ST ANDRE HEALTH CARE FACILITY: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
ST ANDRE HEALTH CARE FACILITY (EIN 01-0342399)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-08-07
IRS object ID
201332199349300033
Schema version
2012v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-08-07T09:53:58-05:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN020383073EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1WILLIAM STEELE & ASSOCIATES PCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line140 STARK STREETAddressLine1
CityMANCHESTERCity
StateNHState
ZIP Code03101ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN010342399EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1ST ANDRE HEALTH CARE FACILITYBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlSTANNameControl
Phone2072825171Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1407 POOL STREETAddressLine1
CityBIDDEFORDCity
StateMEState
ZIP Code04005ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameANDREA OTIS-HIGGINSName
TitleCEO ADMINISTRATORTitle
Phone2072825171Phone
Date Signed2013-08-05DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameWILLIAM G STEELE JR CPAName
PTINP00233103PTIN
Phone6036228881Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonANDREA OTIS-HIGGINSNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1407 POOL STREETAddressLine1
CityBIDDEFORDCity
StateMEState
ZIP Code04005ZIPCode
FieldValueIRS element (for citing)
Gross Receipts7961249GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteSTANDRE.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1946YearFormation
State Legal DomicileMEStateLegalDomicile
Activity Or Mission DescriptionST. ANDRE HEALTH CARE FACILITY ANSWERS GOD'S CALL TO PROMOTE A HIGH QUALITY, COMPASSIONATE HEALTH CARE COMMUNITY WHERE ALL PEOPLE FLOURISH.ActivityOrMissionDescription
Nbr Voting Members Governing Body9NbrVotingMembersGoverningBody
Nbr Independent Voting Members8NbrIndependentVotingMembers
Total Nbr Employees232TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year6481ContributionsGrantsPriorYear
Contributions Grants Current Year8239ContributionsGrantsCurrentYear
Program Service Revenue Prior Year8002979ProgramServiceRevenuePriorYear
Program Service Revenue CY7916129ProgramServiceRevenueCY
Investment Income Prior Year17286InvestmentIncomePriorYear
Investment Income Current Year28073InvestmentIncomeCurrentYear
Other Revenue Prior Year7377OtherRevenuePriorYear
Other Revenue Current Year8808OtherRevenueCurrentYear
Total Revenue Prior Year8034123TotalRevenuePriorYear
Total Revenue Current Year7961249TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year4106705SalariesEtcPriorYear
Salaries Etc Current Year4651948SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year3710866OtherExpensePriorYear
Other Expenses Current Year3369071OtherExpensesCurrentYear
Total Expenses Prior Year7817571TotalExpensesPriorYear
Total Expenses Current Year8021019TotalExpensesCurrentYear
Revenues Less Expenses Prior Year216552RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-59770RevenuesLessExpensesCY
Total Assets BOY5300854TotalAssetsBOY
Total Assets EOY5182711TotalAssetsEOY
Total Liabilities BOY2418789TotalLiabilitiesBOY
Total Liabilities EOY1829962TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY2882065NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY3352749NetAssetsOrFundBalancesEOY
Mission DescriptionST ANDRE HEALTH CARE FACILITY ANSWERS GOD'S CALL TO PROMOTE A HIGH QUALITY,COMPASSIONATE HEALTH CARE COMMUNITY WHERE ALL PEOPLE FLOURISH.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense7897780Expense
Revenue7924937Revenue
DescriptionST ANDRE HEALTH CARE FACILITY PROVIDED 33,129 SKILLED NURSING CARE DAYS OF SERVICE OF WHICH 25,674 DAYS WERE REIMBURSED BY MEDICAID AT WELL BELOW COST.Description
Total Program Service Expense7897780TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required0ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109620NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees232NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members9NbrVotingGoverningBodyMembers
Number Independent Voting Members8NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledMEStatesWhereCopyOfReturnIsFiled
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1ANDREA OTIS-HIGGINSBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number2072825171TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1407 POOL STREETAddressLine1
CityBIDDEFORDCity
StateMEState
ZIP Code04005ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (9 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficer
SR PRISCILLE ROY
TRUSTEE1.00X000
ANDREA OTIS-HIGGINS
PRESIDENT/EX-OFFICIO40.00X1485470784X
RENEE O'NEIL
TRUSTEE1.00X000
PAT CAMIRE
CHAIR1.00X000X
KENNETH FARLEY
TREASURER1.00X000X
MARILYN GUGLIUCCI
TRUSTEE1.00X000
ROLAND CRONKHITE JR
SECRETARY1.00X000X
NANCY DRAPEAU
VICE CHAIR1.00X000X
HELENE GIRARD KENNEDY
TRUSTEE1.00X000
FieldValueIRS element (for citing)
Total Reportable Comp From Org148547TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation784TotalOtherCompensation
Number Individuals GT100 K1NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K0TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
REHABCARE GROUP INC
PO BOX 503534ST LOUISMO63150PATIENT REHABILIATION SERVICES697723
ANTHEM BLUE CROSS BLUE SHIELD
PO BOX 591LEWISTONME04243HEALTH INSURANCE388123
OMNICARE INC
PO BOX 715268ST LOUISMO63150PHARMACY237774
US FOODSERVICE
PO BOX 3155BOSTONMA02241PATIENT FOOD205416
COVENANT HEALTH SYSTEMS INC
100 AMES POND DRIVETEWKSBURYMA01876MANAGEMENT SERVICES157089
FieldValueIRS element (for citing)
Number Of Contractors GT100 K6NumberOfContractorsGT100K
All Other Contributions8239AllOtherContributions
Total Contributions8239TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPATIENT SERVICE REVENUDescription
Business Code623000BusinessCode
Total Revenue Column7916129TotalRevenueColumn
Related Or Exempt Function Income7916129RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue7916129TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column28073TotalRevenueColumn
Exclusion$28,073ExclusionAmount

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionCAFETERIA SALESDescription
Business Code623000BusinessCode
Total Revenue Column8808TotalRevenueColumn
Related Or Exempt Function Income8808RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue8808TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column7961249TotalRevenueColumn
Related Or Exempt Function Income7924937RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$28,073ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total148547Total
Program Services148547ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total3812664Total
Program Services3812664ProgramServices

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total7539Total
Program Services7539ProgramServices

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total390473Total
Program Services390473ProgramServices

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total292725Total
Program Services292725ProgramServices

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total101024Total
Management And General101024ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total28750Total
Program Services28750ProgramServices

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total22215Total
Management And General22215ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total115306Total
Program Services115306ProgramServices

Occupancy Occupancy

FieldValueIRS element (for citing)
Total219786Total
Program Services219786ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total18020Total
Program Services18020ProgramServices

Interest Interest

FieldValueIRS element (for citing)
Total67926Total
Program Services67926ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total301960Total
Program Services301960ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total67668Total
Program Services67668ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServices
PATIENT CARE PURCH SERV11657551165755
MEDICAL & OTHER SUPPLIE630385630385
MEDICAID USER FEE487211487211
OTHER PATIENT CARE EXPE143065143065

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total8021019Total
Program Services7897780ProgramServices
Management And General123239ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY256488BOY
EOY158205EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY15910BOY
EOY16123EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY828793BOY
EOY848788EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY13134BOY
EOY14427EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY76534BOY
EOY61409EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis7207879LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec4486925LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY2816807BOY
EOY2720954EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY1182309BOY
EOY1322195EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY110879BOY
EOY40610EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY5300854BOY
EOY5182711EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY771575BOY
EOY832428EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY1085982BOY
EOY971408EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY49500BOY
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY511732BOY
EOY26126EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY2418789BOY
EOY1829962EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY2882065BOY
EOY3352749EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY2882065BOY
EOY3352749EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY5300854BOY
EOY5182711EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-59770ReconcilationRevenueExpenses
Reconciliation Unrealized Invest112026ReconciliationUnrealizedInvest
Reconcilation Other Changes418428ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years49692CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years27499CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years16355CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year6481CurrentTaxYearMinus1Year
Current Tax Year8239CurrentTaxYear
Total108266Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years7396408CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years7903490CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years7789128CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year8010356CurrentTaxYearMinus1Year
Current Tax Year7924937CurrentTaxYear
Total39024319Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years7446100CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years7930989CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years7805483CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year8016837CurrentTaxYearMinus1Year
Current Tax Year7933176CurrentTaxYear
Total39132585Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total50939132585PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years3610CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years33103CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years30157CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year17286CurrentTaxYearMinus1Year
Current Tax Year28073CurrentTaxYear
Total112229Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years3610CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years33103CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years30157CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year17286CurrentTaxYearMinus1Year
Current Tax Year28073CurrentTaxYear
Total112229Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years7449710CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years7964092CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years7835640CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year8034123CurrentTaxYearMinus1Year
Current Tax Year7961249CurrentTaxYear
Total39244814Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99710PublicSupportPercentage509
Prior Year Support Percentage0.99320PriorYearSupportPercentage
Investment Income Percentage0.00290InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00680PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis1268OtherCostOrOtherBasis
Book Value1268BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis3435999OtherCostOrOtherBasis
Depreciation2119623Depreciation
Book Value1316376BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis3551707OtherCostOrOtherBasis
Depreciation2367302Depreciation
Book Value1184405BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis218905OtherCostOrOtherBasis
Book Value218905BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings2720954TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionRESIDENT PERSONAL FUNDSDescription
Amount$26,126Amount
FieldValueIRS element (for citing)
Total Of Amounts26126TotalOfAmounts
Footnote In Part XIIIXFootnoteInPartXIII

Form990 Schedule D Part XIII Form990ScheduleDPartXIII

FieldValueIRS element (for citing)
IdentifierDESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:Identifier
Return ReferencePART X, LINE 2:ReturnReference
ExplanationINCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS IS THE FOLLOWING, "THE SYSTEM HAS EVALUATED THE POSITIONS TAKEN ON ITS FILED TAX RETURNS. THE SYSTEM HAS CONCLUDED NO UNCERTAIN INCOME TAX POSITIONS EXIST AT DECEMBER 31, 2012."Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 6COVENANT HEALTH SYSTEMS, INC. IS THE SOLE MEMBER OF ST. ANDRE AND AS SUCH HAS CERTAIN RESERVED RIGHTS.
FORM 990, PART VI, SECTION A, LINE 7ACOVENANT HEALTH SYSTEMS, INC. IS THE SOLE MEMBER OF ST ANDRE AND AS SUCH HAS CERTAIN RESERVED RIGHTS.
FORM 990, PART VI, SECTION B, LINE 11THE FORM 990 IS REVIEWED BY THE BOARD OF TRUSTEES PRIOR TO IT'S BEING FILED.
FORM 990, PART VI, SECTION B, LINE 12CST ANDRE HELATH CARE FACILITY HAS A FORMAL, WRITTEN ORGANIZATIONAL INTEGRITY POLICY ADMINISTERED BY A FULL-TIME ORGANIZATIONAL INTEGRITY OFFICER.
FORM 990, PART VI, SECTION B, LINE 15EVERY 2 TO 3 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. OBJECTIVES ARE TO ASSESS THE COMPOSITENESS OF THE CURRENT TOTAL CASH COMPENSATION LEVELS OF THE SENIOR LEADERSHIP TEAM; DEVELOP MARKET BASED COMPETITIVE SALARY RANGES FOR ALL EXECUTIVE POSITIONS AND ENSURE THAT THE ANNUAL INCENTIVE OPPORTUNITIES, IF THERE ARE ANY, ARE COMPETITIVE AND REASONABLE.
FORM 990, PART VI, SECTION C, LINE 19ST ANDRE HEALTH CARE FACILITY MAKES IT'S GOVERNING BODY DOCUMENTS AND POLICIES AVAILABLE TO INTERESTED PARTIES UPON REQUEST.
FORM 990, PART XI, LINE 9:TRANSFER AMONG AFFILIATES 418,428.CHANGES IN NET ASSETS OR FUND BALANCES:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1COVENANT HEALTH SYSTEMS INCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1100 AMES POND DRIVEAddressLine1
CityTEWKSBURYCity
StateMAState
ZIP Code01876ZIPCode
FieldValueIRS element (for citing)
EIN222484505EIN
Primary ActivitiesMANAGEMENTPrimaryActivities
Legal Domicile StateMALegalDomicileState
Exempt Code Section501(C)3ExemptCodeSection
Public Charity Status509A2PublicCharityStatus
Controlled Org0ControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
COVENANT HEALTH SYSTEMS INC
M148224ACTUAL COST
COVENANT HEALTH SYSTEMS INC
C418428ACTUAL COST

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