2021-11-09T07:45:40-06:00 2020-12-31 010494526 Baker Newman & Noyes PO Box 507 Portland ME 04112 990 2020-01-01 042104851 MI Nursing Restorative Center Inc MINU 9786856321 172 Lawrence Street Lawrence MA 01841 Jeanne Leydon President & CEO 9786856321 2021-11-01 1 Jeanne Leydon 999009999 Nicholas E Porto P01310283 2078792100 2021-11-01 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z Jeanne Leydon 172 Lawrence Street Lawrence MA 01841 19282799 0 X www.mihcs.org X 1875 MA Responding to the health, social and spiritual needs of well, sick, and frail elders. 12 11 441 21 0 0 21024 537927 20183259 17839538 2291134 905334 0 0 22495417 19282799 0 0 0 0 13885613 12330763 0 0 0 6263717 5898950 20149330 18229713 2346087 1053086 42057560 43072994 2164897 2453129 39892663 40619865 X The mission of MI Nursing Restorative Center Inc. is to respond with compassionate care and dignity to the health, social and spiritual needs of well, sick, and frail elders. The Center also offers and extends supportive presence and programs to the families of residents. The quality of our services are achieved through embracing core values that include compassion, competence, and collaboration. 0 0 14670954 0 17839538 The Center continues to provide nursing and quality-of-life services the elderly in its community. In 2020, the Center provided eldercare through the operation of a 231 bed skilled nursing facility, 55,390 resident days of skilled nursing care, rehabilitation services, dietary services, laundry and housekeeping services, and numerous social activities. 14670954 1 1 0 1 0 0 0 0 0 0 1 1 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 22 0 1 441 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 11 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X X Jeanne Leydon President & CEO 9786856321 172 Lawrence Street Lawrence MA 01841 Jeanne Leydon President & CEO 33.00 7.00 X X 204923 0 15850 Delbet Downing Administrator 40.00 1.00 X 155751 0 40613 Alysia Pope Director of Nursing 40.00 0.00 X 146896 0 15664 Sitha Bou-Moore Director of Admissions 40.00 0.00 X 101810 0 11274 Raisa T Carrasco-Velez Director 1.00 4.00 X 0 0 0 Rev John Delaney Director 1.00 4.00 X 0 0 0 Roger Desjardins Director 1.00 4.00 X 0 0 0 Arline El-Ashkar MSN RN Director 1.00 4.00 X 0 0 0 Samer Obeid Esq Director 1.00 4.00 X 0 0 0 Eric Peabody Director 1.00 4.00 X 0 0 0 William Shaheen Director 1.00 4.00 X 0 0 0 Sr Marcia Wiley Director 1.00 4.00 X 0 0 0 Deborah L Turiano MD Chair 1.00 4.00 X X 0 0 0 Rosemarie A Connolly CPA Treasurer 1.00 5.00 X X 0 0 0 Karen Gallagher Giangrande Clerk 1.00 4.00 X X 0 0 0 609380 0 83401 4 0 1 0 RehabCare Group Inc 7733 Forsyth Boulevard St Louis MO 63105 Rehabilitative services 973939 Covenant Health Inc 100 Ames Pond Road Suite 102 Tewksbury MA 01876 Management services 600088 Paychex 911 Panorama Trail S Rochester NY 14625 Payroll & IT solutions 130618 3 7500 530427 537927 Patient Services 623000 17839538 17839538 17839538 905334 905334 19282799 17839538 0 905334 X 220773 171905 48868 9846861 7680552 2166309 115758 88115 27643 1340239 1020190 320049 807132 614389 192743 600088 600088 42724 42724 6120 6120 1982180 1982180 19062 15818 3244 256935 213210 43725 11665 9680 1985 309216 256594 52622 12973 10765 2208 621051 621051 223462 185434 38028 Drugs/medical supplies 950391 950391 Food and dining 432216 432216 Provision for bad debts 262482 262482 Medicaid user fees 95500 95500 72885 60482 12403 18229713 14670954 3558759 0 2005164 3383669 238955 451345 2580193 1399107 2693 44063 163209 172744 17760032 12524925 5220363 5235107 31216191 31795277 630792 591682 42057560 43072994 1452756 1737558 712141 715571 2164897 2453129 X 39887663 40407835 5000 212030 39892663 40619865 42057560 43072994 1053086 -325884 0 X X 0 1 X 1 0 X 9305 6707 11173 21024 537927 586136 19493409 19909870 19862756 20183259 17839538 97288832 19502714 19916577 19873929 20204283 18377465 97874968 0 0 0 97874968 377796 422858 652997 2291134 905334 4650119 377796 422858 652997 2291134 905334 4650119 19880510 20339435 20526926 22495417 19282799 102525087 0.95460 0.96070 0.04540 0.03930 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 924 0 0 0 924 0 Part II-B, Line 1: The Center was a member of LeadingAge Massachusetts, a healthcare association, in the year ended December 31, 2020. A portion of the dues paid to this association was available for lobbying expenditures on behalf of the Center and the other member organizations in furtherance of their exempt purposes. At the time of this return's filing, LeadingAge has not provided the Center with the exact amount of dues paid that was available for lobbying. Therefore, the Center is listing an estimate of the total amount of dues paid to LeadingAge in 2020 that may have been available for lobbying ($924). This has been provided for transparency purposes; the actual amount used for lobbying expenditures may have been less. 5000 517488 310458 212030 5000 7000 7000 5000 5000 5000 0.00000 0.00000 1.00000 0 0 104779 104779 15867234 11817239 4049995 1788019 707686 1080333 5235107 Investment in Covenant Health Investment Trust 31795277 F 31795277 Deferred expenses 529776 Resident funds liability 50451 Professional liability loss reserve 101623 Medicaid user fee obligations 33721 715571 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, 2020. X X X X 0 0 0 0 0 0 0 0 0 Jeanne Leydon President & CEO 199519 0 5000 0 404 0 4410 0 11440 0 220773 0 0 0 Delbet Downing Administrator 152251 0 3500 0 0 0 4776 0 35837 0 196364 0 0 0 Alysia Pope Director of Nursing 142976 0 3920 0 0 0 4776 0 10888 0 162560 0 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 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 IX, line 11g Purchased medical and physician services: Program service expenses 1,184,892. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,184,892. Lab and pharmacy fees: Program service expenses 70,026. Management and general expenses 0. Fundraising expenses 0. Total expenses 70,026. Maintenance and other: Program service expenses 727,262. Management and general expenses 0. Fundraising expenses 0. Total expenses 727,262. 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 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 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 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 Penacook Place Inc 150 Water Street Haverhill MA 01830 237090088 Nursing home MA 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 1 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0