2011-08-04T07:53:49-05:00 2010-12-31 WILLIAM STEELE & ASSOCIATES PC 40 STARK STREET MANCHESTER NH 03101 990 2010-01-01 010342399 ST ANDRE HEALTH CARE FACILITY STAN 2072825171 407 POOL STREET BIDDEFORD ME 04005 ANDREA OTIS-HIGGINS 2072825171 2011-08-01 1 MICHAEL A BARBARITA 6036228881 2010 2016-03-07 17:11:31Z ANDREA OTIS-HIGGINS 407 POOL STREET BIDDEFORD ME 04005 7836198 0 0928 X STANDRE.ORG X 1946 ME ST. ANDRE HEALTH CARE FACILITY ANSWERS GOD'S CALL TO PROMOTE A HIGH QUALITY, COMPASSIONATE HEALTH CARE COMMUNITY WHERE ALL PEOPLE FLOURISH. 11 10 231 0 0 0 27499 13647 7875992 7786228 34853 30157 0 5608 7938344 7835640 0 0 0 0 4940313 4333630 0 0 0 3049340 3668127 7989653 8001757 -51309 -166117 5198174 5645951 2446943 2962022 2751231 2683929 ST ANDRE HEALTH CARE FACILITY ANSWERS GOD'S CALL TO PROMOTE A HIGH QUALITY,COMPASSIONATE HEALTH CARE COMMUNITY WHERE ALL PEOPLE FLOURISH. 0 0 7882641 7789128 ST ANDRE HEALTH CARE FACILITY PROVIDED 31,653 SKILLED NURSING CARE DAYS OF SERVICE OF WHICH 23,025 DAYS WERE REIMBURSED BY MEDICAID AT WELL BELOW COST. 7882641 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 32 0 1 231 1 0 0 0 0 0 0 0 0 0 0 X 11 10 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 ME X X ANDREA OTIS-HIGGINS 2072825171 407 POOL STREET BIDDEFORD ME 04005 BONITA POTHIER 1.00 X 0 0 0 ANDREA OTIS-HIGGINS 40.00 X X 106368 0 8703 SR THERESA GAUVIN SCIM 1.00 X 0 0 0 PAT CAMIRE 1.00 X 0 0 0 KENNETH FARLEY 1.00 X X 0 0 0 ROLAND GAGNE 1.00 X X 0 0 0 MARILYN GUGLIUCCI 1.00 X 0 0 0 ROLAND CRONKHITE JR 1.00 X X 0 0 0 NANCY DRAPEAU 1.00 X 0 0 0 JOHN ELMEN ESQ 1.00 X 0 0 0 KIM DENNIS 1.00 X 0 0 0 REV JOSEPH DANIELS 1.00 X 0 0 0 DONALD SHARLAND 1.00 X 0 0 0 106368 0 8703 1 0 0 0 REHABCARE GROUP INC PO BOX 503534 ST LOUIS MO 63150 PATIENT REHABILIATION SERVICES 499825 ANTHEM BLUE CROSS BLUE SHIELD PO BOX 591 LEWISTON ME 04243 HEALTH INSURANCE 466433 OMNICARE INC PO BOX 715268 ST LOUIS MO 63150 PHARMACY 157776 COVENANT HEALTH SYSTEMS 100 AMES POND ROAD TEWKSBURY MA 01876 MEMEBERSHIP FEE 149805 US FOODSERVICE PO BOX 3155 BOSTON MA 02241 PATIENT FOOD 138883 5 13647 13647 PATIENT SERVICE REVENU 623000 7786228 7786228 7786228 30157 30157 3266 558 2708 2708 CAFATERIA SALES 623000 2900 2900 2900 7835640 7789128 0 32865 106368 106368 3849552 3849552 7012 7012 56234 56234 314464 314464 88416 88416 23481 23481 30700 30700 44977 44977 203699 203699 113578 113578 265221 265221 460307 460307 PATIENT CARE PURCH SERV 812906 812906 MEDICAL & OTHER SUPPLIE 751327 751327 MEDICAID USER FEE 413375 413375 BAD DEBT EXPENSE 332311 332311 OTHER PATIENT CARE EXPE 51497 51497 76332 76332 8001757 7882641 119116 0 280797 139685 12084 14219 982231 1192956 12904 12896 39121 88118 6271504 3915189 2262739 2356315 1057082 1181243 551216 660519 5198174 5645951 536193 946400 1244216 150000 1910750 621406 2446943 2962022 X 2751231 2683929 2751231 2683929 5198174 5645951 X -166117 98815 X 0 1 1 X 0 X 2484 16619 49692 27499 16355 112649 7064056 7113549 7396408 7903490 7789128 37266631 7066540 7130168 7446100 7930989 7805483 37379280 0 0 0 37379280 158144 179835 3610 33103 30157 404849 158144 179835 3610 33103 30157 404849 7224684 7310003 7449710 7964092 7835640 37784129 0.98930 0.98950 0.01070 0.01050 X 1268 1268 2758297 1894906 863391 2589500 2020283 569217 922439 922439 2356315 EST. 3RD PARTY SETTLEMENTS 189736 RESIDENT FUNDS 20609 DUE FROM AFFILIATE 450174 660519 DUE TO AFFILIATE 700 OTHER NOTES PAYABLE 600097 RESIDENT PERSONAL FUNDS 20609 621406 7835640 8001757 -166117 98815 98815 -67302 7934455 98815 98815 7835640 0 7835640 8001757 0 8001757 0 8001757 FORM 990, PART VI, SECTION A, LINE 6 COVENANT HEALTH SYSTEMS, INC. IS THE SOLE MEMBER OF ST. ANDRE AND AS SUCH HAS CERTAIN RESERVED RIGHTS. FORM 990, PART VI, SECTION A, LINE 7A COVENANT HEALTH SYSTEMS, INC. IS THE SOLE MEMBER OF ST ANDRE AND AS SUCH HAS CERTAIN RESERVED RIGHTS. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS REVIEWED BY THE BOARD OF TRUSTEES PRIOR TO IT'S BEING FILED. FORM 990, PART VI, SECTION B, LINE 12C ST ANDRE HELATH CARE FACILITY HAS A FORMAL, WRITTEN ORGANIZATIONAL INTEGRITY POLICY ADMINISTERED BY A FULL-TIME ORGANIZATIONAL INTEGRITY OFFICER. FORM 990, PART VI, SECTION B, LINE 15 EVERY 2 TO 3 YEARS THE COMPENSATION COMMITTEE OF THE COVENANT HEALTH SYSTEMS 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 THE ANNUAL INCENTIVE OPPORTUNITIES, IF THERE ARE ANY, ARE COMPETITIVE AND REASONABLE. FORM 990, PART VI, SECTION C, LINE 19 ST ANDRE HEALTH CARE FACILITY MAKES IT'S GOVERNING BODY DOCUMENTS AND POLICIES AVAILABLE TO INTERESTED PARTIES UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 98,815. COVENANT HEALTH SYSTEMS INC 100 AMES POND DRIVE TEWKSBURY MA 01876 222484505 MANAGEMENT MA 501(C)3 509A2 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 COVENANT HEALTH SYSTEMS INC L 149805 ACTUAL COST