2015-05-11T09:00:16-07:00 2014-09-30 990 2013-10-01 223012385 JOHNSON EVERGREEN CORPORATION JOHN 8606846341 205 Chestnut Hill Road Stafford Springs CT 060760549 John Grish Chief Financial Officer 8606848105 2015-05-11 2013 2016-03-07 17:11:31Z Evergreen Health Care Center Stuart E Rosenberg 289 Hill Street Bristol CT 06010 16720370 0 X www.jmmc.com X 1989 CT To develop, operate ,and maintain programs directed toward improving the efficiency of utiliztion of Health Care Facilities and Services in the State of CT, and in Hartford and Tolland Counties and surrouding areas in particular, and reducing the cost of health care to the public while maintaining a high quality of care. Evergreen is skilled nursing facility with 120 long-term-care beds, a 30-bed Subacute unit for patients in need of extensive therapy and care before returning home, and a 30 bed MSU. 15 15 345 58 0 0 10420 8324 16121923 16658078 0 0 21028 53968 16153371 16720370 0 0 0 0 11003418 11045293 0 0 0 8469002 8785015 19472420 19830308 -3319049 -3109938 8172681 5622950 16881755 17441962 -8709074 -11819012 To develop, operate ,and maintain programs directed toward improving the efficiency of utiliztion of Health Care Facilities and Services in the State of CT, and in Hartford and Tolland Counties and surrouding areas in particular, and reducing the cost of health care to the public while maintaining a high quality of care. Evergreen is a Skilled Nursing Facility with 120 long term beds, a 30 bed Subacute Rehabilitation unit and a 30 bed MSU. Services include: 24 hour nursing care, long term care, cardiac recovery, subacute rehabilitation, dental care, hospice care, respite care, iv therapies, medically complex care, mental health services, oncology/cancer care, optometry and opthalmology, orthopedic care, pain management, wound care, podiatry and other special services, postoperative care, pulmonary/respiratory care, social services and therapeutic recreation. 0 0 18888947 0 16720370 Nursing Home Care: Johnson Evergreen Corporation, DBA Evergreen Health Care Center maintains a 180 bed SNF with 24 hour skilled nursing care for residnets. During Fy 14 the facility maintained a high occupancy and high quality care in the facility. The cost shown represents the necessary salary, supplies, and overhead essential for caring for residents at Evergreen. (52078 resident days) 0 0 0 18888947 1 0 0 0 0 0 0 0 0 0 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 1 1 0 0 1 26 0 345 1 0 0 0 0 0 0 0 0 0 0 X 15 15 0 0 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Tia Riedel 8606848742 201 Chestnut Hill Road Stafford Springs CT 06076 Patrick Mahon Chairman 2 X 0 0 0 James M Makuch Vice Chairman 2 X 0 0 0 Evelyne A Parizek Secretary 2 X 0 0 0 David O'connor Treasurer 2 X 0 0 0 Christopher Dadlez Director 2 X 0 0 0 Cathryn-Jean Fleming ESQ Director 2 X 0 0 0 John Giamalis Director 2 X 0 0 0 Joseph Ianello MD Director 2 X 0 0 0 Michael P Krol Director 2 X 0 0 0 Younus F Masih MD Director 2 X 0 0 0 John W Patton Director 2 X 0 0 0 Kevin Sullivan Director 2 X 0 0 0 Christopher Hartley Director 2 X 0 0 0 John Rodis MD Director 2 X 0 0 0 Phil Tartsinis Director 2 X 0 0 0 Stuart E Rosenberg President/CEO 50 X 0 0 388000 John Grish Chief Financial Officer 50 X 0 266742 19247 James Fidanza Administrator /Vice President 50 X 111843 0 16487 Damien R Eilerman Nursing Supervisor 50 X 139208 0 17262 251051 266742 440996 2 0 1 1 0 0 0 0 0 0 8324 0 8324 Resident Revenues 623000 16658078 16658078 0 0 0 0 0 0 16658078 0 0 0 0 0 Title 19 Application fees 561000 6000 6000 0 0 Miscellaneous Revenues 900099 47968 47968 0 0 0 0 0 0 53968 16720370 16712046 0 0 8847186 8596135 251051 1557781 1541804 15977 640326 622555 17771 1052 1052 43625 43625 822456 647953 174503 721509 721509 25329 23217 2112 482053 482053 291808 291808 3003877 3003877 733661 600233 133428 Food 424695 424695 0 0 Patient Care and General Supplies 1258292 1258292 0 0 Provision for Uncollectible Accounts 107536 107536 0 0 Provider Taxes 859088 859088 0 0 10034 10034 19830308 18888947 941361 0 300 300 1560623 1598868 34435 29503 84479 396799 19792639 16792639 6000000 3000000 492844 597480 8172681 5622950 1856808 2275637 14213697 14213697 811250 952628 16881755 17441962 X -8709074 -11819012 0 0 0 0 -8709074 -11819012 8172681 5622950 -3109938 0 0 0 0 0 X 0 1 X 1 0 X 24292 24258 8629 10420 8324 75923 16970737 17547583 16798928 16121923 16658078 84097249 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16995029 17571841 16807557 16132343 16666402 84173172 0 0 0 0 0 0 0 0 0 0 0 0 0 0 84173172 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 551751 108544 43968 21028 53968 779259 17546780 17680385 16851525 16153371 16720370 84952431 0.99083 0.98517 0 0 X Schedule A, Part III, Line 12 Other Income of 53968 is Title 19 Appllications and various Misc. revenues 0 0 0 15733693 0 13640086 2093607 0 0 0 0 2532579 0 2365603 166976 1526367 0 786950 739417 3000000 Other Receivables 414903 Deferred Costs 123047 Patient Trust Fund 59530 597480 0 Other Liabilities 332908 Patient Trust Fund 59530 Payments due under Plan of Reorganization 209650 Due to Affiliated Corporations 163187 Estimated Amounts due to Third-Party Payers 187353 952628 X 16612832 0 0 0 0 0 16612832 0 107538 107538 16720370 19722770 0 0 0 0 0 19722770 0 107538 107538 19830308 Schedule D, Part X, Line 2 Management has analyzed the tax positions taken and has concluded that as of September 30, 2014, there are no uncertain tax positions taken or expected to be taken that would require recognition of a liability (or asset) or disclosure in the financial statements. The company is subject to routine audits by taxing jurisdictions; however, there are currently no audits for any tax periods in progress. Management believes the Company is no longer subject to income tax examinations prior to 2011. Schedule D, Part XI, Line 4b Bad Debt Expense Schedule D, Part XII, Line 4b Bad Debt expnese on audited financial statements is a deduction from revenue X X X X X 0 0 0 0 0 0 0 0 0 Stuart E Rosenberg President/CEO 0 0 0 0 0 388000 0 0 0 0 0 388000 0 0 John Grish Chief Financial Officer 0 266742 0 0 0 19247 0 0 0 0 0 285989 0 0 Damien R Eilerman Nursing Supervisor 139208 0 0 0 17262 0 0 0 0 0 156470 0 0 0 Form 990, Part VI, Section A, Line 6 Article 3 of the Johnson Memorial Medical Center Bylaws stipulates there will be not less than 30 nor more than 60 Members. Form 990, Part VI, Section A, Line 7a Members ae elected by the Board as recommended by the Governance and Nominating Committee Form 990, Part VI, Section B, Line 11b Board policy provides that Members of the Finance Committe are provided opportunity to review and comment to Executive leadership before the 990 is filed. All members of the Board have access to any copy of the Form 990 and the Chief Financial Officer provides a summary of the 990 at the Board meeting following the filing of Form 990. Form 990, Part VI, Section B, Line 12c An annual disclosure statement is required. Executives, Managers, and Board Members are required on an annual basis to disclose interests that may give rise to a conflict of interest. Form 990, Part VI, Section B, Line 15 A Board committee reviews compensation for the executive team and recommends compensation for Board approval. Comparability data is reviewed and may include surveys, documented comparisons of persons holding similiar postions in similiar orgainizations, and expert compensation schedules. Form 990, Part VI, Section C, Line 19 The Johnosn Memorial Medical Center maintains these documents in Administration and are available for viewing upons request during normal business hours. Johnson Memorial Medical Center 201 Chestnut Hill Road Stafford Springs CT 06076 222541974 Parent Corporation CT 501 c 3 11 N/A Johnson Memorial Hospital 201 Chestnut Hill Road Stafford Springs CT 06076 060646696 Acute Care Hospital CT 501 c 3 3 N/A Johnson Development Fund Inc 201 Chestnut Hill Road Stafford Springs CT 06076 222541977 Fund Raising CT 501 c 3 11 N/A Johnson Health Care Inc 201 Chestnut Hill Road Stafford Springs CT 06076 222541981 Occupational Medicine CT 501 c 3 9 N/A Home and Community Health Services 101 Phoenix Avenue Enfield CT 06083 060646620 Visiting Nurse Association CT 501 c 3 9 N/A Wellcare Inc 201 Chestnut Hill Road stafford Springs CT 06076 222541983 Inactive For Profit Corporation CT N/A C 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 Johnson Memorial Hospital k 180000 Reasonable cost Johnson Memorial Hospital p 291808 Reasonable cost N/A