HENRY C NEVINS HOME INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
HENRY C NEVINS HOME INC (EIN 04-2676008)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-11-14
IRS object ID
201143189349300519
Schema version
2010v3.4
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2011-11-14T14:11:42-06:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1LARSONALLEN LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1300 CROWN COLONY DRIVE SUITE 310AddressLine1
CityQUINCYCity
StateMAState
ZIP Code02169ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN042676008EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1THE HENRY C NEVINS HOME INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlHENRNameControl
Phone9786827611Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line110 INGALLS COURTAddressLine1
CityMETHUENCity
StateMAState
ZIP Code01844ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameALAN SHAFERName
TitleTREASURERTitle
Phone9786727611Phone
Date Signed2011-11-09DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameBARBARA J MORRISONName
Phone6179848100Phone
Date Prepared2011-11-08DatePrepared
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonSCOTT DICKINSONNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line110 INGALLS COURTAddressLine1
CityMETHUENCity
StateMAState
ZIP Code01844ZIPCode
FieldValueIRS element (for citing)
Gross Receipts14035955GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.NEVINSFAMILYOFSERVICES.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1979YearFormation
State Legal DomicileMAStateLegalDomicile
Activity Or Mission DescriptionPROVIDING QUALITY CARE TO THE ELDERLYActivityOrMissionDescription
Nbr Voting Members Governing Body9NbrVotingMembersGoverningBody
Nbr Independent Voting Members9NbrIndependentVotingMembers
Total Nbr Employees264TotalNbrEmployees
Total Nbr Volunteers25TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year35797ContributionsGrantsPriorYear
Contributions Grants Current Year60264ContributionsGrantsCurrentYear
Program Service Revenue Prior Year13696682ProgramServiceRevenuePriorYear
Program Service Revenue CY13901780ProgramServiceRevenueCY
Investment Income Prior Year25763InvestmentIncomePriorYear
Investment Income Current Year56711InvestmentIncomeCurrentYear
Other Revenue Prior Year-4158OtherRevenuePriorYear
Other Revenue Current Year7078OtherRevenueCurrentYear
Total Revenue Prior Year13754084TotalRevenuePriorYear
Total Revenue Current Year14025833TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year8879479SalariesEtcPriorYear
Salaries Etc Current Year8956853SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year29092TotalFundrsngExpCurrentYear
Other Expense Prior Year4392265OtherExpensePriorYear
Other Expenses Current Year4607979OtherExpensesCurrentYear
Total Expenses Prior Year13271744TotalExpensesPriorYear
Total Expenses Current Year13564832TotalExpensesCurrentYear
Revenues Less Expenses Prior Year482340RevenuesLessExpensesPriorYear
Revenues Less Expenses CY461001RevenuesLessExpensesCY
Total Assets BOY8912603TotalAssetsBOY
Total Assets EOY9027410TotalAssetsEOY
Total Liabilities BOY5307644TotalLiabilitiesBOY
Total Liabilities EOY5009020TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY3604959NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY4018390NetAssetsOrFundBalancesEOY
Mission DescriptionTO PROVIDE QUALITY NURSING CARE TO THE ELDERLYMissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense12702513Expense
Revenue13911245Revenue
DescriptionNURSING HOME OPERATION INCLUDING ALL RELATED ELDERLY SERVICESDescription
Total Program Service Expense12702513TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities1FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required0ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10967NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees264NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Form8899 Filed0Form8899Filed
Form1098 C Filed0Form1098CFiled
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members9NbrVotingGoverningBodyMembers
Number Independent Voting Members9NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons0AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledMAStatesWhereCopyOfReturnIsFiled
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1JEANNE SCOTTBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number9786827611TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line110 INGALLS COURTAddressLine1
CityMETHUENCity
StateMAState
ZIP Code01844ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (13 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
VICTOR HATEM
DIRECTOR1.00XX000
KAREN NEMETH
PRESIDENT1.00XX000
ALAN P SHAFER
TREASURER1.00XX000
MARC D KLEIN
CLERK1.00XX000
JAMES J MALONEY JR
DIRECTOR1.00X000
EDGAR SIDON
DIRECTOR1.00X000
JAMES SMITH
DIRECTOR1.00X000
GARY MELVILLE
CHAIRMAN1.00XX000
LARRY GIORDANO
DIRECTOR1.00X000
SCOTT B DICKINSON
CEO/ADMINISTRATOR40.00113566028192X
MARY KABUTHIA
LPN40.001059830950X
DEBORAH MCCARTHY
DON40.0010081509940X
P DANIEL GRAVES
EXECUTIVE DIRECTOR40.00011265830453X
FieldValueIRS element (for citing)
Total Reportable Comp From Org206798TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs112658TotalReportableCompFrmRltdOrgs
Total Other Compensation41343TotalOtherCompensation
Number Individuals GT100 K3NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K0TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (2 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
LANDVIEW THERAPY
57 WINGATE STHAVERHILLMA01832REHABILITATION948464
FIRESIDE STAFFING
17 GAUDET LANEPELHAMNH03076NURSING AGENCY125862
FieldValueIRS element (for citing)
Number Of Contractors GT100 K2NumberOfContractorsGT100K
Fundraising Events9060FundraisingEvents
All Other Contributions51204AllOtherContributions
Total Contributions60264TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionNURSING HOME REVENUEDescription
Business Code623000BusinessCode
Total Revenue Column13901780TotalRevenueColumn
Related Or Exempt Function Income13901780RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue13901780TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column56711TotalRevenueColumn
Exclusion$56,711ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events7735GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events9060CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses10122FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-2387TotalRevenueColumn
Exclusion-$2,387ExclusionAmount

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
OTHER INCOME62300062826282
RESIDENT ACTIVITY INCO62300031833183
FieldValueIRS element (for citing)
Total Other Revenue9465TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column14025833TotalRevenueColumn
Related Or Exempt Function Income13911245RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$54,324ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total141758Total
Management And General141758ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total7389859Total
Program Services6989106ProgramServices
Management And General371709ManagementAndGeneral
Fundraising29044Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total7575Total
Program Services7056ProgramServices
Management And General519ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total838615Total
Program Services781132ProgramServices
Management And General57483ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total579046Total
Program Services539356ProgramServices
Management And General39690ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total38944Total
Management And General38944ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total7146Total
Management And General7146ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total290855Total
Program Services211727ProgramServices
Management And General79128ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total3759Total
Program Services3759ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total189998Total
Program Services172416ProgramServices
Management And General17534ManagementAndGeneral
Fundraising48Fundraising

Occupancy Occupancy

FieldValueIRS element (for citing)
Total648216Total
Program Services648216ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total2296Total
Program Services2296ProgramServices

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total8100Total
Program Services8100ProgramServices

Interest Interest

FieldValueIRS element (for citing)
Total3842Total
Program Services3842ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total284360Total
Program Services284360ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total77576Total
Management And General77576ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServices
ANCILLARIES12973151297315
SUPPLIES AND EXPENSE873034873034
MASS. STATE USER FEE AS799816799816
BAD DEBTS5400754007
EQUIPMENT RENTAL & MAIN2697526975

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total1740Total
Management And General1740ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total13564832Total
Program Services12702513ProgramServices
Management And General833227ManagementAndGeneral
Fundraising29092Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY1918320BOY
EOY2401134EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1335433BOY
EOY1252659EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1851008BOY
EOY1886286EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY345491BOY
EOY340314EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY69839BOY
EOY71607EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis8568793LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec5648571LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY3109823BOY
EOY2920222EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY217967BOY
EOY102044EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY64722BOY
EOY53144EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY8912603BOY
EOY9027410EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1437234BOY
EOY1164236EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY3506226BOY
EOY3440172EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY70806BOY
EOY49582EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY293378BOY
EOY355030EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY5307644BOY
EOY5009020EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY3533909BOY
EOY3938508EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY71050BOY
EOY79882EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY3604959BOY
EOY4018390EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY8912603BOY
EOY9027410EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses461001ReconcilationRevenueExpenses
Reconcilation Other Changes-47570ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years60568CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years61416CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years60107CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year47516CurrentTaxYearMinus1Year
Current Tax Year67999CurrentTaxYear
Total297606Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years11829989CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years12825681CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years13229886CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year13696682CurrentTaxYearMinus1Year
Current Tax Year13911245CurrentTaxYear
Total65493483Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years11890557CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years12887097CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years13289993CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year13744198CurrentTaxYearMinus1Year
Current Tax Year13979244CurrentTaxYear
Total65791089Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years10000CurrentTaxYearMinus4Years
Total10000Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years10000CurrentTaxYearMinus4Years
Total10000Total
FieldValueIRS element (for citing)
Public Support Total50965781089PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years44584CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years58557CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years55497CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year25763CurrentTaxYearMinus1Year
Current Tax Year56711CurrentTaxYear
Total241112Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years44584CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years58557CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years55497CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year25763CurrentTaxYearMinus1Year
Current Tax Year56711CurrentTaxYear
Total241112Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years11935141CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years12945654CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years13345490CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year13769961CurrentTaxYearMinus1Year
Current Tax Year14035955CurrentTaxYear
Total66032201Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99620PublicSupportPercentage509
Prior Year Support Percentage0.99630PriorYearSupportPercentage
Investment Income Percentage0.00370InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00350PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance79122BeginningOfYearBalance
Investment Earnings Or Losses380InvestmentEarningsOrLosses
End Of Year Balance79502EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.00000BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.00000PermanentEndowmentEOYBalance
Term Endowment EOY Balance1.00000TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis295146OtherCostOrOtherBasis
Book Value295146BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis4695322OtherCostOrOtherBasis
Depreciation3102789Depreciation
Book Value1592533BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis1239270OtherCostOrOtherBasis
Depreciation788577Depreciation
Book Value450693BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis2339055OtherCostOrOtherBasis
Depreciation1757205Depreciation
Book Value581850BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings2920222TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionFAIR VALUE OF INTEREST RATE SWAPDescription
Amount$355,030Amount
FieldValueIRS element (for citing)
Total Of Amounts355030TotalOfAmounts
Total Revenue14025833TotalRevenue
Total Expenses13564832TotalExpenses
Excess Or Deficit For Year461001ExcessOrDeficitForYear
Net Unrealized GL On Investments14082NetUnrealizedGLOnInvestments
Other-$61,652OtherAmount
Total Adjustments-47570TotalAdjustments
Excess Or Deficit Per FS413431ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt13988385TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments14082NetUnrealizedGainsInvestments
Other Revenues-51530OtherRevenues
Revenue Not Rptd F990-37448RevenueNotRptdF990
Revenue Subtotal14025833RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form99014025833TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt13574954TotExpensesEtcAuditedFinclStmt
Other Expenses Included10122OtherExpensesIncluded
Expenses Not Rptd F99010122ExpensesNotRptdF990
Expenses Subtotal13564832ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99013564832TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)

IdentifierIdentifierExplanationExplanation
PART XI, LINE 8 - OTHER ADJUSTMENTS:CHANGE IN FAIR VALUE OF SWAP -61,652.
PART XII, LINE 2D - OTHER ADJUSTMENTS:CHANGE IN FAIR VALUE OF SWAP -61,652. DIRECT FUNDRAISING EXPENSES ON TAX RETURN 10,122.
PART XIII, LINE 2D - OTHER ADJUSTMENTS:DIRECTO FUNDRAISING EXPENSES ON TAX RETURN 10,122.

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1GOLF TOURNAMENTNameOfEvent1
Gross Receipts Event116795GrossReceiptsEvent1
Charitable Contributions Event19060CharitableContributionsEvent1
Gross Revenue Event17735GrossRevenueEvent1
Non Cash Prizes Event12751NonCashPrizesEvent1
Rent Facility Costs Event16387RentFacilityCostsEvent1
Other Direct Expenses Event1984OtherDirectExpensesEvent1
Gross Receipts Total16795GrossReceiptsTotal
Charitable Contributions Total9060CharitableContributionsTotal
Gross Revenue Total Events7735GrossRevenueTotalEvents
Non Cash Prizes Total Events2751NonCashPrizesTotalEvents
Rent Facility Costs Total Events6387RentFacilityCostsTotalEvents
Other Direct Expenses Total Events984OtherDirectExpensesTotalEvents
Direct Expense Summary Events10122DirectExpenseSummaryEvents
Net Income Summary-2387NetIncomeSummary

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1MASSACHUSETTS DEVELOPMENT FINANCE AGENCYBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN042608195IssuerEIN
CUSIP Number461473209CUSIPNumber
Date Issued2005-02-01DateIssued
Issue Price4800000IssuePrice
Description Of PurposeTO FINANCE COST OF ELIGIBLE PROJECTSDescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer0OnBehalfOfIssuer
Pool Financing0PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Total Proceeds3763872TotalProceeds
Amount In Reserve Fund91419AmountInReserveFund
Issuance Costs From Proceeds33944IssuanceCostsFromProceeds
Other Spent Proceeds3729928OtherSpentProceeds
Year Of Subst Completion2005YearOfSubstCompletion
Current Refunding0CurrentRefunding
Advance Refunding0AdvanceRefunding
Final Allocation Made1FinalAllocationMade
Adequate Books And Recds Maintaind1AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements0AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty0MngmentCntrctBondFinancdPrprty
Any Research Agreements0AnyResearchAgreements
Bond Counsel Routinely Engaged1BondCounselRoutinelyEngaged
Post Issuance Compliance Procdrs1PostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Form8038 T Filed0Form8038TFiled
Variable Rate Issue1VariableRateIssue
Hedge Identified In Books And Recds1HedgeIdentifiedInBooksAndRecds

Name Of Hedge Provider NameOfHedgeProvider

FieldValueIRS element (for citing)
Business Name Line1CITIZENS BANKBusinessNameLine1
FieldValueIRS element (for citing)
Term Of Hedge11.000000000000TermOfHedge
Superintegrated Hedge0SuperintegratedHedge
Hedge Terminated0HedgeTerminated
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGIC
Gross Proceeds Invested0GrossProceedsInvested
Exception To Rebate0ExceptionToRebate

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION B, LINE 11THE 990 WILL BE REVIEWED BY THE BOARD OF DIRECTORS PRIOR TO FILING.
ALL EMPLOYEES ARE REQUIRED TO DISCUSS POTENTIAL CONFLICTS DURING EMPLOYMENT WITH THE DEPARTMENT OR PROGRAM DIRECTOR AND THE DIRECTOR OF HR. ULTIMATE DETERMINATION OF THE EXISTENCE OF A CONFLICT BELONGS TO THE EXECUTIVE DIRECTOR. VIOLATION OF POLICY RESULTS IN DISCIPLINARY ACTIONS, UP TO AND INCLUDING TERMINATION. IF THE CONFLICT IS NOT ELIMINATED OR ADDRESSED IN A TIMELY MANNER DISMISSAL MAY RESULT.FORM 990, PART VI, SECTION B, LINE 12C
COMPENSATION REVIEW FOR CEO, EXECUTIVE DIRECTOR, OTHER OFFICERS AND KEY EMPLOYEES IS APPROVED BY INDENEPENDENT PERSONS WITH THE USE OF COMPARABILITY DATA AND APPROVED BY PROPER LEVEL OF MANAGEMENT . THIS WAS LAST PERFORMED DURING 2009 AND NOTED IN THE BOARD OF DIRECTORS MINUTES.FORM 990, PART VI, SECTION B, LINE 15
UPON REQUEST THE ORGANIZATION MAKES ALL GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC.FORM 990, PART VI, SECTION C, LINE 19
CHANGES IN NET ASSETS OR FUND BALANCES:NET UNREALIZED GAINS ON INVESTMENTS: 14,082. CHANGE IN FAIR VALUE OF SWAP -61,652. TOTAL TO FORM 990, PART XI, LINE 5: -47,570.FORM 990, PART XI, LINE 5:
THE ORGANIZATION HAS AN AUDIT COMMITTEE THAT OVERSEES THE AUDIT AND APPOINTS THE AUDITOR.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusControlled OrgControlledOrg
HENRY C NEVINGS HOME FOR THE AGED AND INCURABLE
12 INGALLS COURTMETHUENMA01844042210743ADULT DAY HEALTH AND CHILD CARE SERVICESMA501 (C)(3)LINE 90
NEVINS MANOR INC
12 INGALLS COURTMETHUENMA01844043265310ELDERLY HOUSINGMA501 (C)(3)LINE 90
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org1LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable

Name Of Other Organization NameOfOtherOrganization

FieldValueIRS element (for citing)
Business Name Line1HENRY C NEVINS HOME FOR THE AGED & INCURABLEBusinessNameLine1
FieldValueIRS element (for citing)
Transaction TypeDTransactionType
Amount Involved340049AmountInvolved

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