2022-11-14T15:27:48-06:00 2021-12-31 410746749 CLIFTONLARSONALLEN LLP 4 BATTERYMARCH PARK SUITE 100 QUINCY MA 02169 990 2021-01-01 208745264 FAIRHAVEN HEALTHCARE CENTER INC C/O ATHENA HEALTH CARE ASSOCIATES FAIR 9784583388 476 VARNUM AVE LOWELL MA 01854 RAYMOND DENEHEY PRESIDENT 9784583388 2022-11-10 1 RAYMOND DENEHEY 999009999 DANIELLE NIHILL P01350943 7819821001 2022-11-10 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z RAYMOND DENEHEY 476 VARNUM AVE LOWELL MA 01854 11897110 0 X WWW.FAIRHAVEN-NURSING.COM X 2007 MA IT IS THE MISSION OF FAIRHAVEN HEALTHCARE CENTER, INC. TO PROVIDE ELDERS WITH DYNAMIC, MEANINGFUL AND SUPPORTIVE LIVING ENVIRONMENTS, INTEGRATING QUALITY CARE, EDUCATION AND RESEARCH, RESPECT FOR INDIVIDUALITY AND THE HUMAN SPIRIT, AND INNOVATIVE APPPROACHES TO MEET THE EVER CHANGING NEEDS OF THE COMMUNITIES WE SERVE. 6 5 174 6 0 0 2016075 620649 12189866 11270827 11034 703 0 4931 14216975 11897110 0 0 0 0 9500658 7555680 0 0 0 7312703 7420129 16813361 14975809 -2596386 -3078699 25516833 23711383 34283350 33880632 -8766517 -10169249 X IT IS THE MISSION OF FAIRHAVEN HEALTHCARE CENTER, INC. TO PROVIDE ELDERS WITH DYNAMIC, MEANINGFUL AND SUPPORTIVE LIVING ENVIRONMENTS, INTEGRATING QUALITY CARE, EDUCATION AND RESEARCH, RESPECT FOR INDIVIDUALITY AND THE HUMAN SPIRIT, AND INNOVATIVE APPROACHES TO MEET THE EVER CHANGING NEEDS OF THE COMMUNITIES WE SERVE. 0 0 13270378 11305035 FAIRHAVEN HEALTHCARE CENTER IS A 169-BED, JCAHO ACCREDITED AND MEDICARE CERTIFIED HEALTHCARE FACILITY OFFERING TRADITIONAL SKILLED NURSING CARE, SHORT-TERM REHABILITATION, PLUS A VARIETY OF SPECIALIZED TREATMENT PROGRAMS. 13270378 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 5 0 174 1 0 0 0 0 0 0 0 0 0 0 0 0 X 6 5 1 1 0 0 1 1 1 1 1 0 0 1 0 0 0 0 0 0 MA X MICHAEL MOSIER 8607513900 135 SOUTH RD FARMINGTON CT 06032 MICHAEL TAKESIAN ADMINISTRATOR 40.00 X 167242 0 12043 EMILY GETCHELL DNS 40.00 X 144443 0 0 SAMANTHA CHUUN LPN 40.00 X 129795 0 12043 DEBORAH LISIECKI REHAB DIRECTOR 40.00 X 116142 0 0 LISA EDZIE RN 40.00 X 114131 0 0 RAYMOND DENNEHY PRESIDENT 1.00 2.00 X X 43200 16800 0 JOEL KIRCHICK DIRECTOR 1.00 2.00 X X 0 0 0 GINA QUEIROS MEMBER 1.00 2.00 X 0 0 0 MICHAEL MOORE DIRECTOR 1.00 2.00 X 0 0 0 ROBERT GREER VANTUYL MEMBER 1.00 2.00 X 0 0 0 JEFFREY WITHERELL DIRECTOR 1.00 2.00 X 0 0 0 714953 16800 24086 9 0 1 0 CLEAN FACILITY 846 LEXINGTON STREET 6 WALTHAM MA 02452 HOUSEKEEPING AND LAUNDRY SERVICES 538243 ATHENA HEALTH CARE SYSTEMS 135 SOUTH ROAD FARMINGTON CT 06032 MANAGEMENT COMPANY 339642 PARTNERS PHARMACY PO BOX 825553 PHILADELPHIA PA 19182 PHARMACY SERVICES 324403 3 620649 620649 PROGRAM SERVICE REVENUE 623000 11270827 11270827 11270827 703 703 BAD DEBT RECOVERY 623990 4931 4931 4931 11897110 11275758 0 703 43200 43200 6595084 6211013 384071 436283 408202 28081 481113 450146 30967 338125 338125 197182 197182 40074 40074 900150 802430 97720 289 289 250859 62836 188023 244625 244625 1784148 1784148 760393 760393 246679 35904 210775 MEDICAL SUPPLIES 1603695 1603695 STATE ASSSESSMENT 850319 850319 BAD DEBTS 128552 128552 FOOD 56667 56667 18372 18372 14975809 13270378 1705431 0 701 700 2983908 1964177 892636 836849 164104 118053 23863338 8964210 15544369 14899128 2932083 2932083 2999032 2960393 25516833 23711383 4203200 5490292 25785976 25837235 760798 760798 1675968 0 1857408 1792307 34283350 33880632 X -8766517 -10169249 -8766517 -10169249 25516833 23711383 X -3078699 1675967 X 0 0 0 X 2016875 620649 2637524 14712230 15418194 15073050 12189866 11270827 68664167 14712230 15418194 15073050 14206741 11891476 71301691 0 0 0 71301691 26901 61220 70201 11034 703 170059 26901 61220 70201 11034 703 170059 4931 4931 14739131 15479414 15143251 14217775 11897110 71476681 0.99760 0.99740 0.00240 0.00260 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: BAD DEBT RECOVERY - 2021 AMOUNT: $ 4,931. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1958000 1958000 20092773 7415484 12677289 1672771 1408932 263839 139794 139794 0 14899128 ESCROW 2475747 TRUSTEE FUNDS HELD - BOND INDENTURE 484646 2960393 MEDICARE COST SETTLEMENT 188651 DUE FROM RELATED PARTY 1603656 1792307 X 0 0 0 0 0 0 0 0 0 MICHAEL TAKESIAN ADMINISTRATOR 167242 0 0 0 0 0 0 0 12043 0 179285 0 0 0 A MASSACHUSETTS DEVELOPMENT FINANCE AGENCY - SERIES 2007A 043431814 57585AAA8 2007-10-25 1982687 PURCHASE FACILITIES 0 0 0 B MASSACHUSETTS DEVELOPMENT FINANCE AGENCY - SERIES 2007A 043431814 57585AAB6 2007-10-25 8051140 PURCHASE FACILITIES 0 0 0 C MASSACHUSETTS DEVELOPMENT FINANCE AGENCY - SERIES 2007A 043431814 57585AAC4 2007-10-25 14755407 PURCHASE FACILITIES 0 0 0 D MASSACHUSETTS DEVELOPMENT FINANCE AGENCY - SERIES 2007D 043431814 2007-10-25 2038290 PURCHASE FACILITIES 0 0 0 A 200439 1982687 1189273 793414 2007 0 0 1 1 B 801757 8051140 2867753 5183387 2007 0 0 1 1 C 1503295 14755407 14755407 2007 0 0 1 1 D 2038290 19338 2018952 2007 0 0 1 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 D 0 0 0 0 0 0 0 A 0 1 0 0 0 0 0 0 B 0 1 0 0 0 0 0 0 C 0 1 0 0 0 0 0 0 D 0 1 0 0 0 0 0 0 A 0 B 0 C 0 D 0 A MASSACHUSETTS DEVELOPMENT FINANCE AGENCY - SERIES 2010 043431818 2010-07-14 2640000 PROJECT REHAB 0 0 0 A 2640000 2640000 2010 0 0 1 1 A 0 0 0 0 0 0 0 A 0 1 0 0 0 0 0 0 A 0 RAYMOND DENNEHY BOD - PRESIDENT 60000 BOD MEMBER IS OWNER OF HEALTH CARE VALUATION ADVISORS WHICH PROVIDES CONSULTING SERVICES TO THE ORGANIZATION. 0 FORM 990, PART VI, SECTION A, LINE 2 PRESIDENT, RAYMOND DENNEHY AND DIRECTOR, JOEL KIRCHICK HAVE A BUSINESS RELATIONSHIP WITH ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 3 IN MAY 1, 2018 THE ORGANIZATION HAS ENTERED INTO A MANAGEMENT AGREEMENT, WITH ATHENA HEALTH CARE ASSOCIATES INC TO MANAGE THE OPERATIONS OF FAIRHAVEN HEALTHCARE CENTER, INC. ACTING THROUGH THE NURSING FACILITY EMPLOYEES, TO SUPERVISE, DIRECT AND CONTROL THE DAY-TO-DAY BUSINESS ACTIVITIES AND MANAGEMENT OF THE NURSING FACILITY. ATHENA HEALTH CARE ASSOCIATES INC PREPARE AND FILE, ALL COST REPORTS, PAYROLL TAX AND REAL ESTATE TAX FILINGS REQUIRED. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE ORGANIZATION IS A RELATED ORGANIZATION, ADVENTCARE, INC. FORM 990, PART VI, SECTION A, LINE 7A THE APPROVAL OF THE MEMBER, ADVENTCARE, INC., IS REQUIRED TO ELECT OR REMOVE DIRECTORS OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING POWERS AND RESPONSIBILITIES ARE EXPRESSLY RESERVED TO ADVENTCARE, INC., THE MEMBER OF THE CORPORATION: (A) TO ELECT AND REMOVE DIRECTORS OF THE CORPORATION WITH OR WITHOUT CAUSE. ANY VACANCY OCCURRING AMONG THE DIRECTORS WILL BE FILLED BY ACTION OF THE MEMBER; (B) TO APPROVE THE ANNUAL OPERATING BUDGET OF THE CORPORATION; (C) TO CONDUCT FINANCIAL PLANNING, MONITOR AND ASSURE LONG-TERM FINANCIAL PERFORMANCE OF THE CORPORATION; (D) TO APPROVE THE PURCHASE, ACQUISITION, ASSIGNN1ENT, SALE, CONVEYANCE OR MORTGAGE OF REAL PROPERTY; (E) TO APPROVE THE INCURRENCE BY THE CORPORATION OF ANY INDEBTEDNESS FOR BORROWED MONEY; (F) TO APPROVE CONTRACTS FOR MANAGEMENT SERVICES; (G) TO APPROVE ANY CAPITAL EXPENDITURES NOT SHOWN ON THE ANNUAL BUDGET WHICH EXCEED $10,000 FOR ANY EXPENDITURE; (H) TO APPROVE ALL CORPORATE REORGANIZATIONS AND THE ESTABLISHMENT OF OR INVESTMENT IN JOINT VENTURES, CORPORATIONS, PARTNERSHIPS, OTHER ENTITIES OR AFFILIATIONS; (I) TO APPROVE INITIATION OR SETTLEMENT OF LITIGATION OR ADMINISTRATIVE PROCEEDINGS TO WHICH THE CORPORATION IS OR MAY BE A PARTY; (J) TO APPROVE ANY AMENDMENTS TO THE ARTICLES OF ORGANIZATION OR BY-LAWS OF THE CORPORATION; (K) TO ENSURE THAT THE CORPORATION PURSUES A MISSION, PHILOSOPHY AND GOALS CONSISTENT WITH THOSE OF THE MEMBER. FORM 990, PART VI, SECTION B, LINE 11B A COMPLETE COPY OF THE FORM 990 TAX RETURN (INCLUDING ALL REQUIRED SCHEDULES) IS PROVIDED TO EACH PERSON WHO IS A VOTING MEMBER OF THE BOARD OF DIRECTORS AT THE TIME THE FORM 990 IS PROVIDED, EITHER IN PAPER OR ELECTRONIC FORM, BEFORE IT IS FILED WITH THE IRS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE MADE AVAILABLE ON THE MSRB ELECTRONIC MUNICIPAL MARKET ACCESS (EMMA) WEBSITE. FORM 990, PART XI, LINE 9: GAIN / (LOSS) ON SALE OF ASSET 1,675,967. ADVENTCARE INC 476 VARNUM AVE LOWELL MA 01854 321012491 MANAGEMENT COMPANY MA 501(C)(3) LINE 10 N/A 0 LAFAYETTE REHABILITATION AND SKILLED NURSING FACILITY 25 LAFAYETTE STREET MARBLEHEAD MA 01945 208745166 SKILLED NURSING FACILITY MA 501(C)(3) LINE 10 ADVENTCARE INC 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0