93,010EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$622,441BOYAmt
EOY$684,392EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$3,488,785BOYAmt
EOY$3,241,875EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$10,000BOYAmt
EOY$1,556EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$3,498,785BOYAmt
EOY$3,243,431EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$4,121,226BOYAmt
EOY$3,927,823EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$246,910ReconcilationRevenueExpnssAmt
Other Changes In Net Assets-$8,444OtherChangesInNetAssetsAmt
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$1,885CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$2,039CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$1,950CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$7,388CurrentTaxYearMinus1YearAmt
Current Tax Year$3,382CurrentTaxYearAmt
Total$16,644TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$8,568,635CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$8,300,349CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$8,965,201CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$8,647,688CurrentTaxYearMinus1YearAmt
Current Tax Year$8,539,793CurrentTaxYearAmt
Total$43,021,666TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$8,570,520CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$8,302,388CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$8,967,151CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$8,655,076CurrentTaxYearMinus1YearAmt
Current Tax Year$8,543,175CurrentTaxYearAmt
Total$43,038,310TotalAmt

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$43,038,310PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,130CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$2,400CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$83CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$82CurrentTaxYearMinus1YearAmt
Current Tax Year$62CurrentTaxYearAmt
Total$3,757TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,130CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$2,400CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$83CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$82CurrentTaxYearMinus1YearAmt
Current Tax Year$62CurrentTaxYearAmt
Total$3,757TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$8,571,650CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$8,304,788CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$8,967,234CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$8,655,158CurrentTaxYearMinus1YearAmt
Current Tax Year$8,543,237CurrentTaxYearAmt
Total$43,042,067TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.99990PublicSupportCY509Pct
Public Support PY5090.99990PublicSupportPY509Pct
Investment Income CY0.00010InvestmentIncomeCYPct
Investment Income PY0.00010InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$10,000BeginningYearBalanceAmt
Contributions$3,500ContributionsAmt
Other Expenditures$11,944OtherExpendituresAmt
End Year Balance$1,556EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Contributions$10,000ContributionsAmt
End Year Balance$10,000EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$31,777BeginningYearBalanceAmt
Other Expenditures$31,777OtherExpendituresAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Contributions$41,000ContributionsAmt
Other Expenditures$9,223OtherExpendituresAmt
End Year Balance$31,777EndYearBalanceAmt
FieldValueIRS element (for citing)
Term Endowment Balance EOY1.00000TermEndowmentBalanceEOYPct
Endowments Held Unrelated Org0EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org0EndowmentsHeldRelatedOrgInd

Land LandGrp

FieldValueIRS element (for citing)
Investment Cost Or Other Basis$176,830InvestmentCostOrOtherBasisAmt
Book Value$176,830BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Investment Cost Or Other Basis$1,576,935InvestmentCostOrOtherBasisAmt
Depreciation$738,565DepreciationAmt
Book Value$838,370BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Investment Cost Or Other Basis$2,875,052InvestmentCostOrOtherBasisAmt
Depreciation$1,690,100DepreciationAmt
Book Value$1,184,952BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Investment Cost Or Other Basis$1,476,815InvestmentCostOrOtherBasisAmt
Depreciation$1,284,130DepreciationAmt
Book Value$192,685BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Investment Cost Or Other Basis$203,996InvestmentCostOrOtherBasisAmt
Depreciation$73,756DepreciationAmt
Book Value$130,240BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$2,523,077TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDescAmtAmt
PROFESSIONAL LIABILITY LOSS RESERVE$26,487
RESIDENT FUNDS LIABILITY$66,523
FieldValueIRS element (for citing)
Total Liability$93,010TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Part V, Line 4:FUNDS ARE USED TO PROVIDE SERVICES,SUPPLIES AND FACILITIES TO RESIDENTS & THE POOR IN THE COMMUNITY
Part X, Line 2:Covenant 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.

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

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 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.
Part I, Line 7The related organization, Covenant Health,Inc., maintains an incentive compensation plan for executives that is administered by the 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 that are set at the beginning of the year. The entitlement to awards for a particular year is not determined until early the following year. The organization did not pay incentive compensation awards in 2016 based on the system's performance during 2015.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part VI, Section A, line 6COVENANT HEALTH, INC. IS THE SOLE MEMBER OF THE ORGANIZATION. AS SUCH IT RETAINS CERTAIN RESERVE RIGHTS CONCERNING CORPORATE DECISIONS AND BOARD COMPOSITION.
Form 990, Part VI, Section A, line 7aCOVENANT HEALTH, Inc. IS THE SOLE MEMBER OF THE ORGANIZATION. AS SUCH IT RETAINS CERTAIN RESERVE RIGHTS CONCERNING CORPORATE DECISIONS AND BOARD COMPOSITION.
Form 990, Part VI, Section A, line 7bCOVENANT HEALTH, Inc. IS THE SOLE MEMBER OF THE ORGANIZATION. AS SUCH IT RETAINS CERTAIN RESERVE RIGHTS OVER BOARD DECISIONS AND BOARD COMPOSITION.
Form 990, Part VI, Section A, line 8bCOVENANT HEALTH, Inc. IS THE SOLE MEMBER OF THE ORGANIZATION. AS SUCH IT RETAINS CERTAIN RESERVE RIGHTS OVER BOARD DECISIONS AND BOARD COMPOSITION.
Form 990, Part VI, Section B, line 11bTHE FORM 990 IS PROVIDED TO THE BOARD FOR REVIEW PRIOR TO ITS BEING FILED
Form 990, Part VI, Section B, line 12cTHE ORGANIZATION REQUIRES CONFLICT OF INTEREST STATEMENTS TO BE SIGNED BY BOARD MEMBERS AND KEY EMPLOYEES REMINDING THEM OF THE DUTIES AND OBLIGATIONS TO REPORT REAL OR POTENTIAL CONFLICTS OF INTEREST.
Form 990, Part VI, Section B, line 15EVERY TWO TO THREE YEARS THE COMPENSATION COMMITTEE OF COVENANT HEALTH'S 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 CURRENT TOTAL CASH COMPENSATION LEVELS OF THE SENIOR LEADERSHIP TEAM, DEVELOP MARKET BASED COMPETITIVE SALARY RANGES FOR ALL EXECUTIVE POSITIONS AND ENSURE THAT ANNUAL INCENTIVE OPPORTUNITIES, IF THERE ARE ANY, ARE COMPETITIVE AND REASONABLE.
Form 990, Part VI, Section C, line 19THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, FINANCIAL STATEMENTS AND THE FORM 990 AVAILABLE TO THE PUBLIC UPON REQUEST. THE FORM 990 IS ALSO POSTED ON COVENANT HEALTH'S WEBSITE.
Form 990, Part XI, line 9:Reclass Temporarily restricted net assets -8444.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1COVENANT HEALTH IncBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1100 AMES POND DRIVEAddressLine1Txt
CityTEWKSBURYCityNm
State AbbreviationMAStateAbbreviationCd
ZIP01876ZIPCd
FieldValueIRS element (for citing)
EIN222484505EIN
Primary ActivitiesHEALTHCARE MANAGEMENT AND RESOURCE ORGANIZATIONPrimaryActivitiesTxt
Legal Domicile StateMALegalDomicileStateCd
Exempt Code Section501(c)(3)ExemptCodeSectionTxt
Public Charity Status9PublicCharityStatusTxt
Controlled Organization0ControlledOrganizationInd
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 Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

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