2015-11-16T14:29:29-06:00 2014-12-31 410746749 CLIFTONLARSONALLEN LLP 300 CROWN COLONY DRIVE SUITE 310 QUINCY MA 02169 990 2014-01-01 208745166 LAFAYETTE REHABILITATION AND SKILLED NURSING FACILITY INC C/O PLATINUM CARE LAFA 9784201500 35 AVCO ROAD HAVERHILL MA 01835 JOEL E KIRCHICK PRESIDENT 9784201500 2015-11-13 1 JUDY DALEY P01294075 6179848100 2015-11-13 2014 2016-03-07 17:11:31Z JOEL E KIRCHIK 35 AVCO ROAD HAVERHILL MA 01835 5559407 0 X WWW.THELAFAYETTE.NET X 2007 MA IT IS THE MISSION OF LAFAYETTE REHABILITATION AND SKILLED NURSING FACILITY, INC. TO PROVIDE ELDERS WITH DYNAMIC, MEANINGFUL AND SUPPORTIVE LIVING ENVIRONMENTS, INTEGRATING QUALITY CARE, EDUCATION AND RESEARCH, RESPECT FOR INDIVIDUALITY AND THE HUMAN SPIRIT, AND INNOVATIVE APPROACHES TO MEET THE EVER CHANGING NEEDS OF THE COMMUNITIES WE SERVE. 7 7 144 10 0 0 14253 34703 5414698 5482233 -21736 38299 0 0 5407215 5555235 0 0 0 0 3218906 3317192 0 0 0 2145967 2112936 5364873 5430128 42342 125107 11353061 11261377 9536099 9336530 1816962 1924847 X IT IS THE MISSION OF LAFAYETTE REHABILITATION AND SKILLED NURSING FACILITY, INC. TO PROVIDE ELDERS WITH DYNAMIC, MEANINGFUL AND SUPPORTIVE LIVING ENVIRONMENTS, INTEGRATING QUALITY CARE, EDUCATION AND RESEARCH, RESPECT FOR INDIVIDUALITY AND THE HUMAN SPIRIT, AND INNOVATIVE APPROACHES TO MEET THE EVER CHANGING NEEDS OF THE COMMUNITIES WE SERVE. 0 0 4737966 5482233 LAFAYETTE REHABILITATION AND SKILLED NURSING FACILITY, INC. IS A 65-BED, JCAHO ACCREDITED AND MEDICARE CERTIFIED HEALTHCARE FACILITY OFFERING TRADITIONAL SKILLED NURSING CARE, SHORT-TERM REHABILITATION, PLUS A VARIETY OF SPECIALIZED TREATMENT PROGRAMS. 4737966 1 0 0 0 0 0 0 0 0 0 1 0 0 1 0 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 6 0 1 144 1 0 0 0 0 0 1 1 0 0 0 0 X 7 7 0 1 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 MA X DEBORAH LEBEL 9784201500 35 AVCO ROAD HAVERHILL MA 01835 X JOEL KIRCHIK PRESIDENT 1.00 2.00 X X 0 0 0 RAYMOND DENNEHY TREASURER 1.00 2.00 X X 0 0 0 JOHN REGAN SECRETARY 1.00 2.00 X X 0 0 0 MICHAEL MOORE DIRECTOR 1.00 2.00 X 0 0 0 DAVID O'DONNELL DIRECTOR 1.00 2.00 X 0 0 0 PATRICIA TORTELLA DIRECTOR 1.00 2.00 X 0 0 0 JEFFREY WITHERELL DIRECTOR 1.00 2.00 X 0 0 0 GEORGE BARBUZZI FACILITY ADMINISTRATOR 40.00 0.00 X 113163 0 1166 113163 0 1166 1 0 0 0 PLATINUM CARE LLC 35 AVCO ROAD HAVERHILL MA 01835 MANAGEMENT SERVICES 360347 PERFORMANCE HEALTHCARE 47R RIVER STREET SUITE 200R WELLESLEY MA 02481 HOUSEKEEPING & LAUNDRY SERVICES 116816 US FOODS PO BOX 3155 BOSTON MA 02241 FOOD SERVICES 104301 3 34703 34703 PROGRAM SERVICE REVENUE 623000 5482233 5482233 5482233 38608 38608 3863 4172 -309 -309 -309 0 34703 0 0 5555235 5482233 0 38299 2888502 2702329 186173 206079 192797 13282 222611 208263 14348 339300 339300 394 394 29235 29235 3863 3863 231057 231057 26396 26396 718331 670545 47786 29350 29350 3528 3528 100056 97600 2456 209273 209273 34652 34652 MEDICAL EXPENSES 244359 244359 DIETARY EXPENSES 139700 139700 OTHER EXPENSES 3442 3442 5430128 4737966 692162 0 1404205 1625458 1147198 1105910 370402 312113 44608 33482 6790381 1268704 5680398 5521677 1513333 1513333 1192917 1149404 11353061 11261377 534723 469354 8196542 8616870 804834 250306 9536099 9336530 X 1816962 1924847 1816962 1924847 11353061 11261377 125107 -17222 0 X 0 1 X 0 0 X 34156 29373 23963 14253 34703 136448 5949097 6031907 5484941 5414698 5482233 28362876 5983253 6061280 5508904 5428951 5516936 28499324 30000 20000 15000 20000 85000 0 30000 20000 15000 20000 85000 28414324 35023 35563 29624 21217 38609 160036 35023 35563 29624 21217 38609 160036 434 6035 6469 6018710 6102878 5538528 5450168 5555545 28665829 0.99120 0.00560 X 584000 584000 5256001 941700 4314301 569289 103679 465610 381091 223325 157766 5521677 DEFERRED FINANCING COSTS, NET 297802 TRUSTEE FUNDS HELD UNDER BOND INDENTURE 851490 INTEREST RECEIVABLE 112 1149404 X PART X, LINE 2: THE ORGANIZATION IS A MASSACHUSETTS 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. THIS ENTITY'S 2011 THROUGH 2014 TAX YEARS ARE OPEN FOR EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES. GOLF TOURNAMENT 34703 34703 0 0 0 0 0 0 34703 34703 A MASSACHUSETTS DEVELOPMENT FINANCE AGENCY - SERIES 2007A 043431814 57585AAA8 2007-10-25 652313 PURCHASE FACILITIES 0 0 0 B MASSACHUSETTS DEVELOPMENT FINANCE AGENCY - SERIES 2007A 043431814 57585AAB6 2007-10-25 2648860 PURCHASE FACILITIES 0 0 0 C MASSACHUSETTS DEVELOPMENT FINANCE AGENCY - SERIES 2007A 043431814 57585AAC4 2007-10-25 4854593 PURCHASE FACILITIES 0 0 0 D MASSACHUSETTS DEVELOPMENT FINANCE AGENCY - SERIES 2007C 043431814 2007-10-25 670606 PURCHASE FACILITIES 0 0 0 A 652313 391271 261042 2007 0 0 1 1 B 2648860 977754 1671106 2007 0 0 1 1 C 4854593 4854593 2007 0 0 1 1 D 670606 6364 664242 2007 0 0 1 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 D 0 0 0 0 0 0 0 A 0 1 0 0 0 0 0 0 B 0 1 0 0 0 0 0 0 C 0 1 0 0 0 0 0 0 D 0 1 0 0 0 0 0 0 A 0 B 0 C 0 D 0 FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION HAS ENTERED INTO A FIFTEEN-YEAR MANAGEMENT AGREEMENT, EXPIRING OCTOBER 2022, WITH PLATINUM CARE, LLC TO MANAGE THE OPERATIONS OF LAFAYETTE REHABILITATION AND SKILLED NURSING FACILITY, INC. ACTING THROUGH THE NURSING FACILITY EMPLOYEES, TO SUPERVISE, DIRECT AND CONTROL THE DAY-TO-DAY BUSINESS ACTIVITIES AND MANAGEMENT OF THE NURSING FACILITY. PLATINUM CARE, LLC PREPARE AND FILE, ALL COST REPORTS, PAYROLL TAX AND REAL ESTATE TAX FILINGS REQUIRED. FORM 990, PART VI, SECTION B, LINE 11 A COMPLETE COPY OF THE FORM 990 TAX RETURN (INCLUDING ALL REQUIRED SCHEDULES) IS PROVIDED TO EACH PERSON WHO IS A VOTING MEMBER OF THE BOARD OF DIRECTORS AT THE TIME THE FORM 990 IS PROVIDED, EITHER IN PAPER OR ELECTRONIC FORM, BEFORE IT IS FILED WITH THE IRS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE MADE AVAILABLE ON THE MSRB ELECTRONIC MUNICIPAL MARKET ACCESS (EMMA) WEBSITE. 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