2015-09-29T15:22:53-05:00 2014-12-31 410746749 CLIFTONLARSONALLEN LLP 300 CROWN COLONY DRIVE SUITE 310 QUINCY MA 02169 990 2014-01-01 042200583 CHELSEA JEWISH NURSING HOME INC C/O CHELSEA JEWISH COMMUNITY INC CHEL 6178870001 165 CAPTAINS ROW CHELSEA MA 02150 BARRY BERMAN CEO & CHAIRMAN 6178870001 2015-08-31 1 JUDY DALEY 6179848100 2015-08-31 2014 2016-04-25 22:37:26Z BARRY BERMAN 165 CAPTAINS ROW CHELSEA MA 02150 12069697 0 X WWW.CJNH.ORG X 1975 MA OPERATING A 123-BED SKILLED NURSING FACILITY PROVIDING NURSING CARE, REHABILITATION THERAPIES AND OTHER SKILLED SERVICES TO FRAIL ELDERLY AND DISABLED. 7 5 225 13 0 0 20000 46263 11484194 12000000 203 227 0 23207 11504397 12069697 0 0 0 0 6586257 6646875 0 0 0 5427086 5135877 12013343 11782752 -508946 286945 8552617 7897416 6397119 5402321 2155498 2495095 TO PROVIDE EXCEPTIONAL SKILLED NURSING CARE FOR OUR RESIDENTS WITH UNWAVERING COMPASSION, DIGNITY AND REPECT. 0 0 9290599 12023207 NURSING HOME: OPERATION OF A 123 BED SKILLED NURSING FACILITY PROVIDING NURSING CARE, REHABILITATION THERAPIES AND OTHER SKILLED SERVICES TO FRAIL ELDERLY AND DISABLED. 9290599 1 1 0 0 0 0 0 0 0 1 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 0 0 0 1 11 0 1 225 1 0 0 0 0 0 0 0 0 0 0 X 7 5 1 0 0 0 1 1 1 1 1 0 0 0 1 1 1 0 0 1 1 0 MA X ELLEN SHONER 6178870001 165 CAPTAINS ROW CHELSEA MA 02150 BARRY BERMAN CEO & CHAIRMAN 1.00 39.00 X X 0 578563 30560 ADAM BERMAN PRESIDENT, TREASURER & CLERK 1.00 39.00 X X 0 303457 24200 LEONA GRELL DIRECTOR 1.00 0.00 X 0 0 0 DORIS TOLTZ FRIEDMAN DIRECTOR 1.00 0.00 X 0 0 0 CHARLOTTE FLORENCE DIRECTOR 1.00 0.00 X 0 0 0 SHELLY KATZ DIRECTOR 1.00 0.00 X 0 0 0 ANN SLOSBERG DIRECTOR 1.00 0.00 X 0 0 0 0 882020 54760 0 0 1 0 0 46263 46263 PATIENT SERVICE REVENUE 623000 12000000 12000000 12000000 227 227 OTHER REVENUE 900099 23207 23207 23207 12069697 12023207 0 227 5651079 5375544 275535 75315 71643 3672 459605 437196 22409 460876 438404 22472 723529 723529 34151 34151 43250 43250 920561 857478 63083 450 450 129282 2569 126713 766616 587352 179264 10421 10421 687 687 302005 296896 5109 USER FEE ASSESSMENT 688239 688239 FOOD 522477 522477 SUPPLIES & EXPENSE 408461 408461 PATIENT ANCILLARY SERVI 292429 292429 293319 150 293169 11782752 9290599 2492153 0 236133 627812 2452537 1383762 138236 204295 9604513 7640183 2232348 1964330 3493363 3717217 8552617 7897416 1653523 1018335 2935772 2715090 1807824 1668896 6397119 5402321 X 457498 744443 1698000 1750652 2155498 2495095 8552617 7897416 X 286945 52652 X 0 1 X 0 1 1 X 86021 176906 170000 20000 46263 499190 11493505 12785895 11716155 11484194 12000000 59479749 11579526 12962801 11886155 11504194 12046263 59978939 86021 176906 170000 20000 98918 551845 0 86021 176906 170000 20000 98918 551845 59427094 30735 32958 6010 203 227 70133 30735 32958 6010 203 227 70133 23207 23207 11610261 12995759 11892165 11504397 12069697 60072279 0.98930 0.98890 0.00120 0.00170 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1698000 52652 1750652 1650000 48000 1698000 1650000 1650000 1650000 1650000 1.00000 1 0 13575 13575 8990911 7194270 1796641 600027 445913 154114 1964330 UNAMORTIZED MORTGAGE ACQUISITION COST 45873 CONSTRUCTION IN PROGRESS 942895 ESCROWS 976822 SOFTWARE, NET 975 BENEFICIAL INTEREST IN TESTAMENTARY TRUST 1750652 3717217 DUE TO RELATED PARTIES 1668896 1668896 X 12122349 52652 52652 12069697 0 12069697 11782752 0 11782752 0 11782752 PART V, LINE 4: THE ORGANIZATION IS THE SOLE BENEFICIARY OF A CHARITABLE TESTAMENTARY TRUST THAT IS ADMINISTERED BY UNRELATED FINANCIAL INSTITUTIONS. THE UNRELATED FINANCIAL INSTITUTIONS SET FORTH THE INVESTMENT POLICIES FOR THE TRUST. THE ORGANIZATION RECEIVED INCOME GENERATED BY THE TRUST FOR GENERAL PURPOSES AND CLASSIFIED AS UNRESTRICTED NET ASSETS. GAINS AND LOSSES ARE CONSIDERED RESTRICTED. PART X, LINE 2: THE ORGANIZATION 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. THE ORGANIZATION FILES AS A TAX-EXEMPT ENTITY. SHOULD THAT STATUS BE CHALLENGED IN THE FUTURE, THE ORGANIZATION'S 2011 THROUGH 2014 TAX YEARS ARE OPEN FOR EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN BENEFICIAL INTEREST IN TESTAMENTARY TRUST 52,652. 0 0 0 0 0 0 0 0 0 BARRY BERMAN CEO & CHAIRMAN 0 578563 0 0 0 0 0 0 0 30560 0 609123 0 0 ADAM BERMAN PRESIDENT, TREASURER & CLERK 0 303457 0 0 0 0 0 0 0 24200 0 327657 0 0 FORM 990, PART VI, SECTION A, LINE 2 BARRY BERMAN AND ADAM BERMAN HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE CORPORATION IS CHELSEA JEWISH NURSING HOME FOUNDATION, INC. FORM 990, PART VI, SECTION A, LINE 7A THE APPROVAL OF THE MEMBER, CHELSEA JEWISH NURSING HOME FOUNDATION, INC., IS REQUIRED TO ELECT OR REMOVE DIRECTORS OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7B THE APPROVAL OF THE MEMBER, CHELSEA JEWISH NURSING HOME FOUNDATION, INC., IS REQUIRED BEFORE THE BOARD OF DIRECTOR'S ACTION ON ANY OF THE FOLLOWING BECOMES EFFECTIVE: (A) TO AMEND OR TO REPEAL THE ARTICLES OF ORGANIZATION OR THE BYLAWS OF THE CORPORATION; (B) TO APPROVE ALL PLANS OF MERGER, CONSOLIDATION, REORGANIZATION OR DISSOLUTION OF THE CORPORATION OR ANY SUBSIDIARY OF THE CORPORATION, OR THE SALE, LEASE, ASSIGNMENT OR TRANSFER OF SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION, OR THE PURCHASE OR ACQUISITION BY THE CORPORATION OF THE CORPORATION OF AN INTEREST IN ANY CORPORATION, PARTNERSHIP, JOINT VENTURE OR OTHER ENTITY, WHETHER NEWLY CREATED OR PREVIOUSLY EXISTING, WHICH INTEREST, IN THE CASE OF A FOR-PROFIT ENTITY, REPRESENTS TWENTY-FIVE PERCENT (25%) OR MORE OF THE VOTING POWER THEREOF OR EQUITY INTEREST THEREIN, OR, IN THE CASE OF A NON-PROFIT ENTITY, REPRESENTS TWENTY-FIVE PERCENT (25%) OR MORE OF THE VOTING POWER THEREOF OR MEMBERSHIP INTEREST THEREIN; (C) TO APPROVE ALL GIFTS, GRANTS, DONATIONS OR SIMILAR TRANSFERS OF FUNDS OF THE CORPORATION TO ANY ENTITY OTHER THAN THE MEMBER OR ITS SUBSIDIARIES; (D) TO ELECT OR REMOVE DIRECTORS OF THE CORPORATION; (E) TO APPROVE THE FORMATION OF ANY SUBSIDIARY OF THE CORPORATION; AND (F) TO APPOINT THE CORPORATION'S AUDITORS. FORM 990, PART VI, SECTION B, LINE 11 MANAGEMENT WILL CONDUCT A REVIEW OF THE FORM 990 AFTER IT HAS BEEN FINALIZED, INCLUDING READING AND REVIEWING THE KEY INFORMATION. THEY WILL REPORT TO THE BOARD IF THERE ARE ANY MAJOR DEVIATIONS FROM THE PROVIDED DATA. ALL MEMBERS RECEIVE A COPY OF THE FEDERAL 990 TO REVIEW. FORM 990, PART VI, SECTION B, LINE 12C ON AN ANNUAL BASIS, ALL BOARD MEMBERS ARE INSTRUCTED TO INFORM THE REST OF THE BOARD IF ANY CONFLICT OF INTEREST EXISTS PERTAINING TO THEIR MEMBERSHIP ON THE BOARD. ANY POTENTIAL CONFLICT OF INTEREST IS THEN DISCUSSED AND ASSESSED BY THE REMAINING BOARD MEMBERS. IF A CONFLICT EXISTS IT MUST BE DISCLOSED AND HELD TO HIGHER LEVEL OF SCRUTINY IN ORDER TO VERIFY THAT ALL TRANSACTIONS ARE ARMS LENGTH. ANY BOARD MEMBER DEEMED TO HAVE A CONFLICT OF INTEREST WILL ABSTAIN FROM PARTICIPATING IN THE BOARD'S DELIBERATIONS AND DECISIONS IN THE TRANSACTION. FORM 990, PART VI, SECTION B, LINE 15 THE CEO IS NOT PAID FROM THE FILING ORGANIZATION. PRIOR TO MAJOR SALARY ADJUSTMENTS FOR THE CEO, A RELATED ORGANIZATION'S BOARD OF DIRECTORS ARRANGES FOR A SALARY STUDY TO BE PERFORMED. THE STUDY INCLUDES THE EXECUTIVE SALARIES OF COMPARABLY-SIZED COMPANIES IN THE INDUSTRY. THE BOARD OF DIRECTORS THEN CONSIDERS THE FINDINGS OF THE STUDY IN SETTING THE CEO'S COMPENSATION. 2014 WAS THE MOST RECENT YEAR IN WHICH THE PROCESS INCLUDED REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION. OFFICERS AND KEY EMPLOYEES ARE NOT PAID FROM THE FILING ORGANIZATION. COMPENSATION FOR KEY EMPLOYEES IS DETERMINED THROUGH THE USE OF SALARY STUDIES OR OTHER DATA AND ADJUSTED BASED ON THE EMPLOYEE'S YEARS OF EXPERIENCE AND RESPONSIBILITIES BY A RELATED ORGANIZATION'S BOARD OF DIRECTORS. 2014 WAS THE MOST RECENT YEAR IN WHICH THE PROCESS INCLUDED REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY & FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST. FORM 990, PART VI, SECTION A, LINE 3: THE ORGANIZATION'S MANAGEMENT PERFORMS MANAGEMENT DUTIES WHICH INCLUDE, BUT ARE NOT LIMITED TO, HIRING, FIRING, AND SUPERVISING PERSONNEL, PLANNING OR EXECUTING BUDGETS OR FINANCIAL OPERATIONS, OR SUPERVISING EXEMPT OPERATIONS OR UNRELATED TRADES OR BUSINESSES OF THE ORGANIZATION FOR SEVERAL RELATED ENTITIES. MANAGEMENT CONTROL IS NOT CONSIDERED DELEGATED AND MANAGEMENT PERSONNEL ARE PAID FROM A CENTRALIZED MANAGEMENT ORGANIZATION, CHELSEA JEWISH COMMUNITY, INC. PLEASE SEE FORM 990, PART VII FOR COMPENSATION DETAIL. FORM 990, PART XI, LINE 9: CHANGE IN BENEFICIAL INTEREST IN TESTAMENTARY TRUST 52,652. CHELSEA JEWISH NURSING HOME FOUNDATION INC 165 CAPTAINS ROW CHELSEA MA 02150 510141617 FUNDRAISING AND SUPPORT TO NURSING HOME MA 501(C)(3) LINE 7 0 CHELSEA JEWISH GREEN HOUSE INC 165 CAPTAINS ROW CHELSEA MA 02150 043326727 NURSING HOME, HOME CARE, HOSPICE, AND PERSONAL CARE AGENCY MA 501(C)(3) LINE 9 CHELSEA JEWISH NURSING HOME FOUNDATION INC 1 CHELSEA JEWISH COMMUNITY INC 165 CAPTAINS ROW CHELSEA MA 02150 271756594 MANAGEMENT COMPANY, ACADEMY FOR TRAINING CERTIFIED NURSING ASSISTANTS MA 501(C)(3) LINE 9 CHELSEA JEWISH NURSING HOME FOUNDATION INC 1 ADMIRAL'S HILL ASSISTED LIVING LP 165 CAPTAINS ROW CHELSEA MA 02150 043255842 ASSISTED LIVING MA N/A ADMIRAL'S HILL ASSISTED LIVING II LLC 165 CAPTAINS ROW CHELSEA MA 02150 043538835 ASSISTED LIVING MA N/A ASAR ELDER SERVICES INC 165 CAPTAINS ROW CHELSEA MA 02150 043289287 MANAGEMENT COMPANY & THERAPY SERVICES MA N/A C 0 ADMIRAL'S HILL ASSISTED LIVING CORP 165 CAPTAINS ROW CHELSEA MA 02150 043255840 ASSISTED LIVING MA N/A C 0 ADMIRAL'S HILL ASSISTED LIVING II CORP 165 CAPTAINS ROW CHELSEA MA 02150 043538833 ASSISTED LIVING MA N/A C 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0