2020-07-07T17:11:52-05:00 2019-12-31 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2019-01-01 020325847 Salemhaven Inc SALE 6038935586 23 Geremonty Drive Salem NH 03079 Beverly Collins President 6038935586 2020-05-11 1 Barbara J McGuan CPA P00219457 2077752387 2020-05-11 69.49.157.66 2020-05-11 18:18:05 ED P BCE379EC6B2F882893C3F02DE0A5A3D951B1B2ED 98B0765DE24833D2D2C68263306E27B9DACD599F 2019 2020-11-06 18:47:13Z Beverly Collins 23 Geremonty Drive Salem NH 03079 12819885 0 X salemhaven.com X 1977 NH Healthcare services for the elderly 13 13 194 22 72028 71028 36125 76284 11846112 11568229 98275 183941 82946 78363 12063458 11906817 0 0 0 0 8027192 6861587 0 0 0 4581845 5616810 12609037 12478397 -545579 -571580 10130104 9962768 4058700 4206569 6071404 5756199 X In February, 1972, a group of Salem, NH residents founded the organization with the goal of developing a facility to provide health care and related services for the community's elderly population. 0 0 11125537 11568229 The Salemhaven complex provides comprehensive healthcare services, resources and accomodations (110 bed facility) for senior citizens, including the operation of a medical day care service. Salemhaven services include providing long term care, rehabilitation including PT, OT Speech, social services for residents and families, meeting of Spiritual needs, activities, supporting many local charities and community services, hospice services and respite care. We employ over 150 workers from the local area, we subsidized Medicaid over 1 million dollars annually, and we are a participant in the local and state emergency planning programs.Silverthorne Adult Medical Day Center provides to participants: Health care monitoring, Social services, Therapeutic and recreational activities, Health Care Education to participants, families and the community. We also provide respite care for caregivers and a Caregiver Support Group monthly for families and community members. 11125537 1 1 0 1 0 0 0 0 1 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 36 0 1 194 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 13 13 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 1 0 0 NH X Ray Milliard Administrator 6038935586 23 Geremonty Drive Salem NH 03079 Beverly Collins Board President 1.00 X X 0 0 0 Michael Collins Board Treasurer 1.00 X X 0 0 0 Philip Cammarata Board Vice President 1.00 X X 0 0 0 Brendan Slein Board Secretary 1.00 X X 0 0 0 Robert Slein Board Member 1.00 X 0 0 0 Jeffrey Scionti Board Member 1.00 X 0 0 0 Jamie Santo Board Member 1.00 X 0 0 0 Ralph Glynn Board Member 1.00 X 0 0 0 Rev David Yasenka Board Member 1.00 X 0 0 0 Michael Carney Jr Board Member 1.00 X 0 0 0 Frank Monteiro Board Member 1.00 X 0 0 0 Amy White Board Member 1.00 X 0 0 0 Greg Brown Board Member 1.00 X 0 0 0 Sonny Tylus Past Board Member 1.00 X 0 0 0 Raymond Milliard Administrator 40.00 X 128451 0 39913 Joanne Consolazio MDS Coordinator 40.00 X 103271 0 12860 231722 0 52773 2 0 1 0 Kindred Rehab Services LLC dba Rehabcar PO Box 277365 Atlanta GA 303847365 Rehab Services 875306 BrightStar Care of BedfordManchester Bedford Commons 601 Riverway Place Bedford NH 03110 Care Services 466413 Medical Solutions LLC 1010 N 102nd Street Suite 300 Omaha NE 68114 Temporary Staffing 447023 Pharmerica PO Box 409251 Atlanta GA 303849251 Pharmacy Services 256032 MAS New Hampshire 156 Harvey Road Londonderry NH 03053 Temporary Staffing 121808 12 20345 55939 76284 Net Long-Term Care Services 623000 11385216 11385216 Adult Daycare Services 623000 178286 178286 Miscellaneous Income 623000 3642 3642 Guest Meals 623000 1085 1085 11568229 98483 98483 993526 908068 85458 85458 85458 6335 20345 0 6335 6335 77028 5000 72028 72028 11906817 11568229 72028 190276 168363 168363 5369101 4826172 542929 55350 48812 6538 872586 804720 67866 396187 349392 46795 32306 32306 48808 2908 45900 17314 17314 131957 114056 17901 48713 2653 46060 210123 149545 60578 94707 94707 318368 274878 43490 9801 5867 3934 139355 133691 5664 433817 417680 16137 102613 98967 3646 Unrelated Business Inco 55343 19781 35562 Purchased Services 2447979 2383421 64558 Food/Drug/Med. Supplies 856483 856483 NH Quality Assessment 629099 629099 40024 7412 32612 12478397 11125537 1352860 0 40350 40350 2833351 2510340 861906 1040900 43031 61270 152026 175411 11017409 7379756 4005938 3637653 1835838 2217791 357664 279053 10130104 9962768 1047353 1028314 4548 4419 3006799 3173836 4058700 4206569 X 6071404 5741199 15000 6071404 5756199 10130104 9962768 -571580 256375 0 X 0 1 X 1 0 X 10686 7772 15332 36125 76284 146199 11977869 11564571 11398001 11846112 11568229 58354782 11988555 11572343 11413333 11882237 11644513 58500981 0 11469 76376 149219 133568 120090 490722 11469 76376 149219 133568 120090 490722 58010259 54254 57913 59157 71547 98483 341354 65737 57112 122849 54254 57913 59157 137284 155595 464203 6335 6335 12042809 11630256 11472490 12019521 11806443 58971519 0.98370 0.98740 0.00790 0.00620 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1774 1774 0 Form 990, Schedule C, Part II-B, Line 1i Lobbying portion of NHHCA Dues 15%. 0 1 X 41189 41189 9362708 6028164 3334544 1377295 1192419 184876 236217 159173 77044 3637653 12145111 256375 256375 11888736 17314 767 18081 11906817 12460316 0 12460316 17314 767 18081 12478397 Part IV, Line 2b: The Organization holds funds for residents and provides these funds to the resident, as needed, for various common expenses. Part XI, Line 4b - Other Adjustments: Loss on abandoment of fixed assets 767. Part XII, Line 4b - Other Adjustments: Loss on abandoment of fixed assets 767. Wreath Stroll Event 26680 20345 6335 26680 20345 6335 6335 77028 5000 0 77028 5000 5000 72028 NH 1 0 1 0 1.00000 Ray Milliard 23 Geremonty Drive Salem NH 03079 1 77028 5000 Chasers Poker 7 Veterans Memorial Parkway Salem NH 03079 Ray Milliard 0 Ray Milliard is an Officer of Salemhaven and the amount of compensation related to gaming activities is indeterminable. X 0 Schedule G, Part III, Line 15a: The Organization had an agreement where Chasers Poker would provide Salemhaven, Inc. a percentage of revenue from Chasers Poker's games of chance proceeds. Salemhaven, Inc. never paid Chasers Poker directly and was not directly involved in administrating any of the games of chance. Salemhaven was charged $500 a day for the ten day event which was taken directly out of the proceeds earned by Chasers Poker which then donated the remaining $72,028 of proceeds to Salemhaven. X X X 0 0 0 0 0 0 0 1 0 Raymond Milliard Administrator 126451 0 2000 0 0 0 0 0 39913 0 168364 0 0 0 Part I, Line 7 Ray Milliard received a Christmas bonus approved by the Board of Directors. Form 990, Part VI, Section A, line 2 Board members Robert Slein and Brendan Slein have a family relationship. Form 990, Part VI, Section B, line 11b The 990 is sent to all board members and reviewed at a board meeting. If necessary the auditors that prepared the 990 are requested to give a presentation. Form 990, Part VI, Section B, line 12c Board members fill out a disclosure form and are given a policy regarding disclosure and conflicts of interest. The administrator and business office monitor for potential conflicts and then report findings to the board of directors. Part of the annual financial audit is a review of potential conflicts and findings that are reported to the board. Form 990, Part VI, Section B, line 15a Salemhavem pulls demographic reports and surveys for the Board to review and decide on compensation for Administrator, Ray Milliard. Form 990, Part VI, Section C, line 19 The organization makes its governing documents, conflict of interest policy and financial statements available to the public upon request. Form 990, Part X, Line 10: Land, Buildings, and Equipment Section 1.263(a)-3(n) Election: Salemhaven, Inc. 23 Geremonty, Salem, NH 03079 EIN 02-0325847 Salemhaven, Inc. is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n).