CHS OF WALTHAM INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- CHS OF WALTHAM INC (EIN 04-3333609)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-11-01
- IRS object ID
- 202203059349301690
- Schema version
- 2021v4.2
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-11-01T12:57:17-05:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 010494526 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Baker Newman & Noyes | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 650 Elm Street Suite 302 | AddressLine1Txt |
| City | Manchester | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03101 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 043333609 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHS of Waltham Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CHSO | BusinessNameControlTxt |
| Phone | 7818930240 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 66 Newton Street | AddressLine1Txt |
| City | Waltham | CityNm |
| State Abbreviation | MA | StateAbbreviationCd |
| ZIP | 02453 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | James Tracy | PersonNm |
| Person Title | President & CEO | PersonTitleTxt |
| Phone | 7818930240 | PhoneNum |
| Signature | 2022-11-01 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | James | PersonFirstNm |
| Person Last | Tracy | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Connor Smart | PreparerPersonNm |
| PTIN | P02285543 | PTIN |
| Phone | 6036262200 | PhoneNum |
| Preparation | 2022-11-01 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Maristhill Nursing & Rehabilitation | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | James Tracy | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 66 Newton Street | AddressLine1Txt |
| City | Waltham | CityNm |
| State Abbreviation | MA | StateAbbreviationCd |
| ZIP | 02453 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $9,219,309 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Group Exemption | 0928 | GroupExemptionNum |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | maristhill.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1996 | FormationYr |
| Legal Domicile State | MA | LegalDomicileStateCd |
| Activity Or Mission | Maristhill is a Catholic skilled nursing and rehabilitation facility that continues the healing ministry of Christ by providing health care services that foster each individual's physical, spiritual, emotional and intellectual well-being. | ActivityOrMissionDesc |
| Voting Members Governing Body | 6 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 5 | VotingMembersIndependentCnt |
| Total Employee | 105 | TotalEmployeeCnt |
| Total Volunteers | 5 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $930,621 | PYContributionsGrantsAmt |
| CY Contributions Grants | $155,920 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $9,334,648 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $8,624,843 | CYProgramServiceRevenueAmt |
| PY Investment Income | $51,725 | PYInvestmentIncomeAmt |
| CY Investment Income | $259,830 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | -$59,503 | CYOtherRevenueAmt |
| PY Total Revenue | $10,316,994 | PYTotalRevenueAmt |
| CY Total Revenue | $8,981,090 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $5,913,878 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $5,599,235 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $4,529,641 | PYOtherExpensesAmt |
| CY Other Expenses | $4,311,112 | CYOtherExpensesAmt |
| PY Total Expenses | $10,443,519 | PYTotalExpensesAmt |
| CY Total Expenses | $9,910,347 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$126,525 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$929,257 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $10,469,491 | TotalAssetsBOYAmt |
| Total Assets EOY | $8,156,502 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $9,382,899 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $8,088,502 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,086,592 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $68,000 | NetAssetsOrFundBalancesEOYAmt |
| Mission | Maristhill is a Catholic skilled nursing and rehabilitation facility that continues the healing ministry of Christ by providing health care services that foster each individual's physical, spiritual, emotional and intellectual well-being. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $8,672,060 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $8,624,843 | RevenueAmt |
| Desc | Maristhill Nursing and Rehabilitation Center provided 27,491 days of skilled nursing services during 2021, and 23,273 days of skilled services to Medicaid recipients. | Desc |
| Total Program Service Expenses | $8,672,060 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (1) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (1) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 7 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 105 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 6 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 5 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | MA | StatesWhereCopyOfReturnIsFldCd |
| Other Website | Yes (X) | OtherWebsiteInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | James Tracy President & CEO | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7818930240 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 66 Newton Street | AddressLine1Txt |
| City | Waltham | CityNm |
| State Abbreviation | MA | StateAbbreviationCd |
| ZIP | 02453 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (10 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| James Tracy | ||||||||
| President & CEO | 41.00 | 0.00 | Yes (X) | Yes (X) | $156,421 | $0 | $13,006 | |
| Joseph Cuzzupoli | ||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Sr Joyce Ann Edelmann | ||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Ellen Leiter | ||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Kelly Hill | ||||||||
| Chair | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Judith Allen | ||||||||
| Vice Chair | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Shirly Yellamaty | ||||||||
| RN Manager | 44.00 | 0.00 | $127,290 | $0 | $20,354 | Yes (X) | ||
| Luanne Deagle | ||||||||
| Director of Nursing | 40.00 | 0.00 | $135,226 | $0 | $8,790 | Yes (X) | ||
| Eric Gwanyalla | ||||||||
| LPN | 66.00 | 0.00 | $145,568 | $0 | $26,785 | Yes (X) | ||
| Anesta Rene | ||||||||
| RN | 65.00 | 0.00 | $130,034 | $0 | $491 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $694,539 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $69,426 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 5 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (3 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Select Rehabilitation LLC | |||||
| PO Box 503534 | St Louis | MO | 63150 | Rehabilitation services | $639,796 |
| Covenant Health Inc | |||||
| 100 Ames Pond Drive | Tewksbury | MA | 01876 | Management services | $392,336 |
| Performance Health Care Services Inc | |||||
| 47R River Street | Wellesley | MA | 02481 | Laundry and housekeeping | $355,560 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $5,051 | RelatedOrganizationsAmt |
| Government Grants | $112,380 | GovernmentGrantsAmt |
| All Other Contributions | $38,489 | AllOtherContributionsAmt |
| Total Contributions | $155,920 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Patient services | Desc |
| Business | 623000 | BusinessCd |
| Total Revenue Column | $8,624,843 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $8,624,843 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $8,624,843 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $22,135 | TotalRevenueColumnAmt |
| Exclusion | $22,135 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $475,914 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $238,219 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $237,695 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $237,695 | TotalRevenueColumnAmt |
| Exclusion | $237,695 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Debt extinguishment | Desc |
| Business | 525990 | BusinessCd |
| Total Revenue Column | -$59,503 | TotalRevenueColumnAmt |
| Exclusion | -$59,503 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | -$59,503 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $8,981,090 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $8,624,843 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $200,327 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $169,427 | TotalAmt |
| Program Services | $153,137 | ProgramServicesAmt |
| Management And General | $16,290 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,409,815 | TotalAmt |
| Program Services | $4,012,933 | ProgramServicesAmt |
| Management And General | $396,882 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $44,247 | TotalAmt |
| Program Services | $36,725 | ProgramServicesAmt |
| Management And General | $7,522 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $597,852 | TotalAmt |
| Program Services | $496,217 | ProgramServicesAmt |
| Management And General | $101,635 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $377,894 | TotalAmt |
| Program Services | $313,652 | ProgramServicesAmt |
| Management And General | $64,242 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $392,336 | TotalAmt |
| Management And General | $392,336 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $49,766 | TotalAmt |
| Management And General | $49,766 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,750 | TotalAmt |
| Management And General | $6,750 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,211,379 | TotalAmt |
| Program Services | $1,008,518 | ProgramServicesAmt |
| Management And General | $202,861 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,858 | TotalAmt |
| Program Services | $27,858 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $240,010 | TotalAmt |
| Program Services | $240,010 | ProgramServicesAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $72,038 | TotalAmt |
| Program Services | $72,038 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $312,039 | TotalAmt |
| Program Services | $312,039 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21 | TotalAmt |
| Program Services | $18 | ProgramServicesAmt |
| Management And General | $3 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $308,011 | TotalAmt |
| Program Services | $308,011 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $349,465 | TotalAmt |
| Program Services | $349,465 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $57,171 | TotalAmt |
| Program Services | $57,171 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| Drugs/medical supplies | $636,402 | $636,402 |
| Medicaid user fee | $517,248 | $517,248 |
| Provision for bad debts | $96,000 | $96,000 |
| Repairs & maintenance | $34,618 | $34,618 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,910,347 | TotalAmt |
| Program Services | $8,672,060 | ProgramServicesAmt |
| Management And General | $1,238,287 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $494,397 | BOYAmt |
| EOY | $357,349 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,880 | BOYAmt |
| EOY | $22,206 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,652,741 | BOYAmt |
| EOY | $1,304,307 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,185 | BOYAmt |
| EOY | $1,178 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $55,846 | BOYAmt |
| EOY | $15,970 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $12,157,019 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $7,112,559 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,356,594 | BOYAmt |
| EOY | $5,044,460 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,686,481 | BOYAmt |
| EOY | $1,356,369 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,212,367 | BOYAmt |
| EOY | $54,663 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,469,491 | BOYAmt |
| EOY | $8,156,502 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,332,302 | BOYAmt |
| EOY | $1,211,121 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,351,164 | BOYAmt |
| EOY | $0 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $6,372,954 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $699,433 | BOYAmt |
| EOY | $504,427 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,382,899 | BOYAmt |
| EOY | $8,088,502 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,076,712 | BOYAmt |
| EOY | $45,554 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,880 | BOYAmt |
| EOY | $22,446 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,086,592 | BOYAmt |
| EOY | $68,000 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,469,491 | BOYAmt |
| EOY | $8,156,502 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$929,257 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$89,335 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $14,115 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $10,317 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $21,229 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $930,621 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $155,920 | CurrentTaxYearAmt |
| Total | $1,132,202 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $10,237,696 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $10,948,859 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $10,200,930 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $9,334,648 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $8,624,843 | CurrentTaxYearAmt |
| Total | $49,346,976 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $10,251,811 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $10,959,176 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $10,222,159 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $10,265,269 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $8,780,763 | CurrentTaxYearAmt |
| Total | $50,479,178 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $50,479,178 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $46,019 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $73,954 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $169,077 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $51,725 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $22,135 | CurrentTaxYearAmt |
| Total | $362,910 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $46,019 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $73,954 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $169,077 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $51,725 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $22,135 | CurrentTaxYearAmt |
| Total | $362,910 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $10,297,830 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $11,033,130 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $10,391,236 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $10,316,994 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $8,802,898 | CurrentTaxYearAmt |
| Total | $50,842,088 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99290 | PublicSupportCY509Pct |
| Public Support PY509 | 0.99270 | PublicSupportPY509Pct |
| Investment Income CY | 0.00710 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00730 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | Yes (1) | GrantsOtherOrganizationsInd |
| Grants Other Organizations | $13,858 | GrantsOtherOrganizationsAmt |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | 0 | OtherActivitiesInd |
| Total Lobbying Expenditures | $13,858 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1: | FormAndLineReferenceDesc |
| Explanation | CHS of Waltham, Inc. was a member of the Massachusetts Senior Care Association and LeadingAge Massachusetts in the year ended December 31, 2021. The associations disclose to their members that a portion of membership dues may be used for lobbying expenditures in furtherance of their exempt purposes. However, the associations did not specifically disclose what amount or percentage of dues paid in 2021 were ultimately used for lobbying purposes. For transparency purposes, CHS of Waltham is disclosing the total amount of dues paid to each trade association, a portion of which may have been used for lobbying expenditures, in detail below and in total on Schedule C, Page 3, Part II-B, Line 1f. Massachusetts Senior Care Association - $9,038 LeadingAge Massachusetts - $4,820 | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $9,880 | BeginningYearBalanceAmt |
| Contributions | $17,568 | ContributionsAmt |
| Other Expenditures | $5,002 | OtherExpendituresAmt |
| End Year Balance | $22,446 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $4,936 | BeginningYearBalanceAmt |
| Contributions | $6,944 | ContributionsAmt |
| Other Expenditures | $2,000 | OtherExpendituresAmt |
| End Year Balance | $9,880 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributions | $6,936 | ContributionsAmt |
| Other Expenditures | $2,000 | OtherExpendituresAmt |
| End Year Balance | $4,936 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $6,000 | BeginningYearBalanceAmt |
| Other Expenditures | $6,000 | OtherExpendituresAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributions | $6,000 | ContributionsAmt |
| End Year Balance | $6,000 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.00000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 1.00000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $485,000 | OtherCostOrOtherBasisAmt |
| Book Value | $485,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,442,913 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,489,410 | DepreciationAmt |
| Book Value | $3,953,503 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,221,662 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,623,149 | DepreciationAmt |
| Book Value | $598,513 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,444 | OtherCostOrOtherBasisAmt |
| Book Value | $7,444 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $5,044,460 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Investment in Covenant Health Investment Trust | Desc |
| Book Value | $1,356,369 | BookValueAmt |
| Method Valuation | F | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $1,356,369 | TotalBookValueSecuritiesAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| Deferred expenses | $289,061 |
| Medicaid user fee obligations | $135,513 |
| Professional liability loss reserves | $32,517 |
| Resident funds | $47,336 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $504,427 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part V, Line 4: | The Organization's Endowment Funds are composed of various restricted assets funded by donors programs to support the Organization's residents, staff, DPH Visitation Grants, and assorted outdoor and property improvements. |
| Part X, Line 2: | Covenant and its member organizations are considered not-for-profit corporations as described in Section 501(c)(3) of the Internal Revenue Code and are exempt from federal income taxes on related income pursuant to Section 501(a) of the Code, except as noted below. Tax-exempt organizations could be required to record an obligation for income taxes as the result of a tax position they have historically taken on various tax exposure items including unrelated business income or tax status. Under guidance issued by the Financial Accounting Standards Board, assets and liabilities are established for uncertain tax positions taken or positions expected to be taken in income tax returns when such positions are judged to not meet the "more-likely-than-not" threshold, based upon the technical merits of the position. The System has evaluated the position taken on its filed tax returns. The System has concluded no uncertain income tax positions exist at December 31, 2021. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (2 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Eric Gwanyalla | ||||||||||||||
| LPN | $142,331 | $0 | $2,950 | $0 | $287 | $0 | $0 | $0 | $26,785 | $0 | $172,353 | $0 | $0 | $0 |
| James Tracy | ||||||||||||||
| President & CEO | $147,709 | $0 | $6,500 | $0 | $2,212 | $0 | $3,718 | $0 | $9,288 | $0 | $169,427 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3 | Any compensation paid to the trustees, directors, officers or key employees of the Organization is subject to the oversight and decisions of Covenant Health, a related tax-exempt organization. Every two-to-three years the Compensation Committee of the Covenant Health Board of Directors engages an external consultant to provide competitive market data from various survey sources, which is then used to develop recommendations for changes to the compensation program. Since 2003, the Compensation Committee has engaged a human resources consultant to conduct this analysis. Objectives of the analysis are to assess the compositeness of the total cash compensation levels of the senior leadership team, develop market based competitive salary ranges for all executive positions, and ensure that the annual incentive opportunities, if there are any, are competitive and reasonable. |
| Part I, Line 7 | A Compensation Committee recommends the variable pay award that may be issued to qualifying employees and officers. The payment of the award is discretionary and is subject to meeting the pre-determined goals of the Organization. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 6 | Covenant Health, Inc. is the sole corporate member of the Organization. |
| Form 990, Part VI, Section A, line 7a | As the sole corporate member of the Organization, Covenant Health, Inc. retains the ability to elect and remove the Organization's board of directors with or without cause. |
| Form 990, Part VI, Section A, line 7b | As the sole corporate member of the Organization, Covenant Health, Inc. has the following powers and rights over the Organization and its subsidiaries as outlined in the Organization's bylaws: 1. To approve any change in the written statements of philosophy and mission; 2. To amend and to repeal the organizing and governing documents; 3. To elect the Board of Directors or remove them with or without cause; 4. To appoint and remove the president; 5. To ratify the Board of Director's election of the Chair of the Board; 6. To approve all plans of merger, consolidation, reorganization, dissolution, or the sale, lease assignment, or transfer of substantially all of the assets, or the purchase or acquisition of an interest in any corporation, partnership, joint venture, or other entity; 7. To approve all long-range strategic plans before implementation; 8. To approve the acquisition, sale, or encumbrance of any real estate valued in excess of an amount set by the Member in writing; 9. To approve all capital budgets and non-budgeted expenses in excess of an amount set by the Member in writing; 10. To approve all debt in excess of limits set by the Member in writing; 11. To appoint the auditors; 12. To approve the sale, assignment, or transfer of any equity interest or membership interest in any subsidiary; 13. To approve any reclassification or other change of any capital stock or other equity security; and, 14. To approve the issuance of, or the creation of any obligation to issue, any equity security. |
| Form 990, Part VI, Section B, line 11b | The Form 990 is provided to the governing body for their review and approval prior to filing. |
| Form 990, Part VI, Section B, line 12c | This process is the responsibility of the Compliance Officer. A conflict of interest disclosure form is submitted to all leadership, board members, board committee members, employed physicians, medical directors and certain employees in key positions annually to be completed. Reminders are sent to all persons of interest to ensure that all conflict of interest disclosure forms are completed and collected. |
| Form 990, Part VI, Section B, line 15 | Any compensation paid to the trustees, directors, officers or key employees of the Organization is subject to the oversight and decisions of Covenant Health, a related tax-exempt organization. Every two-to-three years the Compensation Committee of the Covenant Health Board of Directors engages an external consultant to provide competitive market data from various survey sources, which is then used to develop recommendations for changes to the compensation program. Since 2003, the Compensation Committee has engaged a human resources consultant to conduct this analysis. Objectives of the analysis are to assess the compositeness of the total cash compensation levels of the senior leadership team, develop market based competitive salary ranges for all executive positions, and ensure that the annual incentive opportunities, if there are any, are competitive and reasonable. |
| Form 990, Part VI, Section C, line 19 | The Organization's Form 990, governing documents, conflict of interest policy, and financial statements are made available to the public upon request. The Organization's Form 990 is also made available on the website of its parent organization, Covenant Health, at the following web address: https://www.covenanthealth.net/financial-information/financial-information |
| Form 990, Part IX, line 11g | Purchased medical services: Program service expenses 609,804. Management and general expenses 0. Fundraising expenses 0. Total expenses 609,804. Purchased administrative and maintenance services: Program service expenses 398,714. Management and general expenses 144,444. Fundraising expenses 0. Total expenses 543,158. Consulting: Program service expenses 0. Management and general expenses 58,417. Fundraising expenses 0. Total expenses 58,417. |
| Form 990, Part XII, Line 2c: | The audit process has not changed from the previous year. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (38 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Alternative Health Services | |||||||||||
| 360 Broadway | Bangor | ME | 04402 | 010422885 | Home health and hospice | ME | 501(c)(3) | Line 10 | St Joseph Healthcare Foundation | 0 | |
| CHS of Worcester Inc dba St Mary Care Center | |||||||||||
| 39 Queen Street | Worchester | MA | 01610 | 043419625 | Nursing home and restorative facility | MA | 501(c)(3) | Line 10 | Covenant Health Inc | 0 | |
| Community Clinical Services | |||||||||||
| PO Box 7291 | Lewiston | ME | 04243 | 010409788 | Physician practice | ME | 501(c)(3) | Line 10 | St Mary's Health System | 0 | |
| Covenant Health Foundation Inc | |||||||||||
| 100 Ames Pond Drive | Tewksbury | MA | 01876 | 800199674 | Charitable foundation | MA | 501(c)(3) | Line 12a, I | Covenant Health Inc | 0 | |
| Covenant Health Investment Trust | |||||||||||
| 420 Bedford Street | Lexington | MA | 02420 | 046835128 | Investment trust | MA | 501(c)(3) | Line 12a, I | Covenant Health Inc | 0 | |
| Covenant Health Inc | |||||||||||
| 100 Ames Pond Drive | Tewksbury | MA | 01876 | 222484505 | Health care management and resource organization | MA | 501(c)(3) | Line 10 | 0 | N/A | |
| Fanny Allen Corporation Inc | |||||||||||
| 790 College Parkway | Colchester | VT | 05446 | 222495808 | Charitable foundation | VT | 501(c)(3) | Line 12a, I | Covenant Health Inc | 0 | |
| Fanny Allen Holdings Inc | |||||||||||
| 790 College Parkway | Colchester | VT | 05446 | 030181052 | Real estate holding company | VT | 501(c)(3) | Line 12a, I | Covenant Health Inc | 0 | |
| Helping Hands of St Marguerite Inc | |||||||||||
| 799 Concord Avenue | Cambridge | MA | 02138 | 800199674 | Private home-care health services | MA | 501(c)(3) | Line 10 | Covenant Health Inc | 0 | |
| M & J Company | |||||||||||
| 360 Broadway | Bangor | ME | 04402 | 222480150 | Lease holding company | ME | 501(c)(2) | St Joseph Healthcare Foundation | 0 | ||
| Mary Immaculate Guild Inc | |||||||||||
| 172 Lawrence Street | Lawrence | MA | 01841 | 463073987 | Supporting grants and donations | MA | 501(c)(3) | Line 12a, I | Covenant Health Inc | 0 | |
| MI Adult Day Health Care Center Inc | |||||||||||
| 189 Maple Street | Lawrence | MA | 01841 | 042921888 | Adult day care services | MA | 501(c)(3) | Line 10 | Covenant Health Inc | 0 | |
| MI Management Inc | |||||||||||
| 172 Lawrence Street | Lawrence | MA | 01841 | 042857794 | Assisted living services | MA | 501(c)(3) | Line 12a, I | Covenant Health Inc | 0 | |
| MI Nursing Restorative Center Inc | |||||||||||
| 172 Lawrence Street | Lawrence | MA | 01841 | 042104851 | Nursing home and restorative facility | MA | 501(c)(3) | Line 10 | Covenant Health Inc | 0 | |
| MI Residential Community II Inc | |||||||||||
| 189 Maple Street | Lawrence | MA | 01841 | 042679954 | HUD low income housing | MA | 501(c)(3) | Line 10 | Covenant Health Inc | 0 | |
| MI Residential Community III Inc | |||||||||||
| 189 Maple Street | Lawrence | MA | 01841 | 042186043 | HUD low income housing | MA | 501(c)(3) | Line 10 | Covenant Health Inc | 0 | |
| MI Residential Community Inc | |||||||||||
| 189 Maple Street | Lawrence | MA | 01841 | 042647207 | HUD low income housing | MA | 501(c)(3) | Line 10 | Covenant Health Inc | 0 | |
| MI Transportation Inc | |||||||||||
| 189 Maple Street | Lawrence | MA | 01841 | 042921889 | Elderly transportation services | MA | 501(c)(3) | Line 10 | Covenant Health Inc | 0 | |
| Mount St Rita Health Centre | |||||||||||
| 15 Sumner Brown Road | Cumberland | RI | 02864 | 050342330 | Nursing home | RI | 501(c)(3) | Line 10 | Covenant Health Inc | 0 | |
| Neighborhood Housing Initiative | |||||||||||
| PO Box 7291 | Lewiston | ME | 04243 | 010539730 | Affordable housing services | ME | 501(c)(3) | Line 10 | St Mary's Health System | 0 | |
| Penacook Place Inc | |||||||||||
| 150 Water Street | Haverhill | MA | 01830 | 237090088 | Nursing home | MA | 501(c)(3) | Line 10 | Covenant Health Inc | 0 | |
| Souhegan Nursing Association | |||||||||||
| 24 North River Road | Milford | NH | 03055 | 020222795 | Home health and hospice | NH | 501(c)(3) | Line 10 | St Joseph Hospital of Nashua NH Inc | 0 | |
| St Joseph Ambulatory Care Inc | |||||||||||
| 360 Broadway | Bangor | ME | 04402 | 222480373 | Physician practice | ME | 501(c)(3) | Line 10 | St Joseph Healthcare Foundation | 0 | |
| St Andre Health Care | |||||||||||
| 407 Pool Street | Biddeford | ME | 04005 | 010342399 | Nursing home and restorative facility | ME | 501(c)(3) | Line 10 | Covenant Health Inc | 0 | |
| St Joseph Healthcare Foundation | |||||||||||
| 360 Broadway | Bangor | ME | 04402 | 222480149 | Healthcare foundation | ME | 501(c)(3) | Line 10 | Covenant Health Inc | 0 | |
| St Joseph Hospital | |||||||||||
| 360 Broadway | Bangor | ME | 04402 | 010212435 | Hospital and health care facility | ME | 501(c)(3) | Line 3 | St Joseph Healthcare Foundation | 0 | |
| St Joseph Manor Health Care | |||||||||||
| 215 Thatcher Street | Brockton | MA | 02302 | 042565937 | Nursing home and restorative facility | MA | 501(c)(3) | Line 10 | Covenant Health Inc | 0 | |
| St Joseph's Hospital of Nashua NH Inc | |||||||||||
| 172 Kinsley Street | Nashua | NH | 03061 | 020222215 | Hospital and health care facility | NH | 501(c)(3) | Line 3 | Covenant Health Inc | 0 | |
| St Mary's D'Youville Pavilion | |||||||||||
| PO Box 7291 | Lewiston | ME | 04243 | 010211558 | Nursing home and restorative facility | ME | 501(c)(3) | Line 10 | St Mary's Health System | 0 | |
| St Mary's Health System | |||||||||||
| PO Box 7291 | Lewiston | ME | 04243 | 222504349 | Hospital and health care facility | ME | 501(c)(3) | Line 12a, I | Covenant Health Inc | 0 | |
| St Mary's Regional Medical Center | |||||||||||
| PO Box 7291 | Lewiston | ME | 04243 | 010211551 | Hospital and health care facility | ME | 501(c)(3) | Line 3 | St Mary's Health System | 0 | |
| St Mary's Residences | |||||||||||
| PO Box 7291 | Lewiston | ME | 04243 | 222504356 | Low income housing | ME | 501(c)(3) | Line 10 | St Mary's Health System | 0 | |
| St Mary's Villa Nursing Home Inc | |||||||||||
| 675 St Marys Villa Road | Moscow | PA | 18444 | 232057177 | Nursing home and restorative facility | PA | 501(c)(3) | Line 10 | Covenant Health Inc | 0 | |
| The Surgicenter at St Joseph Hospital Inc | |||||||||||
| 172 Kinsley Street | Nashua | NH | 03061 | 020222215 | Healthcare and surgery center | NH | 501(c)(3) | Line 10 | St Joseph Hospital of Nashua NH Inc | 0 | |
| Youville Hospital and Rehabilitation Center Inc | |||||||||||
| 1575 Cambridge Street | Cambridge | MA | 02138 | 043239563 | Hospital and health care facility | MA | 501(c)(3) | Line 10 | Youville Lifecare Inc | 0 | |
| Youville House Inc | |||||||||||
| 1573 Cambridge Street | Cambridge | MA | 02138 | 043239593 | Assisted living services | MA | 501(c)(3) | Line 10 | Youville Lifecare Inc | 0 | |
| Youville Lifecare Inc | |||||||||||
| 1575 Cambridge Street | Cambridge | MA | 02138 | 042103582 | Hospital and health care facility | MA | 501(c)(3) | Line 10 | Covenant Health Inc | 0 | |
| Youville Place | |||||||||||
| 10 Pelham Road | Lexington | MA | 02421 | 043297834 | Assisted living services | MA | 501(c)(3) | Line 10 | Covenant Health Inc | 0 | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (6 entries)
| Address Line1ForeignAddress/AddressLine1Txt | CityForeignAddress/CityNm | CountryForeignAddress/CountryCd | Foreign PostalForeignAddress/ForeignPostalCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Legal Domicile StateLegalDomicileStateCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Covenant Health Insurance LTD | ||||||||||||||
| PO Box 69 | Grand Cayman | CJ | KY1-1102 | 043360127 | Self-insurance company | CJ | N/A | C | 0 | |||||
| Campus Holding | ||||||||||||||
| 010406049 | Holding company | N/A | C | 0 | PO Box 7291 | Lewiston | ME | 04240 | ME | |||||
| St Joseph Corporate Services Inc | ||||||||||||||
| 020405197 | Holding company | N/A | C | 0 | 172 Kinsley Street | Nashua | NH | 03060 | NH | |||||
| Strauss Incorporated | ||||||||||||||
| 010391369 | Repairs and transcriptions | N/A | C | 0 | 360 Broadway | Bangor | ME | 04402 | ME | |||||
| GNM Corporation | ||||||||||||||
| 020400550 | Real estate holding company | N/A | C | 0 | 172 Kinsley Street | Nashua | NH | 03060 | NH | |||||
| SJ Physicians Services | ||||||||||||||
| 020522234 | Physician practice | N/A | C | 0 | 172 Kinsley Street | Nashua | NH | 03060 | NH | |||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |