2013-05-07T08:56:34-07:00 2012-09-30 990 2011-10-01 223012385 JOHNSON EVERGREEN CORPORATION JOHN 8606846341 205 Chestnut Hill Road Stafford Springs CT 060760549 John Grish 8606848152 2013-05-07 2011 2016-02-25 16:41:14Z Evergreen Health Care Center David Morgan 50 Pleasantview Drive Somers CT 060760549 16851525 0 X www.jmmc.com X 1989 CT To develop, operate ,and maintain programs directed toward improving the efficiency of utiliztion of Health Care Facilities and Services in the State of CT, and in Hartford and Tolland Counties and surrouding areas in particular, and reducing the cost of health care to the public while maintaining a high quality of care. Evergreen is skilled nursing facility with 120 long-term-care beds, a 30-bed Subacute unit for patients in need of extensive therapy and care before returning home, and a 30-bed Memory Support unit for residents with Alzheimers's disease and similiar forms of dimentia. 14 14 326 76 0 0 24258 8629 17547583 16798928 0 0 108544 43968 17680385 16851525 0 0 0 0 11749582 11716653 0 0 0 6019816 6201793 17769398 17918446 -89013 -1066921 12616260 11723027 16939364 17113052 -4323104 -5390025 To develop, operate ,and maintain programs directed toward improving the efficiency of utiliztion of Health Care Facilities and Services in the State of CT, and in Hartford and Tolland Counties and surrouding areas in particular, and reducing the cost of health care to the public while maintaining a high quality of care. Evergreen is a Skilled Nursing Facility with 120 long term beds, a 30 bed Subacute Rehabilitation unit, and a 30 bed Memory Support unity. Services include: 24 hour nursing care, long term care, cardiac recovery, subacute rehabilitation, dental care, hospice care, respite care, iv therapies, medically complex care, mental health services, oncology/cancer care, optometry and opthalmology, orthopedic care, pain management, wound care, podiatry and other special services, postoperative care, pulmonary/respiratory care, social services and therapeutic recreation. 0 0 16860914 0 16842896 Nursing Home Care: Johnson Evergreen Corporation, DBA Evergreen Health Care Center maintains a 180 bed SNF with 24 hour skilled nursing care for residnets. During Fy 12 the facility maintained a high occupancy and high quality care in the facility. The cost shown represents the necessary salary, supplies, and overhead essential for caring for residents at Evergreen. (55156 resident days) 0 0 0 16860914 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 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 1 1 0 0 1 37 0 1 326 1 0 0 0 0 0 0 0 0 0 0 X 14 14 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Tia Riedel 8606848742 201 Chestnut Hill Road Stafford Springs CT 06076 Gary J Roman 2 X 0 0 0 Patrick Mahon 2 X 0 0 0 James M Makuch 2 X 0 0 0 Evelyne A Parizek 2 X 0 0 0 James Baum 2 X 0 0 0 Joseph Ianello MD 2 X 0 0 0 John T Larabee 2 X 0 0 0 Younus F Masih MD 2 X 0 0 0 John W Patton 2 X 0 0 0 John Giamalis 2 X 0 0 0 Christopher Dadlez 2 X 0 0 0 Arthur DeTore MD 2 X 0 0 0 David O'connor 2 X 0 0 0 Michael P Krol 2 X 0 0 0 David Morgan 50 X 0 433996 23035 John Grish 50 X 0 271336 19175 James Fidanza 50 X 165246 0 25029 Damien R Eilerman 40 X 141739 0 21469 Diana Rose 40 X 105345 0 15956 Lynda Schold 40 X 104242 0 15789 516572 705332 120453 4 0 1 0 0 0 0 0 0 0 8629 0 8629 Resident Revenues 623000 16798928 16798928 0 0 0 0 0 0 16798928 0 0 0 0 0 Title 19 Application Fees 561000 14750 14750 0 0 Miscellaneous Revenues 900099 29218 29218 0 0 0 0 0 0 43968 16851525 16842896 0 0 197295 197295 0 9364670 9013344 351326 1463171 1409956 53215 691517 672996 18521 12372 12372 26910 26910 584485 564484 20001 0 716690 716690 20490 19801 689 517972 517972 224472 224472 803210 803210 632347 492069 140278 Food 433649 433649 0 0 Patient Care and General Supplies 1185690 1185690 0 0 Provision for Uncollectible Accounts 80739 80739 0 0 Provider Taxes 950314 950314 0 0 12453 12453 17918446 16860914 1057532 0 300 300 1882964 1772253 404445 34502 42908 160645 109498 19780337 10640121 9939551 9140216 193853 657852 12616260 11723027 1662256 1540139 14829913 14431156 447195 1141757 16939364 17113052 X -4323104 -5390025 0 0 0 0 -4323104 -5390025 12616260 11723027 -1066921 0 X 0 1 1 X 0 X 0 17413 24292 24258 8629 74592 15665476 15862663 16970737 17547583 16798928 82845387 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 15665476 15880076 16995029 17571841 16807557 82919979 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 82919979 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 72127 529585 551751 108544 43968 1305975 15737603 16409661 17546780 17680385 16851525 84225954 0.98449 0.98483 0 0.00001 X Other income of $43,698 is comprised of Revenue from Title 19 Applications of 14750 and Various Misc. Revenues of $29,218 0 0 0 15733693 0 7872884 7860809 0 0 0 0 2520277 0 2169098 351179 1526367 0 598139 928228 9140216 Other Receivable 472272 Deferred Costs 130800 Patient Trust Fund 54780 657852 0 Other Liabilities 472272 Patient Trust Funds 54780 Payments due under Plan of Reorganization 223000 Due to Affilated Corporations 243340 Estimated Amounts due to Third-Party Payers 148365 1141757 16851525 17918446 -1066921 0 0 0 0 0 0 -1066921 16851525 0 0 0 0 0 16851525 0 0 0 16851525 17918446 0 0 0 0 0 17918446 0 0 0 17918446 SchD_P10_S00_L02 Schedule D, Part X, Line 2 Management has analyzed the tax positions taken and has concluded that as of September 30, 2012, there are no uncertain tax postions taken or expected to be taken that would require recognition of a liability (or asset) or disclosure in the financial statements. The Company is subject to routine audits by taxing jurisdictions; however, there are currently no audits for any tax periods in progress. Management believes the Company is no longer subject to income tax examinations prior to 2009. X X X X X 0 0 0 0 0 0 0 0 0 David Morgan 0 433996 0 0 0 23035 0 0 0 0 0 457031 0 0 John Grish 0 271336 0 0 0 19175 0 0 0 0 0 290511 0 0 James Fidanza 165246 0 0 0 32049 0 0 0 0 0 197295 0 0 0 Damien R Eilerman 141739 0 0 0 28148 0 0 0 0 0 169887 0 0 0 F990_P06_S0A_L06 Form 990, Part VI, Section A, Line 6 Article 3 of the Johnson Memorial Medical Center Bylaws stipulates there will be not less than 30 nor more than 60 Members. F990_P06_S0A_L07a Form 990, Part VI, Section A, Line 7a Members are elected by the Board as recommended by the Governance and Nominating Committee F990_P06_S0B_L11b Form 990, Part VI, Section B, Line 11b Board Policy provides that Members of the Finance Committee are provided opportunity to review and comment to Executive leadership before the 990 is filed. All members of the Board have access to any copy of the Form 990 and the Chief Financial Officer provides a summary of the 990 at the Board meeting following the filing of Form 990. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c An annual disclosure statement is required. Executives, Managers, and Board Members are required on an annual basis to disclose interests that may give rise to a conflict of interest. F990_P06_S0B_L15 Form 990, Part VI, Section B, Line 15 A Board committee reviews compensation for the executive team and recommends compensation for Board approval. Comparability data is reviewed and may include surveys, documentated comparisons of persons holding similiar positions in similiar organizations, and expert compensation schedules. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 The Johnson Memorial Medical Center maintains these documents in Administration and are available for viewing upon request during normal business hours. Johnson Memorial Medical Center 201 Chestnut Hill Road Stafford Springs CT 06076 222541974 Parent Corporation CT 501 c 3 11 N/A Johnson Memorial Hospital 201 Chestnut Hill Road Stafford Springs CT 06076 060646696 Acute Care Hospital CT 501 c 3 3 N/A Johnson Development Fund Inc 201 Chestnut Hill Road Stafford Springs CT 06076 222541977 Fund Raising CT 501 c 3 11 N/A Johnson Health Care Inc 201 Chestnut Hill Road Stafford Springs CT 06076 222541981 Occupational Medicine CT 501 c 3 9 N/A Home and Community Health Services 101 Phoenix Avenue Enfield CT 06083 060646620 Visiting Nurse Association CT 501 c 3 9 N/A Wellcare Inc 201 Chestnut Hill Road stafford Springs CT 06076 222541983 Inactive For Profit Corporation CT N/A C 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 Johnson Memorial Hospital j 180000 Reasonable Cost Johnson Memorial Hospital o 224472 Reasonable Allocation N/A