2011-08-08T09:48:19-07:00 2010-09-30 990 2009-10-01 223012385 JOHNSON EVERGREEN CORPORATION JOHN 8606846341 205 Chestnut Hill Road Stafford Springs CT 060760549 John Grish 8606848152 2011-08-08 2009 2016-02-24 21:20:13Z Peter J Betts 580 Laurel Street Longmeadow MA 01106 17546780 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. 7 5 341 96 0 0 17413 24292 15862663 16970737 0 0 529585 551751 16409661 17546780 0 0 0 0 11129604 12097917 0 0 0 5061973 6452624 16191577 18550541 218084 -1003761 15564875 13667265 18609131 17901356 -3044256 -4234091 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 15993529 0 17522488 Nursing Home Care: Johnson Evergreen Corporation, dba Evergreen Health Care Center maintains a 180 bed SNF with 24 hour skilled nursing care for residents. During FY10 the facility maintained high occupancy and high quality care in the facility. The cost shown represent the necessary salary, supplies, and overhead essential for caring for the residnets at Evergreen. (56769 resident days) 0 0 0 15993529 1 1 0 0 0 0 0 0 0 1 1 0 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 1 0 0 1 35 0 341 1 0 0 0 0 0 0 0 0 0 7 5 0 1 0 0 1 1 1 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 Earle W Tarbell 2 X 0 0 0 Charles J McKeen 2 X 0 0 0 James Baum 2 X 0 0 0 Richard P Dobson 2 X 0 0 0 Jerry Parizek ll 2 X 0 0 0 Peter J Betts 5 X 0 0 0 Frank Shiffer 5 X 0 0 0 Francis J Musso 5 X 0 0 0 David Morgan 5 X 0 0 0 James Fidanza 50 X 157444 0 39821 Damien R Eilerman 40 X 129511 0 33931 Janis M Kozikowski 40 X 135643 0 35223 422598 0 108975 3 0 1 1 Marcum LLP 185 Asylum Street City Place II hartford CT 06103 Accounting 104500 1 0 0 0 0 0 24292 0 24292 Resident revenues 623000 16970737 16970737 0 0 0 0 0 0 16970737 0 0 0 0 0 Miscellaneous Revenue 900099 13299 13299 0 0 Discharge of Debt Chapter 11 900099 538452 538452 0 0 0 0 0 0 551751 17546780 17522488 0 0 197265 197265 0 9367433 9002827 364606 100091 95163 4928 1739332 1653689 85643 693796 661707 32089 37836 37836 40000 40000 243374 219374 24000 764754 764754 16401 14271 2130 226180 226180 1054488 1054488 851271 851271 53241 53241 Chapter 11 related expenses 648389 0 648389 0 Food 413831 413831 0 0 Patient Care and General Supplies 1207137 1207137 0 0 Bad Debt Expense 122957 122957 0 0 Provider Tax 758828 758828 0 0 13937 1540 12397 0 18550541 15993529 2557012 0 1493687 948424 1947043 1565543 37729 37119 111584 137382 19780337 9007128 11626662 10773209 348170 205588 15564875 13667265 2516101 1771335 4752 15199990 15199990 888288 930031 18609131 17901356 X -3044256 -4234091 0 0 0 0 -3044256 -4234091 15564875 13667265 X 1 1 1 X 0 X 5507 12062 0 17413 24292 59274 13720989 15843568 15665476 15862663 16970737 78063433 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 13726496 15855630 15665476 15880076 16995029 78122707 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 78122707 0 482 0 0 482 0 0 0 0 0 0 482 0 0 0 482 0 0 0 0 0 0 0 72127 529585 551751 1153463 13726496 15856112 15737603 16409661 17546780 79276652 0.98544 0.99196 0.00001 0.00001 X As a result of Chapter 11 Reorganization, 538455 is recorded as a Gain on Discharge of Debt. Misc. revenue of 13299 is also recorded here for a total of 551,751 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 15733693 0 6703068 9030625 0 0 0 0 2520277 0 1894733 625544 1526367 0 409327 1117040 10773209 Other Current Assets 67038 Deferred Financing Costs,net 138550 205588 0 Malpractice/CGL Insurance Liability 112241 Due to Affiliates/HFG LOC 381807 Patient Trust Fund 72184 Current Portion Long Term Debt 363799 930031 17546780 18550541 -1003761 0 0 0 0 0 0 -1003761 17006786 0 0 0 0 0 17006786 0 539994 539994 17546780 17900612 0 0 0 0 0 17900612 0 649929 649929 18550541 SchD_P10_S00_L00 Schedule D, Part X None SchD_P12_S00_L04b Schedule D, Part XII, Line 4b Discharge of Debt due to Chapter 11 538455 Loss on Disposal of Assets 1539 SchD_P13_S00_L04b Schedule D, Part XIII, Line 4b Chapter 11 related expenses 648390 Loss on disposal of assets 1539 X X X 0 0 0 0 0 0 0 0 0 Peter J Betts 730316 0 0 0 0 0 0 0 31149 0 761465 0 0 0 Frank Shiffer 583613 0 0 0 0 0 0 0 0 0 583613 0 0 0 Francis J Musso 632818 0 0 0 0 0 0 0 0 0 632818 0 0 0 David Morgan 195411 0 0 0 0 0 0 0 0 0 195411 0 0 0 James Fidanza 157444 0 0 0 0 0 0 0 39821 0 197265 0 0 Janis M Kozikowski 135643 0 0 0 0 0 0 0 35223 0 170866 0 0 0 Damien R Eilerman 129511 0 0 0 0 0 0 0 33931 0 163442 0 0 0 SchJ_P02_S00_L00 Schedule J, Part II The amounts recorded for Peter J Betts, Frank Shiffer, and Francis Musso were paid by Johnson Memorial Corporation to Focus Management Group (an unrelated organization) for Interim Management Services F990_P06_S0A_L03 Form 990, Part VI, Section A, Line 3 The Johnson Memorial Corporation Board hired Focus Management Group which provided an Interim CEO, and Interim CFO, an Interim COO, and an Interim Controller. Focus Management Group provides corporate turnaround consultants and have provided interim leadership previous to and during Chapter 11, which was declared on 11/04/2008 and continued through the end of this tax reporting period. F990_P06_S0A_L06 Form 990, Part VI, Section A, Line 6 The Bilaws stipulate that Johnson Evergreen Corporation (dba Evergreen Health Care Center) shall have but one member, Johnson Memorial Corporation (the parent 501 c 3 corporation) F990_P06_S0A_L07a Form 990, Part VI, Section A, Line 7a Johnson Memorial Corporation (a 501 c 3 entity) has the right to elect the Board of Trustees of The Johnson Evergreen Corporation F990_P06_S0A_L07b Form 990, Part VI, Section A, Line 7b Johnson Memorial Corporation has the right to approve all annual budgets, significant expenditures and remove any member of the Board. F990_P06_S0B_L11 Form 990, Part VI, Section B, Line 11 Board policy requires that members of the Budget and Finance Committee are provided the opportunity to review and comment to excecutive leadership 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 the 990. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c An annual disclosure statement is required. Executives 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 annually. This includes the CEO, COO, CFO, and VP's. The committee recommends compensation for Board approval. Comparability data is reviewed and may include industry surveys, documented compensation for persons holding similiar positions in similiar organizations, and expert compensation schedules. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 The Johnson Memorial Corporation maintains these documents in Administration and are available for viewing upon request duing normal business hours. This includes the Johnson Evergreen Corporation. Johnson Memorial Corporation 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 0 1 0 0 0 Johnson Memorial Hospital j 180000 Johnson Memorial Hospital o 1054488 N/A