2016-11-15T13:14:12-06:00 2015-12-31 135381590 BDO USA LLP TWO INTERNATIONAL PLACE BOSTON MA 02110 990 2015-01-01 222843194 OVERLOOK MASONIC HEALTH CENTER INC OVER 5082487344 88 MASONIC HOME ROAD CHARLTON MA 015071000 TAMERYN CAMPBELL CEO/PRESIDENT 5082487344 2016-11-11 1 JEFFREY T ROGERS P01074284 6174220700 2015 2017-02-10 21:41:12Z TAMERYN CAMPBELL 88 MASONIC HOME ROAD CHARLTON MA 015071000 16789239 0 X THEMASONICHOME.ORG X 1987 MA CHARITABLE - THE PROVISION OF LONG-TERM RESIDENTIAL AND REHABILITATIVE CARE TO RESIDENTS OF THE COMMUNITY. 6 6 444 0 0 0 431449 318245 15287415 13715974 1987516 1900927 1500066 854093 19206446 16789239 0 0 0 0 12640611 11769100 0 0 0 9462532 9879263 22103143 21648363 -2896697 -4859124 189594498 172285490 46849237 38318175 142745261 133967315 TO PROVIDE THE RESIDENTS OF THE HEALTH CENTER WITH THE HIGHEST LEVEL OF COMPREHENSIVE MEDICAL CARE SERVICES WITH A CONSIDERATE AND PERSONAL TOUCH. 0 0 17022916 14347501 OPERATION OF A LONG-TERM CARE AND RESIDENTIAL CARE FACILITY IN CHARLTON, MA. TOTAL PATIENT DAYS OF CARE AND TOTAL REST HOME DAYS OF CARE FOR THE YEAR ENDED DECEMBER 31, 2015 AMOUNTED TO 47,651 AND 10,632, RESPECTIVELY, FOR A TOTAL DAYS OF CARE OF 58,283. 17022916 1 1 0 0 0 0 0 1 0 1 1 0 0 1 1 1 0 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 31 0 1 444 1 0 0 0 0 0 1 1 0 0 0 0 X 6 6 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 0 1 1 0 MA X X TAMERYN CAMPBELL 5084342412 88 MASONIC HOME ROAD CHARLTON MA 01507 ROBERT JOLLY CHAIRMAN 1.00 X 0 0 0 HARVEY WAUGH DIRECTOR 1.00 X 0 0 0 ROBERT GRATTAROTI DIRECTOR 1.00 X 0 0 0 JAY JOLICOEUR VICE CHAIRMAN 1.00 X 0 0 0 JOHN MULHALL DIRECTOR 1.00 X 0 0 0 JAMES TRACY TREASURER 1.00 X X 0 0 0 TAMERYN CAMPBELL CLERK 1.00 40.00 X 0 350524 11924 PAMELA JONES ASSISTANT TREASURER 1.00 40.00 X 0 228322 11679 DONALD AKEYO R.N. 40.00 X 141951 0 19731 ROSANNE ANTUNES DON 40.00 X 106991 0 25240 DIANE CROSS UNIT MANAGER 40.00 X 101508 0 20795 ROBERT WHITTEN ADMINISTRATOR 40.00 X 136622 0 2927 487072 578846 92296 4 0 1 0 MAS MEDICAL STAFFING 156 HARVEY ROAD LONDONDERRY NH 03053 NURSING STAFFING AGENCY 271791 HEALTHCARE SERVICES GROUP 3220 TILLMAN DR SUITE 300 BENSALEM PA 19020 MAINTENANCE, HOUSEKEEPING, & LAUNDRY STA 246407 FEELEY & DRISCOLL PC 200 PORTLAND STREET BOSTON MA 02114 ACCOUNTING SERVICES 186206 PROFESSIONAL NURSES HEALTH SERVICES 425 SUNDERLAND ROAD WORCESTER MA 01604 NURSING STAFFING AGENCY 126184 4 318245 318245 NET PATIENT REVENUE 623000 13715974 13715974 13715974 -195275 -195275 222566 0 222566 222566 222566 2096202 0 2096202 2096202 2096202 OTHER INCOME 812900 399501 399501 TENANT SERVICES REVENU 812900 153952 153952 CAFETERIA INCOME 900099 40079 40079 37995 37995 631527 16789239 14347501 0 2123493 9553070 9075416 477654 366951 348603 18348 1062446 1009324 53122 786633 747301 39332 784260 784260 15312 15312 52991 52991 441646 168140 273506 1302792 1237652 65140 17591 17591 1285 1285 1515214 1515214 2043093 1940938 102155 288103 273698 14405 DEPARTMENTAL EXPENSES 1192882 48569 1144313 MEDICAL SUPPLIES 885264 841001 44263 RESIDENT BED TAX 751441 751441 DIETARY SERVICES 554607 554607 32782 26226 6556 21648363 17022916 4625447 0 438145 205018 2625160 2875681 403398 360538 66765072 36370197 32244584 30394875 71023679 54889075 82859532 83560303 189594498 172285490 1517750 2246520 31953066 28622192 2945285 10433136 7449463 46849237 38318175 X 112876775 105288505 24138568 22957585 5729918 5721225 142745261 133967315 189594498 172285490 X -4859124 -4110914 192092 X 0 1 X 0 0 X 411148 357839 480186 466533 318245 2033951 15267499 15558915 15507040 15287415 13715974 75336843 15678647 15916754 15987226 15753948 14034219 77370794 0 0 0 77370794 2550889 1672125 299677 314224 -195275 4641640 2550889 1672125 299677 314224 -195275 4641640 1020863 951841 1016096 1526953 854093 5369846 19250399 18540720 17302999 17595125 14693037 87382280 0.88540 0.84390 0.05310 0.10160 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 160300 X X 0 70190115 2558820 -2061246 15719854 54967835 80076941 487236 1755477 12129539 70190115 86573267 405691 7875100 14777117 80076941 91580327 247597 10326011 15580668 86573267 98782997 6017272 -2491704 10728238 91580327 0 0 336962 336962 57926365 29523218 28403147 6321877 5681988 639889 2179868 1164991 1014877 30394875 DUE FROM AFFILIATES 83560303 83560303 DUE TO AFFILIATES 4081582 DUE TO RESIDENTS 88827 ASSET RETIREMENT OBLIGATION 719703 PENSION LIABILITY 2559351 7449463 X PART III, LINE 4: THE ORGANIZATION HAS TWO NON-DEPRECIABLE FIXED ASSETS: STAINED GLASS WINDOWS VALUED AT $72,700 AND RAILROAD EQUIPMENT AND TRACK VALUED AT $87,600 FOR A TOTAL $160,300. THESE TWO ASSETS FURTHER THE EXEMPT PURPOSE OF THE ORGANIZATION BY ADDING TO THE SOCIAL AND SPIRITUAL WELL BEING OF THE PATIENTS. PART V, LINE 4: THE ORGANIZATION'S ENDOWMENT INCLUDES BOTH DONOR RESTRICTED ENDOWMENT FUNDS AND FUNDS DESIGNATED BY THE BOARD OF DIRECTORS TO FUNCTION AS ENDOWMENTS. AS REQUIRED BY GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, NET ASSETS ASSOCIATED WITH ENDOWMENT FUNDS, INCLUDING FUNDS DESIGNATED BY THE BOARD OF DIRECTORS TO FUNCTION AS ENDOWMENTS, ARE CLASSIFIED AND REPORTED BASED ON THE EXISTENCE OR ABSENCE OF DONOR-IMPOSED RESTRICTIONS. PART X, LINE 2: IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, THE ORGANIZATION ANNUALLY EVALUATES ITS TAX STATUS AND TAX POSITIONS TAKEN WITH RESPECT TO ITS OPERATIONS AND FINANCIAL POSITION. X X X X 0 0 0 0 0 0 0 0 0 TAMERYN CAMPBELL CLERK 0 340357 0 0 0 10167 0 0 0 11924 0 362448 0 0 PAMELA JONES ASSISTANT TREASURER 0 218311 0 0 0 10011 0 1120 0 10559 0 240001 0 0 DONALD AKEYO R.N. 141923 0 0 0 28 0 0 0 19731 0 161682 0 0 0 FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION'S MANAGEMENT DUTIES ARE HANDLED BY ONE OF IT'S RELATED ENTITIES, MASONIC HEALTH SYSTEMS OF MASSACHUSETTS, INC. FORM 990, PART VI, SECTION A, LINE 6 MASONIC HEALTH SYSTEM OF MASSACHUSETTS, INC. IS THE SOLE CORPORATE MEMBER OF OVERLOOK MASONIC HEALTH CENTER, INC. AS SUCH, THE HEALTH SYSTEM HAS THE RIGHT TO APPROVE ACTIONS TAKEN BY THE BOARD MEMBERS OF OVERLOOK MASONIC HEALTH CENTER, INC. FORM 990, PART VI, SECTION A, LINE 7A MASONIC HEALTH SYSTEM OF MASSACHUSETTS, INC. IS THE SOLE CORPORATE MEMBER OF OVERLOOK MASONIC HEALTH CENTER, INC. AS SUCH, THE HEALTH SYSTEM HAS THE RIGHT TO ELECT AND APPROVE BOARD MEMBERS OF OVERLOOK MASONIC HEALTH CENTER, INC. FORM 990, PART VI, SECTION A, LINE 7B MASONIC HEALTH SYSTEM OF MASSACHUSETTS, INC. IS THE SOLE CORPORATE MEMBER OF OVERLOOK MASONIC HEALTH CENTER, INC. AS SUCH, THE HEALTH SYSTEM HAS THE RIGHT TO APPROVE ACTIONS TAKEN BY THE BOARD MEMBERS OF OVERLOOK MASONIC HEALTH CENTER, INC. FORM 990, PART VI, SECTION B, LINE 11 MANAGEMENT WORKS WITH THE ORGANIZATION'S EXTERNAL AUDITORS TO PREPARE THE FINANCIAL INFORMATION AND COMPILE THE DISCLOSURES REQUIRED OF THE FORM 990. UPON ITS COMPLETION, SENIOR MANAGEMENT PROVIDES A DRAFT OF THE FORM 990 WITH THE BOARD OF DIRECTORS PRIOR TO ITS SUBMISSION. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY VIA ANNUAL EXECUTION OF THE CONFLICT OF INTEREST POLICY. THIS CONFLICTS POLICY IS INTENDED TO SUPPLEMENT, BUT NOT REPLACE, ANY APPLICABLE STATE LAWS GOVERNING CONFLICTS OF INTEREST APPLICABLE TO NONPROFIT AND CHARITABLE CORPORATIONS. THIS CONFLICTS POLICY HAS BEEN ADOPTED BY THE BOARD OF DIRECTORS OF MASONIC HEALTH SYSTEM OF MASSACHUSETTS, INC. (MHS) THIS CONFLICTS POLICY SHALL APPLY WITH EQUAL FORCE TO ALL CORPORATIONS RELATED TO, OR AFFILIATED WITH, MHS. FORM 990, PART VI, SECTION B, LINE 13: IT IS THE POLICY OF MHS TO ACTIVELY WORK TO PREVENT FRAUD, WASTE, OR ABUSE OF PROCEDURE. ALL EMPLOYEES, CONTRACTORS, AGENTS, AND VOLUNTEERS OF MHS MUST IMMEDIATELY REPORT ANY SUSPICION OF FRAUD, WASTE, OR ABUSE OF PROCEDURE IN CONNECTION WITH MHS OPERATIONS TO HIS OR HER SUPERVISOR. MHS ENGAGES IN A CORPORATE COMPLIANCE PROGRAM FOR THE PURPOSE OF DETECTING AND PREVENTING FRAUD, WASTE, AND ABUSE OF PROCEDURE. FORM 990, PART VI, SECTION B, LINE 14: MANAGEMENT AND THE BOARD ARE IN THE PROCESS OF INITIATING A WRITTEN DOCUMENT RETENTION AND DESTRUCTION POLICY. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION'S SOLE MEMBER, MASONIC HEALTH SYSTEM OF MASSACHUSETTS, INC. MAINTAINS AN EXECUTIVE COMMITTEE TO ANNUALLY REVIEW THE PERFORMANCE AND COMPENSATION OF THE OFFICERS AND KEY EMPLOYEES. THE EXECUTIVE COMMITTEE DETERMINES THE COMPENSATION FOR OFFICERS AND KEY EMPLOYEES ANNUALLY BASED ON COMPARABLE INDUSTRY DATA AND THROUGH A CONSULTATION AGREEMENT WITH TOWERS PERRIN, A NATIONAL HUMAN RESOURCES CONSULTANT. THE DETERMINATION OF COMPENSATION IS SUBSTANTIATED IN THE ORGANIZATION'S MINUTES OF THE EXECUTIVE COMMITTEE FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATION'S FORM 990 IS AVAILABLE TO THE PUBLIC UPON REQUEST AND CAN BE FOUND AT THE MASSACHUSETTS ATTORNEY GENERAL'S WEBSITE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19: THE ORGANIZATION'S FINANCIAL STATEMENTS ARE AVAILABLE ON THE MASSACHUSETTS ATTORNEY GENERAL'S WEBSITE. FORM 990, PART XI, LINE 9: EQUITY TRANSFERS TO AFFILIATES 192,092. THE MASONIC HEALTH SYSTEM OF MASSACHUSETTS 88 MASONIC HOME ROAD CHARLTON MA 01507 043515688 SOLE MEMBER MA 501(C)(3) LINE 11C, III-FI MHS 0 OVERLOOK VISITING NURSES ASSOCIATION INC 88 MASONIC HOME ROAD CHARLTON MA 01507 043515687 HOME HEALTHCARE MA 501(C)(3) LINE 9 MHS 0 OVERLOOK COMMUNITIES INC 88 MASONIC HOME ROAD CHARLTON MA 01507 043515686 RESIDENTIAL & ASSISTED LIVING MA 501(C)(3) LINE 9 MHS 0 OVERLOOK HEALTH CENTER AT NORTHAMPTON INC 88 MASONIC HOME ROAD CHARLTON MA 01507 270451701 SKILLED NURSING FACILITY MA 501(C)(3) LINE 9 MHS 0 OVERLOOK CATERING INC 88 MASONIC HOME ROAD CHARLTON MA 01507 271472010 CATERING SERVICES MA MHS C 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 OVERLOOK CATERING INC A 131550 FAIR VALUE