2011-11-14T14:11:21-06:00 2010-12-31 LARSONALLEN LLP 300 CROWN COLONY DRIVE SUITE 310 QUINCY MA 02169 990 2010-01-01 042200583 CHELSEA JEWISH NURSING HOME INC CHEL 6178870001 17 LAFAYETTE AVENUE CHELSEA MA 02150 BARRY BERMAN 6178870001 2011-11-10 1 DOUGLAS FIEBELKORN 6179848100 2011-11-10 2010 2016-02-24 21:20:13Z BARRY BERMAN 17 LAFAYETTE AVENUE CHELSEA MA 02150 11610261 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 6 251 5 0 0 99501 86021 10783759 11493505 31580 30735 0 0 10914840 11610261 0 0 0 0 6099434 6688428 0 0 0 4532046 4913957 10631480 11602385 283360 7876 5557066 6032679 5010848 5478585 546218 554094 TO PROVIDE SKILLED NURSING CARE TO THE FRAIL, ELDERLY, AND DISABLED. 0 0 10503333 11493505 NURSING HOME: OPERATION OF A 123 BED SKILLED NURSING FACILITY PROVIDING NURSING CARE, REHABILITATION THERAPIES AND OTHER SKILLED SERVICES TO FRAIL ELDERLY AND DISABLED. 10503333 1 1 0 0 0 0 0 0 0 1 0 0 1 1 0 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 8 0 251 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 0 0 0 1 1 0 MA X ROSALIE STONE 6178870001 165 CAPTAINS ROW CHELSEA MA 02150 LEONA R GRELL 1.00 X X 0 0 0 BARRY BERMAN 40.00 X X 0 554460 54654 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 190632 10110 ANN SLOSBERG 1.00 X 0 0 0 NORINE PASQUARELLO 48.00 X 116075 0 14466 116075 745092 79230 1 0 1 0 NORTON & ASSOCIATES 34 ELM STREET COHASSET MA 02025 THERAPY SERVICES 454911 DIMELLA SHAFFER 281 SUMMER STREET BOSTON MA 02210 ARCHITECT SERVICES 109990 2 86021 86021 86021 PROG.SERV.REVENUE-RELA 623000 11493505 11493505 11493505 30735 30735 11610261 11493505 0 30735 51718 51718 5596712 5402192 194520 61144 58510 2634 544343 523771 20572 434511 415790 18721 696765 696765 13794 13794 45000 45000 492244 436916 55328 3917 3917 88669 88669 771924 771924 29108 29108 1018 1018 5077 5077 285707 285707 PATIENT ANCILLARY SERVI 734667 734667 USER FEE ASSESSMENT 685385 685385 SUPPLIES & EXPENSE 571277 571277 FOOD 392242 392242 BAD DEBT EXPENSE 71184 71184 25979 25979 11602385 10503333 1099052 0 355494 395682 1263134 1741477 101488 119485 9076548 6479956 2659053 2596592 1177897 1179443 5557066 6032679 1284177 1453416 3420 3420 3716337 3523795 6914 497954 5010848 5478585 X 546218 554094 546218 554094 5557066 6032679 7876 0 X 0 1 0 X 1 1 X 51139 108316 109291 99501 86021 454268 9366549 10145421 10706746 10809428 11493505 52521649 9417688 10253737 10816037 10908929 11579526 52975917 116626 108316 109291 99501 86021 519755 0 116626 108316 109291 99501 86021 519755 52456162 13647 8870 6090 31580 30735 90922 13647 8870 6090 31580 30735 90922 9431335 10262607 10822127 10940509 11610261 53066839 0.98850 0.98750 0.00170 0.00140 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 13575 13575 5288428 3738541 1549887 1593565 854205 739360 2180980 1887210 293770 2596592 UNAMORTIZED MORTGAGE ACQUISITION CO 63711 CONSTRUCTION IN PROGRESS 186676 INTEREST RECEIVABLE 11957 ESCROWS 917099 1179443 DUE TO RELATED PARTIES 497954 497954 11610261 11602385 7876 0 7876 11610261 0 11610261 0 11610261 11602385 0 11602385 0 11602385 X X 0 0 0 0 0 0 0 0 0 BARRY BERMAN 0 244460 0 310000 0 0 0 0 0 54654 0 609114 0 0 ADAM BERMAN 0 115632 0 75000 0 0 0 0 0 10110 0 200742 0 0 X SUPPLIES 1 86021 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. 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. 2009 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 DOCUMENTS ARE MADE AVAILABLE UPON REQUEST CHELSEA JEWISH NURSING HOME FOUNDATION 17 LAFAYETTE AVE 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 17 LAFAYETTE AVE CHELSEA MA 02150 043255842 ASSISTED LIVING MA N/A ADMIRAL'S HILL ASSISTED LIVING II LP 17 LAFAYETTE AVE CHELSEA MA 02150 043538835 ASSISTED LIVING MA N/A ASAR ELDER SERVICES 17 LAFAYETTE AVE CHELSEA MA 02150 043289287 MANAGEMENT CO MA N/A C ADMIRAL'S HILL ASSITED LIVING CORP 17 LAFAYETTE AVE CHELSEA MA 02150 043255840 ASSISTED LIVING MA N/A C ADMIRAL'S HILL ASSITED LIVING II CORP 17 LAFAYETTE AVE CHELSEA MA 02150 043538833 ASSISTED LIVING MA N/A C 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1