2015-11-16T14:28:06-06:00 2014-12-31 061009205 BLUM SHAPIRO & COMPANY PC 50 HOLDEN STREET PROVIDENCE RI 02908 990 2014-01-01 222723407 ELMHURST EXTENDED CARE FACILITY INC ELMH 4014562600 50 MAUDE STREET PROVIDENCE RI 02908 DANIEL RYAN CHAIRMAN 4014562600 2015-11-12 1 MONICA MOTTA P01316400 4012725600 2015-11-12 2014 2016-04-25 22:37:26Z X DANIEL RYAN 825 CHALKSTONE AVENUE PROVIDENCE RI 02908 9943601 0 X ELMHURSTEXTENDEDCARE.ORG X 1985 RI ELMHURST EXTENDED CARE FACILITY'S MISSION WAS TO PROVIDE LONG TERM HEALTH CARE SERVICES TO THE ELDERLY AND NEEDY IN PROVIDENCE, RI AREA X 3 3 37 0 0 0 505095 642464 18181970 9272600 0 -2233607 64371 28537 18751436 7709994 0 0 0 0 12281795 6225196 0 0 0 6804055 3219949 19085850 9445145 -334414 -1735151 3114584 0 4709872 0 -1595288 0 ELMHURST EXTENDED CARE FACILITY'S MISSION WAS TO PROVIDE LONG TERM HEALTH CARE SERVICES TO THE ELDERLY AND NEEDY IN THE PROVIDENCE, RI AREA. EFFECTIVE JUNE 20, 2014 ELMHURST EXTENDED CARE FACILITY SOLD THEIR ASSETS TO A FOR PROFIT ENTITY. 0 0 8407502 9272600 ELMHURST EXTENDED CARE FACILITY PROVIDED LONG TERM HEALTH CARE FOR THE ELDERLY THROUGH THE OPERATION OF A NURSING CARE FACILITY. THE FACILITY WAS MEDICARE AND MEDICAID CERTIFIED. FROM THE PERIOD JANUARY 1, 2014 THROUGH JUNE 19, 2014 THERE WERE 32,467 PATIENT BED DAYS PROVIDED. INCLUDED IN THIS TOTAL WERE 16,461 MEDICAID AND 3,626 MEDICARE BED DAYS. 8407502 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 X 13 0 1 37 1 0 0 0 0 0 0 0 0 0 0 X 3 3 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 RI X THE ORGANIZATION 4014562600 50 MAUDE STREET PROVIDENCE RI 02908 DONALD MCQUEEN SECRETARY 1.00 X X 0 0 0 KENNETH BELCHER PRESIDENT (TERMINATED 7/14) 1.00 40.00 X X 0 517817 216506 MICHAEL CONKLIN TREASURER (TERMINATED 8/14) 1.00 40.00 X X 0 383100 153289 RICHARD GAMACHE ADMINISTRATOR 40.00 X 0 288189 121615 0 1189106 491410 0 0 1 0 SODEXO MARRIOTT SERVICES PO BOX 81049 WOBURN MA 01813 FOOD & NUTRITION MANAGEMENT SERVICES 107322 1 X 637462 5002 642464 PROGRAM SERVICE REVENUE 623000 9069654 9069654 ANCILLARY SERVICES 623000 202946 202946 9272600 2233607 -2233607 -2233607 -2233607 MISCELLANEOUS INCOME 900099 27979 27979 HAIRDRESSER INCOME 900099 558 558 28537 7709994 9272600 0 -2205070 409804 409804 4425408 4320015 105393 1018959 1018959 371025 340045 30980 167293 33606 133687 32489 32489 26038 26038 940169 868166 72003 1851 1851 13575 12535 1040 48349 44646 3703 261107 174143 86964 SUPPLIES 547630 547630 HEALTH CARE PROVIDER AS 480419 480419 DRUG AND PHARMACEUTICAL 294637 294637 PURCHASED SERVICES 267238 267238 139154 3612 135542 9445145 8407502 1037643 0 353234 0 0 0 2041966 0 0 0 0 53643 0 3657 0 0 0 652642 0 0 0 0 0 9442 0 3114584 0 2454914 0 563786 0 1691172 0 4709872 0 X -1595288 0 -1595288 0 3114584 0 X -1735151 3330439 X 0 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X X X 0 0 0 0 0 0 0 0 0 KENNETH BELCHER PRESIDENT (TERMINATED 7/14) 0 517817 0 0 0 0 0 161839 0 54667 0 734323 0 0 MICHAEL CONKLIN TREASURER (TERMINATED 8/14) 0 383100 0 0 0 0 0 75984 0 77305 0 536389 0 0 RICHARD GAMACHE ADMINISTRATOR 0 288189 0 0 0 0 0 89049 0 32566 0 409804 0 0 ALL ASSETS AND LIABILITIES EXCEPT INTERCOMPANY ACCOUNTS 2014-06-20 2233607 BOOK VALUE 464672442 PROSPECT CHARTERCARE ELMHURST LLC 10780 SANTA MONICA BLVD SUITE LOS ANGELES CA 90025 LIMITED LIABILITY COMPANY 0 1 0 0 PART II, LINE 2E: PERSON(S) INVOLVED: RICHARD GAMACHE PART II, LINE 2E: EXPLANATION OF INVOLVEMENT: HE WILL BE EMPLOYED BY THE SUCCESSOR ORGANIZATION IN THE SAME CAPACITY AS ADMINISTRATOR, THAT HE HAD UNDER PREDECESSOR ORGANIZATION. FORM 990, PART V, LINE 2(A) THE NUMBER OF W-2'S LISTED REPRESENTS W-2'S FILED WITH THE ORGANIZATION'S EMPLOYER IDENTIFICATION NUMBER AND REPRESENTS EMPLOYEES TERMINATED PRIOR TO THE SALE. ALL OTHER EMPLOYEES WERE CONSIDERED AS EMPLOYEES BY THE SUCCESSOR COMPANY. FORM 990, PART VI, SECTION A, LINE 3 THE PRINCIPAL MANAGEMENT FUNCTIONS OF ELMHURST EXTENDED CARE FACILITY IS CONDUCTED UNDER THE DIRECTION OF CHARTERCARE HEALTH PARTNERS OFFICERS AND KEY EMPLOYEES. FORM 990, PART VI, SECTION B, LINE 11 DANIEL RYAN, CHAIRMAN, WILL REVIEW THE RETURN BEFORE SIGNING. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY INCLUDED IN THE BY-LAWS WAS TO PROTECT THE CORPORATION'S INTEREST WHEN IT WAS CONTEMPLATING ENTERING INTO A TRANSACTION OR ARRANGEMENT THAT MIGHT BENEFIT THE PRIVATE INTEREST OF AN OFFICER OR TRUSTEE OF THE CORPORATION. IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF HIS OR HER FINANCIAL INTEREST AND ALL MATERIAL FACTS TO THE OFFICERS, TRUSTEES, OR MEMBERS OF ANY COMMITTEES WITH BOARD-DELEGATED POWERS CONSIDERING THE PROPOSAED TRANSACTION OR ARRANGEMENT. ON AN ANNUAL BASIS, EACH MEMBER OF THE BOARD WAS REQUIRED TO COMPLETE A CONFLICT OF INTEREST STATEMENT AND ALL RESPONSES WERE SUBMITTED AND REVIEWED BY LEGAL COUNCEL. ANY ACTUAL AND POSSIBLE CONFLICTS OF INTEREST WERE REVIEWED WITH THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION B, LINE 15 ANNUALLY AN OUTSIDE CONSULTING AGENCY, HEALTHCARE STRATEGIES, CONDUCTED A MARKET REVIEW AND ASSESSMENT OF THE ADMINISTRATOR AND OTHER KEY EMPLOYEE SALARIES AND BENEFIT PACKAGES. THIS INCLUDED AN ASSESSMENT OF COMPARABLE COMPENSATION FOR SIMILARLY QUALIFIED PERSONS IN FUNCTIONALLY COMPARABLE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS. RECOMMENDATIONS ON SALARY AND BENEFITS FOR THE ADMINISTRATOR AND THE KEY EMPLOYEES WERE MADE BY THE CONSULTANT TO THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS FOR A REVIEW. THE EXECUTIVE COMMITTEE VOTED ON AND APPROVED ANNUAL ADJUSTMENTS TO KEY EMPLOYEE COMPENSATION BASED ON ALL OF THE RELEVANT DATA. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, FINANCIAL STATEMENT, AND POLICIES WERE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VIII, LINE 7(B) THIS AMOUNT REPRESENTS A LOSS ON DISPOSAL OF ASSETS AT JUNE 19,2014. FORM 990, PART XI, LINE 9: CONTRIBUTIONS BY RELATED ORGANIZATIONS TO FUND NEGATIVE FUND BALANCE 3,330,439. ROGER WILLIAMS MEDICAL ASSOCIATES 825 CHALKSTONE AVENUE PROVIDENCE RI 02908 203346936 HEALTHCARE RI 501(C)(3) LINE 11A, I N/A 0 ROGER WILLIAMS REALTY CORPORATION 825 CHALKSTONE AVENUE PROVIDENCE RI 02908 050423855 HEALTHCARE RI 501(C)(3) LINE 11A, I N/A 0 ROGER WILLIAMS MEDICAL CENTER (FORMERLY ROGER WILLIAMS HOSPITAL) 825 CHALKSTONE AVENUE PROVIDENCE RI 02908 050258959 HEALTHCARE RI 501(C)(3) LINE 3 N/A 0 CHARTERCARE HEALTH PARTNERS 825 CHALKSTONE AVENUE PROVIDENCE RI 02908 264235815 HEALTHCARE RI 501(C)(3) LINE 11A, I N/A 0 RWGH PHYSICIANS OFFICE BUILDING 825 CHALKSTONE AVENUE PROVIDENCE RI 02908 050398588 HEALTHCARE RI 501(C)(3) LINE 11A, I N/A 0 ST JOSEPH HEALTH SERVICES OF RI 200 HIGH SERVICE AVENUE NORTH PROVIDENCE RI 02904 050259026 HEALTHCARE RI 501(C)(3) LINE 3 N/A 0 CHARTERCARE HEALTH PARTNERS FOUNDATION 200 HIGH SERVICE AVENUE NORTH PROVIDENCE RI 02904 260236669 FUNDRAISING RI 501(C)(3) LINE 7 N/A 0 ST JOSEPH HOSPITAL WORKERS COMP TRUST 200 HIGH SERVICE AVENUE NORTH PROVIDENCE RI 02904 056106574 TRUST RI 501(C)(3) LINE 11D, III-O ST JOSEPH HEALTH SERVICES OF RI 0 OUR LADY OF FATIMA ANCILLARY SERVICES 200 HIGH SERVICE AVENUE NORTH PROVIDENCE RI 02904 050519862 HEALTHCARE RI N/A C 0 ELMHURST HEALTH ASSOCIATES 825 CHALKSTONE BLVD PROVIDENCE RI 02908 050437610 HEALTHCARE RI N/A C 0 ROSEBANK CORPORATION 825 CHALKSTONE BLVD PROVIDENCE RI 02908 050342046 REAL ESTATE RI N/A C 0 0 0 1 0 1 0 0 0 0 0 1 0 0 0 1 0 0 0 1