2017-11-15T09:25:18-06:00 2016-12-31 410746749 CLIFTONLARSONALLEN LLP 300 CROWN COLONY DRIVE SUITE 310 QUINCY MA 02169 990 2016-01-01 042200583 CHELSEA JEWISH NURSING HOME INC C/O CHELSEA JEWISH COMMUNITY INC CHEL 6178870001 165 CAPTAINS ROW CHELSEA MA 02150 BARRY BERMAN TREASURER 6178870001 2017-11-13 1 JUDY DALEY P01294075 6179848100 2017-11-02 67.137.57.251 2017-11-13 16:18:22 ES P 499B49BEE9E95068E93680D69C996EB6A62D8814 C1D470E4C4FD0E6018A3BDA039B2AFA75AE02954 2016 2021-01-29 14:40:06Z BARRY BERMAN 165 CAPTAINS ROW CHELSEA MA 02150 11877505 0 X WWW.CJNH.ORG X 1975 MA THE ORGANIZATION'S MISSION IS TO PROVIDE EXCEPTIONAL SKILLED NURSING CARE FOR THEIR RESIDENTS WITH UNWAVERING COMPASSION, DIGNITY AND RESPECT. THE HIGH STANDARD OF CARE AT CHELSEA JEWISH NURSING HOME (CJNH) ENSURES RESIDENTS RECEIVE EXCELLENT ATTENTION AND SERVICE FROM A TEAM OF COMPASSIONATE AND PROFESSIONALLY TRAINED HEALTHCARE STAFF. CJNH RESPECTS EACH INDIVIDUAL AND UNDERSTANDS THE IMPORTANCE OF MAKING RESIDENTS AND THEIR FAMILIES FEEL AT HOME. 9 6 194 6 0 0 25000 41055 11808515 11834736 2254 1714 648 0 11836417 11877505 0 0 0 0 6822179 6770226 0 0 0 5068734 5755953 11890913 12526179 -54496 -648674 12891528 20486822 10480253 18511672 2411275 1975150 X THE ORGANIZATION'S MISSION IS TO PROVIDE EXCEPTIONAL SKILLED NURSING CARE FOR THEIR RESIDENTS WITH UNWAVERING COMPASSION, DIGNITY AND RESPECT. THE HIGH STANDARD OF CARE AT CHELSEA JEWISH NURSING HOME (CJNH) ENSURES RESIDENTS RECEIVE EXCELLENT ATTENTION AND SERVICE FROM A TEAM OF COMPASSIONATE AND PROFESSIONALLY TRAINED HEALTHCARE STAFF. CJNH RESPECTS EACH INDIVIDUAL AND UNDERSTANDS THE IMPORTANCE OF MAKING RESIDENTS AND THEIR FAMILIES FEEL AT HOME. 0 0 9924777 11834736 NURSING HOME: OPERATION OF A 123-BED SKILLED NURSING FACILITY PROVIDING NURSING CARE, REHABILITATION THERAPIES AND OTHER SKILLED SERVICES TO FRAIL ELDERLY AND DISABLED. 9924777 1 1 0 0 0 0 0 0 0 1 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 17 0 1 194 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 LANDA 6178870001 165 CAPTAINS ROW CHELSEA MA 02150 ADAM BERMAN PRESIDENT 1.00 39.00 X X 0 305651 27058 BARRY BERMAN TREASURER 1.00 39.00 X X 0 610459 32880 JOEL MAZER CHAIR 1.00 2.00 X X 0 0 0 ELIZABETH MULLEN CLERK 1.00 39.00 X X 0 206839 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 EDWARD STEWART EXECUTIVE DIRECTOR 40.00 0.00 X 115741 0 15711 LAURA MULLEN DON 40.00 0.00 X 106699 0 5598 ROGELIO CALAUNAN RN 40.00 0.00 X 106842 0 2624 329282 1122949 101037 3 0 1 0 GERIATRIC MEDICAL & SUPPLY INC PO BOX 2503 WOBURN MA 01888 MEDICAL SUPPLIES 238327 DIMELLA SHAFFER 281 SUMMER STREET BOSTON MA 02210 ARCHITECTURAL DESIGN SERVICES 202105 S HARRIS INTERIORS 75 ARLINGTON STREET STE 500 BOSTON MA 02210 INERIOR DESIGN 146800 3 41055 41055 PROGRAM SERVICE REVENUE 623000 11834736 11834736 11834736 1714 1714 11877505 11834736 0 1714 131452 131452 5769202 5600432 168770 95800 92218 3582 287657 287651 6 486115 462613 23502 711019 711019 76044 76044 50904 50904 1040873 895690 145183 6495 6495 130448 793 129655 950372 705330 245042 43656 43656 1013 1013 1308 1308 697962 696642 1320 USER FEE ASSESSMENT 627822 627822 SUPPLIES & EXPENSE 540372 540372 FOOD 376764 376764 PATIENT ANCILLARY SERVI 266272 266272 234629 234629 12526179 9924777 2601402 0 810183 229799 1592735 1743333 176610 199427 22660325 6926274 1987034 15734051 8324966 2580212 12891528 20486822 2195452 2531655 25675 6625078 14274848 1659723 1679494 10480253 18511672 X 689947 212767 1721328 1762383 2411275 1975150 12891528 20486822 X -648674 171494 41055 X 0 1 X 1 1 1 X 170000 20000 46263 25000 41055 302318 11716155 11484194 12023207 11809163 11834736 58867455 11886155 11504194 12069470 11834163 11875791 59169773 170000 20000 98918 25000 41055 354973 0 170000 20000 98918 25000 41055 354973 58814800 6010 203 227 2254 1714 10408 6010 203 227 2254 1714 10408 11892165 11504397 12069697 11836417 11877505 59180181 0.99380 0.99120 0.00020 0.00070 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1721328 41055 1762383 1750652 -29324 1721328 1698000 52652 1750652 1650000 48000 1698000 1650000 1650000 0.00000 0.00000 1.00000 1 0 13575 13575 21283654 6723561 14560093 1363096 202713 1160383 15734051 DEBT SERVICE RESERVE 733364 SOFTWARE, NET 3484 BENEFICIAL INTEREST IN TESTAMENTARY TRUST 1762383 REPLACEMENT RESERVE 80981 2580212 DUE TO RELATED PARTIES 1679494 1679494 X 11877505 0 11877505 0 11877505 12526179 0 12526179 0 12526179 PART V, LINE 4: THE ORGANIZATION IS THE SOLE BENEFICIARY OF A CHARITABLE TESTAMENTARY TRUST THAT IS ADMINISTERED BY UNRELATED FINANCIAL INSTITUTIONS. THE UNRELATED FINANCIAL INSTITUTIONS SET FORTH THE INVESTMENT POLICIES FOR THE TRUST. THE ORGANIZATION RECEIVED INCOME GENERATED BY THE TRUST FOR GENERAL PURPOSES AND CLASSIFIED AS UNRESTRICTED NET ASSETS. GAINS AND LOSSES ARE CONSIDERED RESTRICTED. 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. 0 0 0 0 0 0 0 0 0 ADAM BERMAN PRESIDENT 0 305651 0 0 0 0 0 0 0 27058 0 332709 0 0 BARRY BERMAN TREASURER 0 610459 0 0 0 0 0 0 0 32880 0 643339 0 0 ELIZABETH MULLEN CLERK 0 206839 0 0 0 0 0 0 0 17166 0 224005 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 THE CEO IS PAID FROM A RELATED ORGANIZATION. PRIOR TO MAJOR SALARY ADJUSTMENTS FOR THE CEO, A RELATED ORGANIZATION'S BOARD OF DIRECTORS ARRANGES FOR A SALARY STUDY TO BE PERFORMED. THE STUDY INCLUDES THE EXECUTIVE SALARIES OF COMPARABLY-SIZED COMPANIES IN THE INDUSTRY. THE BOARD OF DIRECTORS THEN CONSIDERS THE FINDINGS OF THE STUDY IN SETTING THE CEO'S COMPENSATION. 2014 WAS THE MOST RECENT YEAR IN WHICH THE PROCESS INCLUDED REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION. OFFICERS AND KEY EMPLOYEES ARE PAID FROM A RELATED ORGANIZATION. 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: CHANGE IN BENEFICIAL INTEREST IN TESTAMENT TRUST 41,055. 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 COMMUNITY INC 165 CAPTAINS ROW CHELSEA MA 02150 271756594 MANAGEMENT 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 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 AGENT MA N/A C 0 ADMIRAL'S HILL ASSISTED LIVING CORP 165 CAPTAINS ROW CHELSEA MA 02150 043255840 ASSISTED LIVING MA N/A C 0 0 0 0 0 1 0 0 0 0 0 1 0 1 0 1 1 0 0 0