2013-10-29T10:15:05-05:00 2012-12-31 410746749 CLIFTONLARSONALLEN LLP 300 CROWN COLONY DRIVE SUITE 310 QUINCY MA 02169 990 2012-01-01 208745264 FAIRHAVEN HEALTHCARE CENTER INC C/O PLATINUM CARE LLC FAIR 9784201500 35 AVCO ROAD HAVERHILL MA 01835 JOEL E KIRCHICK 9784201500 2013-10-04 1 ROBERT DILLAN P01688008 6179848100 2013-10-04 2012 2016-03-07 17:11:31Z JOEL E KIRCHIK 35 AVCO ROAD HAVERHILL MA 01835 14299963 0 X WWW.FAIRHAVEN-NURSING.COM X 2007 MA TO PROVIDE LONG-TERM NURSING CARE TO THE ELDERLY. 6 6 262 10 0 0 20000 25019 14201583 14220321 75193 54623 46602 0 14343378 14299963 0 0 0 0 7436241 7098607 0 0 0 6812376 7426419 14248617 14525026 94761 -225063 32417540 31794126 32252065 31847859 165475 -53733 X IT IS OUR MISSION 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 12232981 14220321 A 169-BED SKILLED NURSING FACILITY PROVIDING NURSING CARE TO THE ELDERLY. 12232981 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 1 262 1 0 0 0 0 0 0 0 0 0 0 X 6 6 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 MA X RICHARD ATKINSON 9784201500 35 AVCO ROAD HAVERHILL MA 01835 JOEL KIRCHIK 1.00 2.00 X X 0 0 0 JOHN REGAN 1.00 2.00 X X 0 0 0 PATRICIA TORTELLA 1.00 2.00 X 0 0 0 RAYMOND DENNEHY 1.00 2.00 X X 0 0 0 JOANNE FREEDMAN SPECTOR 1.00 2.00 X 0 0 0 DAVID O'DONNELL 1.00 2.00 X 0 0 0 JOSEPH DEVEAU 40.00 X 115400 0 6197 115400 0 6197 1 0 0 0 HEALTHCARE SERVICES GROUP 3220 TILLMAN DR STE 300 BENSALEM PA 19020 HSKG, LAUNDRY, DIETARY 1196747 PLATINUM CARE LLC 35 AVCO ROAD HAVERHILL MA 01835 MANAGEMENT 815529 PREFERRED PHARMACY SOLUTIONS 35 AVCO ROAD HAVERHILL MA 01835 PHARMACY SERVICES 478105 GERIATRIC MEDICAL PO BOX 6027 CHELSEA MA 02150 MEDICAL SUPPLIES 153214 4 25019 25019 PROG.SERV.REVENUE-RELA 623000 14220321 14220321 14220321 54623 54623 0 25019 0 0 14299963 14220321 0 54623 121597 121597 5997067 5844328 152739 471088 456346 14742 508855 486532 22323 758472 758472 46191 46191 27832 27832 1438831 1438831 44349 44349 94922 94922 2313208 2313208 12466 12466 691606 691606 85070 85070 USER FEE 949680 949680 MEDICAL SUPPLIES 908043 908043 BAD DEBTS 36382 36382 DUES 17689 17689 1678 32049 -30371 14525026 12232981 2292045 0 4478 30308 1323244 1240258 1894036 1977163 46131 71508 22751636 2703621 18145942 20048015 1046897 1057543 2932083 2932083 7024729 4437248 32417540 31794126 1523342 1466838 29411117 29413301 1317606 967720 32252065 31847859 X 165475 -53733 165475 -53733 32417540 31794126 -225063 5855 0 X 0 1 X 0 0 X 20000 25019 45019 14081534 14201583 14220321 42503438 14081534 14221583 14245340 42548457 0 0 0 42548457 62947 75193 54623 192763 62947 75193 54623 192763 29194 46602 75796 14173675 14343378 14299963 42817016 X 1958000 1958000 17622000 2276175 15345825 2066154 95185 1970969 1076482 330522 745960 29000 1739 27261 20048015 DEFERRED FINANCING COSTS, NET 1281557 OTHER RECEIVABLES 28286 BOND ESCROWS 3127405 4437248 X DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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 2009 THROUGH 2012 TAX YEARS ARE OPEN FOR EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES. GOLF TOURNAMENT 25019 25019 25019 25019 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 2007B 043431814 57585AAD2 2007-10-25 1685472 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 1885472 1685472 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 0 0 1 0 0 0 0 B 0 0 0 1 0 0 0 0 C 0 0 0 1 0 0 0 0 D 0 0 0 1 0 0 0 0 SCHEDULE K PART IV, ARBITRAGE, LINE 2C DATE REBATE COMPUTATION PERFORMED ISSUER NAME: MASSACHUSETTS DEVELOPMENT FINANCE AGENCY - SERIES 2007A DATE THE REBATE COMPUTATION WAS PERFORMED: 06/30/2012 ISSUER NAME: MASSACHUSETTS DEVELOPMENT FINANCE AGENCY - SERIES 2007A DATE THE REBATE COMPUTATION WAS PERFORMED: 06/30/2012 ISSUER NAME: MASSACHUSETTS DEVELOPMENT FINANCE AGENCY - SERIES 2007A DATE THE REBATE COMPUTATION WAS PERFORMED: 06/30/2012 ISSUER NAME: MASSACHUSETTS DEVELOPMENT FINANCE AGENCY - SERIES 2007B DATE THE REBATE COMPUTATION WAS PERFORMED: 06/30/2012 ISSUER NAME: MASSACHUSETTS DEVELOPMENT FINANCE AGENCY - SERIES 2007D DATE THE REBATE COMPUTATION WAS PERFORMED: 06/30/2012 ISSUER NAME: MASSACHUSETTS DEVELOPMENT FINANCE AGENCY - SERIES 2007F DATE THE REBATE COMPUTATION WAS PERFORMED: 06/30/2012 ISSUER NAME: MASSACHUSETTS DEVELOPMENT FINANCE AGENCY - SERIES 2010 DATE THE REBATE COMPUTATION WAS PERFORMED: 06/30/2012 A MASSACHUSETTS DEVELOPMENT FINANCE AGENCY - SERIES 2007D 043431814 2007-10-25 2038290 PURCHASE FACILITIES 0 0 0 B MASSACHUSETTS DEVELOPMENT FINANCE AGENCY - SERIES 2007F 043431814 2007-10-25 760798 PURCHASE FACILITIES 0 0 0 C MASSACHUSETTS DEVELOPMENT FINANCE AGENCY - SERIES 2010 043431818 2010-07-14 2640000 PROJECT REHAB 0 0 0 A 2038290 19338 2018952 2007 0 0 1 1 B 760798 760798 2007 0 0 1 1 C 2640000 2640000 2010 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 A 0 0 0 1 0 0 0 0 B 0 0 0 1 0 0 0 0 C 0 0 0 1 0 0 0 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 B, LINE 12C THE ORGANIZATION HAS A CORPORATE COMPLIANCE PLAN WHICH INCLUDES THE MONITORING OF ITS CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE ON THE MSRB EMMA WEBSITE. 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