2014-06-19T14:45:34-05:00 2013-12-31 020383073 WILLIAM STEELE & ASSOCIATES PC 40 STARK STREET MANCHESTER NH 03101 990 2013-01-01 046835128 PROVIDENTIA PRIMA TRUST PROV 9786546363 100 AMES POND DRIVE TEWKSBURY MA 01876 JOHN AHLE CHIEF FINANCIAL OFFICER 9786546363 2014-06-12 1 WILLIAM G STEELE JR CPA P00233103 6036228881 2013 2015-11-30 17:44:51Z JOHN AHLE 100 AMES POND DRIVE TEWKSBURY MA 01876 12418420 0 X COVENANTHS.ORG X 1996 MA PROVIDENTIA PRIMA WAS ESTABLISHED TO HOLD AND MANAGE POOLED INVESTMENTS OF VARIOUS ORGANIZATIONS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501 (C) (3) 9 4 0 0 0 0 0 0 0 0 9484818 12406639 16455 11781 9501273 12418420 0 0 0 0 0 0 0 0 0 851295 818648 851295 818648 8649978 11599772 179178125 232932602 2638875 2951565 176539250 229981037 PROVIDENTIA PRIMA WAS ESTABLISHED TO HOLD AND MANAGE POOLED INVESTMENTS OF VARIOUS ORGANIZATIONS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501 (C) (3). 0 0 N/A 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 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 0 0 0 0 0 0 0 0 0 0 0 0 0 X 9 4 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X X JOHN AHLE 9786546363 100 AMES POND DRIVE TEWKSBURY MA 01876 JOHN AHLE TREASURER/SECRETARY 1.00 39.00 X X 0 382416 101750 CAROLYN KASABIAN TRUSTEE 1.00 39.00 X 0 278831 23871 DONALD M DEHART CHAIR/PRESIDENT 3.00 X X 0 0 0 RICHARD J PLAMONDON VICE PRESIDENT 1.00 39.00 X X 0 300185 31339 WILLIAM ADAMS TRUSTEE 1.00 X 0 0 0 PAUL ERCOLINI TRUSTEE 1.00 39.00 X 0 172756 32705 KEVIN HALLORAN TRUSTEE 1.00 X 0 0 0 WILLIAM DEMASO TRUSTEE 1.00 X 0 0 0 SR CATHERINE O'CONNOR TRUSTEE 1.00 X 0 0 0 0 1134188 189665 0 0 1 0 SILCHESTER INTERNATIONAL INVESTORS 780 3RD AVENUE 42ND FLOOR NEW YORK NY 10017 INVESTMENT MANAGER 146746 NEPC LLC 255 STATE STREET BOSTON MA 02109 INVESTMENT MANAGER 142900 STATE STREET BANK & TRUST 200 CLARENDON STREET BOSTON MA 02116 CUSTODIAN FEES 116226 IRONBRIDGE CAPITAL MANAGEMENT LP ONE PARKVIEW PLAZA SUITE 600 OAKBROOK TERRACE IL 60181 INVESTMENT MANAGER 108488 4 4294575 4294575 8112064 0 8112064 8112064 8112064 OTHER 900099 11781 11781 11781 12418420 0 0 12418420 35193 35193 710053 710053 ADMINISTRATION EXPENSE 50000 50000 MISCELLANEOUS EXPENSES 23402 23402 818648 0 818648 0 3258411 636711 128325437 182562681 45377110 45854451 2217167 3878759 179178125 232932602 2638875 2951565 2638875 2951565 X 0 0 0 0 176539250 229981037 176539250 229981037 179178125 232932602 X 11599772 21643948 20198067 X 0 1 X 1 0 X X X 0 0 0 COVENANT HEALTH SYSTEMS 222484505 9 1 1 1 0 ST MARY'S HEALTH SYSTEM INC 222504349 9 1 1 1 0 FANNY ALLEN CORPORATION 222495808 9 1 1 1 0 CHS OF WALTHAM INC 043333609 9 1 1 1 0 ST JOSEPH HOSPITAL 020222215 3 1 1 1 0 YOUVILLE HOSPITAL 043239563 3 1 1 1 0 YOUVILLE PLACE INC 043297834 9 1 1 1 0 ST ANDRE HEALTH CARE FACILITY 010342399 9 1 1 1 0 MI NURSINGRESTORATIVE CENTER INC 042104851 9 1 1 1 0 ST MARY'S VILLA NURSING HOME INC 232057177 9 1 1 1 0 MI MANAGEMENT INC 042857794 9 1 1 1 0 MI ADULT DAY HEALTH CENTER INC 042921888 9 1 1 1 0 MI TRANSPORTATION INC 042921889 9 1 1 1 0 YOUVILLE HOUSE INC 043239593 9 1 1 1 0 ST MARY'S REGIONAL MEDICAL CTR 010211551 9 1 1 1 0 ST MARY'S D'YOUVILLE PAVILION 012011558 9 1 1 1 0 ST JOSEPH HOSPITAL 010212435 9 1 1 1 0 ST JOSEPH AMBULATORY CARE INC 010422885 9 1 1 1 0 18 0 0 ALTERNATIVE INVESTMENTS 45854451 F 45854451 X 33243720 21643948 21643948 11599772 818647 818647 12418419 0 0 0 818647 818647 818647 PART X, LINE 2: INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS IS THE FOLLOWING "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. THE SYSTEM HAS EVALUATED THE POSITIONS TAKEN ON ITS FILED TAX RETURNS, AND HAS CONCLUDED NO UNCERTAIN INCOME TAX POSITIONS EXIST AT DECEMBER 31, 2013." PART XI, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT EXPENSES INCLUDED IN REVENUE 818,647. PART XII, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT EXPENSES INCLUDED IN REVENUE 818,647. X X X X X 0 0 0 0 0 0 0 0 0 JOHN AHLE TREASURER/SECRETARY 0 339914 0 0 0 42502 0 70050 0 31700 0 484166 0 0 CAROLYN KASABIAN TRUSTEE 0 256012 0 0 0 22819 0 2472 0 21399 0 302702 0 0 RICHARD J PLAMONDON VICE PRESIDENT 0 246681 0 27880 0 25624 0 7650 0 23689 0 331524 0 0 PAUL ERCOLINI TRUSTEE 0 147221 0 0 0 25535 0 7004 0 25701 0 205461 0 0 FORM 990, PART VI, SECTION A, LINE 3 THE BOARD OF TRUSTEES DELEGATED MANAGEMENT DUTIES TO CARDINAL INVESTMENT MANAGEMENT, INC. (EIN 04-3391257). FORM 990, PART VI, SECTION B, LINE 11 THE 990 IS PRESENTED TO, AND REVIEWED BY, THE BOARD PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE MONITORING AND ENFORCEMENT OF COMPLIANCE WITH THE POLICY IS COMPLETED AT THE INDIVIDUAL BOARD LEVELS OF THE ENTITIES THAT ARE SHAREHOLDERS OF PROVIDENTIA PRIMA. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: NET TRANSFER FROM AFFILIATES 20,198,067. COVENANT HEALTH SYSTEM INC 100 AMES POND DRIVE TEWKSBURY MA 01876 222484505 MANAGEMENT AND HEALTH RESOURCE ORGANIZATION MA 501(C)(3) LINE 9 N/A 0 ST MARY'S HEALTH SYSTEM PO BOX 7291 LEWISTON ME 04243 222504349 PARENT COMPANY ME 501(C)(3) LINE 9 COVENANT HEALTH SYSTEMS 0 FANNY ALLEN CORPORATION 790 COLLEGE PARKWAY COLCHESTER VT 05446 222495808 HEALTH CARE SERVICES VT 501(C)(3) LINE 9 COVENANT HEALTH SYSTEMS 0 CHS WALTHAM 66 NEWTON STREET WALTHAM MA 02453 043333609 SKILLED NURSING FACILITY MA 501(C)(3) LINE 9 COVENANT HEALTH SYSTEMS 0 ST JOSEPH HOSPITAL 172 KINSLEY ST NASHUA NH 03061 020222215 ACUTE CARE HOSPITAL NH 501(C)(3) LINE 3 COVENANT HEALTH SYSTEMS 0 YOUVILLE HOSPITAL 100 AMES POND DRIVE TEWKSBURY MA 01876 023239563 FORMER REHAB HOSPITAL MA 501(C)(3) LINE 3 COVENANT HEALTH SYSTEMS 0 YOUVILLE PLACE 10 PELHAM RD LEXINGTON MA 02421 043297834 ASSISTED LIVING FACILITY MA 501(C)(3) LINE 9 COVENANT HEALTH SYSTEMS 0 ST ANDRE SKILLED NURSING AND REHAB FACILITY 407 POOL ST BIDDEFORD ME 04005 010342399 SKILLED NURSING FACILITY ME 501(C)(3) LINE 9 COVENANT HEALTH SYSTEMS 0 MI NURSING RESTORATIVE CENTER 172 LAWRENCE ST LAWRENCE MA 01841 042104851 SKILLED NURSING FACILITY MA 501(C)(3) LINE 9 COVENANT HEALTH SYSTEMS 0 ST MARY'S VILLA NURSING HOME 675 ST MARYS VILLA ROAD MOSCOW PA 18444 232057177 SKILLED NURSING FACILITY PA 501(C)(3) LINE 9 COVENANT HEALTH SYSTEMS 0 MI MANAGEMENT INC 172 LAWRENCE ST LAWRENCE MA 01841 042857794 SKILLED NURSING FACILITY MA 501(C)(3) LINE 9 COVENANT HEALTH SYSTEMS 0 MI ADULT DAY HEALTH CENTER 172 LAWRENCE ST LAWRENCE MA 01841 042921888 SKILLED NURSING FACILITY MA 501(C)(3) LINE 9 COVENANT HEALTH SYSTEMS 0 MI TRANSPORTATION 172 LAWRENCE ST LAWRENCE MA 01841 042921889 SKILLED NURSING FACILITY MA 501(C)(3) LINE 9 COVENANT HEALTH SYSTEMS 0 YOUVILLE HOUSE 1575 CAMBRIDGE ST CAMBRIDGE MA 02138 043239593 ASSISTED LIVING FACILITY MA 501(C)(3) LINE 9 COVENANT HEALTH SYSTEMS 0 YOUVILLE LIFECARE 100 AMES POND DRIVE TEWKSBURY MA 01876 042103582 MANAGEMENT SERVICES MA 501(C)(3) LINE 11A, I COVENANT HEALTH SYSTEMS 0 ST MARY'S REGIONAL MEDICAL CENTER PO BOX 7291 LEWISTON ME 04243 010211551 HOSPITAL ME 501(C)(3) LINE 9 ST MARY'S HEALTH SYSTEM 0 ST MARY'S D'YOUVILLE PAVILION PO BOX 7291 LEWISTON ME 04243 010211558 NURSING HOME ME 501(C)(3) LINE 9 ST MARY'S HEALTH SYSTEM 0 ST JOSEPH HOSPITAL 360 BROADWAY BANGOR ME 04402 010212435 HOSPITAL ME 501(C)(3) LINE 1 ST JOSEPH HEALTHCARE FOUNDATION 0 ST JOSEPH AMBULATORY CARE INC 360 BROADWAY BANGOR ME 04402 222480373 PHYSICIAN PRATICE ME 501(C)(3) LINE 3 ST JOSEPH HEALTHCARE FOUNDATION 0 COMMUNITY CLINICAL SERVICES PO BOX 7291 LEWISTON ME 04243 010409788 PHYSICIAN PRATICE ME 501(C)(3) LINE 3 ST MARY'S HEALTH SYSTEM 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 COVENANT HEALTH SYSTEMS INC R 20734626 CASH YOUVILLE HOUSE INC R 1192822 CASH ST JOSEPH HOSPITAL (BANGOR ME) R 2000000 CASH YOUVILLE PLACE R 500000 CASH MI NUSING RESTORATIVE CENTER R 448400 CASH MI MANAGEMENT INC R 53024 CASH MI ADULT DAY HEALTH CENTER R 12240 CASH MI TRANSPORTATION R 53000 CASH COVENANT HEALTH SYSTEMS INC S 24906096 CASH ST MARY'S VILLA NURSING HOME S 2525000 CASH ST JOSEPH HOSPITAL (NASHUA NH) S 6551032 CASH MI NUSING RESTORATIVE CENTER S 5513400 CASH MI MANAGEMENT INC S 652024 CASH MI ADULT DAY HEALTH CENTER S 138000 CASH MI TRANSPORTATION S 598000 CASH YOUVILLE HOUSE INC S 2472826 CASH ST JOSEPH HOSPITAL (BANGOR ME) S 18273350 CASH ST MARY'S REGIONAL MEDICAL CENTER S 6133952 CASH COMMUNITY CLINICAL SERVICES S 255000 CASH YOUVILLE PLACE S 80000 CASH