2013-11-14T12:02:26-06:00 2012-12-31 061009205 BLUM SHAPIRO & COMPANY PC CPAS 50 HOLDEN STREET PROVIDENCE RI 02908 990 2012-01-01 222723407 ELMHURST EXTENDED CARE FACILITY INC ELMH 4014562600 50 MAUDE STREET PROVIDENCE RI 02908 KENNETH BELCHER 4014562600 2013-11-13 1 DONALD SULLIVAN P00059830 4012725600 2012 2016-02-25 16:41:14Z KENNETH BELCHER 50 MAUDE STREET PROVIDENCE RI 02908 18088689 0 X ELMHURSTEXTENDEDCARE.ORG X 1985 RI ELMHURST EXTENDED CARE FACILITY'S MISSION IS TO PROVIDE LONG TERM HEALTH CARE SERVICES TO THE ELDERLY AND NEEDY IN PROVIDENCE, RI AREA 3 3 354 7 0 0 4267 27308 18118339 17979254 0 0 67855 82127 18190461 18088689 0 0 0 0 11272780 11265503 0 0 0 6908184 6682597 18180964 17948100 9497 140589 3132742 3267431 4534205 4528305 -1401463 -1260874 ELMHURST EXTENDED CARE FACILITY'S MISSION IS TO PROVIDE LONG TERM HEALTH CARE SERVICES TO THE ELDERLY AND NEEDY IN THE PROVIDENCE, RI AREA. 0 0 16158382 17979254 ELMHURST EXTENDED CARE FACILITY PROVIDES LONG TERM HEALTH CARE FOR THE ELDERLY THROUGH THE OPERATION OF A NURSING CARE FACILITY. THE FACILITY IS MEDICARE AND MEDICAID CERTIFIED. DURING 2012 THERE WERE 67,201 PATIENT BED DAYS PROVIDED. INCLUDED IN THIS TOTAL WERE 45,946 MEDICAID AND 6,113 MEDICARE BED DAYS. 16158382 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 19 0 1 354 1 0 0 0 0 0 1 1 0 0 0 0 X 3 3 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 RI X THE ORGANIZATION 4014562600 50 MAUDE STREET PROVIDENCE RI 02908 DONALD MCQUEEN 1.00 X X 0 0 0 KENNETH BELCHER 1.00 40.00 X X 0 444728 100409 MICHAEL CONKLIN 1.00 40.00 X X 0 335062 110052 RICHARD GAMACHE 40.00 X 0 187465 49887 CHERYL FITZGERALD 40.00 X 134159 0 12323 134159 967255 272671 1 0 1 0 SUNDANCE REHABILITATION 6549 PAYSPHERE CIRCLE CHICAGO IL 60674 THERAPY SERVICES 836605 SODEXO MARRIOTT SERVICES PO BOX 81049 WOBURN MA 01813 FOOD & NUTRITION MANAGEMENT SERVICES 288347 2 17500 9808 27308 PROGRAM SERVICE REVENU 623000 17527254 17527254 ANCILLARY SERVICES 623000 452000 452000 17979254 34601 17500 0 34601 34601 MISCELLANEOUS INCOME 900099 46219 46219 HAIRDRESSER INCOME 900099 1307 1307 47526 18088689 17979254 0 82127 237352 237352 8564971 7991720 573251 1771593 1667502 104091 691587 631478 60109 231194 35570 195624 2675 2675 64977 64977 1546244 1410943 135301 6591 6591 39832 36347 3485 89272 81238 8034 368885 240752 128133 PURCHASED SERVICES 1381538 1381538 SUPPLIES 1207216 1207216 HEALTH CARE PROVIDER AS 972084 972084 DRUG AND PHARMACEUTICAL 485968 485968 286121 9435 276686 17948100 16158382 1789718 0 530480 601095 1998611 1958800 51187 54819 57720 16421 1767352 1131056 494744 636296 3132742 3267431 1926619 2091376 539644 465908 2067942 1971021 4534205 4528305 X -1401463 -1260874 -1401463 -1260874 3132742 3267431 140589 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 477474 294951 182523 1022965 788311 234654 266913 47794 219119 636296 DUE TO AFFILIATES 1971021 1971021 X 18088689 0 18088689 0 18088689 17948100 0 17948100 0 17948100 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE ORGANIZATION HAS ADOPTED THE GUIDANCE IN ASC 740, INCOME TAXES, RELATING TO UNCERTAIN TAX POSITIONS. THIS GUIDANCE PRESCRIBES A TWO STEP PROCESS FOR THE MEASUREMENT OF UNCERTAIN TAX POSITIONS THAT HAVE BEEN TAKEN OR ARE EXPECTED TO BE TAKEN ON A TAX RETURN. THE FIRST STEP IS A DETERMINATION OF WHETHER THE TAX POSITION SHOULD BE RECOGNIZED IN THE FINANCIAL STATEMENTS. THE SECOND STEP DETERMINES THE MEASUREMENT OF THE TAX POSITION. SUCH POSITIONS FOR A NONPROFIT CORPORATION WOULD INCLUDE THE NONPROFIT ORGANIZATION'S STATUS AS AN EXEMPT ORGANIZATION, WHETHER THE ORGANIZATION'S ACTIVITIES ARE RELATED TO ITS TAX EXEMPT PURPOSE AND, IF APPLICABLE, HOW THE ORGANIZATION ALLOCATES REVENUE AND EXPENSES BETWEEN ITS EXEMPT PURPOSE AND UNRELATED BUSINESS ACTIVITIES. ASC 740 ALSO PROVIDES GUIDANCE ON DERECOGNITION OF SUCH TAX POSITIONS, CLASSIFICATION, POTENTIAL INTEREST AND PENALTIES, AND DISCLOSURE. NO UNCERTAIN TAX POSITIONS WITHIN THE SCOPE OF ASC 740 EXIST AS OF DECEMBER 31, 2012. FUNDRAISER 52101 17500 34601 52101 17500 34601 34601 X X X 0 0 0 0 0 0 0 0 0 KENNETH BELCHER 0 444728 0 0 0 0 0 47406 0 53003 0 545137 0 0 MICHAEL CONKLIN 0 335062 0 0 0 0 0 34000 0 76052 0 445114 0 0 RICHARD GAMACHE 0 187465 0 0 0 0 0 19322 0 30565 0 237352 0 0 FORM 990, PART VI, SECTION A, LINE 3 EFFECTIVE JANUARY 2010, THE PRINCIPAL MANAGEMENT FUNCTIONS OF ELMHURST EXTENDED CARE FACILITY IS CONDUCTED UNDER THE DIRECTION OF CHARTERCARE HEALTH PARTNERS OFFICERS AND KEY EMPLOYEES. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990, ONCE COMPLETED, IS DISTRIBUTED IN DRAFT FORM TO THE SENIOR MANAGEMENT TO ENSURE INDIVIDUALS ARE PROVIDED TIME TO REVIEW AND APPROVE THE FORM 990 PRIOR TO THE DEADLINE. AFTER THE INTERNAL REVIEW IS COMPLETED, THE FORM 990 IS PROVIDED TO THE FINANCE COMMITTEE FOR THEIR REVIEW AND COMMENTS. QUESTIONS AND COMMENTS REGARDING THE 990 ARE FORWARDED TO THE APPROPRIATE INDIVIDUAL FOR RESOLUTION. UPON FINANCE COMMITTEE APPROVAL, A FINAL COPY OF THE FORM 990 IS FILED WITH THE TAXING AUTHORITY. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY INCLUDED IN THE BY-LAWS IS TO PROTECT THE CORPORATION'S INTEREST WHEN IT IS CONTEMPLATING ENTERING INTO A TRANSACTION OR ARRANGEMENT THAT MIGHT BENEFIT THE PRIVATE INTEREST OF AN OFFICER OR TRUSTEE OF THE CORPORATION. IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF HIS OR HER FINANCIAL INTEREST AND ALL MATERIAL FACTS TO THE OFFICERS, TRUSTEES, OR MEMBERS OF ANY COMMITTEES WITH BOARD-DELEGATED POWERS CONSIDERING THE PROPOSAED TRANSACTION OR ARRANGEMENT. ON AN ANNUAL BASIS, EACH MEMBER OF THE BOARD IS REQUIRED TO COMPLETE A CONFLICT OF INTEREST STATEMENT AND ALL RESPONSES ARE SUBMITTED AND REVIEWED BY LEGAL COUNCEL. ANY ACTUAL AND POSSIBLE CONFLICTS OF INTEREST ARE REVIEWED WITH THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION B, LINE 15 ANNUALLY AN OUTSIDE CONSULTING AGENCY, HEALTHCARE STRATEGIES, CONDUCTS A MARKET REVIEW AND ASSESSMENT OF THE ADMINISTRATOR AND OTHER KEY EMPLOYEE SALARIES AND BENEFIT PACKAGES. THIS INCLUDES AN ASSESSMENT OF COMPARABLE COMPENSATION FOR SIMILARLY QUALIFIED PERSONS IN FUNCTIONALLY COMPARABLE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS. RECOMMENDATIONS ON SALARY AND BENEFITS FOR THE ADMINISTRATOR AND THE KEY EMPLOYEES ARE MADE BY THE CONSULTANT TO THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS FOR A REVIEW. THE EXECUTIVE COMMITTEE VOTES ON AND APPROVES ANNUAL ADJUSTMENTS TO KEY EMPLOYEE COMPENSATION BASED ON ALL OF THE RELEVANT DATA. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, FINANCIAL STATEMENT, AND POLICIES ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. OVERSIGHT OF ANNUAL AUDIT PART XI, LINE 2C THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS IS RESPONSIBLE FOR THE OVERSIGHT OF THE ANNUAL AUDIT. ROGER WILLIAMS MEDICAL ASSOCIATES 825 CHALKSTONE AVENUE PROVIDENCE RI 02908 203346936 HEALTHCARE RI 501(C)(3) LINE 11A, I N/A 0 ROGER WILLIAMS REALTY CORPORATION 825 CHALKSTONE AVENUE PROVIDENCE RI 02908 050423855 HEALTHCARE RI 501(C)(3) LINE 11A, I N/A 0 ROGER WILLIAMS MEDICAL CENTER (FORMERLY ROGER WILLIAMS HOSPITAL) 825 CHALKSTONE AVENUE PROVIDENCE RI 02908 050258959 HEALTHCARE RI 501(C)(3) LINE 3 N/A 0 CHARTERCARE HEALTH PARTNERS 825 CHALKSTONE AVENUE PROVIDENCE RI 02908 264235815 HEALTHCARE RI 501(C)(3) LINE 11A, I N/A 0 RWGH PHYSICIANS OFFICE BUILDING 825 CHALKSTONE AVENUE PROVIDENCE RI 02908 050398588 HEALTHCARE RI 501(C)(3) LINE 11A, I N/A 0 ST JOSEPH HEALTH SERVICES OF RI 200 HIGH SERVICE AVENUE NORTH PROVIDENCE RI 02904 050259026 HEALTHCARE RI 501(C)(3) LINE 3 N/A 0 CHARTERCARE HEALTH PARTNERS FOUNDATION 200 HIGH SERVICE AVENUE NORTH PROVIDENCE RI 02904 260236669 FUNDRAISING RI 501(C)(3) LINE 7 N/A 0 ST JOSEPH HOSPITAL WORKERS COMP TRUST 200 HIGH SERVICE AVENUE NORTH PROVIDENCE RI 02904 056106574 TRUST RI 501(C)(3) LINE 11D, III-O ST JOSEPH HEALTH SERVICES OF RI 0 OUR LADY OF FATIMA ANCILLARY SERVICES 200 HIGH SERVICE AVENUE NORTH PROVIDENCE RI 02904 050519862 HEALTHCARE RI N/A C 0 ELMHURST HEALTH ASSOCIATES 825 CHALKSTONE BLVD PROVIDENCE RI 02908 050437610 HEALTHCARE RI N/A C 0 ROSEBANK CORPORATION 825 CHALKSTONE BLVD PROVIDENCE RI 02908 050342046 REAL ESTATE RI N/A C 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 1 0 0 0