2012-08-13T09:08:28-07:00 2011-09-30 990 2010-10-01 223012385 JOHNSON EVERGREEN CORPORATION JOHN 8606846341 205 Chestnut Hill Road Stafford Springs CT 060760549 John Grish 8606848152 2012-08-13 2010 2016-02-24 21:20:13Z Evergreen Health Care Center David Morgan 50 Pleasantview Drive Somers CT 06071 17680385 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. 11 10 346 85 0 0 24292 24258 16970737 17547583 0 0 551751 108544 17546780 17680385 0 0 0 0 12097917 11749582 0 0 0 6452624 6019816 18550541 17769398 -1003761 -89013 13667265 12616260 17901356 16939364 -4234091 -4323104 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 16204999 0 17656127 Nursing Home Care: Johnson Evergreen Corproation , DBA Evergreen Health Care Center maintains a 180 bed SNF with 24 hour skilled nursing care for residents. During fy11 the facility maintained a high occupancy and high quality care in the facility. The cost shown represent the necessary salary, supplies, and overhead essential for caring for residents at Evergreen. (56223 resident days) 0 0 0 16204999 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1 1 0 0 1 33 0 1 346 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 10 0 0 1 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 Richard P Dobson 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 Joan C Smith 2 X 0 0 0 Peter Betts 50 X 0 0 471897 David Morgan 50 X 0 338553 23364 John Grish 50 X 0 294915 21971 James Fidanza 50 X 161896 0 23550 Damien R Eilerman 40 X 124922 0 18171 Janis M Kozikowski 40 X 113205 0 16467 Diana Rose 50 X 122759 0 17857 Lynda Schold 40 X 106249 0 15455 629031 633468 608732 5 0 1 0 0 0 0 0 0 0 24258 0 24258 Resident Revenues 623000 17547583 17547583 0 0 0 0 0 0 17547583 0 0 0 0 0 Title 19 Application fees 561000 10000 10000 0 0 Micellaneous Revenues 900099 98544 98544 0 0 0 0 0 0 108544 17680385 17656127 0 0 0 0 0 0 0 0 0 0 194415 0 194415 0 0 0 0 0 9372708 8905573 467135 0 21685 21685 0 1468303 1400352 67951 0 692471 659245 33226 0 0 0 0 0 18358 0 18358 0 31487 0 31487 0 0 0 0 0 0 0 0 0 0 0 340833 321163 19670 0 736479 736479 0 0 18531 17842 689 0 467973 467973 0 0 693479 0 693479 0 837534 837534 0 0 513689 493133 20556 0 Chapter 11 related expenses, net 5201 0 5201 0 Food 438052 438052 0 0 Patient Care and General Supplies 1113087 1113087 0 0 Bad Debt Expense 26785 26785 0 0 Provider Tax 766096 766096 0 0 12232 12232 17769398 16204999 1564399 0 948424 300 1565543 1882964 404445 37119 34502 137382 160645 19780337 9840786 10773209 9939551 205588 193853 13667265 12616260 1771335 1662256 15199990 14829913 930031 447195 17901356 16939364 X -4234091 -4323104 0 0 0 0 -4234091 -4323104 13667265 12616260 -89013 0 X 0 1 1 X 0 X 12062 0 17413 24292 24258 78025 15843568 15665476 15862663 16970737 17547583 81890027 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 15855630 15665476 15880076 16995029 17571841 81968052 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 81968052 482 0 0 0 0 482 0 0 0 0 0 0 482 0 0 0 0 482 0 0 0 0 0 0 0 72127 529585 551751 108544 1262007 15856112 15737603 16409661 17546780 17680385 83230541 0.98483 0.98544 0.00001 0.00001 X Part lll, section B., line 12 Other income of 108544 is comprised primarily of a Workers Compensation premium return of 43434 and a prior year Affiliate accounts payable adjustment of 34810. Revenue from title 19 application fees was 10,000 plus various misc. credits of 20,300. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 15733693 0 7289195 8444498 0 0 0 0 2520277 0 2047858 472419 1526367 0 503733 1022634 9939551 0 Patient Trust Fund 59178 Payments due under plan of Reorganization 253812 Capital Lease Obligations 25450 Malpractice/CGL Insurance Liability 42460 Due to Affiliates 66295 447195 17680385 17769398 -89013 0 0 0 0 0 0 -89013 17680385 0 0 0 0 0 17680385 0 0 0 17680385 17769398 0 0 0 0 0 17769398 0 0 0 17769398 X X X 1 0 0 0 0 0 0 0 0 Peter Betts 0 0 0 0 0 471897 0 0 0 0 0 471897 0 0 David Morgan 0 338553 0 0 0 23364 0 0 0 0 0 361917 0 0 John Grish 0 294915 0 0 0 21971 0 0 0 0 0 316886 0 0 James Fidanza 161896 0 0 0 32519 0 0 0 0 0 194415 0 0 Damien R Eilerman 124922 0 0 0 26604 0 0 0 0 0 151526 0 0 0 SchJ_P01_S00_L04 Schedule J, Part I, Line 4 Peter Betts received a severence package in the amount of $188,998 which is included in the $471,894 on Part ll line 1e of Schedule J. These amounts were paid by the Johnson Memorial Hospital inc. (EIN# 06-0646696) which is a subsidiary of the Johnson Memorial Medical Center. The severence period was 3 months and all amounts were paid to Peter J Betts Inc. David Morgan, previously COO, succeeded Peter Betts as Interim President /CEO on April 22, 2011. Patrick Mahon Vice Chairman of Board 103893 Insurance coverage 0 F990_P06_S0A_L04 Form 990, Part VI, Section A, Line 4 The Parent corporation changed it's name effective Oct 4, 2010 (formerly The Johnson Memorial Corporation). As part of this change the new "Johnson Memorial Medical Center" and the Johnson Evergreen Corporations By-laws were Ammended and Restated on January 17, 2011. F990_P06_S0A_L06 Form 990, Part VI, Section A, Line 6 Article 3 of the Johnson Memorial Medical Center Bylaws (which are the same for Johnson Evergreen Corporation) 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 leadeship 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 ongoing basis to disclose interests that may give rise to conflict of interests. 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 industry surveys, documented compensation of persons holding similiar positions in similair 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. This includes the Johnson Evergreen Corporation. 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 1 1 0 0 0 Johnson Memorial Hospital j 180000 reasonable cost Johnson Memorial Hospital o 693479 reasonable allocation N/A