2016-08-11T07:50:11-05:00 2015-12-31 010494526 BAKER NEWMAN & NOYES LLC 650 ELM STREET SUITE 302 MANCHESTER NH 03101 990 2015-01-01 042565937 ST JOSEPH MANOR HEALTH CARE INC STJO 5085835834 215 THATCHER STREET BROCKTON MA 023023949 JOHN AHLE CFO 5085835834 2016-08-09 E DREW CHENEY P00182972 8002447444 2016-08-09 2015 2016-12-15 16:53:06Z JOHN AHLE 215 THATCHER STREET BROCKTON MA 023023949 11149812 0 X SJMBROCKTON.ORG X 1975 MA OUR CATHOLIC MINISTRY OF COMPASSIONATE OF HEALTH CARE PROVIDES PERSON-CENTERED SERVICES OF ALL FAITHS IN OUR HOME AND WITHIN OUR COMMUNITY. 13 13 289 0 0 0 91066 22788 11462036 11027498 18870 18532 84419 66237 11656391 11135055 0 0 0 0 7075717 6769345 0 0 0 4633830 4522222 11709547 11291567 -53156 -156512 7328173 7139594 2819306 2847697 4508867 4291897 OUR CATHOLIC MINISTRY OF COMPASSIONATE HEALTH CARE PROVIDES PERSON-CENTERED SERVICES TO PEOPLE OF ALL FAITHS IN OUR HOME AND WITHIN OUR COMMUNITY. 0 0 11067559 11086152 ST. JOSEPH MANOR PROVIDED 39,935 DAYS OF SKILLED NURSING CARE TO PATIENTS FROM ALL ECONOMIC, RELIGIOUS AND ETHNIC GROUPS DURING 2015. OF THESE, A TOTAL OF 31,976 DAYS WERE PROVIDED TO MEDICAID RECIPIENTS. 11067559 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 23 0 1 289 1 0 0 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X X OLGA BATISTA 5085835834 215 THATCHER STREET BROCKTON MA 02302 SR MARY VALLIERE TRUSTEE - CLASS A MEMBER 1.00 X 0 0 0 SR RUTH DAUGINIKAS TRUSTEE - CLASS A MEMBER 1.00 X 0 0 0 PAUL ARENBURG VICE CHAIR 1.00 X 0 0 0 ANNA WILLIAMS COTE TRUSTEE THRU 12/18/15 1.00 X 0 0 0 JOHN DRUSINSKAS TRUSTEE 1.00 X 0 0 0 PEG FEODOROFF TRUSTEE 1.00 X 0 0 0 AISHA BONNY CHAIR PERSON 1.00 X X 0 0 0 CHARLES ALTIERI TREASURER 1.00 X X 0 0 0 CLAIRE WHEELER TRUSTEE 1.00 X 0 0 0 REV RICHARD CROWLEY TRUSTEE 1.00 X 0 0 0 ANGELA CARDOSO-FONTES TRUSTEE 1.00 X 0 0 0 ROBERT SULLIVAN TRUSTEE 1.00 X 0 0 0 CHRISTOPHER SHEPARD TRUSTEE 1.00 X 0 0 0 HILLARY TROIA TRUSTEE 1.00 X 0 0 0 CHRISTOPHER KENNEY CEO/ADMINISTRATOR 40.00 X 121605 0 25735 JESSICA MILLER DIRECTOR OF NURSING 40.00 X 102751 0 9950 224356 0 35685 2 0 0 0 REHABCARE GROUP INC 7733 FORSYTH BOULEVARD ST LOUIS MO 63105 REHAB SERVICES 812300 COVENANT HEALTH INC 100 AMES POND DRIVE TEWKSBURY MA 01878 MANAGEMENT SERVICES 348252 2 22788 22788 PROGRAM SERVICE REVENUE 623000 11027498 11027498 11027498 18532 18532 22340 14757 7583 7583 MISCELLANEOUS INCOME 623000 58654 58654 58654 11135055 11086152 0 26115 111911 111911 5582809 5582809 19629 19629 630346 630346 424650 424650 140088 140088 14477 14477 69443 69443 24819 24819 112017 112017 173102 173102 8102 8102 16858 16858 71636 71636 429260 429260 225458 225458 PURCHASED SERVICES 1273032 1273032 SUPPLIES AND MATERIALS 1053480 1053480 MEDICAID USER FEE 634593 634593 UTILITIES 275857 275857 11291567 11067559 224008 0 564483 360808 1069549 1368576 58109 43185 8569445 4510420 4305763 4059025 1311066 1281487 19203 26513 7328173 7139594 511022 706357 2261646 2083272 46638 58068 2819306 2847697 X 4483756 4279428 25111 12469 4508867 4291897 7328173 7139594 X -156512 -47816 -12642 X 0 1 X 1 0 X 8349 16970 42114 91066 22788 181287 10822275 11590554 11958556 11533028 11086152 56990565 10830624 11607524 12000670 11624094 11108940 57171852 0 0 0 57171852 37355 24966 18495 18532 99348 37355 24966 18495 18532 99348 3382 29046 13427 7583 53438 10830624 11648261 12054682 11656016 11135055 57324638 0.99730 0.99780 0.00170 0.00140 X 25111 13062 25704 12469 16000 56127 47016 25111 45089 30935 60024 16000 19848 27418 2177 45089 16912 5617 2681 19848 1.00000 0 0 259590 259590 2224876 278110 1946766 3629383 2278124 1351259 2178111 1747906 430205 277485 206280 71205 4059025 RESIDENT FUNDS LIABILITY 26110 OTHER LIABILITIES 3494 PROFESSIONAL LOSS RESERVES 28464 58068 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. GOLF OUTING 22340 22340 3000 1800 7665 1870 422 22340 22340 3000 1800 7665 1870 422 14757 7583 FORM 990, PART VI, SECTION A, LINE 6 ST. JOSEPH MANOR IS RELATED TO THE POOR SISTERS OF JESUS CRUCIFIED AND THE SORROWFUL MOTHER, INC. WHO IS A CLASS A MEMBER. FORM 990, PART VI, SECTION A, LINE 7A ST. JOSEPH MANOR IS RELATED TO THE POOR SISTERS OF JESUS CRUCIFIED AND THE SORROWFUL MOTHER, INC. WHO IS A CLASS A MEMBER. FORM 990, PART VI, SECTION A, LINE 7B ST. JOSEPH MANOR IS RELATED TO THE POOR SISTERS OF JESUS CRUCIFIED AND THE SORROWFUL MOTHER, INC. WHO IS A CLASS A MEMBER. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS REVIEWED IN DETAIL BY THE GOVERNING BODY PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A FULL-TIME DESIGNATED ORGANIZATIONAL INTEGRITY OFFICER THAT MONITORS OPERATIONS TO DETECT AND/OR RESOLVE CONFLICT OF INTEREST ISSUES. FORM 990, PART VI, SECTION B, LINE 15 EVERY 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. 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 18 THE FORM 990 IS POSTED ON THE COVENANT HEALTH WEBSITE. IT IS ALSO AVAILABLE AT THE FACILITY UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 ST. JOSEPH MANOR MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: DECREASE IN TEMPORARILY RESTRICTED NET ASSETS -12,642. COVENANT HEALTH 100 AMES POND DRIVE TEWKSBURY MA 01876 222484505 MANAGEMENT MA 501 (C)(3) 9 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 0 0