2016-08-02T13:40:21-05:00 2015-12-31 010494526 BAKER NEWMAN & NOYES LLC 650 ELM STREET SUITE 302 MANCHESTER NH 03101 990 2015-01-01 043333609 CHS OF WALTHAM INC CHSO 7818930240 66 NEWTON STREET WALTHAM MA 02453 CAROLYN FENN CEO 7818930240 2016-07-25 E DREW CHENEY P00182972 8002447444 2016-07-25 2015 2016-12-15 16:53:06Z MARISTHILL NURSING & REHABILTATION CENTER CAROLYN FENN 66 NEWTON STREET WALTHAM MA 02453 10399564 0 0928 X MARISTHILL.ORG X 1996 MA MARISTHILL IS A CATHOLIC SKILLED NURSING AND REHABILITATION FACILITY THAT CONTINUES THE HEALING MINISTRY OF CHRIST BY PROVIDING HEALTH CARE SERVICES THAT FOSTER EACH INDIVIDUAL'S PHYSICAL, SPIRITUAL, EMOTIONAL AND INTELLECTUAL WELL-BEING. 9 7 152 0 0 0 18820 47972 10480889 10301039 50454 49643 1191 910 10551354 10399564 0 0 0 0 5947394 6025959 0 0 0 4564986 4438777 10512380 10464736 38974 -65172 11887415 11566102 9685930 9481202 2201485 2084900 MARISTHILL IS A CATHOLIC SKILLED NURSING AND REHABILITATION FACILITY THAT CONTINUES THE HEALING MINISTRY OF CHRIST BY PROVIDING HEALTH CARE SERVICES THAT FOSTER EACH INDIVIDUAL'S PHYSICAL, SPIRITUAL, EMOTIONAL AND INTELLECTUAL WELL-BEING. 0 0 10297698 10301949 MARISTHILL NURSING AND REHABILITATION CENTER PROVIDED 35,814 DAYS OF SKILLED NURSING SERVICES DURING 2015 OF WHICH 24,792 WERE TO MEDICAID RECIPIENTS. 10297698 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 13 0 1 152 1 0 0 0 0 0 0 0 0 0 0 X 9 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X X CAROLYN FENN CEO 7818930240 66 NEWTON STREET WALTHAM MA 02453 KENNETH FERRON TREASURER 1.00 39.00 X X 0 311160 122488 LISA LORGEREE CHAIR 1.00 X X 0 0 0 KELLY HILL VICE CHAIR 1.00 X X 0 0 0 JUDITH ALLEN TRUSTEE 1.00 X 0 0 0 NANCY SMITH TRUSTEE 1.00 X 0 0 0 SRJOYCE ANN EDELMANN TRUSTEE 1.00 X 0 0 0 DR FELIX ZOLLO TRUSTEE 1.00 X 0 0 0 SUSAN STRANG TRUSTEE 1.00 X 0 0 0 CAROLYN FENN CEO/ADMINISTRATOR 40.00 X X 105326 0 15783 JOSEPH SGRO CHIEF FINANCIAL OFFICER 40.00 X 97645 0 7220 SHIRLY YELLAMATY NURSING SUPERVISOR 40.00 X 114172 0 22806 317143 311160 168297 2 0 1 0 REHAB CARE INC PO BOX 277365 ATLANTA GA 30384 REHABILTATION SERVICES 754707 US FOODS PO BOX 3155 BOSTON MA 02241 FOOD SERVICE 303818 OMNI CARE P O BOX 781668 DETROIT MI 48278 PHARMACY 282970 HEALTHCARE SERVICES 1565 MAIN STREET TEWKSBURY MA 01888 HOUSEKEEPING 264632 COVENANT HEALTH 100 AMES POND DRIVE TEWKSBURY MA 01876 MANAGEMENT SERVICES 255658 5 47972 47972 PATIENT SERVICE REVENUE 623000 10301039 10301039 10301039 49643 49643 VENDING MACHINE 623000 797 797 PURCHASE DISCOUNTS 623000 113 113 910 10399564 10301949 0 49643 114587 114587 5062791 5062791 21125 21125 449611 449611 377845 377845 123084 123084 22220 22220 21734 21734 8782 8782 62872 62872 133078 133078 74 74 2726 2726 341396 341396 477067 477067 100179 100179 PURCHASED SERVICES 1388415 1388415 NURSING HOME SUPPLIES A 940413 940413 MEDICAID USER FEE 544826 544826 UTILITIES 271911 271911 10464736 10297698 167038 0 X 85819 66181 976555 420648 916173 953396 29416 45507 11859563 5768325 5773219 6091238 2266821 2760109 1839412 1229023 11887415 11566102 628211 664908 8409068 8195018 648651 621276 9685930 9481202 X 2201485 2084900 2201485 2084900 11887415 11566102 -65172 -51413 0 X 0 1 X 1 0 X 26945 22940 21170 18820 47972 137847 10746498 10268103 10142271 10480889 10301949 51939710 10773443 10291043 10163441 10499709 10349921 52077557 0 0 0 52077557 1660 25301 19064 50454 49643 146122 1660 25301 19064 50454 49643 146122 10775103 10316344 10182505 10550163 10399564 52223679 0.99720 0.99760 0.00280 0.00240 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 485000 485000 6746083 2958880 3787203 3654190 2809445 844745 974290 974290 6091238 RESIDENT FUNDS 17565 DEBT SERVICE RESERVE FUND 713137 DEBT SERVICE SINKING FUND (NET) 498321 1229023 DEFERRED EXPENSES 254411 MEDICAID USER FEES 137431 PROFESSIONAL LIABILITY LOSS RESERVES 23795 DUE TO AFFILIATES 189074 RESIDENT FUNDS 16565 621276 X 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, 2015. UNDER INTERNAL REVENUE SERVICE REGULATIONS, THE SYSTEM'S TAX YEARS FROM 2012 THROUGH 2015 ARE OPEN AND SUBJECT TO EXAMINATION. X X X X 0 1 0 0 0 0 0 1 0 KENNETH FERRON TREASURER 0 287253 0 0 0 23907 0 90295 0 32193 0 433648 0 0 PART I, LINE 3 EVERY 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. THE SPECIFIC OBJECTIVES OF THE ANALYSIS ARE TO ASSESS THE COMPETITIVENESS OF THE CURRENT TOTAL CASH COMPENSATION LEVELS FOR THE SENIOR LEADERSHIP TEAM; DEVELOP MARKET COMPETITIVE SALARY RANGES FOR ALL EXECUTIVE POSITIONS AND ENSURE THAT THE ANNUAL INCENTIVE OPPROTUNITIES, IF ANY, ARE COMPETITIVE AND REASONABLE. PART I, LINE 4B THE RELATED ORGANIZATION, COVENANT HEALTH, MAINTAINS A SUPPLEMENTAL EXECUTIVE RETIREMENT PROGRAM FOR CERTAIN EXECUTIVES UNDER WHICH THE ORGANIZATION MAKES A CONTRIBUTION TO A GRANTOR TRUST FOR THE BENEFIT OF THE EXECUTIVE THAT IS INTENDED TO PROVIDE A SPECIFIED LEVEL OF RETIREMENT BENEFITS AT RETIREMENT AGE COMMENSURATE WITH RETIREMENT BENEFITS PROVIDED TO EXECUTIVES IN COMPARABLE POSITIONS BY SIMILARLY SITUATED ORGANIZATIONS. AMOUNTS CONTRIBUTED TO THE GRANTOR TRUST ARE HELD FOR THE BENEFIT OF THE EXECUTIVE UNTIL HE OR SHE REACHES AGE 60, AT WHICH TIME THEY ARE RELEASED TO THE EXECUTIVE. THE FULL AMOUNT PAID INTO THE GRANTOR TRUST IS TAXABLE TO THE EXECUTIVE WHEN SO PAID, AND IS INCLUDED IN THE EXECUTIVE'S REPORTED COMPENSATION. PART I, LINE 7 THE RELATED ORGANIZATION, COVENANT HEALTH, 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 PAID NO INCENTIVE COMPENSATION AWARDS IN 2015 TO KENNETH FERRON BASED ON PERFORMANCE DURING 2014. A MA HEALTH & EDUCATION FACILITIES AUTHORITY 042456011 57586DBF9 2007-10-30 7221865 TO FINANCE THE PURCHASE OF YOUVILLE PLACE 1 0 0 B MA HEALTH & EDUCATION FACILITIES AUTHORITY 042456011 57584QAA4 2012-06-27 1720000 CAPITAL EQUIPMENT AND PROJECTS 0 0 0 A 7221865 712880 55862 6117244 1 1 1 1 B 1720000 54828 0 0 1 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 A 1 0 0 0 0 0 B 0 0 0 0 0 0 0 0 0 A 0 B 0 PART IV, #7 & PART V: BOTH BONDS ARE CAREFULLY AND CONSISTENTLY MONITORED FOR POTENTIAL VIOLATIONS OF FEDERAL TAX REQUIREMENTS, BUT THE PROCEDURES WERE NOT WRITTEN AS OF THE END OF THE YEAR COVERED BY THIS TAX RETURN. HOWEVER, THE ORGANIZATION IS CONSIDERING ADOPTING FORMAL POLICIES THAT SET FORTH THE ORGANIZATION'S METHODOLOGY FOR ENSURING POST-ISSUANCE COMPLIANCE WITH IRS REQUIREMENTS PERTAINING TO TAX-EXEMPT DEBT AND CONTAIN SPECIFIC LANGUAGE REGARDING ORGANIZATIONAL RESPONSIBILITY, RECORD RETENTION, PRIVATE BUSINESS USE, ARBITRAGE REBATE, AND REMEDIAL ACTION. ALTHOUGH FORMAL POLICIES ARE NOT IN PLACE IN REGARDS TO THE REMEDIATION OF OUR BONDS, THE MONITORING REQUIREMENTS OF SECTION 148, AND PROCEDURES TO ENSURE THAT VIOLATIONS ARE TIMELY IDENTIFIED AND CORRECTED, THE ORGANIZATION HAS COMPLIANCE CHECKS IN PLACE THAT SUBSTANTIATE THESE REQUIREMENTS. FORM 990, PART VI, SECTION A, LINE 6 COVENANT HEALTH IS THE SOLE MEMBER OF THE ORGANIZATION OF THE BOARD. AS SUCH IT RETAINS CERTAIN RESERVE RIGHTS OVER BOARD DECISIONS AND BOARD COMPOSITION. FORM 990, PART VI, SECTION A, LINE 7A COVENANT HEALTH IS THE SOLE MEMBER OF THE ORGANIZATION. AS SUCH IT RETAINS CERTAIN RESERVE RIGHTS OVER CORPORATE DECISIONS AND BOARD COMPOSITION. FORM 990, PART VI, SECTION A, LINE 7B COVENANT HEALTH IS THE SOLE MEMBERS OF THE ORGANIZATION. AS SUCH IT RETAINS CERATIN RESERVE RIGHTS OVER BOARD DECISIONS AND BOARD COMPOSITION. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PROVIDED TO AND REVIEWED WITH THE BOARD PRIOR TO FILING FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A FULL-TIME OPERATIONAL INTEGRITY OFFICER THAT MONITORS ALL AREAS FOR POTENTIAL CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 EVERY TWO TO THREE YEARS THE COMPENSATION COMMITTEE OF THE COVENANT HEALTH 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. THE SPECIFIC OBJECTIVES OF THE ANALYSIS ARE TO ASSESS THE COMPETITIVENESS OF THE CURRENT TOTAL CASH COMPENSATION LEVELS FOR THE SENIOR LEADERSHIP TEAM; DEVELOP MARKET COMPETITIVE SALARY RANGES FOR ALL EXECUTIVE POSITIONS AND ENSURE THAT THE ANNUAL INCENTIVE OPPORTUNITIES, IF ANY, ARE COMPETITIVE AND REASONABLE. FORM 990, PART VI, SECTION C, LINE 19 THE FORM 990 AND GOVERNING DOCUMENTS, INCLUDING THE CONFLICT OF INTEREST POLICY, AND THE FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. F990, PART X, LINE 15 & LINE 20: EFFECTIVE FOR THE YEAR ENDED DECEMBER 31, 2015, THE SYSTEM RETROACTIVELY ADOPTED THE PROVISIONS OF THE FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS UPDATE (ASU) NO. 2015-03, WHICH CHANGES THE PRESENTATION OF DEBT ISSUANCE COSTS BY REQUIRING THAT DEBT ISSUANCE COSTS RELATED TO A RECOGNIZED DEBT LIABILITY BE PRESENTED IN THE BALANCE SHEET AS A DIRECT DEDUCTION FROM THE CARRYING AMOUNT OF THAT DEBT LIABILITY, CONSISTENT WITH DEBT DISCOUNTS. AS A RESULT OF THE ADOPTION, THE SYSTEM HAS CLASSIFIED THE 2015 AMOUNTS AS REQUIRED. COVENANT HEALTH INC 100 AMES POND DRIVE STE 102 TEWKSBURY MA 01876 222484505 HEALTH CARE MANAGEMENT AND RESOURCE ORGANIZATION MA 501(C)(3) 9 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0