2022-11-15T14:44:11-06:00 2021-12-31 111986323 MARCUM LLP 555 LONG WHARF DRIVE NEW HAVEN CT 06511 990 2021-01-01 222843194 OVERLOOK MASONIC HEALTH CENTER INC OVER 5082487344 88 MASONIC HOME ROAD CHARLTON MA 01507 TAMERYN CAMPBELL CEO/PRESIDENT 5082487344 2022-11-15 1 TAMERYN CAMPBELL 999009999 MARY ANTONETTI P00431862 2037819600 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z TAMERYN CAMPBELL 88 MASONIC HOME ROAD CHARLTON MA 01507 29981273 0 X HTTP://OVERLOOK-MASS.ORG X 1987 MA THE PROVISION OF LONG-TERM RESIDENTIAL AND REHABILITATIVE CARE TO RESIDENTS OF THE COMMUNITY. 10 9 409 17 0 0 306839 3662222 23306946 22320762 673663 2070324 383977 382991 24671425 28436299 2500 0 0 0 14753998 16773834 0 0 0 12208021 12601685 26964519 29375519 -2293094 -939220 147982116 148489436 11700155 12005864 136281961 136483572 TO PROVIDE THE RESIDENTS OF THE HEALTH CENTER WITH THE HIGHEST LEVEL OF COMPREHENSIVE MEDICAL CARE SERVICES WITH A CONSIDERATE AND PERSONAL TOUCH. 0 0 20025746 22400873 OPERATION OF A LONG-TERM CARE FACILITY IN CHARLTON, MA. TOTAL PATIENT DAYS OF CARE FOR 2021 TOTALED 36,315. OPERATION OF A POST ACUTE FACILITY IN CHARLTON, MA. TOTAL PATIENT CARE DAYS FOR 2021 TOTALED 6,520. OPERATION OF A RESIDENTIAL ENHANCED LIVING FACILITY IN CHARLTON, MA TOTAL PATIENT CARE DAYS FOR 2021 TOTALED 7,170. OPERATION OF A MEMORY CARE RESIDENTIAL UNIT AND ADULT DAY CARE MEMORY PROGRAM FACILITY IN CHARLTON, MA. FIELDSTONE MEMORY CARE RESIDENTIAL UNIT TOTAL PATIENT CARE DAYS TOTALED 4,471. VISTA ADULT DAY PROGRAM TOTALED 481 DAYS OF CARE. 20025746 1 1 0 0 0 0 0 0 1 1 1 1 0 1 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 1 0 0 0 1 108 0 1 409 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X TAMERYN CAMPBELL 5084342412 88 MASONIC HOME ROAD CHARLTON MA 01507 RICHARD MAGGIO GRAND MASTER 0.15 1.30 X 0 0 0 KENNETH BLAKE MHS BOARD CHAIR 0.15 1.30 X 0 0 0 MASON RUSSELL EX OFFICIO 0.15 1.30 X 0 0 0 ROBERT JOLLY CHAIR 0.15 0.30 X X 0 0 0 JACK MULHALL VICE CHAIR 0.15 0.15 X X 0 0 0 WILLIAM HOLLAND DECEASED 2022 TREASURER 0.15 1.30 X X 0 0 0 DAVID PACE SECRETARY 0.15 1.30 X X 0 0 0 ROBERT SCHREMSER CLERK 0.15 1.30 X X 0 0 0 TAMERYN CAMPBELL PRESIDENT & CEO 40.00 1.30 X X 573867 0 72729 JAMES TRACY FROM 1222021 TREASURER 0.15 1.15 X X 0 0 0 TED WILBUR CHIEF INFORMATION OFFICER 40.00 X 159376 0 20486 JOE SAVIDGE CHIEF FINANCIAL OFFICER 40.00 X 163194 0 22389 AKEYO DONALD O NURSE SUPERVISOR 60.00 X 161316 0 27815 NDUYU PAMELA NURSE SUPERVISOR 57.00 X 127974 0 0 1185727 0 143419 5 0 1 0 PRO EMS SOLUTIONS INC 31 SMITH PLACE CAMBRIDGE MA 02138 COVID TESTING, LAB PROCESSING, AND REPOR 632760 CUSTOM COMPUTER SPECIALISTS INC PO BOX 29786 NEW YORK NY 100879786 IT SUPPORT 376629 MARCUM LLP 185 ASYLUM STREET 25TH FLOOR HARTFORD CT 06103 ACCOUNTING, TAX, AND COST REPORT SERVICE 133150 MINDSETGO INC 36 POWDER HILL WAY WESTBOROUGH MA 01581 LEADERSHIP TRAINING & COACHING 105731 4 3370540 291682 3662222 NET PATIENT REVENUE 623000 19055935 19055935 AFFILIATE MANAGEMENT FEE 900099 3264827 3264827 22320762 110999 110999 302880 0 302880 302880 302880 3504299 1544974 1959325 1959325 1959325 OTHER PAYER REVENUE 623000 57045 57045 OTHER TENANT REVENUE 623000 20842 20842 CABLE TV ACCESS 900099 2224 2224 80111 28436299 22400873 0 2373204 X 964042 964042 12866814 10710400 2156414 319842 279032 40810 1441120 1248577 192543 1182016 987473 194543 1672849 1672849 116324 116324 57265 57265 118427 118427 3620071 1087677 2532394 230609 230609 2026312 1304892 721420 928901 928901 35067 2271 32796 120540 7165 113375 71532 71532 1340824 1296454 44370 437118 437118 DIETARY SERVICES 789818 789818 BAD DEBT EXPENSE 477740 477740 EQUIP RENTAL & MAINT 380066 329856 50210 RESIDENT BED TAX 84611 84611 93611 53761 39850 29375519 20025746 9349773 0 41371 308500 1279774 1563757 747013 413285 64948579 48120996 17474353 16827583 24272112 28847669 104167493 100528642 147982116 148489436 2451684 2519075 1292218 1134222 7956253 8352567 11700155 12005864 X 121326971 120114185 14954990 16369387 136281961 136483572 147982116 148489436 X -939220 796785 344046 X X 0 1 X 1 0 X 157742 345475 190513 306839 3662222 4662791 20985319 21483512 22875495 23306946 22320762 110972034 21143061 21828987 23066008 23613785 25982984 115634825 0 0 0 115634825 531163 573397 455869 360651 413879 2334959 531163 573397 455869 360651 413879 2334959 2058583 92989 80111 2231683 21674224 22402384 25580460 24067425 26476974 120201467 0.96200 0.96190 0.01940 0.02000 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISC INCOME - 2019 AMOUNT: $ 2,058,583. 2020 AMOUNT: $ 92,989. 2021 AMOUNT: $ 80,111. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 50890 33737 1 X 24287640 3210357 2749728 1384528 28863197 22109679 329674 2868492 1020205 24287640 19644993 805705 3140400 1481419 22109679 55155848 1664971 -1508578 35667248 19644993 54967835 178526 24740 15253 55155848 0.43233 0.19854 0.36914 0 0 336084 336084 46511889 34108295 12403594 10203034 8175846 2027188 7897572 5836855 2060717 16827583 MASONIC EDUCATION AND CHARITY TRUST INVESTMENT FUND 28847669 C 28847669 DUE FROM AFFILIATES 100236368 OTHER RECEIVABLES 48113 DUE FROM GRAND LODGE 244161 100528642 DUE TO AFFILIATES 6391766 DUE TO RESIDENTS 33737 ASSET RETIREMENT OBLIGATION 921064 PENSION LIABILITY 1006000 8352567 X 27222520 796785 -477740 319045 26903475 118427 1414397 1532824 28436299 28779352 0 28779352 118427 477740 596167 29375519 PART IV, LINE 2B: PERSONS ADMITTED TO THE HEALTH CENTER WHO DO NOT WISH TO APPOINT A RESPONSIBLE PARTY TO MANAGE THEIR ASSETS MAY, IF THEY WISH, HAVE THE HEALTH CENTER ASSUME THE RESPONSIBILITY OF MANAGING THEIR ASSETS ON THEIR BEHALF. ASSETS THAT ARE TRANSFERRED TO THE HEALTH CENTER UNDER THIS ARRANGEMENT ARE CO-MINGLED WITH THE ASSETS OF OTHER RESIDENTS AND PLACED IN AN INVESTMENT TRUST ACCOUNT PURSUANT TO A REVOCABLE TRUST AGREEMENT. ALL SUCH FUNDS HAVE BEEN PLACED IN A MONEY MARKET ACCOUNT IN THE HEALTH CENTER'S NAME AT A BANK. ALL RECEIPTS FROM RESIDENTS DURING THEIR PERIOD OF RESIDENCY AND ALL CHARGES FOR ROOM AND BOARD AND MEDICAL CARE ARE CREDITED AND/OR CHARGED TO THEIR INDIVIDUAL ACCOUNTS. INTEREST IS CALCULATED MONTHLY ON THE TOTAL TRUST ACCOUNT AND CREDITED TO EACH RESIDENT IN ACCORDANCE WITH HIS/HER PRO RATA BALANCE. THESE FUNDS, AND CORRESPONDING LIABILITIES, ARE RECORDED ON THE CONSOLIDATED BALANCE SHEETS AND ARE INCLUDED IN CASH AND EQUIVALENTS AND ACCOUNTS PAYABLE. THE RESIDENT PORTIONS OF EACH OF THESE RESPECTIVE ACCOUNTS WERE $33,737 AND$50,890 AT DECEMBER 31, 2021 AND 2020, RESPECTIVELY. PART V, LINE 4: THE ORGANIZATION HAS AN ENDOWMENT WHICH IS HELD IN THE MASONIC EDUCATION AND CHARITY TRUST. FUNDS ARE SPENT FROM THE ENDOWMENT WHEN NEEDED FOR OPERATIONS OR CAPITAL IMPROVEMENTS. PART X, LINE 2: BELOW IS AN EXCERPT FROM FOOTNOTE 2 OF THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS FOR THE MASONIC HEALTH SYSTEM OF MASSACHUSETTS, INC. MHS, HEALTH CENTER, OVNA, COMMUNITIES, AND NORTHAMPTON HAVE BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE ORGANIZATION ACCOUNTS FOR UNCERTAINTY IN INCOME TAX POSITIONS BY APPLYING A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2021 AND 2020, THERE ARE NO TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE ORGANIZATION IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS PENDING OR IN PROGRESS. PART XI, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT EXPENSE -477,740. PART XI, LINE 4B - OTHER ADJUSTMENTS: DONOR RESTRICTED ACTIVITY 1,414,397. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 477,740. X 0 0 X X X X 0 0 0 0 0 0 0 0 0 TAMERYN CAMPBELL PRESIDENT & CEO 395329 0 175700 0 2838 0 10872 0 61857 0 646596 0 0 0 AKEYO DONALD O NURSE SUPERVISOR 161215 0 0 0 101 0 3440 0 24375 0 189131 0 0 0 JOE SAVIDGE CHIEF FINANCIAL OFFICER 158912 0 0 0 4282 0 0 0 22389 0 185583 0 0 0 TED WILBUR CHIEF INFORMATION OFFICER 158004 0 0 0 1372 0 3291 0 17195 0 179862 0 0 0 PART I, LINE 1A TAMERYN CAMPBELL RECEIVED A HOUSING ALLOWANCE FROM A RELATED ORGANIZATION (OC) WITH AN ESTIMATED VALUE OF $48,000 DURING THE YEAR ENDING DECEMBER 31, 2021. THIS WAS REPORTED AS A NONTAXABLE BENEFIT TO TAMERYN. FORM 990, PART VI, SECTION A, LINE 6 THE MASONIC HEALTH SYSTEM OF MASSACHUSETTS, INC. IS THE SOLE MEMBER OF THE ORGANIZATION AND ELECTS THE BOARD OF DIRECTORS. THERE ARE NO CLASSES OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7A THE MASONIC HEALTH SYSTEM OF MASSACHUSETTS, INC. HAS THE POWER TO REMOVE DIRECTORS, TO FILL VACANCIES, AND TO INCREASE OR DECREASE THE SIZE OF THE BOARD. FORM 990, PART VI, SECTION A, LINE 7B THE MASONIC HEALTH SYSTEM OF MASSACHUSETTS, INC. HAS THE POWER TO REMOVE DIRECTORS, TO FILL VACANCIES, AND TO INCREASE OR DECREASE THE SIZE OF THE BOARD. FORM 990, PART VI, SECTION B, LINE 11B MANAGEMENT WORKS WITH THE ORGANIZATION'S TAX ADVISOR (CPA FIRM) TO PREPARE THE FINANCIAL INFORMATION AND COMPILE THE DISCLOSURES REQUIRED OF THE FORM 990. UPON ITS COMPLETION, SENIOR MANAGEMENT PROVIDES A DRAFT OF THE FORM 990 TO THE BOARD OF DIRECTORS PRIOR TO ITS SUBMISSION. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REGULARLY AND CONSISTENLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY VIA ANNUAL EXECUTION OF THE CONFLICT OF INTEREST POLICY. THIS CONFLICTS POLICY IS INTENDED TO SUPPLEMENT, BUT NOT REPLACE, ANY APPLICABLE STATE LAWS GOVERNING CONFLICTS OF INTEREST APPLICABLE TO NONPROFIT AND CHARITABLE CORPORATIONS. THIS CONFLICTS POLICY HAS BEEN ADOPTED BY THE BOARD OF DIRECTORS OF MASONIC HEALTH SYSTEM OF MASSACHUSETTS, INC. (MHS). THIS CONFLICTS POLICY SHALL APPLY WITH EQUAL FORCE TO ALL CORPORATIONS RELATED TO, OR AFFILIATED WITH, MHS. ON AN ANNUAL BASIS THE DIRECTORS COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE WHICH IS REVIEWED BY THE PRESIDENT'S OFFICE. IF A CONFLICT ARISES, THE INDIVIDUAL WOULD RECUSE THEMSELVES FROM ALL DISCUSSION ON THE MATTER. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION'S SOLE MEMBER, MASONIC HEALTH SYSTEM OF MASSACHUSETTS, INC. MAINTAINS AN EXECUTIVE COMMITTEE, WHICH AMONG OTHER THINGS, REVIEWS THE COMPENSATION AND TERMS OF THE AGREEMENT WITH ITS EXECUTIVE OFFICER. THE COMMITTEE REVIEWS THE COMPENSATION OF THE INDIVDIUAL IN RELATION TO THE SALARY LEVEL OF OTHER COMPARABLE POSITIONS IN THE MARKET AND THEIR PERFORMANCE. ONCE REASONABLE COMPENSATION IS DETERMINED, IT IS APPROVED BY THE BOARD. FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATION'S FORM 990 IS AVAILABLE TO THE PUBLIC UPON REQUEST AND CAN BE FOUND ONLINE VIA THE MASSACHUSETTS ATTORNEY GENERAL'S WEBSITE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S FINANCIAL STATEMENTS CONFLICT OF INTEREST POLICY, AND GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G CONSULTING FEES: PROGRAM SERVICE EXPENSES 104,121. MANAGEMENT AND GENERAL EXPENSES 49,273. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 153,394. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 47,760. MANAGEMENT AND GENERAL EXPENSES 58,610. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 106,370. RECRUITMENT FEES: PROGRAM SERVICE EXPENSES 35,050. MANAGEMENT AND GENERAL EXPENSES 16,500. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 51,550. MEDICAL DIRECTOR FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 79,937. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 79,937. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 39,250. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 39,250. SERVICE CONTRACTS: PROGRAM SERVICE EXPENSES 900,746. MANAGEMENT AND GENERAL EXPENSES 1,461,691. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,362,437. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 827,133. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 827,133. FORM 990, PART XI, LINE 9: ADJUSTMENT TO MINIMUM PENSION LIABILITY 344,046. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. MASONIC HEALTH SYSTEM OF MASSACHUSETTS INC 88 MASONIC HOME ROAD CHARLTON MA 01507 043515688 PARENT MA 501(C)(3) LINE 12C, III-FI N/A 0 OVERLOOK VISITING NURSES ASSOCIATION 88 MASONIC HOME ROAD CHARLTON MA 01507 043515687 VNA MA 501(C)(3) LINE 10 MASONIC HEALTH SYSTEM OF MASSACHUSETTS 1 OVERLOOK COMMUNITIES INC 88 MASONIC HOME ROAD CHARLTON MA 01507 043515686 NURSING FACILITY MA 501(C)(3) LINE 10 MASONIC HEALTH SYSTEM OF MASSACHUSETTS 1 0 0 0 1 1 0 0 0 0 1 0 1 0 1 0 0 0 0 0 MASONIC HEALTH SYSTEM OF MASSACHUSETTS N 15853 CASH MASONIC HEALTH SYSTEM OF MASSACHUSETTS D 73753605 CASH OVERLOOK VISITING NURSE ASSOCIATION E 928859 CASH OVERLOOK VISITING NURSE ASSOCIATION D 356324 CASH OVERLOOK VISITING NURSE ASSOCIATION J 152880 CASH OVERLOOK VISITING NURSE ASSOCIATION L 1025677 CASH OVERLOOK COMMUNITIES N 713202 CASH OVERLOOK COMMUNITIES D 26542013 CASH OVERLOOK COMMUNITIES J 3031392 CASH OVERLOOK COMMUNITIES L 575559 CASH