2012-07-20T13:28:41-05:00 2011-12-31 020383073 WILLIAM STEELE & ASSOCIATES PC 40 STARK STREET MANCHESTER NH 03101 990 2011-01-01 043419625 CHS OF WORCESTER INC CHSO 9786546363 100 AMES POND DRIVE TEWKSBURY MA 01876 JOHN AHLE 9786546363 2012-07-09 1 MICHAEL A BARBARITA CPA P00801253 6036228881 2011 2016-02-24 21:20:13Z ST MARY HEALTH CARE CENTER JOHN AHLE 100 AMES POND DRIVE TEWKSBURY MA 01876 8663476 0 0928 X COVENANTHS.ORG X 1998 MA ST. MARY HEALTH CARE CENTER, A CATHOLIC REHABILITATION AND SKILLED NURSING FACILITY, WAS ESTABLISHED AS A CONTINUING EXPRESSION OF THE VISION OF ST. MARGUERITE D'YOUVILLE, FOUNDRESS OF THE SISTERS OF CHARITY OF MONTREAL, THE "GREY NUNS". IN THE SPIRIT OF MARGUERITE, WHOSE LEGACY WE SHARE, WE SEEK TO "BRING THE MIRACLE OF LOVE TO ALL" THROUGH COMPASSIONATE CARE. ST MARY HEALTH CARE DESIRES, IN PARTNERSHIP WITH OTHERS COMMITTED TO PROVIDING HOLISITC AND INCLUSIVE CARE FOR ALL, TO DEVELOP INNOVATIVE AND CREATIVE MEANS TO ENHANCE THE PHYSICAL, EMOTIONAL, SOCIAL AND SPIRITUAL WELL-BEING OF THOSE WE SERVE. 8 6 236 0 0 0 6815 4095 8273670 8657458 3899 1500 4746 423 8289130 8663476 0 0 0 0 5608987 5711913 0 0 0 2809530 2998260 8418517 8710173 -129387 -46697 4255609 4191250 696544 678882 3559065 3512368 X ST. MARY HEALTH CARE CENTER, A CATHOLIC REHABILITATION AND SKILLED NURSING FACILITY, WAS ESTABLISHED AS A CONTINUING EXPRESSION OF THE VISION OF ST. MARGUERITE D'YOUVILLE, FOUNDRESS OF THE SISTERS OF CHARITY OF MONTREAL, THE "GREY NUNS". IN THE SPIRIT OF MARGUERITE, WHOSE LEGACY WE SHARE, WE SEEK TO "BRING THE MIRACLE OF LOVE TO ALL" THROUGH COMPASSIONATE CARE. ST. MARY HEALTH CARE DESIRES, IN PARTNERSHIP WITH OTHERS COMMITTED TO PROVIDING HOLISTIC AND INCLUSIVE CARE FOR ALL, TO DEVELOP INNOVATIVE AND CREATIVE MEANS TO ENHANCE THE PHYSICAL, EMOTIONAL, SOCIAL AND SPIRITUAL WELL-BEING OF THOSE WE SERVE. 0 0 8584191 8657458 THE ORGANIZATION PROVIDED 37,842 DAYS OF SKILLED NURSING CARE TO ELDERLY PATIENTS FROM ALL ECONOMIC, ETHNIC AND RELIGIOUS BACKROUNDS. OF THESE DAYS THE ORGANIZATION PROVIDED 32,978 DAYS OF SKILLED SERVICES TO MEDICAID RECIPIENTS. 8584191 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 13 0 1 236 1 0 0 0 0 0 0 0 0 0 0 X 8 6 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 0 MA X X JOHN AHLE CFO 9786546363 100 AMES POND DRIVE TEWKSBURY MA 01876 DIANNE BRUCE 1.00 X X 0 0 0 THOMAS LUCAS RETIRED 32012 1.00 X X 0 237080 120311 FRANCES MCPARTLAND 1.00 X 0 0 0 KENNETH FERRON 1.00 X 0 285362 191638 SUSAN MAEDLER 1.00 X 0 0 0 STEVEN DIORIO 1.00 X X 0 0 0 MELISSA BOYLE 1.00 X 0 0 0 RICHARD FREIJE 1.00 X 0 0 0 MICHAEL ISABELLA 40.00 X 106769 0 0 106769 522442 311949 1 0 1 0 HEALTHCARE SERVICES GROUP 3220 TILLMAN DRIVE BENSALEM PA 19020 HOUSEKEEPING AND LAUNDRY 308712 1 4095 4095 PATIENT SERVICE REVENU 623000 8657458 8657458 8657458 1500 1500 VENDING MACHINES 623000 423 423 423 8663476 8657458 0 1923 119488 119488 4646642 4646642 6376 6376 590101 590101 349306 349306 106488 106488 7913 7913 11581 11581 25334 25334 41673 41673 195997 195997 13102 13102 382240 382240 91576 91576 PURCHASED SERVICES 756902 756902 FOOD AND SUPPLIES 662912 662912 MEDICAID USER FEE 660183 660183 MISCELLANEOUS EXPENSES 23854 23854 18505 18505 8710173 8584191 125982 0 323010 413354 402044 403498 589004 518541 32288 37816 5196575 2415401 2871574 2781174 37689 36867 4255609 4191250 605637 597326 90907 81556 696544 678882 X 3559065 3512368 3559065 3512368 4255609 4191250 -46697 0 X 0 1 1 X 0 X 1516 6028 4391 6815 4095 22845 7961853 8875655 8821198 8278715 8661976 42599397 7963369 8881683 8825589 8285530 8666071 42622242 0 0 0 42622242 86 234 6207 3599 1500 11626 86 234 6207 3599 1500 11626 7963455 8881917 8831796 8289129 8667571 42633868 0.99970 0.99950 0.00030 0.00050 X 65300 65300 1576935 538953 1037982 1186836 759344 427492 2367504 1117104 1250400 2781174 PROFESSIONAL LIABILITY LOSS RESERVE 45189 RESIDENT FUNDS LIABILITY 36367 81556 X X X X 0 1 0 0 0 0 1 0 0 THOMAS LUCAS RETIRED 32012 0 195095 0 0 0 41985 0 88542 0 31769 0 357391 0 0 KENNETH FERRON 0 258208 0 0 0 27154 0 166434 0 25204 0 477000 0 0 PART I, LINE 4B THE RELATED ORGANIZATION, COVENANT HEALTH SYSTEMS, MAINTAINS A SUPPLEMENTAL EXECUTIVE RETIREMENT PROGRAM FOR CERTAIN EXECUTIVES UNDER WHICH THE ORGANIZATION MAKES A CONTRIBUTION TO A GRANTOR TRUST FOR THE BENEFIT OF THE EXECUTIVE THAT IS INTENDED TO PROVIDE A SPECIFIED LEVEL OF RETIREMENT BENEFITS AT RETIREMENT AGE COMMENSURATE WITH RETIREMENT BENEFITS PROVIDED TO EXECUTIVES IN COMPARABLE POSITIONS BY SIMILARLY SITUATED ORGANIZATIONS. AMOUNTS CONTRIBUTED TO THE GRANTOR TRUST ARE HELD FOR THE BENEFIT OF THE EXECUTIVE UNTIL HE OR SHE REACHES AGE 60, AT WHICH TIME THEY ARE RELEASED TO THE EXECUTIVE. THE FULL AMOUNT PAID INTO THE GRANTOR TRUST IS TAXABLE TO THE EXECUTIVE WHEN SO PAID, AND IS INCLUDED IN THE EXECUTIVE'S REPORTED COMPENSATION. PART I, LINE 6 THE RELATED ORGANIZATION, COVENANT HEALTH SYSTEMS, MAINTAINS AN INCENTIVE COMPENSATION PLAN FOR EXECUTIVES THAT IS ADMINISTERED BY THE ORGANIZATION'S COMPENSATION COMMITTEE. THE PLAN PROVIDES EXECUTIVES WITH THE OPPORTUNITY TO EARN REASONABLE INCENTIVE COMPENSATION BASED ON THE PERFORMANCE OF THE ORGANIZATION AND THE PERFORMANCE OF THE INDIVIDUAL EXECUTIVE, AS MEASURED AGAINST GOALS THAT ARE SET AT THE BEGINNING OF THE YEAR. THE ENTITLEMENT TO AWARDS FOR A PARTICULAR YEAR IS NOT DETERMINED UNTIL EARLY THE FOLLOWING YEAR. THE ORGANIZATION PAID NO INCENTIVE COMPENSATION AWARDS IN 2011 BASED ON PERFORMANCE DURING 2010. FORM 990, PART VI, SECTION A, LINE 6 COVENANT HEALTH SYSTEMS IS THE SOLE MEMBER OF THE ORGANIZATION. AS SUCH IT RETAINS CERTAIN RESERVE RIGHTS CONCERNING CORPORATE DECISIONS AND BOARD COMPOSITION. FORM 990, PART VI, SECTION A, LINE 7A COVENANT HEALTH SYSTEMS IS THE SOLE MEMBER OF THE ORGANIZATION. AS SUCH IT RETAINS CERTAIN RESERVE RIGHTS CONCERNING CORPORATE DECISIONS AND BOARD COMPOSITION. FORM 990, PART VI, SECTION A, LINE 7B COVENANT HEALTH SYSTEMS IS THE SOLE MEMBER OF THE ORGANIZATION. AS SUCH IT RETAINS CERTAIN RESERVE RIGHTS OVER BOARD DECISIONS AND BOARD COMPOSITION. FORM 990, PART VI, SECTION A, LINE 8B COVENANT HEALTH SYSTEMS IS THE SOLE MEMBER OF THE ORGANIZATION. AS SUCH IT RETAINS CERTAIN RESERVE RIGHTS OVER BOARD DECISIONS AND BOARD COMPOSITION. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PROVIDED TO THE BOARD FOR REVIEW PRIOR TO ITS BEING FILED FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REQUIRES CONFLICT OF INTEREST STATEMENTS TO BE SIGNED BY BOARD MEMBERS AND KEY EMPLOYEES REMINDING THEM OF THE DUTIES AND OBLIGATIONS TO REPORT REAL OR POTENTIAL CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 EVERY TWO TO THREE YEARS THE COMPENSATION COMMITTEE OF THE COVENANT HEALTH SYSTEM'S 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 ANNUAL INCENTIVE OPPORTUNITIES, IF THERE ARE ANY, ARE COMPETITIVE AND REASONABLE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, FINANCIAL STATEMENTS AND THE FORM 990 AVAILABLE TO THE PUBLIC UPON REQUEST. THE FORM 990 IS ALSO POSTED ON COVENANT HEALTH SYSTEM'S WEBSITE. COVENANT HEALTH SYSTEMS 100 AMES POND DRIVE TEWKSBURY MA 01876 222484505 HEALTHCARE MANAGEMENT AND RESOURCE ORGANIZATION MA 501 (C) 509(A)(2) 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 COVENANT HEALTH SYSTEMS L 106488 ACTUAL COST