2014-11-17T15:22:12-06:00 2013-12-31 410746749 CLIFTONLARSONALLEN LLP 300 CROWN COLONY DRIVE SUITE 310 QUINCY MA 02169 990 2013-01-01 042104452 EDGAR P BENJAMIN HEALTHCARE CENTER INC FKA RESTHAVEN CORPORATION EDGA 6177381500 120 FISHER AVENUE ROXBURY MA 02120 MYRNA WYNN PRESIDENT/CEO/DIRECTOR 6177381500 2014-11-11 1 ROBERT DILLAN P01688008 6179848100 2014-11-10 2013 2015-11-30 17:44:51Z PERRY SMITH 120 FISHER AVENUE ROXBURY MA 02120 11769311 0 X WWW.BENJAMINHEALTHCARE.COM X 1927 MA PROVIDE NURSING CARE TO THE ELDERLY, AND TO PROVIDE HELP TO EDUCATION SERVICES. 9 8 260 8 0 0 1865 24166 11903131 11107027 6266 4466 532639 528775 12443901 11664434 0 0 0 0 8883467 8551833 0 0 0 3691211 3443257 12574678 11995090 -130777 -330656 4461667 3952168 4408664 4200835 53003 -248667 X TO PROVIDE A HOME OR SHELTER FOR AND TO OTHERWISE ASSIST INDIGENT PEOPLE WITHOUT REGARD TO RACE, CREED OR COLOR. TO PROVIDE EDUCATIONAL OPPORTUNITIES AND VOCATIONAL TRAINING FOR INDIVIDUALS WHO WORK IN LONG-TERM CARE FACILITIES OR OTHERWISE CARE FOR THE ELDERLY. TO PROVIDE SCHOOL-AGED CHILDREN WITH INTERGENERATIONAL LEARNING OPPORTUNITIES THAT ALLOW THEM TO GAIN SKILLS AND KNOWLEDGE FROM OLDER GENERATIONS. TO CARRY ON ANY ACTIVITY CONNECTED WITH OR INCIDENTAL TO THE FOREGOING PURPOSE. 0 0 10594758 11631780 OPERATING A 205-BED NURSING HOME 10594758 1 0 0 1 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 6 0 260 1 0 0 0 0 0 0 0 0 0 0 X 9 8 0 0 0 0 1 1 0 1 1 0 0 1 1 1 0 1 1 1 0 0 MA X MYRNA E WYNN 6177381500 120 FISHER AVE ROXBURY MA 02120 PERRY SMITH CHAIRMAN/DIRECTOR 0.90 0.10 X X 0 0 0 SANDY JACKSON TREASURER/DIRECTOR 0.90 0.10 X X 0 0 0 NUNOTTE ZAMA DIRECTOR 0.90 0.10 X 0 0 0 EVAN TOBASKY CLERK/DIRECTOR 0.90 0.10 X X 0 0 0 PHILLIPA WEECH DIRECTOR 0.90 0.10 X 0 0 0 REV GREGORY FERNANDES DIRECTOR 0.90 0.10 X 0 0 0 MYRNA WYNN PRESIDENT/CEO/DIRECTOR 39.20 0.80 X X 156993 0 10425 REV EVAN C HINES DIRECTOR 0.90 0.10 X 0 0 0 ROSALINDA MIDENCE DIRECTOR 0.90 0.10 X 0 0 0 BERTHELINA SPRIGGS DON 40.00 0.00 X 121017 0 6044 278010 0 16469 2 0 1 0 0 15000 4000 5166 24166 PATIENT SERVICE REVENUE 623000 11107027 11107027 11107027 4466 4466 608221 83468 524753 524753 524753 25431 21409 4022 4022 11664434 11631780 0 8488 168568 168568 6738198 6143282 594916 188046 171402 16644 933018 836157 96861 524003 469210 54793 47627 47627 46075 46075 229766 98089 131677 2053 2053 136267 136267 294796 294796 14409 14409 163138 163138 32194 32194 82387 82387 USER FEES 982947 982947 SUPPLIES AND EXPENSE 723080 723080 FOOD 361907 361907 REPAIRS AND MAINTENANCE 185257 185257 141354 118890 22464 11995090 10594758 1400332 0 604709 361573 1495525 1253463 1131808 1094121 86052 82298 5127610 4582039 577764 545571 208242 237226 357567 377916 4461667 3952168 1361675 1153846 2300000 2300000 746989 746989 4408664 4200835 X 53003 -248667 53003 -248667 4461667 3952168 X -330656 28984 2 X 0 1 X 1 0 X 130328 241095 78718 92792 24166 567099 13525989 12549099 11721074 11903131 11107027 60806320 13656317 12790194 11799792 11995923 11131193 61373419 362884 18814 1865 15000 398563 0 362884 18814 1865 15000 398563 60974856 377177 728387 698671 672666 612687 3089588 377177 728387 698671 672666 612687 3089588 14033494 13518581 12498463 12668589 11743880 64463007 0.94590 0.95050 0.04790 0.04380 X 0 0 0 0 0 0 0 0 1 3335 3335 0 PART II-B, LINE 1: PORTION OF PAID MEMBERSHIP DUES TO STATE HEALTHCARE ORGANIZATION THAT IS USED FOR LOBBYING ACTIVITIES. 200000 200000 3504355 3242789 261566 1423255 1339250 84005 545571 DEFERRED DEVELOPMENT COSTS 122576 RENT RECEIVABLE 255340 377916 ACCRUED INTEREST PAYABLE 596989 ASSET RETIREMENT OBLIGATION 150000 746989 X 11798295 28984 104877 133861 11664434 0 11664434 12099965 104877 104877 11995088 2 2 11995090 PART X, LINE 2: THE ORGANIZATION IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SEC 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL AND STATE TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE ORGANIZATIONS 2010 THROUGH 2013 TAX RETURNS ARE OPEN FOR EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES, PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES NETTED AGAINST RENTAL INCOME 83,468. FUNDRAISING EXPENSES NETTED AGAINST FUNDRAISING REVENUE 21,409. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES NETTED AGAINST RENTAL INCOME 83,468. FUNDRAISING EXPENSES NETTED AGAINST FUNDRAISING REVENUE 21,409. PART XII, LINE 4B - OTHER ADJUSTMENTS: ROUNDING 2. GOLF TOURNAMENT 25431 25431 9200 5474 6735 25431 25431 9200 5474 6735 21409 4022 X X X 0 0 0 0 0 0 0 0 0 MYRNA WYNN PRESIDENT/CEO/DIRECTOR 142012 0 14981 0 0 0 0 0 10425 0 167418 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION'S SOLE MEMBER IS RESTHAVEN CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A THE DIRECTORS OF THE SOLE MEMBER, RESTHAVEN CORPORATION, SHALL AUTOMATICALLY SERVE AS THE BOARD OF DIRECTORS OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11 THE BOARD OF DIRECTORS IS GIVEN A COPY OF THE FORM 990 TO REVIEW AND IT IS DISCUSSED AT A BOARD MEETING PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 15A THE BOARD OF DIRECTORS APPROVES ANY CHANGES TO THE CEO'S COMPENSATION. INDUSTRY COMPENSATION DATA AVAILABLE THROUGH THE STATE AND CONSULTANTS IS REVIEWED. ANY ADJUSTMENTS TO THE CEO'S COMPENSATION ARE DOCUMENTED IN WRITING IN THE MEETING MINUTES FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC ON AN UPON REQUEST BASIS. FORM 990, PART XI, LINE 9: ROUNDING 2. RESTHAVEN CORPORATION 120 FISHER AVENUE ROXBURY MA 02120 043448700 SUPPORTS NURSING HOME MA 501(C)(3) LINE 11B, II 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0