2014-11-17T13:29:50-06:00 2013-12-31 410746749 CLIFTONLARSONALLEN LLP 300 CROWN COLONY DRIVE SUITE 310 QUINCY MA 02169 990 2013-01-01 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 2014-11-06 1 ROBERT DILLAN P01688008 6179848100 2014-10-21 2013 2015-11-30 17:44:51Z JOEL E KIRCHIK 35 AVCO ROAD HAVERHILL MA 01835 5973591 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 7 149 10 0 0 23963 14253 5484941 5414698 29624 -21736 0 0 5538528 5407215 0 0 0 0 3347363 3218906 0 0 0 2105344 2145967 5452707 5364873 85821 42342 11423631 11353061 9649011 9536099 1774620 1816962 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 4660583 5414698 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. 4660583 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 7 0 149 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 RICHARD ATKINSON 9784201500 35 AVCO ROAD HAVERHILL MA 01835 JOEL KIRCHIK PRESIDENT 1.00 2.00 X X 0 0 0 JOHN REGAN SECRETARY 1.00 2.00 X X 0 0 0 RAYMOND DENNEHY TREASURER 1.00 2.00 X X 0 0 0 PATRICIA TORTELLA DIRECTOR 1.00 2.00 X 0 0 0 DAVID O'DONNELL DIRECTOR 1.00 2.00 X 0 0 0 JEFFREY WITHERELL DIRECTOR 1.00 2.00 X 0 0 0 MICHAEL MOORE DIRECTOR 1.00 2.00 X 0 0 0 GEORGE BARBUZZI FACILITY ADMINISTRATOR 40.00 0.00 X 105394 0 8552 105394 0 8552 1 0 0 0 PLATINUM CARE LLC 35 AVCO ROAD HAVERHILL MA 01835 MANAGEMENT SERVICES 352916 PERFORMANCE HEALTHCARE 47R RIVER STREET SUITE 200R WELLESLEY MA 02481 HOUSEKEEPING & LAUNDRY SERVICES 182500 US FOODS PO BOX 3155 BOSTON MA 02241 FOOD SERVICES 105818 3 14253 14253 PROGRAM SERVICE REVENUE 623000 5414698 5414698 5414698 21217 21217 494216 537169 -42953 -42953 -42953 29207 14253 29207 0 5407215 5414698 0 -21736 2792056 2609649 182407 226556 211755 14801 200294 187205 13089 335940 335940 207 207 25100 25100 231754 231754 22315 22315 75777 4073 71704 782306 782306 3696 3696 207362 207362 39367 39367 MEDICAL EXPENSES 228479 228479 DIETARY EXPENSES 134681 134681 OTHER EXPENSES 35031 35031 ACTIVITIES EXPENSE 19103 19103 4849 4849 5364873 4660583 704290 0 892216 1404205 941511 1147198 486144 370402 34492 44608 6752871 1072473 5776325 5680398 528769 0 1513333 1513333 1250841 1192917 11423631 11353061 522100 534723 8808527 8196542 318384 804834 9649011 9536099 X 1774620 1816962 1774620 1816962 11423631 11353061 42342 0 X 0 1 X 0 0 X 34156 29373 23963 14253 101745 5949097 6031907 5484941 5414698 22880643 5983253 6061280 5508904 5428951 22982388 30000 20000 15000 20000 85000 0 30000 20000 15000 20000 85000 22897388 35023 35563 29624 21217 121427 35023 35563 29624 21217 121427 434 6035 -42953 -36484 6018710 6102878 5538528 5407215 23067331 X 584000 584000 5256000 810300 4445700 554153 75516 478637 358718 186657 172061 5680398 DEFERRED FINANCING COSTS, NET 310845 TRUSTEE FUNDS HELD UNDER BOND INDENTURE 880290 INTEREST RECEIVABLE 680 ACCOUNTS RECEIVABLE - OTHER 1102 1192917 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 2010 THROUGH 2013 TAX YEARS ARE OPEN FOR EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES. GOLF TOURNAMENT 43460 14253 29207 400 1919 18697 8191 43460 14253 29207 400 1919 18697 8191 29207 0 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, TO REVIEW AND APPROVE BEFORE IT IS FILED WITH THE IRS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE ON THE MSRB EMMA WEBSITE. ADVENTCARE INC 35 AVCO ROAD HAVERHILL MA 01835 321012491 MANAGEMENT COMPANY MA 501(C)(3) LINE 9 0 FAIRHAVEN HEALTHCARE CENTER INC 476 VARNUM AVENUE LOWELL MA 01854 208745264 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