2015-08-06T11:59:48-05:00 2014-12-31 010494526 BAKER NEWMAN & NOYES LLC 650 ELM STREET SUITE 302 MANCHESTER NH 03101 990 2014-01-01 043333609 CHS OF WALTHAM INC CHSO 7818930240 66 NEWTON STREET WALTHAM MA 02453 CAROLYN FENN CEO 7818930240 2015-07-20 E DREW CHENEY P00182972 8002447444 2015-07-20 2014 2016-04-25 22:37:26Z MARISTHILL NURSING & REHABILTATION CENTER CAROLYN FENN 66 NEWTON STREET WALTHAM MA 02453 10551354 0 0928 X MARISTHILL.ORG X 1996 MA MARISTHILL IS A CATHOLIC SKILLED NURSING AND REHABILITATION FACILITY THAT CONTINUES THE HEALING MINISTRY OF CHRIST BY PROVIDING HEALTH CARE SERVICES THAT FOSTER EACH INDIVIDUAL'S PHYSICAL, SPIRITUAL, EMOTIONAL AND INTELLECTUAL WELL-BEING. 8 6 154 0 0 0 21170 18820 10137877 10480889 19064 50454 4394 1191 10182505 10551354 0 0 0 0 5799699 5947394 0 0 0 4391567 4564986 10191266 10512380 -8761 38974 11996011 11887415 9838555 9685930 2157456 2201485 MARISTHILL IS A CATHOLIC SKILLED NURSING AND REHABILITATION FACILITY THAT CONTINUES THE HEALING MINISTRY OF CHRIST BY PROVIDING HEALTH CARE SERVICES THAT FOSTER EACH INDIVIDUAL'S PHYSICAL, SPIRITUAL, EMOTIONAL AND INTELLECTUAL WELL-BEING. 0 0 10354445 10480889 MARISTHILL NURSING AND REHABILITATION CENTER PROVIDED 35,203 DAYS OF SKILLED NURSING SERVICES DURING 2014 OF WHICH 23,188 WERE TO MEDICAID RECIPIENTS. 10354445 1 1 0 0 0 0 0 0 0 0 1 0 0 1 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 9 0 1 154 1 0 0 0 0 0 0 0 0 0 0 X 8 6 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X X CAROLYN FENN CEO 7818930240 66 NEWTON STREET WALTHAM MA 02453 KENNETH FERRON TREASURER 1.00 39.00 X X 0 302427 115847 LISA LORGEREE CHAIR 1.00 X X 0 0 0 KELLY MCDADE VICE CHAIR 1.00 X X 0 0 0 JUDITH ALLEN TRUSTEE 1.00 X 0 0 0 NANCY SMITH TRUSTEE 1.00 X 0 0 0 SRJOYCE ANN EDELMANN TRUSTEE 1.00 X 0 0 0 DR FELIX ZOLLO TRUSTEE 1.00 X 0 0 0 CAROLYN FENN CEO/ADMINISTRATOR 40.00 X X 113044 0 7156 JOSEPH SGRO CHIEF FINANCIAL OFFICER 40.00 X 98564 0 253 SHIRLY YELLAMATY NURSING SUPERVISOR 40.00 X 133655 0 13526 ANNE RICCI DIRECTOR OF NURSING 40.00 X 101500 0 1300 ERIC GWANYALLA NURSE 40.00 X 100701 0 12259 547464 302427 150341 4 0 1 0 REHAB CARE INC PO BOX 277365 ATLANTA GA 30384 REHABILTATION SERVICES 695984 US FOODS PO BOX 3155 BOSTON MA 02241 FOOD SERVICE 322164 HEALTHCARE SERVICES 1565 MAIN STREET TEWKSBURY MA 01888 HOUSEKEEPING 289652 OMNI CARE P O BOX 781668 DETROIT MI 48278 PHARMACY 282218 GULF SOUTH 14 N WENTWORTH AVENUE LONDONDERRY NH 03053 MEDICAL SUPPLIES 139400 5 18820 18820 PATIENT SERVICE REVENUE 623000 10480889 10480889 10480889 50454 50454 VENDING MACHINE 623000 987 987 PURCHASE DISCOUNTS 623000 204 204 1191 10551354 10480889 0 51645 113044 113044 4918599 4918599 19993 19993 523577 523577 372181 372181 123084 123084 13700 13700 21151 21151 9820 9820 131586 131586 89926 89926 399979 399979 462 462 340598 340598 457266 457266 63021 63021 NURSING HOME SUPPLIES A 1155957 1155957 MEDICAID USER FEE 516308 516308 PURCHASED SERVICES 399858 399858 EDUCATION AND TRAINING 4402 4402 837868 837868 10512380 10354445 157935 0 142325 85819 2079331 976555 935629 916173 29132 29416 11082785 5309566 5651863 5773219 924377 2266821 2233354 1839412 11996011 11887415 695102 628211 8515290 8409068 628163 648651 9838555 9685930 X 2157456 2201485 2157456 2201485 11996011 11887415 38974 5055 0 X 0 1 X 1 0 X 44938 26945 22940 21170 18820 134813 11027802 10746498 10268103 10142271 10480889 52665563 11072740 10773443 10291043 10163441 10499709 52800376 0 0 0 52800376 28185 1660 25301 19064 50454 124664 28185 1660 25301 19064 50454 124664 11100925 10775103 10316344 10182505 10550163 52925040 0.99760 0.99790 0.00240 0.00210 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 485000 485000 6583171 2721597 3861574 0 3488731 2587969 900762 525883 525883 5773219 RESIDENT FUNDS 17685 DEBT SERVICE RESERVE FUND 713090 BOND ISSUE COSTS (NET) 36363 BOND UNDERWRITING COSTS (NET) 15857 BOND DISCOUNT (NET) 38865 DEBT SERVICE SINKING FUND (NET) 960890 CAPITALIZED FINANCING COSTS (NET) 56662 1839412 DEFERRED EXPENSES 248111 MEDICAID USER FEES 138977 PROFESSIONAL LIABILITY LOSS RESERVES 23111 DUE TO AFFILIATES 190771 RESIDENT FUNDS 16685 ORIGINAL ISSUE DISCOUNT 30996 648651 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, 2014. UNDER INTERNAL REVENUE SERVICE REGULATIONS, THE SYSTEM'S TAX YEARS FROM 2011 THROUGH 2014 ARE OPEN AND SUBJECT TO EXAMINATION. X X X X 0 1 0 0 0 0 0 1 0 KENNETH FERRON TREASURER 0 256130 0 0 0 46297 0 85079 0 30768 0 418274 0 0 PART I, LINE 3 EVERY TWO TO THREE YEARS THE COMPENSATION COMMITTEE OF 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 OPPROTUNITIES, IF ANY, ARE COMPETITIVE AND REASONABLE. PART I, LINE 4B THE RELATED ORGANIZATION, COVENANT HEALTH, MAINTAINS A SUPPLEMENTAL EXECUTIVE RETIREMENT PROGRAM FOR CERTAIN EXECUTIVES UNDER WHICH THE ORGANIZATION MAKES A CONTRIBUTION TO A GRANTOR TRUST FOR THE BENEFIT OF THE EXECUTIVE THAT IS INTENDED TO PROVIDE A SPECIFIED LEVEL OF RETIREMENT BENEFITS AT RETIREMENT AGE COMMENSURATE WITH RETIREMENT BENEFITS PROVIDED TO EXECUTIVES IN COMPARABLE POSITIONS BY SIMILARLY SITUATED ORGANIZATIONS. AMOUNTS CONTRIBUTED TO THE GRANTOR TRUST ARE HELD FOR THE BENEFIT OF THE EXECUTIVE UNTIL HE OR SHE REACHES AGE 60, AT WHICH TIME THEY ARE RELEASED TO THE EXECUTIVE. THE FULL AMOUNT PAID INTO THE GRANTOR TRUST IS TAXABLE TO THE EXECUTIVE WHEN SO PAID, AND IS INCLUDED IN THE EXECUTIVE'S REPORTED COMPENSATION. PART I, LINE 7 THE RELATED ORGANIZATION, COVENANT HEALTH, MAINTAINS AN INCENTIVE COMPENSATION PLAN FOR EXECUTIVES THAT IS ADMINISTERED BY THE ORGANIZATION'S COMPENSATION COMMITTEE. THE PLAN PROVIDES EXECUTIVES WITH THE OPPORTUNITY TO EARN REASONABLE INCENTIVE COMPENSATION BASED ON THE PERFORMANCE OF THE ORGANIZATION AND THE PERFORMANCE OF THE INDIVIDUAL EXECUTIVE, AS MEASURED AGAINST GOALS THAT ARE SET AT THE BEGINNING OF THE YEAR. THE ENTITLEMENT TO AWARDS FOR A PARTICULAR YEAR IS NOT DETERMINED UNTIL EARLY THE FOLLOWING YEAR. THE ORGANIZATION PAID NO INCENTIVE COMPENSATION AWARDS IN 2014 TO KENNETH FERRON BASED ON PERFORMANCE DURING 2013. A MA HEALTH & EDUCATION FACILITIES AUTHORITY 042456011 57586DBF9 2007-10-30 7221865 TO FINANCE THE PURCHASE OF YOUVILLE PLACE 1 0 0 B MA HEALTH & EDUCATION FACILITIES AUTHORITY 042456011 57584QAA4 2012-06-27 1720000 CAPITAL EQUIPMENT AND PROJECTS 0 0 0 A 7221865 712880 55862 6117244 1 1 1 1 B 1720000 54828 0 0 1 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 A 1 0 0 0 0 0 B 0 0 0 0 0 0 0 0 0 A 0 B 0 PART IV, #7 & PART V: BOTH BONDS ARE CAREFULLY AND CONSISTENTLY MONITORED FOR POTENTIAL VIOLATIONS OF FEDERAL TAX REQUIREMENTS, BUT THE PROCEDURES WERE NOT WRITTEN AS OF THE END OF THE YEAR COVERED BY THIS TAX RETURN. HOWEVER, THE ORGANIZATION IS CONSIDERING ADOPTING FORMAL POLICIES THAT SET FORTH THE ORGANIZATION'S METHODOLOGY FOR ENSURING POST-ISSUANCE COMPLIANCE WITH IRS REQUIREMENTS PERTAINING TO TAX-EXEMPT DEBT AND CONTAIN SPECIFIC LANGUAGE REGARDING ORGANIZATIONAL RESPONSIBILITY, RECORD RETENTION, PRIVATE BUSINESS USE, ARBITRAGE REBATE, AND REMEDIAL ACTION. ALTHOUGH FORMAL POLICIES ARE NOT IN PLACE IN REGARDS TO THE REMEDIATION OF OUR BONDS, THE MONITORING REQUIREMENTS OF SECTION 148, AND PROCEDURES TO ENSURE THAT VIOLATIONS ARE TIMELY IDENTIFIED AND CORRECTED, THE ORGANIZATION HAS COMPLIANCE CHECKS IN PLACE THAT SUBSTANTIATE THESE REQUIREMENTS. FORM 990, PART VI, SECTION A, LINE 6 COVENANT HEALTH IS THE SOLE MEMBER OF THE ORGANIZATION OF THE BOARD. AS SUCH IT RETAINS CERTAIN RESERVE RIGHTS OVER BOARD DECISIONS AND BOARD COMPOSITION. FORM 990, PART VI, SECTION A, LINE 7A COVENANT HEALTH IS THE SOLE MEMBER OF THE ORGANIZATION. AS SUCH IT RETAINS CERTAIN RESERVE RIGHTS OVER CORPORATE DECISIONS AND BOARD COMPOSITION. FORM 990, PART VI, SECTION A, LINE 7B COVENANT HEALTH IS THE SOLE MEMBERS OF THE ORGANIZATION. AS SUCH IT RETAINS CERATIN RESERVE RIGHTS OVER BOARD DECISIONS AND BOARD COMPOSITION. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PROVIDED TO AND REVIEWED WITH THE BOARD PRIOR TO FILING FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A FULL-TIME OPERATIONAL INTEGRITY OFFICER THAT MONITORS ALL AREAS FOR POTENTIAL CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 EVERY TWO TO THREE YEARS THE COMPENSATION COMMITTEE OF THE COVENANT HEALTH 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 19 THE FORM 990 AND GOVERNING DOCUMENTS, INCLUDING THE CONFLICT OF INTEREST POLICY, AND THE FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. COVENANT HEALTH 100 AMES POND DRIVE TEWKSBURY MA 01876 222484505 HEALTH CARE MANAGEMENT AND RESOURCE ORGANIZATION MA 501(C) 9 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0