2011-07-25T08:28:59-05:00 2010-12-31 WILLIAM STEELE & ASSOCIATES PC 40 STARK STREET MANCHESTER NH 03101 990 2010-01-01 046835128 PROVIDENTIA PRIMA TRUST PROV 9786546363 100 AMES POND DRIVE TEWKSBURY MA 01876 JOHN AHLE 9786546363 2011-07-19 1 MICHAEL A BARBARITA 6036228881 2010 2016-02-24 21:20:13Z X JOHN AHLE 100 AMES POND DRIVE TEWKSBURY MA 01876 3861998 0 X COVENANTHS.ORG X 1996 MA PROVIDENTIA PRIMA WAS ESTABLISHED TO HOLD AND MANAGE POOLED INVESTMENTS OF VARIOUS ORGANIZATIONS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501 (C) (3) 7 3 0 0 0 0 0 0 0 0 -1812424 3861998 0 0 -1812424 3861998 0 0 0 0 0 0 0 0 0 562885 700050 562885 700050 -2375309 3161948 117189255 129137949 225255 145768 116964000 128992181 PROVIDENTIA PRIMA WAS ESTABLISHED TO HOLD AND MANAGE POOLED INVESTMENTS OF VARIOUS ORGANIZATIONS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501 (C) (3). 0 0 N/A 1 0 0 0 0 0 0 0 0 0 1 0 0 0 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 0 0 0 0 0 0 0 0 0 0 0 0 0 X 7 3 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X X JOHN AHLE 9786546363 100 AMES POND DRIVE TEWKSBURY MA 01876 JOHN AHLE 1.00 X X 0 359936 42623 CAROLYN KASABIAN 1.00 X 0 263895 29088 DONALD M DEHART 3.00 X X 0 0 0 RICHARD J PLAMONDON 1.00 X X 0 290414 39822 WILLIAM ADAMS 1.00 X 0 0 0 PAUL ERCOLINI 1.00 X 0 138471 22350 KEVIN HALLORAN 1.00 X 0 0 0 0 1052716 133883 0 0 0 1 SILCHESTER INTERNATIONAL INVESTORS 780 3RD AVENUE 42ND FLOOR NEW YORK NY 10017 INVESTMENT MANAGER 111874 WELLINGTON TRUST COMPANY PO BOX 13766 NEWARK NJ 07188 INVESTMENT MANAGER 100675 2 3861998 3861998 3861998 0 0 3861998 27298 27298 621190 621190 ADMINISTRATION EXPENSE 40000 40000 MISCELLANEOUS EXPENSES 11562 11562 700050 0 700050 0 4815922 1408728 71924193 88494535 40340601 39173148 108539 61538 117189255 129137949 85354 145768 139901 0 225255 145768 X 0 0 0 0 116964000 128992181 116964000 128992181 117189255 129137949 X 3161948 8866233 X 0 1 1 X 0 X X X 0 0 0 COVENANT HEALTH SYSTEMS 222484505 9 1 1 1 0 ST MARY'S HEALTH SYSTEM INC 222504349 9 1 1 1 0 FANNY ALLEN CORPORATION 222495808 9 1 1 1 0 CHS OF WALTHAM INC 043333609 9 1 1 1 0 ST JOSEPH HOSPITAL 020222215 3 1 1 1 0 YOUVILLE HOSPITAL 043239563 3 1 1 1 0 YOUVILLE PLACE INC 043297834 9 1 1 1 0 ST ANDRE HEALTH CARE FACILITY 010342399 9 1 1 1 0 MI NURSINGRESTORATIVE CENTER INC 042104851 9 1 1 1 0 ST MARY'S VILLA NURSING HOME INC 232057177 9 1 1 1 0 MI MANAGEMENT INC 042857794 9 1 1 1 0 MI ADULT DAY HEALTH CENTER INC 042921888 9 1 1 1 0 MI TRANSPORTATION INC 042921889 9 1 1 1 0 YOUVILLE HOUSE INC 043239593 9 1 1 1 0 14 0 0 ALTERNATIVE INVESTMENTS 39173148 F 39173148 3861998 700050 3161948 10066052 -1199819 8866233 12028181 13228000 10066052 10066052 3161948 700050 700050 3861998 0 0 0 700050 700050 700050 PART XI, LINE 8 - OTHER ADJUSTMENTS: TRANSFER TO AFFILIATES -1,200,000. ROUNDING 181. PART XII, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT EXPENSES INCLUDED IN REVENUE 700,050. PART XIII, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT EXPENSES INCLUDED IN REVENUE 700,050. X X X X X 0 0 0 0 0 0 0 0 0 JOHN AHLE 0 328651 0 0 0 31285 0 12250 0 30373 0 402559 0 0 CAROLYN KASABIAN 0 241901 0 0 0 21994 0 6909 0 22179 0 292983 0 0 RICHARD J PLAMONDON 0 226120 0 24430 0 39864 0 16500 0 23322 0 330236 0 0 PAUL ERCOLINI 0 120801 0 761 0 16909 0 2116 0 20234 0 160821 0 0 FORM 990, PART VI, SECTION A, LINE 3 THE BOARD OF TRUSTEES DELEGATED MANAGEMENT DUTIES TO CARDINAL INVESTMENT MANAGEMENT, INC. (EIN 04-3391257). FORM 990, PART VI, SECTION B, LINE 11 THE 990 IS PRESENTED TO, AND REVIEWED BY, THE BOARD PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE MONITORING AND ENFORCEMENT OF COMPLIANCE WITH THE POLICY IS COMPLETED AT THE INDIVIDUAL BOARD LEVELS OF THE ENTITIES THAT ARE SHAREHOLDERS OF PROVIDENTIA PRIMA. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 10,066,052. TRANSFER TO AFFILIATES -1,200,000. ROUNDING 181. TOTAL TO FORM 990, PART XI, LINE 5: 8,866,233. COVENANT HEALTH SYSTEM INC 100 AMES POND DRIVE TEWKSBURY MA 01876 222484505 MANAGEMENT AND HEALTH RESOURCE ORGANIZATION MA 501(C)(3) LINE 9 N/A 0 ST MARY'S HEALTH SYSTEM PO BOX 7291 LEWISTON ME 04243 222504349 PARENT COMPANY ME 501(C)(3) LINE 9 COVENANT HEALTH SYSTEMS 0 FANNY ALLEN CORPORATION 790 COLLEGE PARKWAY COLCHESTER VT 05446 222495808 HEALTH CARE SERVICES VT 501(C)(3) LINE 9 COVENANT HEALTH SYSTEMS 0 CHS WALTHAM 66 NEWTON STREET WALTHAM MA 02453 043333609 SKILLED NURSING FACILITY MA 501(C)(3) LINE 9 COVENANT HEALTH SYSTEMS 0 ST JOSEPH HOSPITAL 172 KINSLEY ST NASHUA NH 03061 020222215 ACUTE CARE HOSPITAL NH 501(C)(3) LINE 3 COVENANT HEALTH SYSTEMS 0 YOUVILLE HOSPITAL 100 AMES POND DRIVE TEWKSBURY MA 01876 023239563 FORMER REHAB HOSPITAL MA 501(C)(3) LINE 3 COVENANT HEALTH SYSTEMS 0 YOUVILLE PLACE 10 PELHAM RD LEXINGTON MA 02421 043297834 ASSISTED LIVING FACILITY MA 501(C)(3) LINE 9 COVENANT HEALTH SYSTEMS 0 ST ANDRE SKILLED NURSING AND REHAB FACILITY 407 POOL ST BIDDEFORD ME 04005 010342399 SKILLED NURSING FACILITY ME 501(C)(3) LINE 9 COVENANT HEALTH SYSTEMS 0 MI NURSING RESTORATIVE CENTER 172 LAWRENCE ST LAWRENCE MA 01841 042104851 SKILLED NURSING FACILITY MA 501(C)(3) LINE 9 COVENANT HEALTH SYSTEMS 0 ST MARY'S VILLA NURSING HOME 675 ST MARYS VILLA ROAD MOSCOW PA 18444 232057177 SKILLED NURSING FACILITY PA 501(C)(3) LINE 9 COVENANT HEALTH SYSTEMS 0 MI MANAGEMENT INC 172 LAWRENCE ST LAWRENCE MA 01841 042857794 SKILLED NURSING FACILITY MA 501(C)(3) LINE 9 COVENANT HEALTH SYSTEMS 0 MI ADULT DAY HEALTH CENTER 172 LAWRENCE ST LAWRENCE MA 01841 042921888 SKILLED NURSING FACILITY MA 501(C)(3) LINE 9 COVENANT HEALTH SYSTEMS 0 MI TRANSPORTATION 172 LAWRENCE ST LAWRENCE MA 01841 042921889 SKILLED NURSING FACILITY MA 501(C)(3) LINE 9 COVENANT HEALTH SYSTEMS 0 YOUVILLE HOUSE 1575 CAMBRIDGE ST CAMBRIDGE MA 02138 043239593 ASSISTED LIVING FACILITY MA 501(C)(3) LINE 9 COVENANT HEALTH SYSTEMS 0 YOUVILLE LIFECARE 100 AMES POND DRIVE TEWKSBURY MA 01876 042103582 MANAGEMENT SERVICES MA 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 COVENANT HEALTH SYSTEM Q 500000 CASH YOUVILLE HOUSE R 588000 CASH COVENANT HEALTH SYSTEM R 500000 CASH ST MARY'S HEALTH SYSTEM Q 16890 CASH ST MARY'S HEALTH SYSTEM R 4416890 CASH YOUVILLE HOUSE Q 588000 CASH YOUVILLE HOSPITAL Q 4200000 CASH YOUVILLE HOSPITAL R 1000000 CASH