2021-11-10T14:07:48-06:00 2020-12-31 010494526 BAKER NEWMAN & NOYES LLC 650 ELM STREET SUITE 302 MANCHESTER NH 03101 990 2020-01-01 043333609 CHS of Waltham Inc CHSO 7818930240 66 Newton Street Waltham MA 02453 James Tracey President & CEO 7818930240 2021-11-01 1 James Tracey 999009999 Nicholas E Porto P01310283 8002447444 2021-11-01 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z Maristhill Nursing & Rehabilitation James Tracey 66 Newton Street Waltham MA 02453 10316994 0 0928 X maristhill.org X 1996 MA Maristhill is a Catholic skilled nursing and rehabilitation facility that continues the healing ministry of Christ by providing health care services that foster each individual's physical, spiritual, emotional and intellectual well-being. 6 5 121 11 0 0 21229 930621 10200930 9334648 169077 51725 0 0 10391236 10316994 0 0 0 0 6019617 5913878 0 0 0 4618673 4529641 10638290 10443519 -247054 -126525 10628155 10469491 9404280 9382899 1223875 1086592 Maristhill is a Catholic skilled nursing and rehabilitation facility that continues the healing ministry of Christ by providing health care services that foster each individual's physical, spiritual, emotional and intellectual well-being. 0 0 9502172 0 10241484 Maristhill Nursing and Rehabilitation Center provided 29,267 days of skilled nursing services during 2020, and 21,993 days of skilled services to Medicaid recipients. 9502172 1 1 0 1 0 0 0 0 0 0 1 1 0 1 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 1 121 1 0 0 0 0 0 0 0 0 0 0 0 0 X 6 5 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 MA X X James Tracy President & CEO 7818930240 66 Newton Street Waltham MA 02453 David Becker Interim President (end 1/2020) 40.00 2.00 X X 0 200310 8530 Eric Gwanyalla LPN 60.00 0.00 X 132216 0 28593 Shirly Yellamaty RN Manager 43.00 0.00 X 132488 0 20974 James Tracey President & CEO 41.00 0.00 X X 128968 0 13171 Luanne Deagle Director of Nursing 40.00 0.00 X 123085 0 12411 Anesta Rene RN 53.00 0.00 X 121509 0 4442 Michelle Zeng RN/MDS 40.00 0.00 X 111258 0 2189 Joseph Cuzzupoli Trustee 1.00 0.00 X 0 0 0 Richard Daggett Trustee (end 9/2020) 1.00 0.00 X 0 0 0 Sr Joyce Ann Edelmann Trustee 1.00 0.00 X 0 0 0 Ellen Leiter Trustee 1.00 0.00 X 0 0 0 Kelly Hill Chair 1.00 0.00 X X 0 0 0 Judith Allen Vice Chair 1.00 0.00 X X 0 0 0 749524 200310 90310 8 0 1 0 Rehab Care Group Inc PO Box 503534 St Louis MO 63150 Rehabilitation services 547567 Performance Health Care Services Inc 47R River Street Wellesley MA 02481 Laundry and housekeeping 406902 2 906836 23785 930621 Patient services 623000 9334648 9334648 9334648 51725 51725 10316994 9334648 0 51725 X 142140 128294 13846 4718581 4293909 424672 36878 30609 6269 636883 528613 108270 379396 314899 64497 32757 32757 73721 73721 1448768 1231453 217315 23033 23033 240934 240934 239477 239477 301064 301064 357353 357353 393606 393606 37979 37979 Drugs/medical supplies 700440 700440 Medicaid user fee 539846 539846 Provision for bad debts 99500 99500 Repairs & maintenance 41163 41163 10443519 9502172 941347 0 411275 494397 9880 1734959 1652741 1185 20639 55846 12130810 6774216 5628163 5356594 1650346 1686481 1182773 1212367 10628155 10469491 1116968 1332302 7615990 7351164 671322 699433 9404280 9382899 X 1218939 1076712 4936 9880 1223875 1086592 10628155 10469491 -126525 -10758 0 X X 0 1 X 1 0 X 17752 14115 10317 21229 930621 994034 10482175 10237696 10948859 10200930 9334648 51204308 10499927 10251811 10959176 10222159 10265269 52198342 0 0 0 52198342 40443 46019 73954 169077 51725 381218 40443 46019 73954 169077 51725 381218 10540370 10297830 11033130 10391236 10316994 52579560 0.99270 0.99280 0.00730 0.00720 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 18054 0 0 0 18054 0 Part II-B, Line 1: CHS of Waltham, Inc. was a member of the Massachusetts Senior Care Association and LeadingAge Massachusetts in the year ended December 31, 2020. The associations disclose to their members that a portion of membership dues may be used for lobbying expenditures in furtherance of their exempt purposes. However, the associations did not specifically disclose what amount or percentage of dues paid in 2020 were ultimately used for lobbying purposes. For transparency purposes, CHS of Waltham is disclosing the total amount of dues paid to each trade association, a portion of which may have been used for lobbying expenditures, in detail below and in total on Schedule C, Page 3, Part II-B, Line 1f. Massachusetts Senior Care Association - $12,411 LeadingAge Massachusetts - $5,643 4936 6944 2000 9880 6936 2000 4936 6000 6000 6000 6000 0.00000 0.00000 1.00000 0 0 485000 485000 8427613 4238764 4188849 3179184 2535452 643732 39013 39013 5356594 Investment in Covenant Health Investment Trust 1686481 F 1686481 Resident funds 66971 Debt service reserve funds 750000 Debt service sinking funds (net) 317351 Bond financing funds (net) 75706 Other general assets 2339 1212367 Deferred expenses 285911 Medicaid user fee obligations 142664 Professional liability loss reserves 32517 Due to affiliates 168008 Resident funds 70333 699433 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 1 0 David Becker Interim President (end 1/2020) 0 194113 0 5000 0 1197 0 3832 0 4698 0 208840 0 0 Eric Gwanyalla LPN 128873 0 0 0 3343 0 0 0 28593 0 160809 0 0 0 Shirly Yellamaty RN Manager 132488 0 0 0 0 0 2638 0 18336 0 153462 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. Part I, Line 7 A Compensation Committee recommends the variable pay award that may be issued to qualifying employees and officers. The payment of the award is discretionary and is subject to meeting the pre-determined goals of the Organization. A MA Health & Education Facilities Authority 042456011 57586DBF9 2007-10-30 7221865 To finance the purchase of Youville Place 1 0 0 B MA Health & Education Facilities Authority 042456011 57584QAA4 2012-06-27 1720000 Capital equipment and projects 0 0 0 A 7221865 712880 55862 6117244 1 1 1 1 B 1720000 54828 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 1 0 0 0 0 0 B 0 0 0 0 0 0 0 0 0 A 0 B 0 Schedule K, Part III, Line 9; Part IV, Line 7, & Part V: While formal, written policies have not been adopted by the Organization, CHS of Waltham, Inc. 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 IX, line 11g Purchased medical services: Program service expenses 698,886. Management and general expenses 0. Fundraising expenses 0. Total expenses 698,886. Purchased administrative and maintenance services: Program service expenses 532,567. Management and general expenses 176,297. Fundraising expenses 0. Total expenses 708,864. Consulting: Program service expenses 0. Management and general expenses 41,018. Fundraising expenses 0. Total expenses 41,018. 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 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 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 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0