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ALTERNATIVE HEALTH SERVICES OF ST JOSEPH INC: Form 990, tax year 2021

View the entire original 990 at ProPublica ↗

Organization
ALTERNATIVE HEALTH SERVICES OF ST JOSEPH INC (EIN 01-0422885)
Tax period
2021-01-01 to 2021-12-31
Filed
2022-11-08
IRS object ID
202243129349301684
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

FieldValueIRS element (for citing)
Return2022-11-08T12:07:26-06:00ReturnTs
Tax Period End2021-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN010494526PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1Baker Newman & NoyesBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1PO Box 507AddressLine1Txt
CityPortlandCityNm
State AbbreviationMEStateAbbreviationCd
ZIP04112ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2021-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN010422885EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Alternative Health ServicesBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlALTEBusinessNameControlTxt
Phone2079071233PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1360 Broadway PO Box 403AddressLine1Txt
CityBangorCityNm
State AbbreviationMEStateAbbreviationCd
ZIP044020403ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonMichael HendrixPersonNm
Person TitleCFOPersonTitleTxt
Phone2079071233PhoneNum
Signature2022-11-07SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstMichaelPersonFirstNm
Person LastHendrixPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonConnor SmartPreparerPersonNm
PTINP02285543PTIN
Phone2078792100PhoneNum
Preparation2022-11-07PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer3TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2021TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerMary PrybyloPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1360 Broadway PO Box 403AddressLine1Txt
CityBangorCityNm
State AbbreviationMEStateAbbreviationCd
ZIP044020403ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$4,269,536GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressN/AWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1987FormationYr
Legal Domicile StateMELegalDomicileStateCd
Activity Or MissionHome health and hospice agencyActivityOrMissionDesc
Voting Members Governing Body15VotingMembersGoverningBodyCnt
Voting Members Independent12VotingMembersIndependentCnt
Total Employee44TotalEmployeeCnt
Total Volunteers13TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$66,106PYContributionsGrantsAmt
CY Contributions Grants$56,154CYContributionsGrantsAmt
PY Program Service Revenue$4,415,619PYProgramServiceRevenueAmt
CY Program Service Revenue$4,213,382CYProgramServiceRevenueAmt
PY Investment Income$0PYInvestmentIncomeAmt
CY Investment Income$0CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$4,481,725PYTotalRevenueAmt
CY Total Revenue$4,269,536CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$2,458,322PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$2,539,327CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$1,899,307PYOtherExpensesAmt
CY Other Expenses$2,007,160CYOtherExpensesAmt
PY Total Expenses$4,357,629PYTotalExpensesAmt
CY Total Expenses$4,546,487CYTotalExpensesAmt
PY Revenues Less Expenses$124,096PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$276,951CYRevenuesLessExpensesAmt
Total Assets BOY$649,364TotalAssetsBOYAmt
Total Assets EOY$692,977TotalAssetsEOYAmt
Total Liabilities BOY$1,412,242TotalLiabilitiesBOYAmt
Total Liabilities EOY$1,732,806TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY-$762,878NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY-$1,039,829NetAssetsOrFundBalancesEOYAmt
MissionHome health care and hospice agencyMissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$4,010,153ExpenseAmt
Grant$0GrantAmt
Revenue$4,213,382RevenueAmt
DescHome health and hospice services - a wide range of treatment and rehabilitation services are delivered in the home by nurses, therapists, social workers, and home health aides. Nursing staff are available 24 hours a day. Services also include hospice care, a program of physical, emotional, and spiritual support for terminally ill individuals and their families. Trained hospice volunteers are an integral part of the program; they serve as a liaison between the multidisciplinary clinical team and the patient and family, while providing needed social and emotional support. Hospice services are available to individuals living at home, and to residents of long term care facilities.Desc
Total Program Service Expenses$4,010,153TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document5IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee44EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members15GoverningBodyVotingMembersCnt
Independent Voting Member12IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldMEStatesWhereCopyOfReturnIsFldCd
Other WebsiteYes (X)OtherWebsiteInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Michael Hendrix CFOBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone2079071233PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1360 Broadway PO Box 403AddressLine1Txt
CityBangorCityNm
State AbbreviationMEStateAbbreviationCd
ZIP044020403ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (24 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
Stephen Grubbs
Trustee0.1045.40Yes (X)$0$909,317$36,190
Ganesha Santhyadka MD
Trustee0.1040.40Yes (X)$0$737,772$42,448
Heather Evans DO
Trustee0.1040.40Yes (X)$0$240,978$26,320
William Buckley
Trustee0.100.40Yes (X)$0$0$0
Robert Clark
Trustee0.100.40Yes (X)$0$0$0
Thomas Daffron
Trustee (end 6/2021)0.100.40Yes (X)$0$0$0
Rosalind Prince Gilman Esq
Trustee0.100.40Yes (X)$0$0$0
Anita Haskell
Trustee0.100.40Yes (X)$0$0$0
Curtis Kimball Esq
Trustee0.100.40Yes (X)$0$0$0
Bernard LaBree
Trustee0.100.40Yes (X)$0$0$0
Adrien Roy Jr
Trustee0.100.40Yes (X)$0$0$0
Bradley Ryder
Trustee0.100.40Yes (X)$0$0$0
Rebecca Whitmore
Trustee0.100.40Yes (X)$0$0$0
William Wood MD
Trustee1.000.40Yes (X)$0$0$0
William Lucy
Chair0.100.40Yes (X)$0$0$0Yes (X)
L William Demaso
Vice Chair0.100.40Yes (X)$0$0$0Yes (X)
Mary Prybylo RN MSN
President & CEO, Ex-Officio0.1040.40$0$706,461$44,672Yes (X)
Michael Hendrix
Treasurer, VP Finance0.1040.40$0$345,986$41,692Yes (X)
Donna Berry
Secretary0.1040.40$0$79,469$24,353Yes (X)
Dana Cassidy
Homecare and Hospice Lead40.000.00$115,251$0$14,828Yes (X)
Kevin Kenny
Staff RN Home Health40.000.00$110,793$0$14,729Yes (X)
Caroline Vickers
Staff RN Home Health40.000.00$107,754$0$14,474Yes (X)
Melanie Glidden
Staff RN Home Health40.000.00$106,664$0$11,770Yes (X)
Heidi Ketch
Executive Director Community Health and Hospice40.000.00$101,970$0$4,519Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$542,432TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$3,019,983TotReportableCompRltdOrgAmt
Total Other Compensation$275,995TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K5IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (2 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
Dragonfly Therapy
840 Hammond Street Suite 2BangorME04401Physical therapy and rehabilatation$1,390,729
Blacktree Healthcare Consulting
1030 Continental DrKing of PrussiaPA19406Healthcare consulting$130,880
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K2CntrctRcvdGreaterThan100KCnt
Government Grants$56,154GovernmentGrantsAmt
Total Contributions$56,154TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescPatient servicesDesc
Business621610BusinessCd
Total Revenue Column$4,213,382TotalRevenueColumnAmt
Related Or Exempt Func Income$4,213,382RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$4,213,382TotalProgramServiceRevenueAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$4,269,536TotalRevenueColumnAmt
Related Or Exempt Func Income$4,213,382RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$2,099,309TotalAmt
Program Services$1,679,447ProgramServicesAmt
Management And General$419,862ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$31,833TotalAmt
Program Services$25,466ProgramServicesAmt
Management And General$6,367ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$255,909TotalAmt
Program Services$204,727ProgramServicesAmt
Management And General$51,182ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$152,276TotalAmt
Program Services$121,821ProgramServicesAmt
Management And General$30,455ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$1,596,194TotalAmt
Program Services$1,596,194ProgramServicesAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$72,925TotalAmt
Program Services$61,767ProgramServicesAmt
Management And General$11,158ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$908TotalAmt
Program Services$844ProgramServicesAmt
Management And General$64ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$84,259TotalAmt
Program Services$67,407ProgramServicesAmt
Management And General$16,852ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (3 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
Drugs/medical supplies$143,446$143,446
Provision for bad debts$107,460$107,460
Minor equipment/repairs$1,968$1,574$394

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$4,546,487TotalAmt
Program Services$4,010,153ProgramServicesAmt
Management And General$536,334ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$44,314BOYAmt
EOY$32,856EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$605,050BOYAmt
EOY$621,954EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
EOY$9,419EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$123,899LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$123,899LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$28,748EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$649,364BOYAmt
EOY$692,977EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$220,580BOYAmt
EOY$299,422EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$1,191,662BOYAmt
EOY$1,433,384EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$1,412,242BOYAmt
EOY$1,732,806EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY-$762,878BOYAmt
EOY-$1,040,829EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
EOY$1,000EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY-$762,878BOYAmt
EOY-$1,039,829EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$649,364BOYAmt
EOY$692,977EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$276,951ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit RequiredYes (1)FederalGrantAuditRequiredInd
Federal Grant Audit PerformedYes (1)FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2Yes (X)PubliclySupportedOrg509a2Ind

Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$120CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus1 Year$66,106CurrentTaxYearMinus1YearAmt
Current Tax Year$56,154CurrentTaxYearAmt
Total$122,380TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$2,421,710CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$3,384,204CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$4,267,173CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$4,415,619CurrentTaxYearMinus1YearAmt
Current Tax Year$4,213,382CurrentTaxYearAmt
Total$18,702,088TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$2,421,830CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$3,384,204CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$4,267,173CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$4,481,725CurrentTaxYearMinus1YearAmt
Current Tax Year$4,269,536CurrentTaxYearAmt
Total$18,824,468TotalAmt

Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$42CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$6,389CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$5,660CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$138CurrentTaxYearMinus1YearAmt
Total$12,229TotalAmt

Substantial Contributors Amt SubstantialContributorsAmtGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$42CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$6,389CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$5,660CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$138CurrentTaxYearMinus1YearAmt
Total$12,229TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$18,812,239PublicSupportTotal509Amt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$2,421,830CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$3,384,204CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$4,267,173CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$4,481,725CurrentTaxYearMinus1YearAmt
Current Tax Year$4,269,536CurrentTaxYearAmt
Total$18,824,468TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.99940PublicSupportCY509Pct
Public Support PY5090.99920PublicSupportPY509Pct
Investment Income CY0.00000InvestmentIncomeCYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$123,899OtherCostOrOtherBasisAmt
Depreciation$123,899DepreciationAmt
Book Value$0BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$0TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDescAmtAmt
Due to affiliates$813,916
Medicare obligations$619,468
FieldValueIRS element (for citing)
Total Liability$1,433,384TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePart X, Line 2:FormAndLineReferenceDesc
ExplanationCovenant 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. 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. Estimated interest and penalties, if applicable, related to uncertain tax positions are included as a component of income tax expense. 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.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (5 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
Stephen Grubbs
Trustee$0$851,411$0$30,924$0$26,982$0$8,700$0$27,490$0$945,507$0$0
Ganesha Santhyadka MD
Trustee$0$716,097$0$105$0$21,570$0$8,700$0$33,748$0$780,220$0$0
Mary Prybylo RN MSN
President & CEO, Ex-Officio$0$457,173$0$241,643$0$7,645$0$8,700$0$35,972$0$751,133$0$0
Michael Hendrix
Treasurer, VP Finance$0$324,148$0$8,509$0$13,329$0$7,349$0$34,343$0$387,678$0$0
Heather Evans DO
Trustee$0$240,744$0$0$0$234$0$6,788$0$19,532$0$267,298$0$0

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePart I, Line 3FormAndLineReferenceDesc
ExplanationAny 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.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part VI, Section A, line 6St. Joseph Healthcare Foundation is the sole corporate member of the Organization.
Form 990, Part VI, Section A, line 7aAs the sole corporate member of the Organization, St. Joseph Healthcare Foundation retains the ability to elect and remove the Organization's board of directors with or without cause.
Form 990, Part VI, Section A, line 7bAs the sole corporate member of the Organization, St. Joseph Healthcare Foundation 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 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; 4. To approve all long-range strategic plans before implementation; 5. To approve the acquisition, sale, or encumbrance of any real estate valued in excess of an amount set by the Member in writing; 6. To approve all capital budgets and non-budgeted expenses in excess of an amount set by the Member in writing; 7. To approve all debt in excess of limits set by the Member in writing; 8. To appoint the auditors; 9. To approve the sale, assignment, or transfer of any equity interest or membership interest in any subsidiary; 10. To approve any reclassification or other change of any capital stock or other equity security; 11. To approve the issuance of, or the creation of any obligation to issue, an equity security; and, 12. To evaluate the performance of the Medical Center in preserving, furthering, and promoting the purposes of the Medical Center.
Form 990, Part VI, Section B, line 11bThe Form 990 is provided to the governing body for their review and approval prior to filing.
Form 990, Part VI, Section B, line 12cThis process is the responsibility of the Compliance Officer of Covenant Health. 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 15Any 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 19The 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: www.covenanthealth.net/financial-information/financial-information
Form 990, Part IX, line 11gMedical and physician services: Program service expenses 1,596,194. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,596,194.
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 (36 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationIndDirect Controlling NADirectControllingNACd
CHS of Waltham Inc dba Maristhill Nursing & Rehab Center
66 Newton StreetWalthamMA02453043333609Nursing home and restorative facilityMA501(c)(3)Line 10Covenant Health Inc0
CHS of Worcester Inc dba St Mary Care Center
39 Queen StreetWorchesterMA01610043419625Nursing home and restorative facilityMA501(c)(3)Line 10Covenant Health Inc0
Community Clinical Services
PO Box 7291LewistonME04243010409788Physician practiceME501(c)(3)Line 10St Mary's Health System0
Covenant Health Foundation Inc
100 Ames Pond DriveTewksburyMA01876800199674Charitable foundationMA501(c)(3)Line 12a, ICovenant Health Inc0
Covenant Health Investment Trust
420 Bedford StreetLexingtonMA02420046835128Investment trustMA501(c)(3)Line 12a, ICovenant Health Inc0
Covenant Health Inc
100 Ames Pond DriveTewksburyMA01876222484505Health care management and resource organizationMA501(c)(3)Line 100N/A
Fanny Allen Corporation Inc
790 College ParkwayColchesterVT05446222495808Charitable foundationVT501(c)(3)Line 12a, ICovenant Health Inc0
Fanny Allen Holdings Inc
790 College ParkwayColchesterVT05446030181052Real estate holding companyVT501(c)(3)Line 12a, ICovenant Health Inc0
Helping Hands of St Marguerite Inc
799 Concord AvenueCambridgeMA02138800199674Private home-care health servicesMA501(c)(3)Line 10Covenant Health Inc0
M & J Company
360 BroadwayBangorME04402222480150Lease holding companyME501(c)(2)St Joseph Healthcare Foundation0
Mary Immaculate Guild Inc
172 Lawrence StreetLawrenceMA01841463073987Supporting grants and donationsMA501(c)(3)Line 12a, ICovenant Health Inc0
MI Adult Day Health Care Center Inc
189 Maple StreetLawrenceMA01841042921888Adult day care servicesMA501(c)(3)Line 10Covenant Health Inc0
MI Management Inc
172 Lawrence StreetLawrenceMA01841042857794Assisted living servicesMA501(c)(3)Line 12a, ICovenant Health Inc0
MI Nursing Restorative Center Inc
172 Lawrence StreetLawrenceMA01841042104851Nursing home and restorative facilityMA501(c)(3)Line 10Covenant Health Inc0
MI Residential Community Inc
189 Maple StreetLawrenceMA01841042647207HUD low income housingMA501(c)(3)Line 10Covenant Health Inc0
MI Transportation Inc
189 Maple StreetLawrenceMA01841042921889Elderly transportation servicesMA501(c)(3)Line 10Covenant Health Inc0
Mount St Rita Health Centre
15 Sumner Brown RoadCumberlandRI02864050342330Nursing homeRI501(c)(3)Line 10Covenant Health Inc0
Neighborhood Housing Initiative
PO Box 7291LewistonME04243010539730Affordable housing servicesME501(c)(3)Line 10St Mary's Health System0
Penacook Place Inc
150 Water StreetHaverhillMA01830237090088Nursing homeMA501(c)(3)Line 10Covenant Health Inc0
Souhegan Nursing Association
24 North River RoadMilfordNH03055020222795Home health and hospiceNH501(c)(3)Line 10St Joseph Hospital of Nashua NH Inc0
St Joseph Ambulatory Care Inc
360 BroadwayBangorME04402222480373Physician practiceME501(c)(3)Line 3St Joseph Healthcare Foundation0
St Andre Health Care
407 Pool StreetBiddefordME04005010342399Nursing home and restorative facilityME501(c)(3)Line 10Covenant Health Inc0
St Joseph Healthcare Foundation
360 BroadwayBangorME04402222480149Healthcare foundationME501(c)(3)Line 7Covenant Health Inc0
St Joseph Hospital
360 BroadwayBangorME04402010212435Hospital and health care facilityME501(c)(3)Line 3St Joseph Healthcare Foundation0
St Joseph Manor Health Care
215 Thatcher StreetBrocktonMA02302042565937Nursing home and restorative facilityMA501(c)(3)Line 10Covenant Health Inc0
St Joseph's Hospital of Nashua NH Inc
172 Kinsley StreetNashuaNH03061020222215Hospital and health care facilityNH501(c)(3)Line 3Covenant Health Inc0
St Mary's D'Youville Pavilion
PO Box 7291LewistonME04243010211558Nursing home and restorative facilityME501(c)(3)Line 10St Mary's Health System0
St Mary's Health System
PO Box 7291LewistonME04243222504349Hospital and health care facilityME501(c)(3)Line 12a, ICovenant Health Inc0
St Mary's Regional Medical Center
PO Box 7291LewistonME04243010211551Hospital and health care facilityME501(c)(3)Line 3St Mary's Health System0
St Mary's Residences
PO Box 7291LewistonME04243222504356Low income housingME501(c)(3)Line 10St Mary's Health System0
St Mary's Villa Nursing Home Inc
675 St Marys Villa RoadMoscowPA18444232057177Nursing home and restorative facilityPA501(c)(3)Line 10Covenant Health Inc0
The Surgicenter at St Joseph Hospital Inc
172 Kinsley StreetNashuaNH03061020222215Healthcare and surgery centerNH501(c)(3)Line 10St Joseph Hospital of Nashua NH Inc0
Youville Hospital and Rehabilitation Center Inc
1575 Cambridge StreetCambridgeMA02138043239563Hospital and health care facilityMA501(c)(3)Line 10Youville Lifecare Inc0
Youville House Inc
1573 Cambridge StreetCambridgeMA02138043239593Assisted living servicesMA501(c)(3)Line 10Youville Lifecare Inc0
Youville Lifecare Inc
1575 Cambridge StreetCambridgeMA02138042103582Hospital and health care facilityMA501(c)(3)Line 10Covenant Health Inc0
Youville Place
10 Pelham RoadLexingtonMA02421043297834Assisted living servicesMA501(c)(3)Line 10Covenant Health Inc0

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (6 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdDirect Controlling NADirectControllingNACdEntity TypeEntityTypeTxtControlled OrganizationControlledOrganizationIndAddress Line1ForeignAddress/AddressLine1TxtCityForeignAddress/CityNmCountryForeignAddress/CountryCdForeign PostalForeignAddress/ForeignPostalCdLegal Domicile Foreign CountryLegalDomicileForeignCountryCd
Campus Holding
PO box 7291LewistonME04240010406049Holding companyMEN/AC0
Covenant Health Insurance LTD
043360127Self-insurance companyN/AC0PO Box 69Grand CaymanCJKY1-1102CJ
GNM Corporation
172 Kinsley StreetNashuaNH03060020400550Real estate holding companyNHN/AC0
SJ Physicians Services
172 Kinsley StreetNashuaNH03060020522234Physician practiceNHN/AC0
St Joseph Corporate Services Inc
172 Kinsley StreetNashuaNH03060020405197Holding companyNHN/AC0
Strauss Incorporated
360 BroadwayBangorME04402010391369Repairs and transcriptionsMEN/AC0
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgYes (1)RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (1)PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (1)PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees Sharing0PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (1)ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd