2023-05-12T13:36:27-05:00 2022-06-30 410746749 CLIFTONLARSONALLEN LLP 4 BATTERYMARCH PARK SUITE 100 QUINCY MA 02169 990 2021-07-01 161644288 LUTHERAN HOME OF SOUTHBURY INC LUTH 7819970900 990 MAIN STREET NORTH SOUTHBURY CT 06488 ANGELA BOVILL PRESIDENT & CEO 7819970900 2023-05-10 1 ANGELA BOVILL 999009999 DANIELLE NIHILL P01350943 7819821001 2023-05-01 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z ANGELA BOVILL 990 MAIN STREET NORTH SOUTHBURY CT 06488 17433326 0 6011 X WWW.ASCENTRIA.ORG X 1985 CT WE ARE CALLED TO STRENGTHEN COMMUNITIES BY EMPOWERING PEOPLE TO RESPOND TO LIFE'S CHALLENGES. 13 12 313 12 0 0 913932 1765865 15267497 15266704 92367 106014 32265 294743 16306061 17433326 0 0 0 0 8965056 9862545 0 0 0 6298297 6379116 15263353 16241661 1042708 1191665 9884971 41167913 4027509 34748887 5857462 6419026 WE ARE CALLED TO STRENGTHEN COMMUNITIES BY EMPOWERING PEOPLE TO RESPOND TO LIFE'S CHALLENGES. 0 0 14205395 15266704 THE ORGANIZATION OPERATES A 120-BED NURSING FACILITY WHICH PROVIDES SKILLED NURSING AND REHABILITATIVE SERVICES TO THE ELDERLY. 14205395 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 13 0 1 313 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 12 1 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 CT X ANGELA BOVILL 7742433900 11 SHATTUCK STREET WORCESTER MA 01605 ANGELA BOVILL PRESIDENT & CEO 4.00 36.00 X X 0 397934 13393 THE REV ROSS GOODMAN VICE CHAIR 0.50 5.00 X X 0 0 0 SCOTT HAMILTON DIRECTOR 0.50 5.00 X 0 0 0 STACEY LUSTER DIRECTOR 0.50 5.00 X 0 0 0 KEITH ROBERTSON DIRECTOR 0.50 5.00 X 0 0 0 BARBARA RUHE DIRECTOR 0.50 5.00 X 0 0 0 PETER SCHMIDT DIRECTOR 0.50 5.00 X 0 0 0 WILLIAM MAYO CHAIR 2.00 20.00 X X 0 0 0 FREDERICK JENOURE CHAIR 5.00 50.00 X X 0 0 0 KAREN GAYLIN DIRECTOR 0.50 5.00 X 0 0 0 GARTH GREIMANN FINANCIAL SECRETARY 1.00 10.00 X X 0 0 0 ALEXANDER BARTHOLOMEW FINANCIAL SECRETARY 0.50 5.00 X X 0 0 0 ASISH COWLAGI SECRETARY 0.50 5.00 X X 0 0 0 AIMEE MITCHELL CHIEF COMMUNITY SERVICES OFFICER 0.50 39.50 X 0 160307 13879 JEFFREY KINNEY CHIEF OF STRATEGIC DEVELOPMENT OFFICER 4.00 36.00 X 0 210484 16458 JEANETTE WADE EXECUTIVE VP/CFO 4.00 36.00 X 0 273181 204 NANCY MEEGAN CHIEF HUMAN SERVICES OFFICER 4.00 36.00 X 0 216504 16383 NICHOLAS RUSSO TREASURER 4.00 36.00 X 0 138288 6320 TARA BROWNE CLERK/EXECUTIVE ASSISTANT 4.00 36.00 X 0 75842 13677 MICHELLE BETTIGOLE CHIEF SENIOR CARE OFFICER 5.00 36.00 X 0 240516 13937 ZIAD BAROODY ADMINISTRATOR 40.00 0.00 X 150000 0 0 BRENDA CASH QA NURSE 40.00 0.00 X 144977 0 23287 JENNIFER KELLEY RN NIGHT SUPERVISOR 40.00 0.00 X 119250 0 23287 KRIS LUDINGTON LICENSED PRACTICAL NURSE 40.00 0.00 X 126585 0 22614 MARY MCGRATH DIRECTOR OF REHABILITATION 40.00 0.00 X 111027 0 23784 651839 1713056 187223 7 0 1 0 PAC GROUP 126 S MAIN ST 200 TORRINGTON CT 06790 CONSTRUCTION 2285827 CIGNA HEALTH AND LIFE INSURANCE COMPANY 900 COTTAGE GROVE ROAD BLOOMFIELD CT 06002 INSURANCE 582571 HARVARD PILGRIM 1 WELLNESS WAY CANTON MA 02021 INSURANCE 488110 ASCENTRIA CARE ALLIANCE 11 SHATTUCK STREET WORCESTER MA 01605 MANAGEMENT SERVICES 345638 CLIPBOARD HEALTH 77 VAN NESS AVE SUITE 101 SAN FRANCISCO CA 94102 SAFF AGENCY 309161 5 1765865 1765865 RESIDENT REVENUE 623000 15266704 15266704 15266704 106014 106014 MISCELLANEOUS REVENUE 623000 294743 294743 294743 17433326 15266704 0 400757 8003854 7390013 613841 1280680 1182460 98220 578011 533681 44330 909538 909538 36634 33725 2909 39268 36150 3118 453269 422147 31122 69558 64035 5523 102997 102997 381067 350811 30256 3843 3843 7750 7750 1294532 1191688 102844 1060241 976010 84231 142132 130847 11285 MEDICAID USER FEES 736373 736373 DIETARY EXPENSES 361965 361965 MEDICAL SUPPLIES AND PU 347746 347746 ANCILLARY EXPENSES 203079 203079 229124 130075 99049 16241661 14205395 2036266 0 1944858 571884 892793 1194461 1498216 2225760 42095 29405 138079 122546 26441643 1192061 1435493 25249582 3305000 3933437 8469275 9884971 41167913 1324211 2771778 211978 20622 1460316 30713092 1031004 1243395 4027509 34748887 X 1925429 3180689 3932033 3238337 5857462 6419026 9884971 41167913 X 1191665 -630101 X X 0 1 X 1 1 1 X 465460 913932 1765865 3145257 13042452 14057243 14675911 15267497 15266704 72309807 13042452 14057243 15141371 16181429 17032569 75455064 0 0 0 75455064 83239 85771 87957 92367 106014 455348 83239 85771 87957 92367 106014 455348 143067 64814 61903 32263 294743 596790 13268758 14207828 15291231 16306059 17433326 76507202 0.98620 0.98720 0.00600 0.00620 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME - 2017 AMOUNT: $ 143,067. 2018 AMOUNT: $ 64,814. 2019 AMOUNT: $ 61,903. 2020 AMOUNT: $ 32,263. 2021 AMOUNT: $ 294,743. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3710972 -692445 3018527 2937124 773848 3710972 2930941 6183 2937124 2921089 9852 2930941 2764344 156745 2921089 1.00000 1 0 3671583 3671583 20461995 1060408 19401587 1219427 126295 1093132 1088638 5358 1083280 25249582 BENEFICIAL INTERESTS IN THIRD-PARTY 3017822 DUE FROM RELATED ORGANIZATIONS 1320515 SOFTWARE, NET 12407 ESCROW FUNDS 3964319 DEPOSITS 154212 8469275 DUE TO THIRD PARTY PAYORS 168578 DUE FROM MEDICARE 308315 DUE TO ASCENTRIA 766502 1243395 X PART V, LINE 4: IN ACCORDANCE WITH THE DONOR REQUIREMENTS, THE ENDOWMENT FUNDS ARE HELD IN PERPETUITY WITH DISBURSEMENTS ONLY BEING USED TO SATISFY THE DONOR'S REQUIREMENTS. DISTRIBUTIONS ARE TO BE USED FOR GENERAL PURPOSES OF THE ORGANIZATION. PART X, LINE 2: ALL THE MEMBERS OF THE ORGANIZATION ARE EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC) AND APPLICABLE STATE CODES. ACCORDINGLY, NO PROVISIONS FOR FEDERAL OR STATE INCOME TAXES HAVE BEEN MADE. ADDITIONALLY, THE ORGANIZATION QUALIFIES FOR CHARITABLE CONTRIBUTION DEDUCTIONS UNDER SECTION 170(B)(1)(A) AND HAS BEEN CLASSIFIED AS AN ORGANIZATION OTHER THAN PRIVATE FOUNDATION UNDER SECTION 509(A)(2). THE ORGANIZATION FILES AS A TAX-EXEMPT ORGANIZATION. 0 0 0 0 0 0 0 0 0 ANGELA BOVILL PRESIDENT & CEO 0 397934 0 0 0 0 0 0 0 13393 0 411327 0 0 JEANETTE WADE EXECUTIVE VP/CFO 0 273181 0 0 0 0 0 0 0 204 0 273385 0 0 MICHELLE BETTIGOLE CHIEF SENIOR CARE OFFICER 0 240516 0 0 0 0 0 0 0 13937 0 254453 0 0 NANCY MEEGAN CHIEF HUMAN SERVICES OFFICER 0 216504 0 0 0 0 0 0 0 16383 0 232887 0 0 JEFFREY KINNEY CHIEF OF STRATEGIC DEVELOPMENT OFFIC 0 210484 0 0 0 0 0 0 0 16458 0 226942 0 0 AIMEE MITCHELL CHIEF COMMUNITY SERVICES OFFICER 0 160307 0 0 0 0 0 0 0 13879 0 174186 0 0 BRENDA CASH QA NURSE 144977 0 0 0 0 0 0 0 23287 0 168264 0 0 0 PART I, LINE 3 ASCENTRIA CARE ALLIANCE, INC. (ACA) IS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION. THE COMPENSATION OF THE ORGANIZATION'S CEO IS DETERMINED AND PAID BY ACA. THE CEO OF ACA IS THE PRINCIPAL REPRESENTATIVE OF ASCENTRIA CARE ALLIANCE, INCLUDING ITS AFFILIATES AND SUBSIDIARIES, AND IS THE PERSON RESPONSIBLE FOR THE EFFICIENT OPERATION OF THE ACA, ITS AFFILIATES, AND ITS SUBSIDIARIES. THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS OF ACA ANNUALLY EVALUATES THE CEO ON HIS/HER PERFORMANCE. THE CHAIR OF ACA'S BOARD OF DIRECTORS, AN UNCOMPENSATED VOLUNTEER, IS THE CHAIR OF THE EXECUTIVE COMMITTEE AND IS INDEPENDENT WITHOUT UNDUE INFLUENCE FROM THE CEO. THE EXECUTIVE COMMITTEE WILL OBTAIN RESEARCH TO MAKE A RECOMMENDATION FOR THE COMPENSATION OF THE CEO. A REVIEW OF COMPARABILITY DATA MAY INCLUDE THE FOLLOWING: COMPENSATION STUDIES BY INDEPENDENT SOURCES, WRITTEN JOB OFFERS FOR POSITIONS AT SIMILAR ORGANIZATIONS, DOCUMENTED PHONE CALLS ABOUT SIMILAR CEO POSITIONS, AND INFORMATION OBTAINED FROM THE IRS FORM 990 FILINGS OF SIMILAR ORGANIZATIONS. THE EXECUTIVE COMMITTEE WILL DOCUMENT ITS DECISIONS IN THE MINUTES OF THE MEETING. THE DOCUMENTATION OF THE CEO'S COMPENSATION INCLUDES: A DISCUSSION OF THE CEO'S RESPONSIBILITIES; ANNUAL PERFORMANCE REVIEW; DESCRIPTION OF THE COMPENSATION, BENEFITS, AND APPROVAL DATE; LIST OF COMMITTEE MEMBERS PRESENT DURING THE DISCUSSION; ACTIONS TAKEN WITH RESPECT TO ANY CONFLICTS OF INTEREST BY ANY MEMBER WITH RESPECT TO THE DECISION ON THE COMPENSATION; AND A RECORD OF THE RESULT OF THE COMPENSATION VOTE. A NATIONAL FINANCE AUTHORITY 521304598 63607YAT7 2021-07-15 31530337 BUILDING CONSTRUCTION 0 0 1 A 31530337 1800750 610876 29118711 2021 0 0 1 1 A 0 0 0 0 0 0 1 A 0 1 0 0 0 0 0 0 1 A 1 PART I, LINE A ISSUER NAME: NATIONAL FINANCE AUTHORITY FORM 990, PART VI, SECTION A, LINE 2 OFFICERS ANGELA BOVILL, MICHELLE BETTIGOLE, NANCY MEEGAN, JEANETTE WADE, NICHOLAS RUSSO, JEFFREY KINNEY, AIMEE MITCHELL AND TARA BROWNE HAVE A BUSINESS RELATIONSHIP WITH ALL OF THE BOARD MEMBERS BECAUSE THESE OFFICERS ARE EMPLOYED BY A RELATED ORGANIZATION OF WHICH THE DIRECTORS ARE ALSO BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 3 ON FEBRUARY 24, 2015, THE ORGANIZATION ENTERED INTO A MANAGEMENT CONTRACT WITH SHEEHAN HEALTH GROUP LLC (SHG). SHG MANAGES THE DAY TO DAY OPERATIONS OF THE SKILLED NURSING FACILITY ONSITE. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE CORPORATE MEMBER OF THE ORGANIZATION IS ASCENTRIA CARE ALLIANCE, INC. (FKA LUTHERAN SOCIAL SERVICES OF NEW ENGLAND, INC.). FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS OF ASCENTRIA CARE ALLIANCE, INC.'S GOVERNING BOARD ELECT ALL THE MEMBERS OF THIS ORGANIZATION'S GOVERNING BOARD. FORM 990, PART VI, SECTION A, LINE 7B THE TRANSACTIONS SUBJECT TO MEMBER APPROVAL ARE ACQUISITIONS OF DEBT, SALE OF ASSETS, ANNUAL BUDGET, MERGERS AND BYLAW REVISIONS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY A NATIONAL INDEPENDENT ACCOUNTING FIRM FROM INFORMATION PROVIDED BY MANAGEMENT. FINANCIAL MANAGEMENT WILL REVIEW THE FORM 990 WHEN IT IS COMPLETED. ASCENTRIA CARE ALLIANCE, INC.'S (ACA) AUDIT COMMITTEE PROVIDES SECONDARY REVIEW AND APPROVAL PRIOR TO SUBMISSION TO THE IRS. THE COMPLETE FORM 990 IS POSTED TO THE BOARD INTRANET FOR REVIEW BY THE ACA FINANCE COMMITTEE AS WELL AS ALL BOARD MEMBERS PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ANY DIRECTOR, OFFICER, EMPLOYEE, COMMITTEE MEMBER, OR VOLUNTEER OF ACA OR ITS SUBSIDIARIES, WHETHER BECAUSE OF HIS/HER EMPLOYMENT, BUSINESS INTERESTS, INVESTMENTS, OR OTHERWISE, WHO HAS INTERESTS THAT DO OR MAY, DIRECTLY OR INDIRECTLY, COMPETE WITH OR BE IN CONFLICT WITH THE INTERESTS OF ACA SHALL PROMPTLY DISCLOSE ALL MATERIAL FACTS OF SUCH CONFLICT OF INTEREST IN WRITING TO THE CHAIRPERSON OF THE BOARD OF DIRECTORS AND/OR TO THE PRESIDENT OF ACA. SUCH PERSON SHALL ALSO ANNOUNCE THE SAME AT ANY MEETING OR DISCUSSION IN WHICH HE/SHE IS A PARTICIPANT AND AT WHICH SUCH CONFLICT ARISES AND SHALL REFRAIN FROM ACTING THEREON. AFTER DISCLOSURE OF A FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE/SHE SHALL LEAVE THE GOVERNING BOARD OR COMMITTEE MEETING WHILE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. AN INTERESTED PERSON MAY MAKE A PRESENTATION AT THE GOVERNING BOARD OR COMMITTEE MEETING, BUT AFTER THE PRESENTATION HE/SHE SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT INVOLVING THE POSSIBLE CONFLICT OF INTEREST. THE CHAIRPERSON OF THE GOVERNING BOARD OR COMMITTEE SHALL, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER EXERCISING DUE DILIGENCE, THE GOVERNING BOARD OR COMMITTEE SHALL DETERMINE WHETHER ACA CAN OBTAIN WITH REASONABLE EFFORTS A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY POSSIBLE UNDER CIRCUMSTANCES NOT PRODUCING A CONFLICT OF INTEREST, THE GOVERNING BOARD OR COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS WHETHER THE TRANSACTION OR ARRANGEMENT IS IN ACA'S BEST INTEREST, FOR ITS OWN BENEFIT, AND WHETHER IT IS FAIR AND REASONABLE. IN CONFORMITY WITH THE ABOVE DETERMINATION IT SHALL MAKE ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: EQUITY TRANSFER 62,890. CHANGE IN BENEFICIAL INTEREST IN NA -692,991. FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THE PROCESS HAS NOT CHANGED SINCE THE PRIOR YEAR. RELATED ORGANIZATIONS FILE UNDER GROUP EXEMPTION 6011 - DISCLOSURE NOT REQ CT 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0