2021-11-10T13:42:13-06:00 2020-12-31 410746749 CLIFTONLARSONALLEN LLP 2 INTERNATIONAL PLACE 22ND FLOOR BOSTON MA 02110 990 2020-01-01 050382511 JOHN CLARKE RETIREMENT CENTER JOHN 4018460743 600 VALLEY ROAD MIDDLETOWN RI 02846 JOAN M WOODS CEO 4018460743 2021-11-10 1 JOAN WOODS 999009999 LAURA J KENNEY P00202198 6177170831 2021-11-10 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z JOAN M WOODS 600 VALLEY ROAD MIDDLETOWN RI 02846 8968762 0 X WWW.JOHNCLARKERETIREMENT.ORG X 1979 RI OPERATION OF NURSING HOME AND RETIREMENT CENTER 11 9 114 13 0 0 30351 1239876 6377762 6282812 173136 378535 3713 0 6584962 7901223 0 0 0 0 3821566 3908307 0 0 0 3129942 3022767 6951508 6931074 -366546 970149 5410132 5931040 3477179 3183738 1932953 2747302 X JOHN CLARKE RETIREMENT AND NURSING CENTER WILL ENDEAVOR TO PROVIDE IN A CHRISTIAN ATMOSPHERE, A RETIREMENT LIVING PHILOSOPHY THAT WILL MEET THE NEEDS OF THE ELDERLY COMMUNITY. THIS APPROACH WILL INCLUDE RESIDENTIAL SERVICES, SKILLED NURSING CARE, AND ATTEMPT TO PROVIDE OTHER SERVICES ASSOCIATED WITH RETIREMENT LIVING AND LONG TERM CARE AS WARRANTED. IT IS THE POLICY OF JOHN CLARKE RETIREMENT AND NURSING CENTER TO ADMIT ALL RESIDENTS WITHOUT REGARD TO RACE, SEXUAL ORIENTATION, RELIGION, AND/OR HANDICAP. THE SAME REQUIREMENTS FOR ADMISSION ARE APPLIED TO ALL. RETIREMENT CENTER TENANTS AND NURSING CENTER RESIDENTS ARE ASSIGNED APARTMENTS OR ROOMS WITHIN EACH FACILITY WITHOUT REGARD FOR ANY OF THE ABOVE. 0 0 5571790 5397650 JOHN CLARKE RETIREMENT CENTER OPERATION INCLUDES A NURSING CENTER AND RETIREMENT CENTER FOR THE ELDERLY AND NEEDY. THE NURSING CENTER FACILITY IS MEDICARE AND MEDICAID CERTIFIED. THE FACILITY ALSO PROVIDED PHYSICAL THERAPY, OCCUPATIONAL THERAPY, AND SPEECH THERAPY. DURING 2020 THERE WERE 17,939 BED DAYS PROVIDED. INCLUDED IN THIS TOTAL WERE 10,993 MEDICAID AND 1,752 MEDICARE BED DAYS PROVIDED. 522608 885162 THE RETIREMENT CENTER IS A TWO LEVEL 50 APARTMENT FACILITY FEATURING LIVING ROOM, BEDROOM, FULL BATH AND ALL-ELECTRIC KITCHENS. 6094398 1 1 0 0 0 0 0 0 1 1 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 9 0 1 114 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 1 0 0 X JOAN WOODS 4018460743 600 VALLEY ROAD MIDDLETOWN RI 02846 JOHN THORPE PRESIDENT 5.00 X X 0 0 0 DIANE LITTERICK VICE PRESIDENT 5.00 X X 0 0 0 PETER CHATELLIER TREASURER 5.00 X X 0 0 0 DAVID MAINE SECRETARY 5.00 X X 0 0 0 ROBERT BUTZIER FINANCE COMMITTEE CHAIRPER 5.00 X 0 0 0 RACHEL CARPENTER DIRECTOR 5.00 X 0 0 0 RJ CONNELLY DIRECTOR 5.00 X 0 0 0 GREGORY A PAOLINO DIRECTOR 5.00 X 0 0 0 JOHN BAGWILL DIRECTOR 5.00 X 0 0 0 VIRGINIA BUTTERWORTH DIRECTOR 5.00 X 0 0 0 HUGH J HALL ADMINISTRATOR (UNTIL 4/20)/DIRECTOR 32.00 X X 37989 0 0 JOAN WOODS CEO/ADMINISTRATOR (SINCE 4/20) 40.00 X 106731 0 9388 DRUSILLA BOIANI DIRECTOR OF NURSING 40.00 X 113128 0 3635 257848 0 13023 2 0 0 0 SELECT REHABILITATION LLC PO BOX 71985 CHICAGO IL 60694 THERAPY 293714 HERITAGE ENVIRONMENTAL SERVICES PO BOX 870784 KANSAS CITY MO 64187 CLEANING AND LAUNDRY 251235 SYSCO BOSTON LLC 99 SPRING STREET PLYMPTON MA 02367 FOOD PROVISIONING 230372 BLUMSHAPIRO & COMPANY PO BOX 272000 WEST HARTFORD CT 06127 ACCOUNTING 103306 4 1081876 158000 1239876 NURSING CENTER 623000 5397650 5397650 RETIREMENT CENTER 623990 885162 885162 6282812 40168 40168 1405906 1067539 338367 338367 338367 7901223 6282812 0 378535 154108 154108 3055668 2835694 219974 35263 34177 1086 410673 371943 38730 252595 225398 27197 3802 3802 132830 132830 16582 16582 203777 60640 143137 28235 15419 12816 150848 92116 58732 219603 219603 3170 3170 86950 86950 313077 313077 163343 157429 5914 SUPPLIES 728042 728042 PURCHASED SERVICES 620137 620137 HEALTH CARE PROVIDER AS 326975 326975 LICENSES AND DUES 11252 521 10731 14144 3107 11037 6931074 6094398 836676 0 95727 302817 592547 1708060 740504 398849 21077 21523 8934435 7091160 1956694 1843275 2003583 1656516 5410132 5931040 572310 626982 1875250 1773042 1029619 783714 3477179 3183738 X 1886499 2668617 46454 78685 1932953 2747302 5410132 5931040 970149 -155800 0 X X 0 1 X 1 0 X 12588 11280 11280 30351 1239876 1305375 6114989 6041359 6372503 6377762 6282812 31189425 6127577 6052639 6383783 6408113 7522688 32494800 0 0 0 32494800 95995 101513 91417 65928 40168 395021 95995 101513 91417 65928 40168 395021 8628 48973 3713 61314 6232200 6203125 6475200 6477754 7562856 32951135 0.98620 0.98080 0.01200 0.01490 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS REVENUE - 2016 AMOUNT: $ 8,628. 2017 AMOUNT: $ 48,973. 2019 AMOUNT: $ 3,713. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 24155 125639 94362 55432 0 2003583 199785 546852 1656516 2352566 421384 770367 2003583 2816328 -125762 338000 2352566 2936300 335121 455093 2816328 2720858 215442 2936300 1.00000 0 0 120000 120000 6790086 5416526 1373560 1301584 1124370 177214 722765 550264 172501 1843275 DUE TO THIRD-PARTY PAYORS 783714 783714 X 7884641 0 7884641 16582 16582 7901223 6914492 0 6914492 16582 16582 6931074 PART IV, LINE 1B: JOHN CLARKE RETIREMENT CENTER MAINTAINS TWO CUSTODIAL ARRANGEMENTS - THE ACTIVITIES ACCOUNT AND THE RESIDENT ACCOUNT. THE ACTIVITIES ACCOUNT HOLDS FUNDS THAT HAVE BEEN RAISED EITHER THROUGH RESIDENT ACTIVITIES (I.E. HOLIDAY BAZAAR) OR BY DONATIONS MADE TO JOHN CLARK RETIREMENT CENTER FOR ITS RESIDENTS FUND. THESE FUNDS ARE USED FOR SPECIFIC ACTIVITIES THAT BENEFIT ALL RESIDENTS (I.E. HOLIDAY GIFTS, OUTINGS, ICE CREAM TRUCK RENTAL, ETCETERA). IT IS HELD SEPARATE AND DISTINCT FROM THE OPERATING ACCOUNT. THE RESIDENT ACCOUNT IS FUNDED EITHER THROUGH DIRECT DEPOSITS OF RESIDENT PENSIONS, SOCIAL SECURITY PAYMENTS OR PAYMENTS FROM FAMILY MEMBERS ON BEHALF OF SPECIFIC RESIDENTS. EACH DOLLAR DEPOSITED IS ASSIGNED TO A PARTICULAR RESIDENT AND SPENT ONLY ON EXPENSES INCURRED BY THAT RESIDENT. RESIDENTS USE THIS FUND TO PAY PHONE BILLS, HAIRDRESSER BILLS, MEDICAL PREMIUMS, ETCETERA. THESE FUNDS ARE HELD IN AN INTEREST-BEARING CHECKING ACCOUNT AND THE MONTHLY INTEREST IS DISBURSED TO RESIDENTS BASED ON ACCOUNT BALANCE ON THE LAST DAY OF THE MONTH. PART V, LINE 4: THE DESIGNATED ENDOWMENT FUNDS ARE TO BE USED TO SUPPORT FUTURE OPERATING AND CAPITAL BUDGETS. PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE CENTER AND RECOGNIZE A TAX LIABILITY IF THE CENTER HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. THE CENTER IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. THE CENTER RECOGNIZES INTEREST AND PENALTIES, IF APPLICABLE, AS A COMPONENT OF MISCELLANEOUS EXPENSE. GREGORY A PAOLINO BOARD MEMBER 117351 PAOLINO INSURANCE CONTRACTS THE ORGANIZATION'S WORKERS' COMPENSATION INSURANCE AND PROPERTY INSURANCE POLICIES. 0 FORM 990, PART VI, SECTION B, LINE 11B THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS WILL REVIEW THE FORM 990. THEY WILL THEN REPORT TO THE BOARD OF DIRECTORS AND PROVIDE THEM WITH A COPY OF THE FORM 990 PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C JOHN CLARKE RETIREMENT CENTER HAS ADOPTED A CONFLICT OF INTEREST POLICY. THE POLICY REQUIRES ALL MEMBERS OF THE BOARD OF DIRECTORS TO DISCLOSE ANY POTENTIAL CONFLICTS OF INTEREST. THE BOARD OF DIRECTORS WILL REVIEW ALL INFORMATION AND DECIDE WHAT ACTION WILL BE NECESSARY BECAUSE OF THE POTENTIAL CONFLICT. FORM 990, PART VI, SECTION B, LINE 15A THE ADMINISTRATOR'S COMPENSATION IS DETERMINED BY THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS. THE COMMITTEE TAKES INTO ACCOUNT THE COMPENSATION PAID TO SIMILAR ADMINISTRATORS AT COMPARABLE NON-PROFIT ORGANIZATIONS IN THE AREA. THE COMMITTEE ALSO CONSIDERS THE PERFORMANCE OF THE ORGANIZATION DURING THE REVIEW PERIOD AND THE ADMINISTRATOR'S SUCCESS IN ACHIEVING THE ORGANIZATION'S GOALS. THE DISCUSSIONS AND DECISION OF THE ADMINISTRATOR COMPENSATION ARE DOCUMENTED BY THE BOARD OF DIRECTORS DURING THE BOARD MEETING. THE ADMINISTRATOR REVIEWS ALL OTHER EMPLOYEES FOR COMPENSATION. THE ADMINISTRATOR CONSIDERS THE PERFORMANCE OF EACH INDIVIDUAL EMPLOYEE DURING THE REVIEW PERIOD AND CONSIDERS THE EMPLOYEE'S SUCCESS IN ACHIEVING THE ORGANIZATIONAL GOALS. ALSO, THE ADMINISTRATOR COMPARES COMPENSATION OF COMPARABLE NON-PROFIT ORGANIZATIONS IN THE AREA. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, FINANCIAL STATEMENTS, AND CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. PART XII, LINE 2C THE FINANCE COMMITTEE BODY OF THE BOARD OF DIRECTORS IS RESPONSIBLE FOR THE OVERSIGHT OF THE ANNUAL AUDIT.