2011-11-14T14:11:42-06:00 2010-12-31 LARSONALLEN LLP 300 CROWN COLONY DRIVE SUITE 310 QUINCY MA 02169 990 2010-01-01 042676008 THE HENRY C NEVINS HOME INC HENR 9786827611 10 INGALLS COURT METHUEN MA 01844 ALAN SHAFER 9786727611 2011-11-09 1 BARBARA J MORRISON 6179848100 2011-11-08 2010 2016-02-24 21:20:13Z SCOTT DICKINSON 10 INGALLS COURT METHUEN MA 01844 14035955 0 X WWW.NEVINSFAMILYOFSERVICES.ORG X 1979 MA PROVIDING QUALITY CARE TO THE ELDERLY 9 9 264 25 0 0 35797 60264 13696682 13901780 25763 56711 -4158 7078 13754084 14025833 0 0 0 0 8879479 8956853 0 0 29092 4392265 4607979 13271744 13564832 482340 461001 8912603 9027410 5307644 5009020 3604959 4018390 TO PROVIDE QUALITY NURSING CARE TO THE ELDERLY 0 0 12702513 13911245 NURSING HOME OPERATION INCLUDING ALL RELATED ELDERLY SERVICES 12702513 1 1 0 0 0 0 0 0 1 1 0 0 0 1 0 1 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 0 0 0 0 1 0 0 0 0 1 7 0 1 264 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 1 0 0 1 1 0 1 1 1 1 1 0 MA X X JEANNE SCOTT 9786827611 10 INGALLS COURT METHUEN MA 01844 VICTOR HATEM 1.00 X X 0 0 0 KAREN NEMETH 1.00 X X 0 0 0 ALAN P SHAFER 1.00 X X 0 0 0 MARC D KLEIN 1.00 X X 0 0 0 JAMES J MALONEY JR 1.00 X 0 0 0 EDGAR SIDON 1.00 X 0 0 0 JAMES SMITH 1.00 X 0 0 0 GARY MELVILLE 1.00 X X 0 0 0 LARRY GIORDANO 1.00 X 0 0 0 SCOTT B DICKINSON 40.00 X 113566 0 28192 MARY KABUTHIA 40.00 X 105983 0 950 DEBORAH MCCARTHY 40.00 X 100815 0 9940 P DANIEL GRAVES 40.00 X 0 112658 30453 206798 112658 41343 3 0 0 0 LANDVIEW THERAPY 57 WINGATE ST HAVERHILL MA 01832 REHABILITATION 948464 FIRESIDE STAFFING 17 GAUDET LANE PELHAM NH 03076 NURSING AGENCY 125862 2 9060 51204 60264 NURSING HOME REVENUE 623000 13901780 13901780 13901780 56711 56711 7735 9060 10122 -2387 -2387 OTHER INCOME 623000 6282 6282 RESIDENT ACTIVITY INCO 623000 3183 3183 9465 14025833 13911245 0 54324 141758 141758 7389859 6989106 371709 29044 7575 7056 519 838615 781132 57483 579046 539356 39690 38944 38944 7146 7146 290855 211727 79128 3759 3759 189998 172416 17534 48 648216 648216 2296 2296 8100 8100 3842 3842 284360 284360 77576 77576 ANCILLARIES 1297315 1297315 SUPPLIES AND EXPENSE 873034 873034 MASS. STATE USER FEE AS 799816 799816 BAD DEBTS 54007 54007 EQUIPMENT RENTAL & MAIN 26975 26975 1740 1740 13564832 12702513 833227 29092 1918320 2401134 1335433 1252659 1851008 1886286 345491 340314 69839 71607 8568793 5648571 3109823 2920222 217967 102044 64722 53144 8912603 9027410 1437234 1164236 3506226 3440172 70806 49582 293378 355030 5307644 5009020 X 3533909 3938508 71050 79882 3604959 4018390 8912603 9027410 X 461001 -47570 X X 0 1 1 X 0 X 60568 61416 60107 47516 67999 297606 11829989 12825681 13229886 13696682 13911245 65493483 11890557 12887097 13289993 13744198 13979244 65791089 10000 10000 0 10000 10000 65781089 44584 58557 55497 25763 56711 241112 44584 58557 55497 25763 56711 241112 11935141 12945654 13345490 13769961 14035955 66032201 0.99620 0.99630 0.00370 0.00350 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 79122 380 79502 0.00000 0.00000 1.00000 0 0 295146 295146 4695322 3102789 1592533 1239270 788577 450693 2339055 1757205 581850 2920222 FAIR VALUE OF INTEREST RATE SWAP 355030 355030 14025833 13564832 461001 14082 -61652 -47570 413431 13988385 14082 -51530 -37448 14025833 0 14025833 13574954 10122 10122 13564832 0 13564832 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. GOLF TOURNAMENT 16795 9060 7735 2751 6387 984 16795 9060 7735 2751 6387 984 10122 -2387 MASSACHUSETTS DEVELOPMENT FINANCE AGENCY 042608195 461473209 2005-02-01 4800000 TO FINANCE COST OF ELIGIBLE PROJECTS 0 0 0 3763872 91419 33944 3729928 2005 0 0 1 1 0 0 0 0 1 1 0 1 1 CITIZENS BANK 11.000000000000 0 0 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 THE 990 WILL BE REVIEWED BY THE BOARD OF DIRECTORS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C 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 15 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 C, LINE 19 UPON REQUEST THE ORGANIZATION MAKES ALL GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: 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. THE ORGANIZATION HAS AN AUDIT COMMITTEE THAT OVERSEES THE AUDIT AND APPOINTS THE AUDITOR. HENRY C NEVINGS HOME FOR THE AGED AND INCURABLE 12 INGALLS COURT METHUEN MA 01844 042210743 ADULT DAY HEALTH AND CHILD CARE SERVICES MA 501 (C)(3) LINE 9 0 NEVINS MANOR INC 12 INGALLS COURT METHUEN MA 01844 043265310 ELDERLY HOUSING MA 501 (C)(3) LINE 9 0 0 0 0 1 0 0 0 0 0 1 1 0 0 0 0 0 0 0 HENRY C NEVINS HOME FOR THE AGED & INCURABLE D 340049