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 208745264 FAIRHAVEN HEALTHCARE CENTER INC C/O PLATINUM CARE LLC FAIR 9784583388 35 AVCO ROAD HAVERHILL MA 01835 JOEL E KIRCHICK PRESIDENT 9784583388 2015-11-13 1 JUDY DALEY P01294075 6179848100 2015-11-13 2014 2016-04-25 22:37:26Z JOEL E KIRCHIK 35 AVCO ROAD HAVERHILL MA 01835 14827627 0 X WWW.FAIRHAVEN-NURSING.COM X 2007 MA IT IS THE MISSION OF FAIRHAVEN HEALTHCARE CENTER, 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 7 277 10 0 0 37500 0 14639448 14809285 -51785 17401 0 0 14625163 14826686 0 0 0 0 6966524 7290675 0 0 0 7778817 7937980 14745341 15228655 -120178 -401969 31370284 30518381 31544195 31076491 -173911 -558110 X IT IS THE MISSION OF FAIRHAVEN HEALTHCARE CENTER, 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 13779711 14809285 FAIRHAVEN HEALTHCARE CENTER IS A 169-BED, JCAHO ACCREDITED AND MEDICARE CERTIFIED HEALTHCARE FACILITY OFFERING TRADITIONAL SKILLED NURSING CARE, SHORT-TERM REHABILITATION, PLUS A VARIETY OF SPECIALIZED TREATMENT PROGRAMS. 13779711 1 0 0 0 0 0 0 0 0 0 1 0 0 1 0 1 0 1 0 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 0 0 1 0 0 0 1 21 0 1 277 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 TERESA ROCK MDS/PPS NURSE 40.00 0.00 X 107352 0 0 GAIL BARATTA DIRECTOR OF NURSES 40.00 0.00 X 103597 0 0 210949 0 0 2 0 0 0 HEALTHCARE SERVICES GROUP 3220 TILLMAN DR STE 300 BENSALEM PA 19020 HOUSEKEEPING & DIETARY SERVICES 1222092 PLATINUM CARE LLC 35 AVCO ROAD HAVERHILL MA 01835 MANAGEMENT SERVICES 915835 PREFERRED PHARMACY SOLUTIONS 35 AVCO ROAD HAVERHILL MA 01835 PHARMACY SERVICES 498668 GERIATRIC MEDICAL PO BOX 6027 CHELSEA MA 02150 MEDICAL SUPPLIES 213834 4 PROGRAM SERVICE REVENUE 623000 14809285 14809285 14809285 18342 18342 941 -941 -941 -941 14826686 14809285 0 17401 6277736 6008088 269648 544010 520891 23119 468929 449000 19929 781380 781380 62958 62958 28700 28700 1454803 1381650 73153 35798 35798 161013 43077 117936 196470 196470 14475 14475 2049729 2049729 737861 737861 105470 105470 MEDICAL SUPPLIES 1139326 1139326 USER FEE 883828 883828 BAD DEBT EXPENSE 260062 260062 DUES 21848 21848 4259 4259 15228655 13779711 1448944 0 700 700 2417362 2159361 1984242 2146249 97291 53407 22908521 4035768 19451252 18872753 2932083 2932083 4487354 4353828 31370284 30518381 1579737 1554930 27518188 28760763 2446270 760798 31544195 31076491 X -173911 -558110 -173911 -558110 31370284 30518381 X -401969 17771 -1 X 0 1 X 0 0 X 20000 25019 37500 82519 14081534 14201583 14220321 14639448 14809285 71952171 14081534 14221583 14245340 14676948 14809285 72034690 0 0 0 72034690 62947 75193 54623 34112 18342 245217 62947 75193 54623 34112 18342 245217 29194 46602 75796 14173675 14343378 14299963 14711060 14827627 72355703 0.99560 0.00340 X 1958000 1958000 19747060 3466162 16280898 1177111 563191 613920 26350 6415 19935 18872753 DEFERRED FINANCING COSTS, NET 1183407 OTHER RECEIVABLES 7688 TRUSTEE FUNDS HELD UNDER BOND INDENTURE 3125843 SOFTWARE, NET 36890 4353828 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. A MASSACHUSETTS DEVELOPMENT FINANCE AGENCY - SERIES 2007A 043431814 57585AAA8 2007-10-25 1982687 PURCHASE FACILITIES 0 0 0 B MASSACHUSETTS DEVELOPMENT FINANCE AGENCY - SERIES 2007A 043431814 57585AAB6 2007-10-25 8051140 PURCHASE FACILITIES 0 0 0 C MASSACHUSETTS DEVELOPMENT FINANCE AGENCY - SERIES 2007A 043431814 57585AAC4 2007-10-25 14755407 PURCHASE FACILITIES 0 0 0 D MASSACHUSETTS DEVELOPMENT FINANCE AGENCY - SERIES 2007D 043431814 2007-10-25 2038290 PURCHASE FACILITIES 0 0 0 A 1982687 1189273 793414 2007 0 0 1 1 B 8051140 2867753 5183387 2007 0 0 1 1 C 14755407 14755407 2007 0 0 1 1 D 2038290 19338 2018952 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 A MASSACHUSETTS DEVELOPMENT FINANCE AGENCY - SERIES 2010 043431818 2010-07-14 2640000 PROJECT REHAB 0 0 0 A 2640000 2640000 2010 0 0 1 1 A 0 0 0 0 0 0 0 A 0 1 0 0 0 0 0 0 A 0 FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION ENTERED INTO A FIFTEEN-YEAR MANAGEMENT AGREEMENT, EXPIRING OCTOBER 2022, WITH PLATINUM CARE, LLC TO MANAGE THE OPERATIONS OF FAIRHAVEN HEALTHCARE CENTER, 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. FORM 990, PART XI, LINE 9: ROUNDING ADJUSTMENT -1. ADVENTCARE INC 35 AVCO ROAD HAVERHILL MA 01835 321012491 MANAGEMENT COMPANY MA 501(C)(3) LINE 9 0 LAFAYETTE REHABILITATION AND SKILLED NURSING FACILITY 25 LAFAYETTE STREET MARBLEHEAD MA 01945 208745166 SKILLED NURSING FACILITY MA 501(C)(3) LINE 9 ADVENTCARE INC 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0