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 208745264 FAIRHAVEN HEALTHCARE CENTER INC C/O PLATINUM CARE LLC FAIR 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 15699503 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 7 269 10 0 0 25019 37500 14220321 14639448 54623 -51785 0 0 14299963 14625163 0 0 0 0 7098607 6966524 0 0 0 7426419 7778817 14525026 14745341 -225063 -120178 31794126 31370284 31847859 31544195 -53733 -173911 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 13296725 14639448 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. 13296725 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 6 0 269 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 JOSEPH DEVEAU FACILITY ADMINISTRATOR 40.00 0.00 X 123991 0 11995 TERESA ROCK MDS/PPS NURSE 40.00 0.00 X 102713 0 9937 GAIL BARATTA DIRECTOR OF NURSES 40.00 0.00 X 100851 0 9756 327555 0 31688 3 0 0 0 HEALTHCARE SERVICES GROUP 3220 TILLMAN DR STE 300 BENSALEM PA 19020 HOUSEKEEPING & DIETARY SERVICES 1220678 PLATINUM CARE LLC 35 AVCO ROAD HAVERHILL MA 01835 MANAGEMENT SERVICES 974198 PREFERRED PHARMACY SOLUTIONS 35 AVCO ROAD HAVERHILL MA 01835 PHARMACY SERVICES 364184 GERIATRIC MEDICAL PO BOX 6027 CHELSEA MA 02150 MEDICAL SUPPLIES 221763 4 37500 37500 PROGRAM SERVICE REVENUE 623000 14639448 14639448 14639448 34112 34112 988443 1074340 -85897 -85897 -85897 0 37500 0 0 14625163 14639448 0 -51785 X 5935950 5694342 241608 574254 550881 23373 456320 437747 18573 773646 773646 122445 122445 25635 25635 1624792 1568337 56455 53700 53700 104558 15961 88597 202635 202635 14330 14330 2080775 2080775 715406 715406 97491 97491 USER FEE 938891 938891 MEDICAL SUPPLIES 894152 894152 BAD DEBT EXPENSE 81353 81353 DUES 17137 17137 31871 18754 13117 14745341 13296725 1448616 0 30308 700 1240258 2417362 1977163 1984242 71508 97291 22816243 3364991 20048015 19451252 1057543 0 2932083 2932083 4437248 4487354 31794126 31370284 1466838 1579737 29413301 27518188 967720 2446270 31847859 31544195 X -53733 -173911 -53733 -173911 31794126 31370284 -120178 0 X 0 1 X 0 0 X 20000 25019 37500 82519 14081534 14201583 14220321 14639448 57142886 14081534 14221583 14245340 14676948 57225405 0 0 0 57225405 62947 75193 54623 34112 226875 62947 75193 54623 34112 226875 29194 46602 -85897 -10101 14173675 14343378 14299963 14625163 57442179 X 1958000 1958000 17622000 2716725 14905275 2081802 198695 1883107 1125441 445899 679542 29000 3672 25328 19451252 DEFERRED FINANCING COSTS, NET 1232482 OTHER RECEIVABLES 7738 TRUSTEE FUNDS HELD UNDER BOND INDENTURE 3211094 SOFTWARE, NET 36040 4487354 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 37500 37500 37500 37500 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 HAS 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 EMMA WEBSITE. FORM 990, PART IX, LINE 11G OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 105,375. MANAGEMENT AND GENERAL EXPENSES 56,455. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 161,830. DIETARY SERVICES: PROGRAM SERVICE EXPENSES 900,973. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 900,973. HOUSEKEEPING SERVICES: PROGRAM SERVICE EXPENSES 183,600. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 183,600. LAUNDRY SERVICES: PROGRAM SERVICE EXPENSES 126,505. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 126,505. MAINTENANCE SERVICES: PROGRAM SERVICE EXPENSES 120,708. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 120,708. SOCIAL SERVICE CONSULTANT: PROGRAM SERVICE EXPENSES 131,176. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 131,176. 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