2015-11-03T13:43:58-06:00 2014-12-31 410746749 CLIFTONLARSONALLEN LLP 300 CROWN COLONY DRIVE SUITE 310 QUINCY MA 02169 990 2014-01-01 042106768 JEWISH REHABILITATION CENTER FOR THE AGED OF THE NORTH SHORE INC JEWI 9784715100 240 LYNNFIELD STREET PEABODY MA 01960 KIM JOYCE ASST TREASURER & CFO 9784715100 2015-09-25 1 JUDY DALEY P01294075 6179848100 2015-09-11 2014 2016-03-07 17:11:31Z KIM JOYCE 240 LYNNFIELD STREET PEABODY MA 01960 22915549 0 X WWW.AVIVLIVING.ORG X 1944 MA THE ORGANIZATION'S MISSION IS TO ENRICH THE LIFE OF EACH OF OUR RESIDENTS AND PROGRAM PARTICIPANTS, SO THAT EACH CAN CONTINUE TO LIVE HIS OR HER LIFE WITH A SENSE OF MEANING AND PURPOSE THROUGH THE OPERATION OF A 180-BED NURSING HOME WITH AN ADULT DAY CARE CENTER. 7 7 0 33 0 0 0 0 17113013 17527831 136 2087948 0 533 17113149 19616312 0 0 0 0 11464605 11539972 0 0 0 8902945 8419977 20367550 19959949 -3254401 -343637 42176405 37067898 47410323 42710705 -5233918 -5642807 THE ORGANIZATION'S MISSION IS TO ENRICH THE LIFE OF EACH OF OUR RESIDENTS AND PROGRAM PARTICIPANTS, SO THAT EACH CAN CONTINUE TO LIVE HIS OR HER LIFE WITH A SENSE OF MEANING AND PURPOSE THROUGH THE OPERATION OF A 180-BED NURSING HOME WITH AN ADULT DAY CARE CENTER. 0 0 17283664 16722647 NURSING HOME - PROVIDE QUALITY SKILLED NURSING CARE & REHABILITATIVE THERAPY FOR UP TO 144 ELDERLY RESIDENTS OF A 180-BED NURSING HOME. 832747 805717 ADULT DAY CARE - PROVIDE SUPPORTIVE CARE TO PATIENTS OF THE ADULT DAY CARE FACILITY. 18116411 1 0 0 0 0 0 0 0 0 0 1 0 0 0 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 0 0 0 0 0 0 0 0 0 0 0 X 7 7 1 1 1 0 0 0 0 1 1 0 0 0 1 1 1 1 0 1 1 0 MA X KIM JOYCE CFO 9784715100 240 LYNNFIELD STREET PEABODY MA 01960 ERIC LEVY CHAIR (THRU 11/30/14) 2.00 5.00 X X 0 0 0 DAVID VARSANO VICE CHAIR (THRU 11/30/14) 1.00 3.00 X X 0 0 0 WAYNE SHERIDAN TREASURER (THRU 03/01/14) 1.00 3.00 X X 0 0 0 NEAL MIZNER SECRETARY (THRU 03/01/14) 1.00 3.00 X X 0 0 0 TOM DICKER DIRECTOR (THRU 11/30/14) 1.00 1.00 X 0 0 0 RONALD ROSEN MD DIRECTOR (THRU 11/30/14) 1.00 1.00 X 0 0 0 DIANA MEICHES DIRECTOR (THRU 04/01/14) 1.00 1.00 X 0 0 0 DANIEL RUBIN DIRECTOR (THRU 11/30/14) 1.00 1.00 X 0 0 0 ROBERT MAZOW DIRECTOR (THRU 11/30/14) 1.00 1.00 X 0 0 0 STEVEN HOLLIS MD DIRECTOR (THRU 11/30/14) 1.00 1.00 X 0 0 0 ANDREW MERKEN DIRECTOR (THRU 11/30/14) 1.00 1.00 X 0 0 0 ROBERT SMITH DIRECTOR (THRU 11/30/14) 1.00 1.00 X 0 0 0 MARK JAFFE DIRECTOR (THRU 11/30/14) 1.00 1.00 X 0 0 0 SEYMOUR SCHWARTZ DIRECTOR (THRU 11/30/14) 1.00 3.00 X 0 0 0 DAVID PLINER DIRECTOR (THRU 11/30/14) 1.00 3.00 X 0 0 0 ANDREW KATZ DIRECTOR (THRU 11/30/14) 1.00 1.00 X 0 0 0 ADAM BERMAN PRESIDENT (AS OF 12/01/14) 1.00 3.00 X X 0 0 0 JOEL MAZER CHAIR (AS OF 12/01/14) 2.00 6.00 X X 0 0 0 BARRY BERMAN TREASURER (AS OF 12/01/14) 1.00 3.00 X X 0 0 0 ELIZABETH MULLEN SECRETARY (AS OF 12/01/14) 1.00 3.00 X X 0 0 0 SUSAN BRUDNICK DIRECTOR (AS OF 12/01/14) 1.00 3.00 X 0 0 0 SHARON FORMAN DIRECTOR (AS OF 12/01/14) 1.00 3.00 X 0 0 0 ROBERT RICHMAN DIRECTOR (AS OF 12/01/14) 1.00 3.00 X 0 0 0 KIM JOYCE ASST TREASURER & CFO 0.00 40.00 X 0 178462 41808 JEFF GOPEN EXECUTIVE VP OF OPERATIONS 40.00 0.00 X 184038 0 47344 JEAN CICATELLI DIRECTOR OF NURSING 40.00 0.00 X 115533 0 11386 CARLEEN MCLAUGHLIN REGISTERED NURSE 40.00 0.00 X 115409 0 16204 MARY OGAH REGISTERED NURSE 40.00 0.00 X 108965 0 10708 523945 178462 127450 4 0 1 0 CLIFTONLARSONALLEN 300 CROWN COLONY DRIVE QUINCY MA 02169 ACCOUNTING & TAX SERVICES 110285 1 PROGRAM SERVICE INCOME 623000 17457679 17457679 OTHER INCOME 624100 70152 70152 17527831 1185 1185 5386000 3299237 2086763 2086763 2086763 533 0 533 533 19616312 17528364 0 2087948 10004164 9667640 336524 22686 21923 763 670292 647744 22548 842830 814479 28351 1290000 1290000 2781 2781 43042 43042 502755 383226 119529 140072 140072 151028 151028 555609 555609 5274 5274 18065 18065 1479050 1479050 1562515 1562515 16500 16500 ANCILLARIES 858650 858650 USER FEE 656243 656243 SUPPLIES 455527 455527 FOOD 452888 452888 229978 229978 19959949 18116411 1843538 0 1686279 931133 80 0 1397411 1943544 499 370308 351577 36870302 3971849 34316379 32898453 4405948 942692 42176405 37067898 1260897 1514107 183376 155442 34035888 29136380 242333 269034 11687829 11635742 47410323 42710705 X -5233918 -5642807 -5233918 -5642807 42176405 37067898 X -343637 -65253 X 0 1 X 1 0 X 738 1607943 1608681 16742872 17078920 15224807 17113013 17528364 83687976 16743610 18686863 15224807 17113013 17528364 85296657 1607943 1607943 0 1607943 1607943 83688714 935711 138 135 1185 937169 935711 138 135 1185 937169 -406566 2086763 1680197 16743610 19622574 14818379 17113148 19616312 87914023 0.95190 0.97500 0.01070 0.01100 X 31483678 1970175 29513503 5329568 1955191 3374377 57056 46483 10573 32898453 DUE TO RELATED PARTIES 11398188 FAIR VALUE OF INTEREST RATE SWAPS 215859 SECURITY DEPOSITS 21695 11635742 X PART X, LINE 2: JEWISH RAHBILITATION CENTER FOR AGED OF THE NORTH SHORE, INC. 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. JEWISH REHABILITATION CENTER FOR AGED OF THE NORTH SHORE, INC. FILES AS A TAX-EXEMPT ORGANIZATION. THE 2011 THROUGH 2014 TAX YEARS ARE OPEN TO EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES. 0 0 0 0 0 0 0 0 0 KIM JOYCE ASST TREASURER & CFO 0 160000 0 18462 0 0 0 25000 0 16808 0 220270 0 0 JEFF GOPEN EXECUTIVE VP OF OPERATIONS 165000 0 19038 0 0 0 25000 0 22344 0 231382 0 0 0 A MASS DEVELOPMENT FINANCE AGENCY 043431814 57583UBR8 2011-04-29 34553888 TO REFUND OLD BONDS AND REPLACE EXISTING FACILITY. 0 0 0 A 5417508 34553888 1314672 690823 529178 26601707 2012 1 0 1 1 A 0 0 0 0 0 0 0 A 0 1 0 0 1 1 M&T BANK 5.000000000000 0 0 0 0 0 A 0 SCHEDULE K SUPPLENTAL INFORMATION THIS ORGANIZATION IS REPORTING THEIR RESPECTIVE SHARE OF THE $50M BOND ISSUED ON 04/29/11. SEE AVIV ASSISTED LIVING, INC. (EIN 04-3274643) FOR THE REMAINING PORTION. FORM 990, PART VI, SECTION A, LINE 1 DURING 2014, A STRATEGIC PLANNING COMMITTEE WAS PUT IN PLACE TO REVIEW AND EVALUATE THE ORGANIZATIONS. SIX MEMBERS OF FORMER BOARD WORKED TOGETHER WITH BANKS AND MANAGEMENT TO IDENTIFY OUTSIDE ORGANIZATION TO CONTINUE MISSION OF AVIV WITH THE CAPACITY TO TAKE ON AVIV DEBT AND PROJECT IMPROVEMENT IN OPERATIONS TO BE ABLE TO PAY DEBT. FORM 990, PART VI, SECTION A, LINE 2 BARRY BERMAN AND ADAM BERMAN HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION ENTERED INTO A MANAGEMENT AGREEMENT WITH CHELSEA JEWISH COMMUNITY, INC., A SUBSIDIARY OF CHELSEA JEWISH FOUNDATION, EFFECTIVE DECEMBER 1, 2014. CHELSEA JEWISH COMMUNITY, INC. PROVIDED MANAGEMENT SERVICES WHICH INCLUDED THE FOLLOWING RESPONSIBILITIES: 1) KEY PERSONNEL MANAGEMENT 2) PERSONNEL OVERSIGHT (EMPLOYEES & ADMINISTRATION) 3) FINANCIAL RESPONSIBILITIES 4) MANAGEMENT REPORTS 5) REGULATORY COMPLIANCE 6) QUALITY ASSURANCE 7) PURCHASING & CONTRACTING 8) BANK ACCOUNTS FORM 990, PART VI, SECTION A, LINE 4 THE COMPOSITION OF THE BOARD OF DIRECTORS CHANGED ON 12/01/14. FORM 990, PART VI, SECTION B, LINE 11 MANAGEMENT REVIEWS THE CPA-PREPARED FORM 990 PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF DIRECTORS AND EXECUTIVE MANAGERS ARE REQUIRED ANNUALLY TO COMPLETE A CONFLICT OF INTEREST STATEMENT. STATEMENTS ARE REVIEWED BY A SUBCOMMITTEE OF BOARD MEMBERS AND EXECUTIVE MANAGEMENT. MONTHLY COMPLIANCE COMMITTEE MEETINGS INCLUDE REVIEW AND MONITORING OF ANY POTENTIAL OR ACTUAL CONFLICTS. DETERMINING THE LEVEL OF CONFLICT FOR REVIEW IS BASED ON POTENTIAL FINANCIAL OR LEGAL RISK TO THE ORGANIZATION. IF A CONFLICT (ACTUAL OR POTENTIAL) IS RAISED FOR A BOARD MEMBER, HE/SHE IS REFRAINED FROM VOTING ON RELATED TOPICS. MANAGERS WITH CONFLICT (ACTUAL OR POTENTIAL) ARE BANNED FROM OVERSIGHT AND DECISION MAKING FOR THAT SUBJECT. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION COMMITTEE, A SUBCOMMITTEE OF THE BOARD, ANNUALLY REVIEWS CEO AND TOP MANAGEMENT COMPENSATION. INDUSTRY SALARY AND BENEFIT SURVEYS AS WELL AS MARKET DATA ARE REVIEWED AS DEEMED NECESSARY. THE COMPENSATION COMMITTEE AND REVIEW OF COMPENSATION IS DOCUMENTED IN THE FORM OF A REPORT AND MAINTAINED IN HUMAN RESOURCE FILES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN FAIR VALUE OF INTEREST RATE SWAPS -65,253. AVIV FOUNDATION INC 240 LYNNFIELD STREET PEABODY MA 01960 223102199 FUNDRAISING MA 501(C)(3) LINE 7 AVIV CENTERS FOR LIVING 0 AVIV ASSISTED LIVING INC 240 LYNNFIELD STREET PEABODY MA 01960 043274643 ASSISTED LIVING MA 501(C)(3) LINE 9 AVIV CENTERS FOR LIVING 0 AVIV CENTERS FOR LIVING INC 240 LYNNFIELD STREET PEABODY MA 01960 261244471 MANAGEMENT MA 501(C)(3) LINE 11B, II 0 JRC REALTY CORPORATION INC 240 LYNNFIELD STREET PEABODY MA 01960 043321272 REAL ESTATE MA N/A C 0 0 0 0 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0