2020-10-26T14:44:30-05:00 2019-12-31 410746749 CLIFTONLARSONALLEN LLP 300 CROWN COLONY DRIVE SUITE 310 QUINCY MA 02169 990 2019-01-01 042104318 HOME FOR AGED WOMEN IN SALEM HOME 9787402493 180 DERBY STREET SALEM MA 01970 THOMAS CRANE PRESIDENT 9787402493 2020-10-22 1 MICHAELA CROMAR P00895728 6179848100 2020-10-07 108.20.24.183 2020-10-22 09:42:58 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 8691CE57B3CA54F67807ABE18706F5E1A699ECB4 2019 2021-01-29 14:40:06Z BROOKHOUSE HOME FOR AGED WOMEN THOMAS CRANE 180 DERBY STREET SALEM MA 01970 2894736 0 X WWW.BROOKHOUSEHOME.COM X 1861 MA TO OFFER RESIDENTIAL CARE FOR SENIOR WOMEN. 13 13 38 17 0 0 115210 180632 1296455 1433348 290868 175128 6589 1201 1709122 1790309 0 0 0 0 950571 859535 0 0 0 487414 633052 1437985 1492587 271137 297722 4043984 4882535 129816 179741 3914168 4702794 X THE ORGANIZATION'S MISSION IS TO ENCOURAGE AND SUPPORT THE FACILITY'S RESIDENTS IN MAINTAINING FAMILY AND LIFE LONG RELATIONSHIPS THROUGH THE OPERATION OF A 36-BED RESIDENTIAL CARE FACILITY IN SALEM, MASSACHUSETTS. BROOKHOUSE HOME WELCOMES SENIOR WOMEN WITHOUT REGARD OF RACE, CREED OR NATIONAL ORIGIN. 0 0 1228710 1434549 RESIDENTIAL CARE FACILITY - OPERATION OF A 36-BED RESIDENTIAL CARE FACILITY LOCATED IN SALEM, MASSACHUSETTS. BROOKHOUSE HOME WELCOMES SENIOR WOMEN WITHOUT REGARD OF RACE, CREED OR NATIONAL ORIGIN. ALL RESIDENTS ENJOY THE PRIVACY OF THEIR OWN ROOM, FURNISHED AND DECORATED WITH THEIR OWN BELONGINGS WHICH PROMOTES A FEELING OF PERSONAL SPACE. THE ORGANIZATION ALSO OFFERS RESPITE SERVICES FOR WOMEN WHO MAY REQUIRE SUPERVISED SUPPORT FOR SHORTER PERIODS OF STAY. 1228710 1 1 0 0 0 0 0 0 0 0 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 0 0 0 0 0 0 0 0 0 0 1 14 0 38 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 0 1 1 0 MA X JUDITH KANE 9787440219 180 DERBY STREET SALEM MA 01970 THOMAS CRANE PRESIDENT 5.00 X X 0 0 0 KEVIN DALY TREASURER 5.00 X X 0 0 0 MARTHA RYAN SECRETARY 5.00 X X 0 0 0 MARY SIMPSON DIRECTOR 5.00 X 0 0 0 BECKY PUTNAM DIRECTOR 5.00 X 0 0 0 HELEN GIFFORD DIRECTOR 5.00 X 0 0 0 STAN USOVICZ DIRECTOR 5.00 X 0 0 0 CARLOTTA TYLER DIRECTOR 5.00 X 0 0 0 GEORGE BARBUZZI DIRECTOR 5.00 X 0 0 0 DONNA DUNNE DIRECTOR 5.00 X 0 0 0 MARLENE SCHAEDLE DIRECTOR 5.00 X 0 0 0 JACK MELIN DIRECTOR 5.00 X 0 0 0 PETER LACHAPELLE DIRECTOR 5.00 X 0 0 0 JUDITH KANE ADMINISTRATOR 40.00 X 98823 0 2320 98823 0 2320 0 0 0 0 HEALTHCARE SERVICES GROUP INC 3220 TILLMAN DRIVE SUITE 300 BENSALEM PA 19020 PURCHASED SERVICE 321537 1 128760 51872 180632 NET RESIDENT SERVICE REVENUE 623000 1430078 1430078 3270 3270 1433348 93967 93967 1185588 1104427 81161 81161 81161 OTHER REVENUE 623000 1201 1201 1201 1790309 1434549 0 175128 101143 101143 654159 516871 137288 40780 32518 8262 63453 52297 11156 1320 1320 25385 25385 26709 26709 14227 813 13414 4385 4385 21008 3028 17980 108908 102769 6139 2710 2269 441 56800 51120 5680 26494 22375 4119 FOOD EXPENSES 311356 311356 SUPPLIES EXPENSE 31181 31181 MISCELLANEOUS 2484 970 1514 LICENSES AND DUES 85 85 1492587 1228710 263877 0 224615 331201 39320 22673 13771 38904 1698655 934225 640824 764430 3125454 3725327 4043984 4882535 92416 67515 74826 37400 37400 129816 179741 X 3862696 4677048 51472 25746 3914168 4702794 4043984 4882535 297722 490904 0 X 0 1 X 1 0 X 5630 5452 3485 115210 180632 310409 1265802 1228605 1238145 1296455 1433347 6462354 1271432 1234057 1241630 1411665 1613979 6772763 0 0 0 6772763 42784 45990 67326 74511 93967 324578 42784 45990 67326 74511 93967 324578 30652 16878 11667 6589 1201 66987 1344868 1296925 1320623 1492765 1709147 7164328 0.94530 0.94820 0.04530 0.04160 X SCHEDULE A, PART III, LINE 12, EXPLANATION FOR OTHER INCOME: OTHER INCOME $1,201 - ADMINISTRATIVE FEES AND MISC INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 16657 16657 90532 90532 0 1439707 724350 715357 151759 119343 32416 764430 DUE TO THIRD-PARTY PAYOR 37400 37400 X 2254505 490904 490904 1763601 26708 26708 1790309 1465879 0 1465879 26708 26708 1492587 PART X, LINE 2: THE ORGANIZATION IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL AND STATE INCOME TAX ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE ORGANIZATION FOLLOWS THE POLICY FOR UNCERTAINTY IN INCOME TAXES TO BE RECOGNIZED IN AN ENTITY'S FINANCIAL STATEMENTS. THE POLICY PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT PRINCIPLES FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. NO UNCERTAIN INCOME TAX POSITIONS WERE IDENTIFIED FOR THE YEARS ENDED DECEMBER 31, 2019 AND 2018. FORM 990, PART VI, SECTION A, LINE 1 THE BOARD OF DIRECTORS HAS AN EXECUTIVE COMMITTEE WITH GENERAL CHARGE OF THE AFFAIRS OF THE INSTITUTION DURING THE INTERVALS BETWEEN THE REGULAR QUARTERLY BOARD MEETINGS. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION'S TOP MANAGEMENT REVIEWS THE DRAFT FORM 990 AND PROVIDES FEEDBACK TO THE TAX PREPARER. THE FINAL FORM 990 IS PROVIDED TO THE PRESIDENT FOR SIGNATURE BEFORE FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, THE BOARD MEMBERS ARE PROVIDED A COPY OF THE CONFLICT OF INTEREST POLICY AND ARE REQUIRED TO SIGN A STATEMENT INDICATING THAT THEY HAVE RECEIVED A COPY OF THE POLICY, HAVE READ AND UNDERSTAND THE POLICY, AND AGREE TO COMPLY WITH THE POLICY. THE BOARD MEMBERS ARE REQUIRED TO DISCLOSE ANY POTENTIAL CONFLICTS. THIS POLICY IS PERIODICALLY REVIEWED AND MONITORED AT LEAST ANNUALLY DURING A BOARD MEETING. AFTER A BOARD MEMBER DISCLOSES A POTENTIAL CONFLICT, THE REMAINING MEMBERS SHALL APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT AND WILL DISCUSS TO DECIDE IF A CONFLICT EXISTS, AND THE APPROPRIATE COURSE OF ACTION. THE PERSON WITH THE CONFLICT IS EXCLUDED FROM PARTICIPATING IN DELIBERATION, DECISIONS REGARDING THE TRANSACTION, AND VOTING. SEE CONFLICT OF INTEREST POLICY FOR FURTHER DETAILED PROCEDURES. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT AND OFFICERS IS DETERMINED THROUGH COMPENSATION SURVEYS, EMPLOYMENT AGREEMENTS, AND APPROVAL BY THE BOARD OF DIRECTORS. COMPENSATION ANALYSIS AND DECISIONS ARE DOCUMENTED THROUGH MEETING MINUTES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST.