2013-08-05T11:47:59-05:00 2012-12-31 020383073 WILLIAM STEELE & ASSOCIATES PC 40 STARK STREET MANCHESTER NH 03101 990 2012-01-01 043333609 CHS OF WALTHAM INC CHSO 7818930240 66 NEWTON STREET WALTHAM MA 02453 CAROLYN FENN 7818930240 2013-07-29 1 WILLIAM G STEELE JR CPA P00233103 6036228881 2012 2016-02-24 21:20:13Z MARISTHILL NURSING & REHABILTATION CENTER CAROLYN FENN 66 NEWTON STREET WALTHAM MA 02453 10316344 0 0928 X MARITHILL.ORG X 1996 MA MARISTHILL IS A CATHOLIC SKILLED NURSING AND REHABILITATION FACILITY THAT CONTINUES THE HEALING MINISTRY OF CHRIST BY PROVIDING HEALTH CARE SERVICES THAT FOSTER EACH INDIVIDUAL'S PHYSICAL, SPIRITUAL, EMOTIONAL AND INTELLECTUAL WELL-BEING. 10 8 154 0 0 0 26945 22940 10747752 10242485 16060 -37791 4796 25618 10795553 10253252 0 0 0 0 6216478 5945374 0 0 0 4526338 4315150 10742816 10260524 52737 -7272 10254605 11999662 8302897 9915763 1951708 2083899 MARISTHILL IS A CATHOLIC SKILLED NURSING AND REHABILITATION FACILITY THAT CONTINUES THE HEALING MINISTRY OF CHRIST BY PROVIDING HEALTH CARE SERVICES THAT FOSTER EACH INDIVIDUAL'S PHYSICAL, SPIRITUAL, EMOTIONAL AND INTELLECTUAL WELL-BEING. 0 0 10043062 10242485 MARISTHILL NURSING AND REHABILITATION CENTER PROVIDED 37,446 DAYS OF SKILLED NURSING SERVICES DURING 2012 OF WHICH 25,535 WERE TO MEDICAID RECIPIENTS. 10043062 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 9 0 1 154 1 0 0 0 0 0 0 0 0 0 0 X 10 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X X CAROLYN FENN CEO 7818930240 66 NEWTON STREET WALTHAM MA 02453 KENNETH FERRON 1.00 X X 0 389749 99855 LUKE STANTON ESQ 1.00 X 0 0 0 CAROL EAST MSWLCSW 1.00 X 0 0 0 MARY ELIZABETH SCANLON RN 1.00 X 0 0 0 MICHAEL DELANEY ESQ 1.00 X 0 0 0 LISA LORGEREE 1.00 X X 0 0 0 MARIE LABOLLITA SC 1.00 X X 0 0 0 JOSEPH SGRO 40.00 X X 88468 0 1103 CAROLYN FENN 40.00 X X 103248 0 6693 KELLY MCDADE 1.00 X 0 0 0 JUDITH ALLEN 1.00 X 0 0 0 SHIRLY YELLAMATY 40.00 X 123204 0 12839 ANNI RICCI 40.00 X 103332 0 1248 418252 389749 121738 3 0 1 0 PEOPLE FIRST REHABILITATION PO BOX 277365 ATLANTA GA 30384 REHABILTATION SERVICES 760754 NEHM CORPORATION 1565 MAIN STREET TEWKSBURY MA 01888 HOUSEKEEPING 316850 US FOODS PO BOX 3155 BOSTON MA 02241 FOOD SERVICE 292015 PARTNERS PHARMACY OF MA 181 CEDAR HILL ROAD MARLBORO MA 01752 PHARMACY 232516 GULF SOUTH 14 N WENTWORTH AVENUE LONDONDERRY NH 03053 MEDICAL SUPPLIES 156005 5 22940 22940 PATIENT SERVICE REVENU 623000 10242485 10242485 10242485 25301 25301 63092 -63092 -63092 -63092 MISCELLANEOUS 623000 19953 19953 CAFETERIA 623000 2907 2907 VENDING MACHINE 623000 2758 2758 25618 10253252 10242485 0 -12173 191716 191716 4886889 4886889 19352 19352 469540 469540 377877 377877 176680 176680 19536 19536 21246 21246 5873 5873 120524 120524 71848 71848 355039 355039 15025 15025 348797 348797 415323 415323 60021 60021 PURCHASED SERVICES 1273533 1273533 NURSING HOME SUPPLIES A 856639 856639 MEDICAID USER FEE 571132 571132 EDUCATION AND TRAINING 3509 3509 425 425 10260524 10043062 217462 0 306600 194966 1570324 1877553 1017054 957247 55716 49497 10015515 4445124 5493185 5570391 744779 829322 1066947 2520686 10254605 11999662 670945 693584 6986207 8583828 645745 638351 8302897 9915763 X 1951708 2083899 1951708 2083899 10254605 11999662 X -7272 66013 73450 X 0 1 X 1 0 X 32861 5997 44938 26945 22940 133681 11133664 10925173 11027802 10746498 10268103 54101240 11166525 10931170 11072740 10773443 10291043 54234921 0 0 0 54234921 22158 35704 28185 1660 25301 113008 22158 35704 28185 1660 25301 113008 11188683 10966874 11100925 10775103 10316344 54347929 0.99790 0.99740 0.00210 0.00260 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 485000 485000 6042919 2278476 3764443 3127883 2166648 961235 359713 359713 5570391 RESIDENT FUNDS 17981 DEBT SERVICE RESERVE FUND 713012 BOND ISSUE COSTS (NET) 44071 BOND UNDERWRITING COSTS (NET) 17779 BOND DISCOUNT (NET) 43576 DEBT SERVICE SINKING FUND (NET) 1617011 CAPITALIZED FINANCING COSTS (NET) 67256 2520686 DEFERRED EXPENSES 235511 MEDICAID USER FEES 136363 PROFESSIONAL LIABILITY LOSS RESERVES 23991 DUE TO AFFILIATES 194509 RESIDENT FUNDS 16981 ORIGINAL ISSUE DISCOUNT 30996 638351 X DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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, 2012." X X X X 0 1 0 0 0 0 1 0 0 KENNETH FERRON 0 248748 0 92139 0 48862 0 72605 0 27250 0 489604 0 92139 PART I, LINE 1A EVERY TWO TO THREE YEARS THE COMPENSATION COMMITTEE OF OF THE COVENANT HEALTH SYSTEMS BOARD OF DIRECTORS ENGAGES AN EXTERNAL CONSULTANT TO PROVIDE COMPETITIVE MARKET DATA FROM VARIOUS SURVEY SOURCES, WHICH IS USED TO DEVELOP RECOMMENDATIONS FOR CHANGES TO THE COMPENSATION PROGRAM. SINCE 2003 THE COMPENSATION COMMITTEE HAS ENGAGED MERCER HUMAN RESOURCES CONSULTING TO CONDUCT THIS ANALYSIS. THE SPECIFIC OBJECTIVES OF THE ANALYSIS ARE TO ASSESS THE COMPETITIVENESS OF THE CURRENT TOTAL CASH COMPENSATION LEVELS FOR THE SENIOR LEADERSHIP TEAM; DEVELOP MARKET COMPETITIVE SALARY RANGES FOR ALL EXECUTIVE POSITIONS AND ENSURE THAT THE ANNUAL INCENTIVE OPPROTUNITIES, IF ANY, ARE COMPETITIVE AND REASONABLE. PART I, LINE 4B THE RELATED ORGANIZATION, COVENANT HEALTH SYSTEMS, MAINTAINS A SUPPLEMENTAL EXECUTIVE RETIREMENT PROGRAM FOR CERTAIN EXECUTIVES UNDER WHICH THE ORGANIZATION MAKES A CONTRIBUTION TO A GRANTOR TRUST FOR THE BENEFIT OF THE EXECUTIVE THAT IS INTENDED TO PROVIDE A SPECIFIED LEVEL OF RETIREMENT BENEFITS AT RETIREMENT AGE COMMENSURATE WITH RETIREMENT BENEFITS PROVIDED TO EXECUTIVES IN COMPARABLE POSITIONS BY SIMILARLY SITUATED ORGANIZATIONS. AMOUNTS CONTRIBUTED TO THE GRANTOR TRUST ARE HELD FOR THE BENEFIT OF THE EXECUTIVE UNTIL HE OR SHE REACHES AGE 60, AT WHICH TIME THEY ARE RELEASED TO THE EXECUTIVE. THE FULL AMOUNT PAID INTO THE GRANTOR TRUST IS TAXABLE TO THE EXECUTIVE WHEN SO PAID, AND IS INCLUDED IN THE EXECUTIVE'S REPORTED COMPENSATION. PART I, LINE 6 THE RELATED ORGANIZATION, COVENANT HEALTH SYSTEMS, MAINTAINS AN INCENTIVE COMPENSATION PLAN FOR EXECUTIVES THAT IS ADMINISTERED BY THE ORGANIZATION'S COMPENSATION COMMITTEE. THE PLAN PROVIDES EXECUTIVES WITH THE OPPORTUNITY TO EARN REASONABLE INCENTIVE COMPENSATION BASED ON THE PERFORMANCE OF THE ORGANIZATION AND THE PERFORMANCE OF THE INDIVIDUAL EXECUTIVE, AS MEASURED AGAINST GOALS THAT ARE SET AT THE BEGINNING OF THE YEAR. THE ENTITLEMENT TO AWARDS FOR A PARTICULAR YEAR IS NOT DETERMINED UNTIL EARLY THE FOLLOWING YEAR. THE ORGANIZATION PAID INCENTIVE COMPENSATION AWARDS OF $92,139 IN 2012 TO KENNETH FERRON BASED ON PERFORMANCE DURING 2011. A MA HEALTH & EDUCATION FACILITIES AUTHORITY 042456011 57586DBF9 2007-10-30 7221865 TO FINANCE THE PURCHASE OF YOUVILLE PLACE 1 0 0 B MA HEALTH & EDUCATION FACILITIES AUTHORITY 042456011 57584QAA4 2012-06-27 1720000 CAPITAL EQUIPMENT AND PROJECTS 0 0 0 A 7221865 712880 55862 6117244 1 1 1 1 B 1720000 54828 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 1 0 0 0 0 0 B 0 0 0 0 0 0 0 0 0 A 0 B 0 FORM 990, PART VI, SECTION A, LINE 6 COVENANT HEALTH SYSTEMS IS THE SOLE MEMBER OF THE ORGANIZATION OF THE BOARD. AS SUCH IT RETAINS CERTAIN RESERVE RIGHTS OVER BOARD DECISIONS AND BOARD COMPOSITION. FORM 990, PART VI, SECTION A, LINE 7A COVENANT HEALTH SYSTEMS IS THE SOLE MEMBER OF THE ORGANIZATION. AS SUCH IT RETAINS CERTAIN RESERVE RIGHTS OVER CORPORATE DECISIONS AND BOARD COMPOSITION. FORM 990, PART VI, SECTION A, LINE 7B COVENANT HEALTH SYSTEMS IS THE SOLE MEMBERS OF THE ORGANIZATION. AS SUCH IT RETAINS CERATIN RESERVE RIGHTS OVER BOARD DECISIONS AND BOARD COMPOSITION. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PROVIDED TO AND REVIEWED WITH THE BOARD PRIOR TO FILING FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A FULL-TIME OPERATIONAL INTEGRITY OFFICER THAT MONITORS ALL AREAS FOR POTENTIAL CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 EVERY TWO TO THREE YEARS THE COMPENSATION COMMITTEE OF THE COVENANT HEALTH SYSTEMS BOARD OF DIRECTORS ENGAGES AN EXTERNAL CONSULTANT TO PROVIDE COMPETITIVE MARKET DATA FROM VARIOUS SURVEY SOURCES, WHICH IS USED TO DEVELOP RECOMMENDATIONS FOR CHANGES TO THE COMPENSATION PROGRAM. SINCE 2003 THE COMPENSATION COMMITTEE HAS ENGAGED MERCER HUMAN RESOURCES CONSULTING TO CONDUCT THIS ANALYSIS. THE SPECIFIC OBJECTIVES OF THE ANALYSIS ARE TO ASSESS THE COMPETITIVENESS OF THE CURRENT TOTAL CASH COMPENSATION LEVELS FOR THE SENIOR LEADERSHIP TEAM; DEVELOP MARKET COMPETITIVE SALARY RANGES FOR ALL EXECUTIVE POSITIONS AND ENSURE THAT THE ANNUAL INCENTIVE OPPORTUNITIES, IF ANY, ARE COMPETITIVE AND REASONABLE. FORM 990, PART VI, SECTION C, LINE 19 THE FORM 990 AND GOVERNING DOCUMENTS, INCLUDING THE CONFLICT OF INTEREST POLICY, AND THE FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: TRANSFER AMONG AFFILATES 73,450. COVENANT HEALTH SYSTEMS 100 AMES POND DRIVE TEWKSBURY MA 01876 222484505 HEALTH CARE MANAGEMENT AND RESOURCE ORGANIZATION MA 501(C) 509(A) 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 COVENANT HEALTH SYSTEMS M 176680 COST