2012-11-15T09:08:00-06:00 2011-12-31 410746749 CLIFTONLARSONALLEN LLP 300 CROWN COLONY DRIVE SUITE 310 QUINCY MA 02169 990 2011-01-01 042200583 CHELSEA JEWISH NURSING HOME INC CHEL 6178870001 165 CAPTAINS ROW CHELSEA MA 02150 BARRY BERMAN 6178870001 2012-11-05 1 BARBARA MORRISON P00173340 6179848100 2012-11-05 2011 2016-02-24 21:20:13Z BARRY BERMAN 165 CAPTAINS ROW CHELSEA MA 02150 12995759 0 X WWW.CJNH.ORG X 1975 MA OPERATING A 123 BED SKILLED NURSING FACILITY PROVIDING NURSING CARE, REHABILITATION THERAPIES AND OTHER SKILLED SERVICES TO FRAIL ELDERLY AND DISABLED. 8 6 252 6 0 0 86021 176906 11493505 12785895 30735 32958 0 0 11610261 12995759 0 0 0 0 6688428 7117590 0 0 0 4913957 5228811 11602385 12346401 7876 649358 6032679 8442750 5478585 5589298 554094 2853452 TO PROVIDE SKILLED NURSING CARE TO THE FRAIL, ELDERLY, AND DISABLED. 0 0 11049504 12785895 NURSING HOME: OPERATION OF A 123 BED SKILLED NURSING FACILITY PROVIDING NURSING CARE, REHABILITATION THERAPIES AND OTHER SKILLED SERVICES TO FRAIL ELDERLY AND DISABLED. 11049504 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 13 0 252 1 0 0 0 0 0 0 0 0 0 0 X 8 6 1 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 0 1 1 0 MA X ELLEN SHONER 6178870001 165 CAPTAINS ROW CHELSEA MA 02150 LEONA R GRELL 1.00 X X 0 0 0 BARRY BERMAN 40.00 X X 0 565313 27362 NORMAN ALPERT 1.00 X 0 0 0 CHARLOTTE FLORENCE 1.00 X 0 0 0 DORIS T FRIEDMAN 1.00 X 0 0 0 SHELLY KATZ 1.00 X 0 0 0 ADAM BERMAN 40.00 X X 0 152296 8132 ANN SLOSBERG 1.00 X 0 0 0 0 717609 35494 0 0 1 0 ASAR ELDER SERVICES INC 165 CAPTAINS ROW CHELSEA MA 02150 MANAGEMENT & THERAPY 1346430 1 176906 99189 176906 PROG.SERV.REVENUE-RELA 623000 12785895 12785895 12785895 32958 32958 12995759 12785895 0 32958 5892325 5551788 340537 55549 52339 3210 576009 542720 33289 593707 559395 34312 768414 768414 14616 14616 37050 37050 374130 308661 65469 1172 1172 105436 105436 777808 777808 23252 23252 2893 2893 5845 5845 285329 285329 PATIENT ANCILLARY SERVI 1016337 1016337 SUPPLIES & EXPENSE 632204 632204 USER FEE ASSESSMENT 623696 623696 FOOD 429940 429940 130689 130689 12346401 11049504 1296897 0 395682 500689 1741477 1867998 119485 86583 9197767 6760500 2596592 2437267 1179443 3550213 6032679 8442750 1453416 1652763 3420 3420 3523795 3340098 497954 593017 5478585 5589298 X 554094 1203452 0 1650000 554094 2853452 6032679 8442750 X 649358 1650000 X 0 1 0 X 1 1 X 108316 109291 99501 86021 176906 580035 10145421 10706746 10809428 11493505 12785895 55940995 10253737 10816037 10908929 11579526 12962801 56521030 108316 109291 99501 86021 176906 580035 0 108316 109291 99501 86021 176906 580035 55940995 8870 6090 31580 30735 32958 110233 8870 6090 31580 30735 32958 110233 10262607 10822127 10940509 11610261 12995759 56631263 0.98780 0.98850 0.00190 0.00170 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 13575 13575 6881993 4789255 2092738 2302199 1971245 330954 2437267 UNAMORTIZED MORTGAGE ACQUISITION CO 59251 CONSTRUCTION IN PROGRESS 818141 INTEREST RECEIVABLE 11159 ESCROWS 1008737 SOFTWARE, NET 2925 BENEFICIAL INT DONOR RESTR. TESTAMENTARY TRUST 1650000 3550213 DUE TO RELATED PARTIES 593017 593017 12995759 12346401 649358 1650000 1650000 2299358 12995759 0 12995759 0 12995759 12346401 0 12346401 0 12346401 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE 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 2008 THROUGH 2011 TAX YEARS ARE OPEN FOR EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN BENEFICIAL INTEREST IN TESTAMENTARY TRUST 1,650,000. X X 0 0 0 0 0 0 0 0 0 BARRY BERMAN 0 565313 0 0 0 0 0 0 0 27362 0 592675 0 0 ADAM BERMAN 0 152296 0 0 0 0 0 0 0 8132 0 160428 0 0 X SUPPLIES 1 99189 VALUE OF STORE SUPPLIES PROVIDED TO EMPLOYEES 0 0 0 FORM 990, PART VI, SECTION A, LINE 2 BARRY BERMAN AND ADAM BERMAN HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 8B THERE ARE NO COMMITTEES AUTHORIZED TO ACT ON BEHALF OF THE GOVERNING BODY FORM 990, PART VI, SECTION B, LINE 11 MANAGEMENT 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 GET A COPY FOR REVIEW. FORM 990, PART VI, SECTION B, LINE 12C THE POLICY IS REVIEWED ON AN ANNUAL BASIS. FORM 990, PART VI, SECTION B, LINE 15 PRIOR TO MAJOR SALARY ADJUSTMENTS, THE 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. 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. 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 19 FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: CHANGE IN BENEFICIAL INTEREST IN TESTAMENTARY TRUST 1,650,000. TOTAL TO FORM 990, PART XI, LINE 5: 1,650,000. CHELSEA JEWISH NURSING HOME FOUNDATION 165 CAPTAINS ROW CHELSEA MA 02150 510141617 FUNDRAISING AND SUPPORT TO NURSING HOME MA 501(C)(3) 509(A)(2) 0 CHELSEA JEWISH GREEN HOUSE INC 165 CAPTAINS ROW CHELSEA MA 02150 043326727 NURSING HOME, HOME CARE, HOSPICE, AND PERSONAL CARE AGENCY MA 501(C)(3) 509(A)(2) 0 ADMIRAL'S HILL ASSISTED LIVING LP 165 CAPTAINS ROW CHELSEA MA 02150 043255842 ASSISTED LIVING MA N/A ADMIRAL'S HILL ASSISTED LIVING II LP 165 CAPTAINS ROW CHELSEA MA 02150 043538835 ASSISTED LIVING MA N/A ASAR ELDER SERVICES INC 165 CAPTAINS ROW CHELSEA MA 02150 043289287 MANAGEMENT COMPANY & THERAPY SERVICES MA N/A C ADMIRAL'S HILL ASSITED LIVING CORP 165 CAPTAINS ROW CHELSEA MA 02150 043255840 ASSISTED LIVING MA N/A C ADMIRAL'S HILL ASSITED LIVING II CORP 165 CAPTAINS ROW CHELSEA MA 02150 043538833 ASSISTED LIVING MA N/A C 0 0 0 0 1 0 0 0 0 0 0 1 0 0 1 0 0 1