2013-11-14T09:57:03-06:00 2012-12-31 410746749 CLIFTONLARSONALLEN LLP 300 CROWN COLONY DRIVE SUITE 310 QUINCY MA 02169 990 2012-01-01 042106768 JEWISH REHABILITATION CENTER FOR AGED OF THE NORTH SHORE INC JEWI 9784715100 240 LYNNFIELD STREET PEABODY MA 01960 KIM JOYCE 9784715100 2013-11-12 1 ROBERT DILLAN P01688008 6179848100 2013-11-12 2012 2016-02-25 16:41:14Z X KIM JOYCE 240 LYNNFIELD STREET PEABODY MA 01960 16070126 0 X WWW.AVIVLIVING.ORG X 1944 MA THE ORGANIZATION OPERATES A 180 BED NURSING HOME WITH AN ADULT DAY CARE CENTER. 22 19 389 25 0 0 2543654 0 17078920 15224807 0 -406428 0 0 19622574 14818379 0 0 0 0 11437877 11539778 0 0 0 6758872 7840548 18196749 19380326 1425825 -4561947 46119499 43599596 43795833 46019438 2323666 -2419842 THE ORGANIZATION OPERATES A 180 BED NURSING HOME WITH AN ADULT DAY CARE CENTER. THE MISSION OF THE ORGANIZATION IS TO ENRICH THE LIFE OF EACH OF OUR RESIDENTS AND PROGRAM PARTICIPANTS, SO THAT EACH CAN CONTINUE TO LIVE HIS OR HER LIFE WITH A SENSE OF MEANING AND PURPOSE. 0 0 16553736 14169769 PROVIDE QUALITY SKILLED NURSING CARE & THERAPY FOR 180 ELDERLY RESIDENTS. 565598 648610 PROVIDE DAY CARE FOR THE ELDERLY. 17119334 1 0 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 18 0 389 1 0 0 0 0 0 0 0 0 0 0 X 22 19 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 0 1 1 0 MA X KIM JOYCE CFO 9784715100 240 LYNNFIELD STREET PEABODY MA 01960 STEPHEN H NEFF 0.00 40.00 X X 0 360732 41338 ERIC LEVY 2.00 5.00 X X 0 0 0 DAVID VARSANO 1.00 3.00 X X 0 0 0 WAYNE SHERIDAN 1.00 3.00 X X 0 0 0 NATALIE LEDERMAN 1.00 2.00 X X 0 0 0 MATTHEW WEINSTOCK 0.00 40.00 X X 0 194000 16282 KIM JOYCE 0.00 40.00 X X 0 160000 16110 TOM DICKER 1.00 1.00 X 0 0 0 NEAL MIZNER 1.00 1.00 X 0 0 0 RONALD ROSEN MD 1.00 1.00 X 0 0 0 MATHEW REMIS 1.00 1.00 X 0 0 0 DIANA MEICHES 1.00 1.00 X 0 0 0 DANIEL RUBIN 1.00 1.00 X 0 0 0 ROBERT MAZOW 1.00 1.00 X 0 0 0 ANDREW MERKEN 1.00 1.00 X 0 0 0 SUZANNE GRUHL 1.00 1.00 X 0 0 0 STEVEN HOLLIS 1.00 1.00 X 0 0 0 ROBERT SMITH 1.00 1.00 X 0 0 0 MARK JAFFE 1.00 1.00 X 0 0 0 SEYMOUR SCHWARTZ 1.00 3.00 X 0 0 0 DAVID PLINER 1.00 3.00 X 0 0 0 ANDREW KATZ 1.00 3.00 X 0 0 0 JAY GOLDMAN 1.00 1.00 X 0 0 0 ELLEN GORDON 1.00 1.00 X 0 0 0 DEBRA SLOAN 1.00 1.00 X 0 0 0 THERESA HALLIDAY-BURRI 0.00 40.00 X 0 152538 10358 JEFF GOPEN 40.00 0.00 X 137556 0 19131 MICHAEL HAMMERSCHMIDT 0.00 40.00 X 0 135079 9433 KATY AHERN-TAVARES 0.00 40.00 X 0 121208 10066 ETTA DIAZ 40.00 0.00 X 111864 0 14897 249420 1123557 137615 6 0 1 0 MERLINO DESIGN PARTNERSHIPS 2200 RENAISSANCE BLVDSTE 300 GULP MILLS PA 19406 PROFESSIONAL SERVICES 1496949 SIGNET ELECTRONIC SYSTEMS 106 LONGWATER DRIVE NORWELL MA 02061 PROFESSIONAL SERVICES 1361337 PERKINS EQUIPMENT 7 PERMITER ROAD MANCHESTER NH 03103 EQUIPMENT SUPPLIER 578750 BOSTON SYSTEMS & SOLUTIONS 241 WINTER STREET 5TH FLOOR HAVERHILL MA 01830 IT SUPPORT 380559 KONINGISOR CONSULTING 27 LAKEVIEW ROAD FRAMINGHAM MA 01701 CONSULTING 304665 6 PROGRAM SERVICE REV. 623000 15224807 15224807 15224807 138 138 845181 1251747 -406566 -406566 -406566 14818379 14818379 0 0 10039737 9646296 393441 22088 21222 866 671872 645542 26330 806081 774492 31589 1623000 1623000 38798 38798 5734 5734 623467 482233 141234 21872 21872 180243 180243 570797 570797 121829 121829 40986 40986 659419 659419 1179330 1179330 13500 13500 USER FEE 763095 763095 FOOD 665916 665916 ANCILLARIES 534212 534212 SUPPLIES 472694 472694 325656 325656 19380326 17119334 2260992 0 573740 679454 20483567 917481 0 1888026 1466783 20263 21188 275152 318301 36669656 922192 4442402 35747464 18436349 4448925 46119499 43599596 4801829 1530547 46916 68794 34553888 34315888 4393200 10104209 43795833 46019438 X 2323666 -2419842 2323666 -2419842 46119499 43599596 X -4561947 -30384 -151177 X X 0 1 X 1 0 X 5813 5462 738 1607943 1619956 16692051 17109731 16742872 17078920 15224807 82848381 16697864 17115193 16743610 18686863 15224807 84468337 1607943 1607943 0 1607943 1607943 82860394 935711 138 935849 935711 138 935849 -406566 -406566 16697864 17115193 16743610 19622574 14818379 84997620 0.97490 0.97050 0.01100 0.01090 X SCHEDULE A, PART IV, SUPPLEMENTAL INFORMATION: SCHEDULE A, PART III, SECTION B. TOTAL SUPPORT OTHER INCOME INCLUDES A LOSS ON DISPOSAL OF EQUIPMENT OF $406,566 IN 2012. 31443534 393256 31050278 5169066 482453 4686613 57056 46483 10573 35747464 SOFTWARE 12134 DEFERRED FINANCING CHARGES 989732 CAPITAL INTEREST FUND 3943 SECURITY DEPOSITS 14828 ASSET HELD FOR SALE 3428288 4448925 DUE TO RELATED PARTIES 7776672 FAIR VALUE OF INTEREST RATE SWAPS 1538709 ASSET RETIREMENT OBLIGATION 774000 SECURITY DEPOSITS 14828 10104209 X DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE ORGANIZATION IS A NOT-FOR-PROFIT CORPORATION UNDER SEC 501(C)(3) OF THE INTERNAL REVENUE CODE. THE 2009 THROUGH 2012 TAX YEARS ARE OPEN TO EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES. X 1 0 1 0 0 0 0 0 0 0 0 STEPHEN H NEFF 0 324288 0 0 0 36444 0 0 0 41338 0 402070 0 0 MATTHEW WEINSTOCK 0 194000 0 0 0 0 0 0 0 16282 0 210282 0 0 KIM JOYCE 0 160000 0 0 0 0 0 0 0 16110 0 176110 0 0 THERESA HALLIDAY-BURRI 0 152538 0 0 0 0 0 0 0 10358 0 162896 0 0 JEFF GOPEN 137556 0 0 0 0 0 0 0 19131 0 156687 0 0 0 PART I, LINE 1A STEPHEN NEFF, PRESIDENT & CEO, RECEIVED A HOUSING ALLOWANCE OF $36,444 IN CALENDAR YEAR 2012 AS INCLUDED IN OTHER REPORTABLE INCOME ON FORM 990, PART VII AND SCHEDULE J, COL. B(III). PART I, LINE 4A MICHAEL HAMMERSCHMIDT, CHIEF DEVELOPMENT OFFICER, RETIRED ON 11/16/2012 AND RECEIVED APPROXIMATELY $5,000 AS A SEVERANCE PAYMENT IN CALENDAR YEAR 2012. A MASS DEVELOPMENT FINANCE AGENCY 043431814 57583UBR8 2011-04-29 34553888 TO REFUND OLD BONDS AND REPLACE EXISTING FACILITY. 0 0 0 A 1601175 34553888 1314672 690823 529178 29501040 917000 2012 1 0 1 1 A 0 0 0 0 0 0 0 A 0 1 0 0 1 1 M&T BANK 5.000000000000 0 0 0 0 0 A 0 SCHEDULE K SUPPLENTAL INFORMATION THIS ORGANIZATION IS REPORTING THEIR RESPECTIVE SHARE OF THE $50M BOND ISSUED ON 04/29/11. SEE AVIV ASSISTED LIVING, INC. (EIN 04-3274643) FOR THE REMAINING PORTION. 990, SCHEDULE K, PART III, LINE 9, PART IV, LINE 7 & PART V POLICIES AND PROCEDURES RELATING TO COMPLIANCE THE ORGANIZATION DID NOT HAVE FORMAL WRITTEN POLICIES AND PROCEDURES IN PLACE DURING THE 2012 TAX YEAR. HOWEVER, THE ORGANIZATION WAS IN COMPLIANCE DURING THE TAX YEAR AND PLAN TO ADOPT WRITTEN POLICIES AND PROCEDURES DURING 2013. FORM 990, PART VI, SECTION B, LINE 11 MANAGEMENT REVIEWS CPA PREPARED FORM 990 PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF DIRECTORS AND EXECUTIVE MANAGERS ARE REQUIRED ANNUALLY TO COMPLETE A CONFLICT OF INTEREST STATEMENT. STATEMENTS ARE REVIEWED BY A SUBCOMMITTEE OF BOARD MEMBERS AND THE CEO. MONTHLY COMPLIANCE COMMITTEE MEETINGS INCLUDE REVIEW AND MONITORING OF ANY POTENTIAL OR ACTUAL CONFLICTS. DETERMINING THE LEVEL OF CONFLICT FOR REVIEW IS BASED ON POTENTIAL FINANCIAL OR LEGAL RISK TO THE ORGANIZATION. IF A CONFLICT (ACTUAL OR POTENTIAL) IS RAISED FOR A BOARD MEMBER, HE/SHE IS REFRAINED FROM VOTING ON RELATED TOPICS. MANAGERS WITH CONFLICT (ACTUAL OR POTENTIAL) ARE BANNED FROM OVERSIGHT AND DECISION MAKING FOR THAT SUBJECT. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION COMMITTEE, A SUBCOMMITTEE OF THE BOARD, ANNUALLY REVIEWS CEO AND TOP MANAGEMENT COMPENSATION. INDUSTRY SALARY AND BENEFIT SURVEYS AS WELL AS MARKET DATA ARE REVIEWED AS DEEMED NECESSARY. THE COMPENSATION COMMITTEE AND REVIEW OF COMPENSATION IS DOCUMENTED IN THE FORM OF A REPORT AND MAINTAINED IN HUMAN RESOURCE FILES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. MANAGEMENT DUTIES FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION'S MANAGEMENT PERFORMS MANAGEMENT DUTIES WHICH INCLUDE, BUT ARE NOT LIMITED TO, HIRING, FIRING, AND SUPERVISING PERSONNEL, PLANNING OR EXECUTING BUDGETS OR FINANCIAL OPERATIONS, OR SUPERVISING EXEMPT OPERATIONS OR UNRELATED TRADES OR BUSINESSES OF THE ORGANIZATION FOR SEVERAL RELATED ENTITIES. MANAGEMENT CONTROL IS NOT CONSIDERED DELEGATED AND MANAGEMENT PERSONNEL ARE PAID FROM A CENTRALIZED MANAGEMENT ORGANIZATION, AVIV CENTERS FOR LIVING, INC. PLEASE SEE FORM 990, PART VII FOR COMPENSATION DETAIL. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CHANGE IN FAIR VALUE OF INTEREST RATE SWAPS -164,464. EQUITY TRANSFER WITH RELATED PARTY 13,286. ROUNDING 1. OVERSEE AUDIT AND SELECTION OF AUDITOR FORM 990, PART IX, LINE 2C THE ORGANIZATION HAS A COMMITTEE THAT OVERSEES THE AUDIT AND SELECTS THE AUDITOR. AVIV FOUNDATION INC 240 LYNNFIELD STREET PEABODY MA 01960 223102199 FUNDRAISING MA 501(C)(3) LINE 7 AVIV CENTERS FOR LIVING 1 AVIV ASSISTED LIVING INC 240 LYNNFIELD STREET PEABODY MA 01960 043274643 ASSISTED LIVING MA 501(C)(3) LINE 9 AVIV CENTERS FOR LIVING 1 AVIV CENTERS FOR LIVING INC 240 LYNNFIELD STREET PEABODY MA 01960 261244471 MANAGEMENT MA 501(C)(3) LINE 11B, II 0 JRCL HOMECARE LLC 240 LYNNFIELD STREET PEABODY MA 01960 262743823 HOME BASED SKILLED NURSING MA N/A JRC REALTY CORP 240 LYNNFIELD STREET PEABODY MA 01960 043321272 REAL ESTATE MA N/A C 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1 0 0 0 0 1