2021-11-10T06:55:20-06:00 2020-12-31 010494526 Baker Newman & Noyes PO Box 507 Portland ME 04112 990 2020-01-01 237090088 Penacook Place Inc PENA 9783740707 150 Water Street Haverhill MA 01830 Michael Bell President & CEO 9783740707 2021-11-01 1 Michael Bell 999009999 Nicholas E Porto P01310283 2078792100 2021-11-01 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z Michael Bell 150 Water Street Haverhill MA 01830 11417561 0 X www.penacookplace.org X 1969 MA To promote the highest possible quality of life for our residents. 8 8 271 9 0 0 54220 18611 11670938 11398800 100 150 0 0 11725258 11417561 0 0 0 0 8457679 6673536 0 0 0 4145192 5145224 12602871 11818760 -877613 -401199 4806261 5391409 3928112 4252270 878149 1139139 X To promote the highest possible quality of life for our residents in a clean, safe, and attractive environment. To care for our residents as we would want to be cared for - the Golden Rule of Penacook Place. To meet or exceed the expectations of our residents, as well as others with whom we come in contact. To show hospitality, courtesy, cooperation, and respect to all residents, family members, fellow employees, volunteers, and visitors. 0 0 10464409 0 11398800 Penacook Place is an independent, non-profit, 160 bed nursing home and rehabilitation facility located in Haverhill, MA that strives to offer the finest care and best quality of life for its residents. The facility's team of professionals is specially trained to meet the medical, social, psychological, and therapeutic needs of those they serve. Their dedicated caregivers are highly trained and compassionate, and help make Penacook Place a warm and welcoming facility. 10464409 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 8 0 1 271 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X X Christine Habeeb 9783740707 150 Water Street Haverhill MA 01830 David Becker Interim President (end 10/2020) 38.00 40.00 X 0 200310 8530 Scott Drapeau DON (end 12/2020) 37.50 0.00 X 122013 0 11457 Paula Drelick President (end 7/2020) 38.00 0.00 X 98103 0 15992 Michael Bell President 38.00 0.00 X 22000 0 0 Janis Cordischi Member 2.00 0.00 X 0 0 0 Rev John Delaney Member 2.00 0.00 X 0 0 0 Diane Lavallo Member (end 7/2020) 2.00 0.00 X 0 0 0 Caitlin Masys Member 2.00 0.00 X 0 0 0 John Sarro Member 2.00 0.00 X 0 0 0 Gregory Shaw Member 2.00 0.00 X 0 0 0 Thomas L Mortimer Chair 2.00 0.00 X X 0 0 0 William Kleuber Treasurer 2.00 0.00 X X 0 0 0 Frank Novak Clerk 2.00 0.00 X X 0 0 0 242116 200310 35979 1 0 1 0 Rehabcare 7733 Forsyth Boulevard St Louis MO 63105 Rehabilitation and therapy services 622119 Lya's Helping Hands 16 Fisher Street Lowell MA 01850 Nursing and home health care 435341 Performance Healthcare Services 47 River Street Wellesley MA 02481 Housekeeping and laundry 321563 Aberthaw Construction 672 Suffolk Street Suite 200 Lowell MA 01854 Construction and renovations 302336 Covenant Health Inc 100 Ames Pond Drive Tewksbury MA 01876 Management and consulting 292210 5 10000 8611 18611 Patient services 623000 11398800 11398800 11398800 150 150 11417561 11398800 0 150 136095 125374 10721 5237341 4923511 313830 32614 25427 7187 700101 545823 154278 567385 442353 125032 292210 292210 50167 50167 81086 81086 621914 559789 62125 22725 20455 2270 114309 102890 11419 92951 83666 9285 311467 280353 31114 1076 969 107 1942 1748 194 94643 94643 304419 228314 76105 279969 252002 27967 Medical care/supplies 1793271 1793271 Medicaid user fee 626300 626300 Nutrition and dining 305338 305338 Provision for bad debts 105275 105275 46162 41551 4611 11818760 10464409 1354351 0 1162499 1367837 8172 142421 1252727 1351937 65144 66185 10083993 7769643 2199339 2314350 118380 148679 4806261 5391409 1057795 1408558 2465817 2471460 404500 372252 3928112 4252270 X 744149 1005139 134000 134000 878149 1139139 4806261 5391409 X -401199 189 662000 X X 0 1 X 1 0 X 53378 106151 70911 54220 18611 303271 10538142 12486550 12509943 11670938 11398800 58604373 10591520 12592701 12580854 11725158 11417411 58907644 0 0 0 58907644 18149 2193 82 100 150 20674 18149 2193 82 100 150 20674 10609669 12594894 12580936 11725258 11417561 58928318 0.99960 0.99940 0.00040 0.00060 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 134000 10000 10000 134000 84000 50000 134000 65000 84000 65000 84000 65000 65000 44784 44784 0.00000 0.00000 1.00000 0 0 30859 30859 7561356 5709790 1851566 2342635 1922823 419812 149143 137030 12113 2314350 Due to third party payors 60000 Asset retirement obligations 66000 Professional loss liability reserve 50409 Medicaid obligations 144482 Resident funds and deposits 51361 372252 X Part V, Line 4: The Organization's Endowment Funds are used to provide services, supplies, and facilities to residents and the poor in the community. 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, 2020. X X X X 1 0 0 0 0 0 0 0 0 David Becker Interim President (end 10/2020) 0 199113 0 0 0 1197 0 3832 0 4698 0 208840 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. Part I, Line 4a Scott Drapeau, who served as the Organization's Director of Nursing during the tax year, resigned from this role in December, 2020. As part of his resignation, Scott Drapeau received $10,000 in severance pay. However, as Scott Drapeau's total 2020 compensation was below $150,000, the compensation and benefits paid to Scott Drapeau in 2020 are not detailed on this Organization's 2020 Schedule J, Part II. This is in accordance with IRS Guidance and Instructions for the Form 990, Schedule J. A Massachusetts Development Finance Agency 043431814 2017-03-21 2530707 Redeem bank debt, renovations, and improvements 0 0 0 A 2530707 80707 2223845 226155 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 1 0 0 0 0 0 A 0 Schedule K, Part III, Line 9; Part IV, Line 7, & Part V: While formal, written policies have not been adopted by the Organization, Penacook Place carefully and consistently monitors its tax-exempt bond for potential violations. Additionally, the Organization routinely confers with bond counsel to ensure all relevant compliance requirements have been met. Form 990, Part VI, Section A, line 6 Covenant Health Inc. is the sole corporate member of the Organization. Form 990, Part VI, Section A, line 7a As the sole corporate member of the Organization, Covenant Health, Inc. 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, Covenant Health, Inc. 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 elect the Board of Directors or remove them with or without cause; 4. To appoint and remove the president; 5. To ratify the Board of Director's election of the Chair of the Board; 6. 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; 7. To approve all long-range strategic plans before implementation; 8. To approve the acquisition, sale, or encumberance of any real estate valued in excess of an amount set by the Member in writing; 9. To approve all capital budgets and non-budgeted expeness in excess of an amount set by the Member in writing; 10. To approve all debt in excess of limits set by the Member in writing; 11. To appoint the auditors; 12. To approve the sale, assignment, or transfer of any equity interest or membership interest in any subsidiary; 13. To approve any reclassification or other change of any capital stock or other equity security; and, 14. To approve the issuance of, or the creation of any obligation to issue, any equity security. 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. 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: https://www.covenanthealth.net/financial-information/financial-information Form 990, Part XI, line 9: Transfers from affiliates 662,000. Form 990, Part XII, Line 2c: The audit process has not changed from the previous year. 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 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 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 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 Youville Place 10 Pelham Road Lexington MA 02421 043297834 Assisted living services MA 501(c)(3) Line 10 Covenant Health Inc 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 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 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 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 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 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 Covenant Health Investment Trust 420 Bedford Street Lexington MA 02420 046835128 Investment trust MA 501(c)(3) Line 12a, I Covenant Health Inc 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 Youville House Inc 1573 Cambridge Street Cambridge MA 02138 043239593 Assisted living services MA 501(c)(3) Line 10 Youville Lifecare 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 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 Community Clinical Services PO Box 7291 Lewiston ME 04243 010409788 Physician practice ME 501(c)(3) Line 10 St Mary's Health System 1 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 Residences PO Box 7291 Lewiston ME 04243 222504356 Low income housing ME 501(c)(3) Line 10 St Mary's Health System 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 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 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 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 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 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 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 Transportation Inc 189 Maple Street Lawrence MA 01841 042921889 Elderly transportation services MA 501(c)(3) Line 10 Covenant Health Inc 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 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 M & J Company 360 Broadway Bangor ME 04402 222480150 Lease holding company ME 501(c)(2) St Joseph Healthcare Foundation 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 Alternative Health Services 360 Broadway Bangor ME 04402 010422885 Home health and hospice ME 501(c)(3) Line 10 St Joseph Healthcare Foundation 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 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 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 Insurance LTD PO Box 69 Grand Cayman CJ KY1-1102 043360127 Self-insurance company CJ N/A C 0 Campus Holding PO Box 7291 Lewiston ME 04240 010406049 Holding company ME 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 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 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 1