CHELSEA JEWISH NURSING HOME INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
CHELSEA JEWISH NURSING HOME INC (EIN 04-2200583)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-11-15
IRS object ID
201343199349307554
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)
Timestamp2013-11-15T14:12:28-06:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN410746749EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1CLIFTONLARSONALLEN LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1300 CROWN COLONY DRIVE SUITE 310AddressLine1
CityQUINCYCity
StateMAState
ZIP Code02169ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN042200583EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1CHELSEA JEWISH NURSING HOME INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCHELNameControl
Phone6178870001Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1165 CAPTAINS ROWAddressLine1
CityCHELSEACity
StateMAState
ZIP Code02150ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameBARRY BERMANName
TitleCEO & CHAIRMANTitle
Phone6178870001Phone
Date Signed2013-11-15DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameROBERT DILLANName
PTINP01688008PTIN
Phone6179848100Phone
Date Prepared2013-11-14DatePrepared
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonBARRY BERMANNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1165 CAPTAINS ROWAddressLine1
CityCHELSEACity
StateMAState
ZIP Code02150ZIPCode
FieldValueIRS element (for citing)
Gross Receipts11892165GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.CJNH.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1975YearFormation
State Legal DomicileMAStateLegalDomicile
Activity Or Mission DescriptionOPERATING A 123-BED SKILLED NURSING FACILITY PROVIDING NURSING CARE, REHABILITATION THERAPIES AND OTHER SKILLED SERVICES TO FRAIL ELDERLY AND DISABLED.ActivityOrMissionDescription
Nbr Voting Members Governing Body8NbrVotingMembersGoverningBody
Nbr Independent Voting Members6NbrIndependentVotingMembers
Total Nbr Employees247TotalNbrEmployees
Total Nbr Volunteers6TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year176906ContributionsGrantsPriorYear
Contributions Grants Current Year170000ContributionsGrantsCurrentYear
Program Service Revenue Prior Year12785895ProgramServiceRevenuePriorYear
Program Service Revenue CY11716155ProgramServiceRevenueCY
Investment Income Prior Year32958InvestmentIncomePriorYear
Investment Income Current Year6010InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year12995759TotalRevenuePriorYear
Total Revenue Current Year11892165TotalRevenueCurrentYear
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 Year7117590SalariesEtcPriorYear
Salaries Etc Current Year6620088SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year5228811OtherExpensePriorYear
Other Expenses Current Year5509085OtherExpensesCurrentYear
Total Expenses Prior Year12346401TotalExpensesPriorYear
Total Expenses Current Year12129173TotalExpensesCurrentYear
Revenues Less Expenses Prior Year649358RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-237008RevenuesLessExpensesCY
Total Assets BOY8442750TotalAssetsBOY
Total Assets EOY7939580TotalAssetsEOY
Total Liabilities BOY5589298TotalLiabilitiesBOY
Total Liabilities EOY5323136TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY2853452NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY2616444NetAssetsOrFundBalancesEOY
Mission DescriptionTO PROVIDE SKILLED NURSING CARE TO THE FRAIL, ELDERLY, AND DISABLED.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense10913024Expense
Revenue11716155Revenue
DescriptionNURSING HOME: OPERATION OF A 123 BED SKILLED NURSING FACILITY PROVIDING NURSING CARE, REHABILITATION THERAPIES AND OTHER SKILLED SERVICES TO FRAIL ELDERLY AND DISABLED.Description
Total Program Service Expense10913024TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
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 Required1ScheduleJRequired
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
Number Of Employees247NumberOfEmployees
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 Members8NbrVotingGoverningBodyMembers
Number Independent Voting Members6NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees0MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body0Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy0WhistleblowerPolicy
Document Retention Policy0DocumentRetentionPolicy
Compensation Process CEO0CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledMAStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonELLEN SHONERNamePerson
Telephone Number6178870001TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1165 CAPTAINS ROWAddressLine1
CityCHELSEACity
StateMAState
ZIP Code02150ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (13 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
LEONA R GRELL
PRESIDENT1.000.00XX000
BARRY BERMAN
CEO & CHAIRMAN1.0043.00XX05676708498
NORMAN ALPERT
DIRECTOR1.000.00X000
CHARLOTTE FLORENCE
DIRECTOR1.000.00X000
DORIS T FRIEDMAN
DIRECTOR1.000.00X000
SHELLY KATZ
DIRECTOR1.000.00X000
ADAM BERMAN
CLERK & TREASURER1.0043.00XX02507826248
ANN SLOSBERG
DIRECTOR1.000.00X000
MILDRED KRAKOW
GRANT WRITER0.0040.000152370466X
RONILO ANGLO
ASSOC. VP0.0040.0001503699385X
DEREK PIRES
PLANT OPERATIONS0.0040.0001080619770X
EMILY STIER
DIRECTOR HC & HOSP.0.0040.0001074213645X
ROSA ROSARIO
DIRECTOR OF NURSING40.000.00101102015014X
FieldValueIRS element (for citing)
Total Reportable Comp From Org101102TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1336673TotalReportableCompFrmRltdOrgs
Total Other Compensation53026TotalOtherCompensation
Number Individuals GT100 K1NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1ASAR ELDER SERVICES INCBusinessNameLine1

Address Of Contractor AddressOfContractor

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1165 CAPTAINS ROWAddressLine1
CityCHELSEACity
StateMAState
ZIP Code02150ZIPCode
FieldValueIRS element (for citing)
Description Of ServicesMANAGEMENT SERVICESDescriptionOfServices
Compensation695577Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K
All Other Contributions170000AllOtherContributions
Total Contributions170000TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPATIENT SERVICE REVENUEDescription
Business Code623000BusinessCode
Total Revenue Column11716155TotalRevenueColumn
Related Or Exempt Function Income11716155RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue11716155TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column6010TotalRevenueColumn
Exclusion$6,010ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column11892165TotalRevenueColumn
Related Or Exempt Function Income11716155RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$6,010ExclusionAmount

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total5482139Total
Program Services5176222ProgramServices
Management And General305917ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total88027Total
Program Services83115ProgramServices
Management And General4912ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total636799Total
Program Services601264ProgramServices
Management And General35535ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total413123Total
Program Services390070ProgramServices
Management And General23053ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total695577Total
Management And General695577ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total32272Total
Management And General32272ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total57275Total
Management And General57275ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total528677Total
Program Services467069ProgramServices
Management And General61608ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total3429Total
Program Services3429ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total103921Total
Program Services103921ProgramServices

Occupancy Occupancy

FieldValueIRS element (for citing)
Total764363Total
Program Services764363ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total18686Total
Program Services18686ProgramServices

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total536Total
Program Services536ProgramServices

Interest Interest

FieldValueIRS element (for citing)
Total874Total
Program Services874ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total288253Total
Program Services288253ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServices
PATIENT ANCILLARY SERVI10001081000108
USER FEE ASSESSMENT631813631813
SUPPLIES & EXPENSE495640495640
BAD DEBT EXPENSE438625438625

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total449036Total
Program Services449036ProgramServices

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total12129173Total
Program Services10913024ProgramServices
Management And General1216149ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY500689BOY
EOY312664EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1867998BOY
EOY1898777EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY86583BOY
EOY131162EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis9541914LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec7043644LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY2437267BOY
EOY2498270EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY3550213BOY
EOY3098707EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY8442750BOY
EOY7939580EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1652763BOY
EOY1186154EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY3420BOY
EOY0EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY3340098BOY
EOY3145766EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY593017BOY
EOY991216EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY5589298BOY
EOY5323136EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY1203452BOY
EOY966444EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1650000BOY
EOY1650000EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY2853452BOY
EOY2616444EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY8442750BOY
EOY7939580EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses-237008ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement BothXFinancialStatementBoth
FieldValueIRS element (for citing)
Audit Committee0AuditCommittee
Federal Grant Audit Required1FederalGrantAuditRequired
Federal Grant Audit Performed1FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years109291CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years99501CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years86021CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year176906CurrentTaxYearMinus1Year
Current Tax Year170000CurrentTaxYear
Total641719Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years10706746CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years10809428CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years11493505CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year12785895CurrentTaxYearMinus1Year
Current Tax Year11716155CurrentTaxYear
Total57511729Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years10816037CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years10908929CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years11579526CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year12962801CurrentTaxYearMinus1Year
Current Tax Year11886155CurrentTaxYear
Total58153448Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years109291CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years99501CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years86021CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year176906CurrentTaxYearMinus1Year
Current Tax Year170000CurrentTaxYear
Total641719Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years109291CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years99501CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years86021CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year176906CurrentTaxYearMinus1Year
Current Tax Year170000CurrentTaxYear
Total641719Total
FieldValueIRS element (for citing)
Public Support Total50957511729PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years6090CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years31580CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years30735CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year32958CurrentTaxYearMinus1Year
Current Tax Year6010CurrentTaxYear
Total107373Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years6090CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years31580CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years30735CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year32958CurrentTaxYearMinus1Year
Current Tax Year6010CurrentTaxYear
Total107373Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years10822127CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years10940509CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years11610261CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year12995759CurrentTaxYearMinus1Year
Current Tax Year11892165CurrentTaxYear
Total58260821Total
FieldValueIRS element (for citing)
Public Support Percentage5090.98710PublicSupportPercentage509
Prior Year Support Percentage0.98780PriorYearSupportPercentage
Investment Income Percentage0.00180InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00190PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance1650000BeginningOfYearBalance
End Of Year Balance1650000EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Investment Earnings Or Losses1650000InvestmentEarningsOrLosses
End Of Year Balance1650000EndOfYearBalance
FieldValueIRS element (for citing)
Term Endowment EOY Balance1.00000TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis13575OtherCostOrOtherBasis
Book Value13575BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis7230822OtherCostOrOtherBasis
Depreciation4990614Depreciation
Book Value2240208BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis2297517OtherCostOrOtherBasis
Depreciation2053030Depreciation
Book Value244487BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings2498270TotalOfBookValueLandBuildings

Other Assets OtherAssets (5 entries)

DescriptionDescriptionBook ValueBookValue
UNAMORTIZED MORTGAGE ACQUISITION COST54792
CONSTRUCTION IN PROGRESS507875
ESCROWS883765
SOFTWARE, NET2275
BENEFICIAL INTEREST IN TESTAMENTARY TRUST1650000
FieldValueIRS element (for citing)
Total Book Value Other Assets3098707TotalBookValueOtherAssets

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionDUE TO RELATED PARTIESDescription
Amount$991,216Amount
FieldValueIRS element (for citing)
Total Of Amounts991216TotalOfAmounts
Footnote In Part XIIIXFootnoteInPartXIII
Tot Revenue Etc Audited Fincl Stmt11892165TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal11892165RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form99011892165TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt12129173TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal12129173ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99012129173TotalExpensesPerForm990

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
ExplanationTHE ORGANIZATION IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE ORGANIZATION FILES AS A TAX-EXEMPT ENTITY. SHOULD THAT STATUS BE CHALLENGED IN THE FUTURE, THE ORGANIZATION'S 2009 THROUGH 2012 TAX YEARS ARE OPEN FOR EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (4 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
BARRY BERMAN
CEO & CHAIRMAN056767000000008498057616800
ADAM BERMAN
CLERK & TREASURER025078200000006248025703000
MILDRED KRAKOW
GRANT WRITER01523700000000466015283600
RONILO ANGLO
ASSOC. VP015036900000009385015975400

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

Return ReferenceReturnReferenceExplanationExplanation
FORM 990, PART VI, SECTION A, LINE 2BARRY BERMAN AND ADAM BERMAN HAVE A FAMILY RELATIONSHIP.
FORM 990, PART VI, SECTION A, LINE 8BTHERE ARE NO COMMITTEES AUTHORIZED TO ACT ON BEHALF OF THE GOVERNING BODY.
FORM 990, PART VI, SECTION B, LINE 11MANAGEMENT WILL CONDUCT A REVIEW OF THE FORM 990 AFTER IT HAS BEEN FINALIZED, INCLUDING READING AND REVIEWING THE KEY INFORMATION. THEY WILL REPORT TO THE BOARD IF THERE ARE ANY MAJOR DEVIATIONS FROM THE PROVIDED DATA. ALL MEMBERS RECEIVE A COPY OF THE FEDERAL 990 TO REVIEW.
FORM 990, PART VI, SECTION B, LINE 12CON AN ANNUAL BASIS, ALL BOARD MEMBERS ARE INSTRUCTED TO INFORM THE REST OF THE BOARD IF ANY CONFLICT OF INTEREST EXISTS PERTAINING TO THEIR MEMBERSHIP ON THE BOARD. ANY POTENTIAL CONFLICT OF INTEREST IS THEN DISCUSSED AND ASSESSED BY THE REMAINING BOARD MEMBERS. IF A CONFLICT EXISTS IT MUST BE DISCLOSED AND HELD TO HIGHER LEVEL OF SCRUTINY IN ORDER TO VERIFY THAT ALL TRANSACTIONS ARE ARMS LENGTH. ANY BOARD MEMBER DEEMED TO HAVE A CONFLICT OF INTEREST WILL ABSTAIN FROM PARTICIPATING IN THE BOARD'S DELIBERATIONS AND DECISIONS IN THE TRANSACTION.
THE CEO IS NOT PAID FROM THE FILING ORGANIZATION. PRIOR TO MAJOR SALARY ADJUSTMENTS FOR THE CEO, A RELATED ORGANIZATION'S BOARD OF DIRECTORS ARRANGES FOR A SALARY STUDY TO BE PERFORMED. THE STUDY INCLUDES THE EXECUTIVE SALARIES OF COMPARABLY-SIZED COMPANIES IN THE INDUSTRY. THE BOARD OF DIRECTORS THEN CONSIDERS THE FINDINGS OF THE STUDY IN SETTING THE CEO'S COMPENSATION. 2011 WAS THE MOST RECENT YEAR IN WHICH THE PROCESS INCLUDED REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION. OFFICERS AND KEY EMPLOYEES ARE NOT PAID FROM THE FILING ORGANIZATION. COMPENSATION FOR KEY EMPLOYEES IS DETERMINED THROUGH THE USE OF SALARY STUDIES OR OTHER DATA AND ADJUSTED BASED ON THE EMPLOYEE'S YEARS OF EXPERIENCE AND RESPONSIBILITIES BY A RELATED ORGANIZATION'S BOARD OF DIRECTORS. 2011 WAS THE MOST RECENT YEAR IN WHICH THE PROCESS INCLUDED REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION.
FORM 990, PART VI, SECTION C, LINE 19GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY & FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST.
FORM 990, PART VI, SECTION A, LINE 3THE 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, ASAR ELDER SERVICES, INC. PLEASE SEE FORM 990, PART VII FOR COMPENSATION DETAIL.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusControlled OrgControlledOrgBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
CHELSEA JEWISH NURSING HOME FOUNDATION INC
165 CAPTAINS ROWCHELSEAMA02150510141617FUNDRAISING AND SUPPORT TO NURSING HOMEMA501(C)(3)LINE 70
CHELSEA JEWISH GREEN HOUSE INC
165 CAPTAINS ROWCHELSEAMA02150043326727NURSING HOME, HOME CARE, HOSPICE, AND PERSONAL CARE AGENCYMA501(C)(3)LINE 90CHELSEA JEWISH NURSING HOME FOUNDATION INC
CHELSEA JEWISH COMMUNITY INC
165 CAPTAINS ROWCHELSEAMA02150271756594ACADEMY FOR TRAINING CERTIFIED NURSING ASSISTANTSMA501(C)(3)LINE 90CHELSEA JEWISH NURSING HOME FOUNDATION INC

Form990 Schedule R Part III Form990ScheduleRPartIII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNA
ADMIRAL'S HILL ASSISTED LIVING LP
165 CAPTAINS ROWCHELSEAMA02150043255842ASSISTED LIVINGMAN/A
ADMIRAL'S HILL ASSISTED LIVING II LP
165 CAPTAINS ROWCHELSEAMA02150043538835ASSISTED LIVINGMAN/A

Form990 Schedule R Part IV Form990ScheduleRPartIV (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNAType Of EntityTypeOfEntityControlled OrgControlledOrg
ASAR ELDER SERVICES INC
165 CAPTAINS ROWCHELSEAMA02150043289287MANAGEMENT COMPANY & THERAPY SERVICESMAN/AC0
ADMIRAL'S HILL ASSITED LIVING CORP
165 CAPTAINS ROWCHELSEAMA02150043255840ASSISTED LIVINGMAN/AC0
ADMIRAL'S HILL ASSITED LIVING II CORP
165 CAPTAINS ROWCHELSEAMA02150043538833ASSISTED LIVINGMAN/AC0
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 Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org1LoansOrGuaranteesFromOtherOrg
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 Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

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