2022-11-08T12:07:26-06:00 2021-12-31 010494526 Baker Newman & Noyes PO Box 507 Portland ME 04112 990 2021-01-01 010422885 Alternative Health Services ALTE 2079071233 360 Broadway PO Box 403 Bangor ME 044020403 Michael Hendrix CFO 2079071233 2022-11-07 1 Michael Hendrix 999009999 Connor Smart P02285543 2078792100 2022-11-07 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z Mary Prybylo 360 Broadway PO Box 403 Bangor ME 044020403 4269536 0 X N/A X 1987 ME Home health and hospice agency 15 12 44 13 0 0 66106 56154 4415619 4213382 0 0 0 0 4481725 4269536 0 0 0 0 2458322 2539327 0 0 0 1899307 2007160 4357629 4546487 124096 -276951 649364 692977 1412242 1732806 -762878 -1039829 Home health care and hospice agency 0 0 4010153 0 4213382 Home 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. 4010153 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 5 0 1 44 1 0 0 0 0 0 0 0 0 0 0 X 15 12 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 ME X X Michael Hendrix CFO 2079071233 360 Broadway PO Box 403 Bangor ME 044020403 Stephen Grubbs Trustee 0.10 45.40 X 0 909317 36190 Ganesha Santhyadka MD Trustee 0.10 40.40 X 0 737772 42448 Heather Evans DO Trustee 0.10 40.40 X 0 240978 26320 William Buckley Trustee 0.10 0.40 X 0 0 0 Robert Clark Trustee 0.10 0.40 X 0 0 0 Thomas Daffron Trustee (end 6/2021) 0.10 0.40 X 0 0 0 Rosalind Prince Gilman Esq Trustee 0.10 0.40 X 0 0 0 Anita Haskell Trustee 0.10 0.40 X 0 0 0 Curtis Kimball Esq Trustee 0.10 0.40 X 0 0 0 Bernard LaBree Trustee 0.10 0.40 X 0 0 0 Adrien Roy Jr Trustee 0.10 0.40 X 0 0 0 Bradley Ryder Trustee 0.10 0.40 X 0 0 0 Rebecca Whitmore Trustee 0.10 0.40 X 0 0 0 William Wood MD Trustee 1.00 0.40 X 0 0 0 William Lucy Chair 0.10 0.40 X X 0 0 0 L William Demaso Vice Chair 0.10 0.40 X X 0 0 0 Mary Prybylo RN MSN President & CEO, Ex-Officio 0.10 40.40 X 0 706461 44672 Michael Hendrix Treasurer, VP Finance 0.10 40.40 X 0 345986 41692 Donna Berry Secretary 0.10 40.40 X 0 79469 24353 Dana Cassidy Homecare and Hospice Lead 40.00 0.00 X 115251 0 14828 Kevin Kenny Staff RN Home Health 40.00 0.00 X 110793 0 14729 Caroline Vickers Staff RN Home Health 40.00 0.00 X 107754 0 14474 Melanie Glidden Staff RN Home Health 40.00 0.00 X 106664 0 11770 Heidi Ketch Executive Director Community Health and Hospice 40.00 0.00 X 101970 0 4519 542432 3019983 275995 5 0 1 0 Dragonfly Therapy 840 Hammond Street Suite 2 Bangor ME 04401 Physical therapy and rehabilatation 1390729 Blacktree Healthcare Consulting 1030 Continental Dr King of Prussia PA 19406 Healthcare consulting 130880 2 56154 56154 Patient services 621610 4213382 4213382 4213382 4269536 4213382 0 0 X 2099309 1679447 419862 31833 25466 6367 255909 204727 51182 152276 121821 30455 1596194 1596194 72925 61767 11158 908 844 64 84259 67407 16852 Drugs/medical supplies 143446 143446 Provision for bad debts 107460 107460 Minor equipment/repairs 1968 1574 394 4546487 4010153 536334 0 44314 32856 605050 621954 9419 123899 123899 0 0 0 28748 649364 692977 220580 299422 1191662 1433384 1412242 1732806 X -762878 -1040829 1000 -762878 -1039829 649364 692977 -276951 0 X X 0 1 X 1 1 1 X 120 66106 56154 122380 2421710 3384204 4267173 4415619 4213382 18702088 2421830 3384204 4267173 4481725 4269536 18824468 42 6389 5660 138 12229 0 42 6389 5660 138 12229 18812239 2421830 3384204 4267173 4481725 4269536 18824468 0.99940 0.99920 0.00000 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 123899 123899 0 0 Due to affiliates 813916 Medicare obligations 619468 1433384 X Part X, Line 2: Covenant and its member organizations are considered not-for-profit corporations as described in Section 501(c)(3) of the Internal Revenue Code and are exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. 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. 0 0 0 0 0 0 0 0 0 Stephen Grubbs Trustee 0 851411 0 30924 0 26982 0 8700 0 27490 0 945507 0 0 Ganesha Santhyadka MD Trustee 0 716097 0 105 0 21570 0 8700 0 33748 0 780220 0 0 Mary Prybylo RN MSN President & CEO, Ex-Officio 0 457173 0 241643 0 7645 0 8700 0 35972 0 751133 0 0 Michael Hendrix Treasurer, VP Finance 0 324148 0 8509 0 13329 0 7349 0 34343 0 387678 0 0 Heather Evans DO Trustee 0 240744 0 0 0 234 0 6788 0 19532 0 267298 0 0 Part I, Line 3 Any compensation paid to the trustees, directors, officers or key employees of the Organization is subject to the oversight and decisions of Covenant Health, a related tax-exempt organization. Every two-to-three years the Compensation Committee of the Covenant Health Board of Directors engages an external consultant to provide competitive market data from various survey sources, which is then used to develop recommendations for changes to the compensation program. Since 2003, the Compensation Committee has engaged a human resources consultant to conduct this analysis. Objectives of the analysis are to assess the compositeness of the total cash compensation levels of the senior leadership team, develop market based competitive salary ranges for all executive positions, and ensure that the annual incentive opportunities, if there are any, are competitive and reasonable. Form 990, Part VI, Section A, line 6 St. Joseph Healthcare Foundation is the sole corporate member of the Organization. Form 990, Part VI, Section A, line 7a As 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 7b As 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 11b The Form 990 is provided to the governing body for their review and approval prior to filing. Form 990, Part VI, Section B, line 12c This process is the responsibility of the Compliance Officer 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 15 Any compensation paid to the trustees, directors, officers or key employees of the Organization is subject to the oversight and decisions of Covenant Health, a related tax-exempt organization. Every two-to-three years the Compensation Committee of the Covenant Health Board of Directors engages an external consultant to provide competitive market data from various survey sources, which is then used to develop recommendations for changes to the compensation program. Since 2003, the Compensation Committee has engaged a human resources consultant to conduct this analysis. Objectives of the analysis are to assess the compositeness of the total cash compensation levels of the senior leadership team, develop market based competitive salary ranges for all executive positions, and ensure that the annual incentive opportunities, if there are any, are competitive and reasonable. Form 990, Part VI, Section C, line 19 The Organization's Form 990, governing documents, conflict of interest policy, and financial statements are made available to the public upon request. The Organization's Form 990 is also made available on the website of its parent organization, Covenant Health, at the following web address: www.covenanthealth.net/financial-information/financial-information Form 990, Part IX, line 11g Medical 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. 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 Worchester MA 01610 043419625 Nursing home and restorative facility MA 501(c)(3) Line 10 Covenant Health Inc 0 Community Clinical Services PO Box 7291 Lewiston ME 04243 010409788 Physician practice ME 501(c)(3) Line 10 St Mary's Health System 0 Covenant Health Foundation Inc 100 Ames Pond Drive Tewksbury MA 01876 800199674 Charitable foundation MA 501(c)(3) Line 12a, I Covenant Health Inc 0 Covenant Health Investment Trust 420 Bedford Street Lexington MA 02420 046835128 Investment trust MA 501(c)(3) Line 12a, I Covenant Health Inc 0 Covenant Health Inc 100 Ames Pond Drive Tewksbury MA 01876 222484505 Health care management and resource organization MA 501(c)(3) Line 10 N/A 0 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 Inc 189 Maple Street Lawrence MA 01841 042647207 HUD low income housing MA 501(c)(3) Line 10 Covenant Health Inc 0 MI Transportation Inc 189 Maple Street Lawrence MA 01841 042921889 Elderly transportation services MA 501(c)(3) Line 10 Covenant Health Inc 0 Mount St Rita Health Centre 15 Sumner Brown Road Cumberland RI 02864 050342330 Nursing home RI 501(c)(3) Line 10 Covenant Health Inc 0 Neighborhood Housing Initiative PO Box 7291 Lewiston ME 04243 010539730 Affordable housing services ME 501(c)(3) Line 10 St Mary's Health System 0 Penacook Place Inc 150 Water Street Haverhill MA 01830 237090088 Nursing home MA 501(c)(3) Line 10 Covenant Health Inc 0 Souhegan Nursing Association 24 North River Road Milford NH 03055 020222795 Home health and hospice NH 501(c)(3) Line 10 St Joseph Hospital of Nashua NH Inc 0 St Joseph Ambulatory Care Inc 360 Broadway Bangor ME 04402 222480373 Physician practice ME 501(c)(3) Line 3 St Joseph Healthcare Foundation 0 St Andre Health Care 407 Pool Street Biddeford ME 04005 010342399 Nursing home and restorative facility ME 501(c)(3) Line 10 Covenant Health Inc 0 St Joseph Healthcare Foundation 360 Broadway Bangor ME 04402 222480149 Healthcare foundation ME 501(c)(3) Line 7 Covenant Health Inc 0 St Joseph Hospital 360 Broadway Bangor ME 04402 010212435 Hospital and health care facility ME 501(c)(3) Line 3 St Joseph Healthcare Foundation 0 St Joseph Manor Health Care 215 Thatcher Street Brockton MA 02302 042565937 Nursing home and restorative facility MA 501(c)(3) Line 10 Covenant Health Inc 0 St Joseph's Hospital of Nashua NH Inc 172 Kinsley Street Nashua NH 03061 020222215 Hospital and health care facility NH 501(c)(3) Line 3 Covenant Health Inc 0 St Mary's D'Youville Pavilion PO Box 7291 Lewiston ME 04243 010211558 Nursing home and restorative facility ME 501(c)(3) Line 10 St Mary's Health System 0 St Mary's Health System PO Box 7291 Lewiston ME 04243 222504349 Hospital and health care facility ME 501(c)(3) Line 12a, I Covenant Health Inc 0 St Mary's Regional Medical Center PO Box 7291 Lewiston ME 04243 010211551 Hospital and health care facility ME 501(c)(3) Line 3 St Mary's Health System 0 St Mary's Residences PO Box 7291 Lewiston ME 04243 222504356 Low income housing ME 501(c)(3) Line 10 St Mary's Health System 0 St Mary's Villa Nursing Home Inc 675 St Marys Villa Road Moscow PA 18444 232057177 Nursing home and restorative facility PA 501(c)(3) Line 10 Covenant Health Inc 0 The Surgicenter at St Joseph Hospital Inc 172 Kinsley Street Nashua NH 03061 020222215 Healthcare and surgery center NH 501(c)(3) Line 10 St Joseph Hospital of Nashua NH Inc 0 Youville Hospital and Rehabilitation Center Inc 1575 Cambridge Street Cambridge MA 02138 043239563 Hospital and health care facility MA 501(c)(3) Line 10 Youville Lifecare Inc 0 Youville House Inc 1573 Cambridge Street Cambridge MA 02138 043239593 Assisted living services MA 501(c)(3) Line 10 Youville Lifecare Inc 0 Youville Lifecare Inc 1575 Cambridge Street Cambridge MA 02138 042103582 Hospital and health care facility MA 501(c)(3) Line 10 Covenant Health Inc 0 Youville Place 10 Pelham Road Lexington MA 02421 043297834 Assisted living services MA 501(c)(3) Line 10 Covenant Health Inc 0 Campus Holding PO box 7291 Lewiston ME 04240 010406049 Holding company ME N/A C 0 Covenant Health Insurance LTD PO Box 69 Grand Cayman CJ KY1-1102 043360127 Self-insurance company CJ N/A C 0 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 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 1 0 0