BANGOR NURSING & REHABILITATION CENTER: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- BANGOR NURSING & REHABILITATION CENTER (EIN 01-0538534)
- Tax period
- 2021-07-01 to 2021-12-31
- Filed
- 2022-11-08
- IRS object ID
- 202233129349300233
- 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 | 2022-11-08T07:45:03-06:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 010523282 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Berry Dunn McNeil & Parker LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2211 Congress St | AddressLine1Txt |
| City | Portland | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 04102 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 010538534 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Bangor Nursing & Rehabilitation Center | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | BANG | BusinessNameControlTxt |
| Phone | 2079474557 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 103 Texas Avenue | AddressLine1Txt |
| City | Bangor | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 04401 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Melissa Martin | PersonNm |
| Person Title | Administrator | PersonTitleTxt |
| Phone | 2079474557 | PhoneNum |
| Signature | 2022-11-04 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | Melissa | PersonFirstNm |
| Person Last | Martin | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Joseph R Byrne | PreparerPersonNm |
| PTIN | P01289281 | PTIN |
| Phone | 2077752387 | PhoneNum |
| Preparation | 2022-11-04 | 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Melissa Martin | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 103 Texas Avenue | AddressLine1Txt |
| City | Bangor | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 04401 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $2,901,288 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.bangornrc.com | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2001 | FormationYr |
| Legal Domicile State | ME | LegalDomicileStateCd |
| Activity Or Mission | Long-term care nursing facility | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 56 | TotalEmployeeCnt |
| Total Volunteers | 22 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,016,401 | PYContributionsGrantsAmt |
| CY Contributions Grants | $188,409 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $5,654,048 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $2,653,079 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,394 | PYInvestmentIncomeAmt |
| CY Investment Income | $665 | CYInvestmentIncomeAmt |
| PY Other Revenue | $118,270 | PYOtherRevenueAmt |
| CY Other Revenue | $59,135 | CYOtherRevenueAmt |
| PY Total Revenue | $6,790,113 | PYTotalRevenueAmt |
| CY Total Revenue | $2,901,288 | 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 | $2,361,335 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $880,955 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $3,916,240 | PYOtherExpensesAmt |
| CY Other Expenses | $2,357,806 | CYOtherExpensesAmt |
| PY Total Expenses | $6,277,575 | PYTotalExpensesAmt |
| CY Total Expenses | $3,238,761 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $512,538 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$337,473 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $3,127,404 | TotalAssetsBOYAmt |
| Total Assets EOY | $3,163,906 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $548,932 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $922,907 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $2,578,472 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $2,240,999 | NetAssetsOrFundBalancesEOYAmt |
| Mission | It is the mission of the Bangor Nursing and Rehabilitation Center to provide the highest level of care with the highest level of quality, competency and professionalism that focuses on the health and well-being of the community it serves. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $2,776,135 | ExpenseAmt |
| Revenue | $2,653,079 | RevenueAmt |
| Desc | BNRC is a 60-bed skilled nursing facility providing complex nursing and rehabilitation care to a significantly large sub-acute population with short average lengths of stay. | Desc |
| Total Program Service Expenses | $2,776,135 | 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 | Yes (1) | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | 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 | 0 | 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 | 15 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 56 | 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 | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (1) | 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 | 0 | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Brian Donahue | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2079474557 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 103 Texas Ave | AddressLine1Txt |
| City | Bangor | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 04401 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (20 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|
| Nichi Farnham | ||||||
| President | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| Helen Burlock RN | ||||||
| Vice President | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| John Muth | ||||||
| Treasurer | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| Deborah Laurie | ||||||
| Secretary | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| Janna Gau | ||||||
| Board Member | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Eileen McAvoy | ||||||
| Board Member | 1.00 | Yes (X) | $0 | $0 | $0 | |
| John Miller | ||||||
| Board Member | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Alicia Murray | ||||||
| Board Member | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Sandy Nesin | ||||||
| Board Member | 1.00 | Yes (X) | $0 | $0 | $0 | |
| John Patten | ||||||
| Board Member | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Stephen Rich | ||||||
| Board Member | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Kathy Bernier | ||||||
| Past Board Member | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Geoff Gratwick | ||||||
| Past Board Member | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Larry Lavigne | ||||||
| Past Board Member | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Dana Lippitt | ||||||
| Past Board Member | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Jon Pottle | ||||||
| Past Board Member | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Jonathan Spraque | ||||||
| Past Board Member | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Tony Tsismenakis | ||||||
| Past Board Member | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Melissa Martin | ||||||
| Administrator | 40.00 | Yes (X) | $88,347 | $0 | $18,212 | |
| Brian Donahue | ||||||
| CFO | 40.00 | Yes (X) | $107,039 | $0 | $888 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $195,386 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $19,100 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 1 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | 0 | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Medefis Consolidated | |||||
| PO Box 5068 | New York | NY | 10087 | Staffing Services | $673,525 |
| Metz Culinary Management | |||||
| 2 Woodland Drive | Dallas | PA | 18612 | Food and Dietary Services | $656,295 |
| MAS Medical Staffing | |||||
| 156 Harvey Road | Londonderry | NH | 03053 | Staffing Services | $503,195 |
| Select Rehabilitation | |||||
| PO Box 71985 | Chicago | IL | 60694 | Rehabilitation Services | $379,780 |
| Healthcare Services Group | |||||
| PO Box 829677 | Philadelphia | PA | 191829677 | Housekeeping, Laundry and Maintenance | $293,982 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 10 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $171,572 | GovernmentGrantsAmt |
| All Other Contributions | $16,837 | AllOtherContributionsAmt |
| Total Contributions | $188,409 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Resident Revenue | 623000 | $2,752,262 | $2,752,262 |
| Other Revenue | 900099 | $2,350 | $2,350 |
| Contractual Adjustment | 623000 | -$101,533 | -$101,533 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $2,653,079 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $665 | TotalRevenueColumnAmt |
| Exclusion | $665 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $59,135 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $59,135 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $59,135 | TotalRevenueColumnAmt |
| Exclusion | $59,135 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,901,288 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2,653,079 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $59,800 | 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 | $137,760 | TotalAmt |
| Management And General | $137,760 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $507,984 | TotalAmt |
| Program Services | $466,120 | ProgramServicesAmt |
| Management And General | $41,864 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $166,049 | TotalAmt |
| Program Services | $128,372 | ProgramServicesAmt |
| Management And General | $37,677 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $69,162 | TotalAmt |
| Program Services | $51,854 | ProgramServicesAmt |
| Management And General | $17,308 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,500 | TotalAmt |
| Management And General | $37,500 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,877 | TotalAmt |
| Management And General | $19,877 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,000 | TotalAmt |
| Management And General | $18,000 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,479,728 | TotalAmt |
| Program Services | $1,450,705 | ProgramServicesAmt |
| Management And General | $29,023 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,382 | TotalAmt |
| Management And General | $2,382 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $129,675 | TotalAmt |
| Program Services | $110,445 | ProgramServicesAmt |
| Management And General | $19,230 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,469 | TotalAmt |
| Management And General | $14,469 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $165,287 | TotalAmt |
| Program Services | $165,287 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $474 | TotalAmt |
| Program Services | $192 | ProgramServicesAmt |
| Management And General | $282 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $660 | TotalAmt |
| Management And General | $660 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $284 | TotalAmt |
| Program Services | $284 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $81,479 | TotalAmt |
| Program Services | $81,479 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,956 | TotalAmt |
| Management And General | $18,956 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Provider Tax Expense | $159,044 | $159,044 | |
| Medical Supplies | $145,829 | $145,829 | |
| Miscellaneous | $84,162 | $16,524 | $67,638 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,238,761 | TotalAmt |
| Program Services | $2,776,135 | ProgramServicesAmt |
| Management And General | $462,626 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part X | Yes (X) | InfoInScheduleOPartXInd |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,213 | BOYAmt |
| EOY | $161,498 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,121,512 | BOYAmt |
| EOY | $1,039,588 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $434,368 | BOYAmt |
| EOY | $415,203 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $45,432 | BOYAmt |
| EOY | $45,432 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $59,873 | BOYAmt |
| EOY | $21,248 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $6,573,408 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $5,316,571 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,288,506 | BOYAmt |
| EOY | $1,256,837 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $141,500 | BOYAmt |
| EOY | $224,100 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,127,404 | BOYAmt |
| EOY | $3,163,906 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $387,511 | BOYAmt |
| EOY | $252,074 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,813 | BOYAmt |
| EOY | $16,813 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,475 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $140,133 | BOYAmt |
| EOY | $654,020 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $548,932 | BOYAmt |
| EOY | $922,907 | 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 | $2,578,472 | BOYAmt |
| EOY | $2,240,999 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,578,472 | BOYAmt |
| EOY | $2,240,999 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,127,404 | BOYAmt |
| EOY | $3,163,906 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$337,473 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | Yes (1) | AccountantCompileOrReviewInd |
Acct Compile Or Review Basis AcctCompileOrReviewBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FS Audited | 0 | FSAuditedInd |
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
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 | $79,511 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $6,438 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $432,976 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,016,401 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $188,409 | CurrentTaxYearAmt |
| Total | $1,723,735 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $5,760,579 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $6,171,312 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $6,029,353 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $5,654,048 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,653,079 | CurrentTaxYearAmt |
| Total | $26,268,371 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $5,840,090 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $6,177,750 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $6,462,329 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $6,670,449 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,841,488 | CurrentTaxYearAmt |
| Total | $27,992,106 | 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) |
|---|---|---|
| Current Tax Year Minus4 Years | $871,499 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $337,218 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $720,451 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $421,883 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $448,462 | CurrentTaxYearAmt |
| Total | $2,799,513 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $871,499 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $337,218 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $720,451 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $421,883 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $448,462 | CurrentTaxYearAmt |
| Total | $2,799,513 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $25,192,593 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $119,862 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $120,791 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $119,812 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $119,664 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $59,800 | CurrentTaxYearAmt |
| Total | $539,929 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $119,862 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $120,791 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $119,812 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $119,664 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $59,800 | CurrentTaxYearAmt |
| Total | $539,929 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $5,959,952 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $6,298,541 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $6,582,141 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $6,790,113 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,901,288 | CurrentTaxYearAmt |
| Total | $28,532,035 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.88300 | PublicSupportCY509Pct |
| Public Support PY509 | 0.88030 | PublicSupportPY509Pct |
| Investment Income CY | 0.01890 | InvestmentIncomeCYPct |
| Investment Income PY | 0.01900 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule A, Part III: | FormAndLineReferenceDesc |
| Explanation | In 2021, Bangor Nursing & Rehabilitation Center changed its year end to December 31. The amounts reported in the 2021 column of Schedule A, Part III reflect the short period activity from 7/1/21 to 12/31/21. | ExplanationTxt |
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 | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $876 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $876 | 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 | The Organization pays dues to various organizations, a portion of which is attributable to lobbying. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | 0 | AgentTrusteeEtcInd |
| Incl Escrow Custodial Acct Liab | Yes (1) | InclEscrowCustodialAcctLiabInd |
| Explanation Provided | Yes (X) | ExplanationProvidedInd |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,376,470 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,350,590 | DepreciationAmt |
| Book Value | $1,025,880 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,125,621 | OtherCostOrOtherBasisAmt |
| Depreciation | $945,801 | DepreciationAmt |
| Book Value | $179,820 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $71,317 | OtherCostOrOtherBasisAmt |
| Depreciation | $20,180 | DepreciationAmt |
| Book Value | $51,137 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $1,256,837 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Estimated Third-Party Payor Settlements | Desc |
| Book Value | $224,100 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $224,100 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CARES Act Funding | Desc |
| Amt | $654,020 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $654,020 | TotalLiabilityAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part IV, Line 2b: | FormAndLineReferenceDesc |
| Explanation | The Organization holds funds for residents and provides these funds to the resident, as needed. The funds are reported as a liability on Form 990, Part X, line 21. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 3 | Effective December 1, 2021, Covenant Health Systems assumed certain management duties and responsibilities including the execution of operational budgets, management of certain operations, supervision of employee benefit plans, etc. As of December 31, 2021, no one from Bangor Nursing & Rehabilitation Center (including current or former officers, directors, trustees, key employees, or highly compensated employees) received any compensation from Covenant Health Systems. |
| Form 990, Part VI, Section A, line 4 | In December 2021, the Organization amended its bylaws. Significant changes include reference to the new sole corporate member as well as powers reserved to the Member. Please refer to Schedule O for responses to Form 990, Part VI, questions 6, 7a, and 7b for a comprehensive list of significant changes made. |
| Form 990, Part VI, Section A, line 6 | Prior to December 1, 2021, any person, group of persons, corporation or association with an interest in or expertise useful for the provision of medical, rehabilitative, and support services to individuals served by or who qualify for services by the corporation, shall be eligible to be a voting member. Employees of Bangor Nursing and Rehabiliation Center cannot be members. Effective December 1, 2021, Covenant Health, Inc. became the sole corporate member of the Organization. |
| Form 990, Part VI, Section A, line 7a | Effective December 1, 2021, Covenant Heath, Inc. (as sole corporate member of the Organization) has the power to elect the Directors of the Corporation and the remove them with or without cause. |
| Form 990, Part VI, Section A, line 7b | Effective December 1, 2021, Covenant Heath, Inc. (as sole corporate member of the organization) has the following governance decisions/powers pursuant to the Organization's amended bylaws: 1. To approve any change in the written statements of philosophy and mission of the Corporation or any subsidiary of the Corporation, and to monitor compliance with same; 2. To amend and to repeal the Articles of Incorporation and the Bylaws of the Corporation, and to approve the adoption, amendment or repeal of the governing instruments of any subsidiary of the Corporation; 3. To appoint and remove the President of the Corporation, including a President secured by management contract; 4. To ratify the Board of Directors' election of the Chair of the Board of Directors; 5. To approve all plans of merger, consolidation, reorganization or dissolution of the Corporation or any subsidiary of the Corporation, or the sale, lease, assignment or transfer of substantially all of the assets of the Corporation or any subsidiary of the Corporation, or the purchase or acquisition by the Corporation or any subsidiary of the Corporation of an interest in any corporation, partnership, joint venture or other entity, whether newly created or previously existing, which interest, in the case of a for-profit entity, represents twenty-five percent (25%) or more of the voting power thereof or equity interest therein, or, in the case of a nonprofit entity, represents twenty-five percent (25%) or more of the voting power thereof or membership interest therein; 6. To approve all long-range strategic plans of the Corporation before their implementation; 7. To approve the acquisition, sale or encumbrance by the Corporation or any subsidiary of the Corporation of any real estate valued in excess of the amount set by the Member in writing from time to time; 8. To approve all capital budgets of the Corporation and non-budgeted expenses which are in excess of the amount set by the Member in writing from time to time, and to approve the Corporation's operating budget in accordance with policies set by the Member in writing from time to time; 9. To approve all debt of the Corporation, not part of the approved budget, in excess of limits set by the Member in writing from time to time before such debt is incurred; 10. To appoint the auditors of the Corporation and any subsidiary of the Corporation; 11. To approve the sale, assignment or transfer by the Corporation or any subsidiary of the Corporation of any equity interest or membership interest in any subsidiary of the Corporation; 12. To approve any reclassification or other change of any capital stock or other equity security of any subsidiary of the Corporation, or any recapitalization of any subsidiary of the Corporation; and 13. To approve the issuance of, or the creation of any obligation to issue, any equity security of any subsidiary of the Corporation, or any increase or decrease in the total number of shares of authorized capital stock or other equity security of any subsidiary of the Corporation. |
| Form 990, Part VI, Section B, line 11b | The 990 is initially reviewed by the Administrator and CFO. It then is presented to the entire board who are asked for any updates before filing. The board is asked to review this thoroughly. |
| Form 990, Part VI, Section B, line 12c | A copy of the conflict of interest policy is given to every officer, board member, and key employee on an annual basis, along with an annual disclosure statement, listing any known financial interest that the individual, or a member of the individual's family, has in any business entity that transacts business with the organization. The executive committee of the board then reviews and maintains the disclosure statements for future reference. If a conflict arises, the board member will recuse themself from participation in the deliberations and decisions relating to the conflict. The administrator personally approves contracts, dealings with subcontractors, and any internal hires to ensure that there is no conflict of interest. The Organization also maintains an electronic disclosure policy that requires an annual manager review and sign off. The board is also made aware of any contractors of consequence and is alerted to any potential conflicts of interest. |
| Form 990, Part VI, Section B, line 15a | The compensation packages of officers and key employees are determined by independent members of the board. The compensation arrangements are approved in advance and are based upon appropriate comparability data. The deliberations and decisions made by the board are contemporaneously substantiated in written meeting minutes. Comparability data involves looking to compensation levels paid by similarly situated organizations for functionally comparable positions, including the use of compensation surveys and studies from outside organizations. |
| Form 990, Part VI, Section C, line 19 | The Organization maintains copies of these documents on file. They are made available to the public upon request. |
| Form 990, Part IX, line 11g | Consultant Services: Program service expenses 25,744. Management and general expenses 0. Fundraising expenses 0. Total expenses 25,744. Service Contracts: Program service expenses 286,937. Management and general expenses 18,222. Fundraising expenses 0. Total expenses 305,159. Contract Labor: Program service expenses 996,942. Management and general expenses 0. Fundraising expenses 0. Total expenses 996,942. Outside Services: Program service expenses 141,082. Management and general expenses 10,801. Fundraising expenses 0. Total expenses 151,883. |
| Form 990, Part X, Line 10: Land, Buildings, and Equipment | Section 1.263(a)-3(n) Election: Bangor Nursing & Rehabilitation Center 103 Texas Avenune Bangor, ME 04401 EIN 01-0538534 Bangor Nursing & Rehabilitation Center is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n). |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (39 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 | Homes health and hospice | ME | 501(c)(3) | Line 10 | St Joseph Healthcare Foundation | 0 | |
| CHS of Waltham Inc dba Maristhill Nursing & Rehab Center | |||||||||||
| 66 Newton Street | Waltham | MA | 02453 | 043333609 | Nursing home and restorative facility | MA | 501(c)(3) | Line 10 | Covenant Health Inc | 0 | |
| CHS of Worcester Inc dba St Mary Care Center | |||||||||||
| 39 Queen Street | Worcester | 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 11 | 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 Andre Health Care Facility | |||||||||||
| 407 Pool Street | Biddeford | ME | 04005 | 010342399 | Nursing home and restorative facility | ME | 501(c)(3) | Line 10 | Covenant Health 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 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 Rehabiliation 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 Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Address Line1ForeignAddress/AddressLine1Txt | CityForeignAddress/CityNm | CountryForeignAddress/CountryCd | Foreign PostalForeignAddress/ForeignPostalCd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Campus Holding | ||||||||||||||
| PO Box 7291 | Lewiston | ME | 04240 | 010406049 | Holding company | ME | N/A | C | 0 | |||||
| Covenant Health Insurance LTD | ||||||||||||||
| 043360127 | Self-insurance company | N/A | C | 0 | PO Box 69 | Grand Cayman | CJ | KY1-1102 | CJ | |||||
| GNM Corporation | ||||||||||||||
| 172 Kinsley Street | Nashua | NH | 03060 | 020400550 | Real estate holding company | NH | N/A | C | 0 | |||||
| SJ Physicians Services | ||||||||||||||
| 172 Kinsley Street | Nashua | NH | 03060 | 020522234 | Physician practice | NH | N/A | C | 0 | |||||
| St Joseph Corporate Services Inc | ||||||||||||||
| 172 Kinsley Street | Nashua | NH | 03060 | 020405197 | Holding company | NH | N/A | C | 0 | |||||
| Strauss Incorporated | ||||||||||||||
| 360 Broadway | Bangor | ME | 04402 | 010391369 | Repairs and transcriptions | ME | N/A | C | 0 | |||||
| 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 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part IV, Identification of Related Organizations Taxable as Corp or Trust | FormAndLineReferenceDesc |
| Explanation | Name of Related Organization: St. Joseph Corporate Services, Inc. Direct Controlling Entity: St. Joseph's Hospital of Nashua, NH Inc. | ExplanationTxt |