2016-11-15T11:06:28-06:00 2015-12-31 410746749 CLIFTONLARSONALLEN LLP 300 CROWN COLONY DRIVE SUITE 310 QUINCY MA 02169 990 2015-01-01 043108782 NOTRE DAME HEALTH CARE CENTER INC NOTR 5088523011 559 PLANTATION STREET WORCESTER MA 01605 SR EDIE DALY SND PRESIDENT 5088523011 2016-11-14 1 JUDY DALEY P01294075 6179848100 2016-11-14 2015 2017-02-10 21:41:12Z NOTRE DAME LONG TERM CARE CENTER NOTRE DAME DU LAC NOTRE DAME AT HOME KAREN LAGANELLI 559 PLANTATION STREET WORCESTER MA 01605 28305484 0 X WWW.NOTREDAMEHEALTHCARE.ORG X 1990 MA NOTRE DAME HEALTH CARE CENTER, ROOTED IN THE HERITAGE OF SAINT JULIE BILLIART AND SPONSORED BY THE SISTERS OF NOTRE DAME DE NAMUR, IS DEDICATED TO THE HEALING MINISTRY PROCLAIMED IN THE GOSPEL AND BY THE CATHOLIC CHURCH.- WE DEMONSTRATE CONCERN FOR THE WHOLE PERSON IN CARING FOR THE SPIRITUAL, SOCIAL, PHYSICAL AND PSYCHOLOGICAL WELL-BEING OF OUR RESIDENTS, THEIR FAMILIES AND THE COMMUNITY WE SERVE.- WE HONOR THE PERSONAL DIGNITY OF ALL INDIVIDUALS WITH COMPASSION AND WITHOUT DISTINCTION OF GENDER, AGE, ETHNICITY, SEXUAL ORIENTATION, RACE OR CREED. WE STRIVE TO CREATE A WORK ENVIRONMENT WHERE EACH PERSON IS VALUED, RESPECTED AND GIVEN AN OPPORTUNITY FOR PERSONAL, EDUCATIONAL AND PROFESSIONAL GROWTH.- WE USE OUR RESOURCES WITH A PARTICULAR CONCERN FOR THE ELDERLY, THE POOR AND THE VULNERABLE.- WE MAKE KNOWN GOD'S GOODNESS TO THE ENTIRE NDHCC COMMUNITY. 14 8 475 100 0 0 103156 60165 21238755 22524395 445478 745897 286356 233312 22073745 23563769 0 0 0 0 14361399 15020074 0 0 112252 7245704 7589159 21607103 22609233 466642 954536 38359314 37641925 19811931 18955807 18547383 18686118 X SEE SCHEDULE O. 0 0 18197173 20440422 NOTRE DAME LONG TERM CARE CENTER/NOTRE DAME DU LAC/HOSPICE & OTHER PROGRAM SERVICES - PROVIDE SKILLED NURSING CARE TO THE ELDERLY AND DISABLED AS WELL AS OTHER SERVICES IN LINE WITH THE ORGANIZATION'S MISSION. 2433396 2733372 NOTRE DAME LONG TERM CARE CENTER/NOTRE DAME DU LAC/HOSPICE - PEDIPAL PROGRAM - PROVIDES HOME CARE TO CHILDREN WITH LIFE LIMITING ILLNESSES. 20630569 1 1 0 1 0 0 1 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 18 0 1 475 1 0 0 0 0 0 0 0 0 0 0 X 14 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X SR MARY FARREN SND TREASURER 5088523011 559 PLANTATION STREET WORCESTER MA 01605 SR EDIE DALY SND PRESIDENT 1.00 X X 0 0 0 SR ELLEN AGRITELLEY SND CHAIRMAN 1.00 X X 0 0 0 SR ANNE MALONE SND CLERK 1.00 X X 0 0 0 MS JENNIFER DAVIS CAREY BOARD MEMBER 1.00 X 0 0 0 MS KATHLEEN FISHER BOARD MEMBER 1.00 X 0 0 0 MR PAUL GRIBBONS BOARD MEMBER 1.00 X 0 0 0 SR BARBARA-JEAN KUBIK SND BOARD MEMBER 1.00 X 0 0 0 MR ROBERT LIAN BOARD MEMBER 1.00 X 0 0 0 SR MARGARET MCCARTHY SND BOARD MEMBER 1.00 X 0 0 0 MS KATHLEEN O'CONNOR BOARD MEMBER 1.00 X 0 0 0 MS VIRGINA RYAN BOARD MEMBER 1.00 X 0 0 0 MR DAVID PUTNAM BOARD MEMBER 1.00 X 0 0 0 SR LORRAINE CONNELL BOARD MEMBER 1.00 X 0 0 0 MR GARTH JOHNSON BOARD MEMBER 1.00 X 0 0 0 SR MARY FARREN SND TREASURER 1.00 X 0 0 0 MR STEPHEN TOTINO EXECUTIVE DIR. OF FINANCE 40.00 X 100656 0 22197 MS KAREN LAGANELLI CEO 40.00 X 84569 0 6954 MS KARYN COONEY EXECUTIVE DIR. OF HOSPICE 40.00 X 123608 0 5375 MS CAROL KAPOLKA EXECUTIVE DIR. OF NURSING CARE 40.00 X 100950 0 11337 MS DEBRA FORSS DIRECTOR OF NURSING - LTC 40.00 X 143901 0 2988 MS CAROL SMITH DIRECTOR OF ENVIRONMENTAL & IT SERVICES 40.00 X 101030 0 30381 654714 0 79232 5 0 0 0 HEALTHPRO MANAGEMENT INC 10600 YORK ROAD SUITE 105 COCKEYSILLE MD 21030 REHAB THERAPY SERVICES 471019 1 60165 11845 60165 PATIENT SERVICE REVENUE 623000 16845495 16845495 RESIDENT SERVICE REVENUE 623000 5503170 5503170 EDUCATION CENTER 611430 175730 175730 22524395 329810 329810 5157802 4741715 416087 416087 416087 OTHER OPERATING INCOME 623000 233312 233312 233312 23563769 23173794 0 329810 559030 323890 235140 11627139 10706482 863446 57211 79103 72818 5934 351 1764583 1651555 104932 8096 990219 911270 74258 4691 59422 59422 73480 73480 1142 1142 352327 202749 149578 142128 22404 119724 410084 188083 180098 41903 1579333 1579333 93470 93470 9217 9217 1022449 1022449 94128 94128 PATIENT CARE EXPENSES 2596109 2596109 USER FEE 776718 776718 BAD DEBTS 215695 215695 HOSPICE EXPENSES 60063 60063 103394 102994 400 22609233 20630569 1866412 112252 155550 32678 1885080 1863992 2283656 2137961 17355 46335 180051 225308 34362201 15243270 19649181 19118931 13426618 13514369 761823 702351 38359314 37641925 1859511 1949662 119638 35624 14710000 14000000 3122782 2970521 19811931 18955807 X 18509972 18669466 37411 16652 18547383 18686118 38359314 37641925 X 954536 -994612 178811 X 0 1 X 1 0 X 60770 91216 99777 103156 60165 415084 20174779 20357982 20944496 21525111 22757707 105760075 20235549 20449198 21044273 21628267 22817872 106175159 25000 43900 37500 54500 146025 306925 0 25000 43900 37500 54500 146025 306925 105868234 344127 427974 521423 255556 329810 1878890 344127 427974 521423 255556 329810 1878890 20579676 20877172 21565696 21883823 23147682 108054049 0.97980 0.98000 0.01740 0.01810 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1142 1142 0 PART II-B, LINE 1: A PORTION OF MEMBERSHIP DUES PAID TO STATE HEALTHCARE ORGANIZATIONS IS DEVOTED TO LOBBYING. X 1 3.20 0 0 0 1 0 52.00 0 2625000 2625000 27427603 12203165 15224438 4183065 2958725 1224340 126533 81380 45153 19118931 FAIR VALUE OF INTEREST RATE SWAP 2576621 DEPOSITS FROM TENANTS 393900 2970521 X 23274362 0 23274362 289407 289407 23563769 22319826 0 22319826 289407 289407 22609233 PART II, LINE 9: CONSERVATION EASEMENTS NOT REPORTED. PART X, LINE 2: THE ORGANIZATION IS A NOT-FOR-PROFIT 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. THE ENTITY'S 2012 THROUGH 2015 TAX YEARS ARE OPEN FOR EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES. PART XI, LINE 4B - OTHER ADJUSTMENTS: RECLASS OF EDUCATION CENTER EXPENSES 289,407. PART XII, LINE 4B - OTHER ADJUSTMENTS: RECLASS OF EDUCATION CENTER EXPENSES 289,407. FORM 990, PART III, LINE 1, DESCRIPTION OF ORGANIZATION MISSION: NOTRE DAME HEALTH CARE CENTER, ROOTED IN THE HERITAGE OF SAINT JULIE BILLIART AND SPONSORED BY THE SISTERS OF NOTRE DAME DE NAMUR, IS DEDICATED TO THE HEALING MINISTRY PROCLAIMED IN THE GOSPEL AND BY THE CATHOLIC CHURCH. PART OF OUR MISSION AT NOTRE DAME HEALTH CARE CENTER IS CONTINUED EDUCATION FOR THE STAFF AND MEMBERS IN THE COMMUNITY. WE OPERATE AN EDUCATIONAL CENTER ON THE CAMPUS AND THE TOTAL NET LOSS FOR THIS YEAR IS $113,677. OUR ASSISTED LIVING FACILITY OFFERS REDUCED OR CHARITY CARE TO SOME RESIDENTS WHICH HAVE EXHAUSTED THEIR PERSONAL FUNDS. THE TOTAL REDUCED OR CHARITY CARE AMOUNT INCURRED BY THE OPERATIONS OF THE ASSISTED LIVING FACILITY FOR 2015 IS $104,043. - WE DEMONSTRATE CONCERN FOR THE WHOLE PERSON IN CARING FOR THE SPIRITUAL, SOCIAL, PHYSICAL AND PSYCHOLOGICAL WELL-BEING OF OUR RESIDENTS, THEIR FAMILIES AND THE COMMUNITY WE SERVE. - WE HONOR THE PERSONAL DIGNITY OF ALL INDIVIDUALS WITH COMPASSION AND WITHOUT DISTINCTION OF GENDER, AGE, ETHNICITY, SEXUAL ORIENTATION, RACE OR CREED. WE STRIVE TO CREATE A WORK ENVIRONMENT WHERE EACH PERSON IS VALUED, RESPECTED AND GIVEN AN OPPORTUNITY FOR PERSONAL, EDUCATIONAL AND PROFESSIONAL GROWTH. - WE USE OUR RESOURCES WITH A PARTICULAR CONCERN FOR THE ELDERLY, THE POOR AND THE VULNERABLE. - WE MAKE KNOWN GOD'S GOODNESS TO THE ENTIRE NDHCC COMMUNITY. FORM 990, PART VI, SECTION A, LINE 1 THE ORGANIZATION'S GOVERNING BODY DELEGATE BROAD AUTHORITY TO ACT ON ITS BEHALF TO SEVERAL COMMITTEES WHICH INCLUDE: HUMAN RESOURCES, ETHICS, FINANCE, INVESTMENT, MISSION, ADVANCEMENT, NOMINATING, AND STRATEGIC DEVELOPMENT COMMITTEES. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS MEMBERS WHICH INCLUDES EX -OFFICIO AND ALL THE MEMBERS OF THE ADMINISTRATIVE TEAMS OF THE BOSTON, IPSWICH AND CONNECTICUT PROVINCES OF THE CONGREGATION. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION'S MEMBERS ELECT THE BOARD OF DIRECTORS ANNUALLY. FORM 990, PART VI, SECTION A, LINE 7B THERE ARE ORGANIZATION GOVERNANCE DECISIONS THAT ARE SUBJECT TO THE APPROVAL BY MEMBERS OTHER THAN THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11 THE FINANCE DIRECTOR WILL SEND A DRAFT COPY OF THE TAX RETURN TO EACH BOARD MEMBER FOR REVIEW. THE COMPLETE REVISED FORM 990 IS PRESENTED AT A SCHEDULED MEETING TO THE BOARD OF DIRECTORS FOR FINAL APPROVAL BY THE CEO/BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 12C IT IS THE ORGANIZATION'S POLICY NOT TO ENGAGE IN TRANSACTIONS OR ARRANGEMENTS WITH DIRECTORS, OFFICERS, COMMITTEE MEMBERS OR KEY EMPLOYEES. NO TRANSACTION OR ARRANGEMENT BETWEEN THE CORPORATION AND ANY DIRECTOR, OFFICER, COMMITTEE MEMBER OR KEY EMPLOYEE, OR A MEMBER OF HIS OR HER IMMEDIATE FAMILY, OR ANY ENTITY WITH WHICH ANY SUCH PERSON HAS A PERSONAL INTEREST, WILL BE ENTERED INTO OR CONTINUED UNLESS IT HAS BEEN THOROUGHLY REVIEWED AND CONSIDERED BY THE BOARD OR THE FINANCE COMMITTEE AND HAS BEEN FOUND TO BE OF CLEAR BENEFIT TO THE CORPORATION. THE ORGANIZATION'S BOD COLLECTS SIGNED CONFLICTS OF INTEREST POLICY AND REVIEWS THEM ANNUALLY. FORM 990, PART VI, SECTION B, LINE 15 THE CEO'S COMPENSATION IS DETERMINED BY REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THIS IS DONE ON AN ANNUAL BASIS BY THE FINANCE COMMITTEE AND BOARD OF DIRECTORS. OTHER EMPLOYEE SALARIES & BENEFITS ARE REVIEWED ANNUALLY BY THE CEO. & COMPARED TO OTHER SIMILAR ENTITIES IN THE REGION, AND DOCUMENTED AS PART OF THE ANNUAL REVIEW PROCESS, WHICH IS DONE ON THE ANNIVERSARY DATE. 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: UNREALIZED GAIN ON INTEREST RATE SWAP 178,811.