2020-11-16T11:32:26-06:00 2019-12-31 410746749 CLIFTONLARSONALLEN LLP 300 CROWN COLONY DRIVE SUITE 310 QUINCY MA 02169 990 2019-01-01 043274643 CHELSEA JEWISH NORTH SHORE ASSISTED LIVING INC CHEL 9785324411 240 LYNNFIELD STREET PEABODY MA 01960 JEFFREY LANDA CHEIF FINANCIAL OFFICER 9785324411 2020-11-15 1 DOUGLAS FIEBELKORN P00173341 6179848100 2020-11-14 67.137.57.251 2020-11-15 18:48:08 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 2A57722B0E70568697EDE127A206D410EA2AEB6A 2019 2021-01-29 14:40:06Z HARRIETT & RALPH KAPLAN ESTATES ADAM BERMAN 240 LYNNFIELD STREET PEABODY MA 01960 8165052 0 X WWW.CHELSEAJEWISH.ORG X 1995 MA THE ORGANIZATION'S MISSION IS TO ENRICH THE LIFE OF EACH OF OUR RESIDENTS AND PROGRAM PARTICIPANTS. 6 2 157 25 0 0 250 0 8011807 8130543 0 34350 1018 159 8013075 8165052 0 0 0 0 3975372 3967535 0 0 59969 3063958 2979716 7039330 6947251 973745 1217801 14831613 22985844 13212001 18608840 1619612 4377004 TO ENRICH THE LIFE OF EACH OF OUR RESIDENTS AND PROGRAM PARTICIPANTS SO THAT EACH MAY CONTINUE TO LIVE HIS OR HER LIFE WITH A SENSE OF MEANING AND PURPOSE. WE PROVIDE ASSISTED LIVING UNITS FOR OUR TENANTS. 0 0 5460040 0 8130702 ASSISTED LIVING - OPERATION OF A 130-UNIT ASSISTED LIVING FACILITY IN PEABODY, MA. 32 UNITS WERE SPECIALLY DESIGNED AND DESIGNATED FOR CARE SPECIALIZING IN MEMORY ISSUES. 5460040 1 0 0 0 0 0 0 0 0 1 1 0 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 1 0 0 0 0 0 0 1 0 0 0 1 1 0 157 1 0 0 0 0 0 0 0 0 0 0 0 0 X 6 2 1 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X JEFFREY LANDA 9784715100 240 LYNNFIELD STREET PEABODY MA 01960 BARRY BERMAN CEO AND TREASURER 1.00 39.00 X X 0 677517 75257 ADAM BERMAN PRESIDENT 1.00 39.00 X X 0 349563 51303 ELIZABETH MULLEN COO AND CLERK 1.00 39.00 X X 0 229257 28058 GILDA RICHMAN CHAIR 1.00 39.00 X X 0 74333 5774 JOEL MAZER DIRECTOR 1.00 8.00 X 0 0 0 JUDY WEISS DIRECTOR 1.00 8.00 X 0 0 0 JEFFREY LANDA CFO 1.00 39.00 X 0 285500 31390 0 1616170 191782 0 0 1 0 KTM EXTERIORS 10 HAZEL DR HAMPSTEAD NH 03841 CONTRACTOR 563213 LANDMARK STRUCTURES 282 MONTVALE AVE STONEHAM MA 01801 CONTRACTOR 297958 2 PROGRAM SERVICE INCOME 623990 8012604 8012604 OTHER INCOME 623000 117939 117939 8130543 30122 30122 4228 0 4228 4228 4228 159 0 159 159 8165052 8130702 0 34350 3477216 2808299 608948 59969 4440 4240 200 216597 167149 49448 269282 257164 12118 483645 483645 20574 19648 926 286458 219156 67302 52884 52884 96892 70544 26348 336245 311076 25169 13710 12154 1556 8271 8271 347779 329373 18406 555621 514031 41590 87616 83673 3943 FOOD 408610 408610 SUPPLIES 246050 238744 7306 LICENSE, DUES, & SUBSCR 18341 17241 1100 BAD DEBTS 6000 6000 11020 -1062 12082 6947251 5460040 1427242 59969 1117766 1353622 72735 98766 28742 185510 21375663 9283261 12460838 12092402 1467224 1151532 7788320 14831613 22985844 482793 889015 226392 120864 10148031 11569331 574122 2354785 5455508 13212001 18608840 X 1619612 4377004 1619612 4377004 14831613 22985844 X 1217801 20600 1518991 X 0 1 X 1 0 X 250 250 8190785 8148438 7876822 8012898 8130702 40359645 8190785 8148438 7876822 8013148 8130702 40359895 0 0 0 40359895 8190785 8148438 7876822 8013148 8130702 40359895 1.00000 1.00000 0.00000 0.00000 X 246220 28011 218209 0.99000 0.01000 0 0 1926935 1926935 17186421 7342590 9843831 2262307 1940671 321636 12092402 DUE FROM RELATED PARTY 6503894 DEPOSITS 5838 SOFTWARE, NET 500 CONSTRUCTION IN PROGRESS 1278088 7788320 RESIDENT SECURITY DEPOSITS 579955 DEFERRED MANAGEMENT FEES - RELATED PARTY 1794420 DUE TO RELATED PARTIES 3021334 FAIR VALUE INTEREST OF INTEREST RATE SWAPS 59799 5455508 X PART X, LINE 2: THE ORGANIZATION IS A NONPROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC) AND IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE ORGANIZATION FILES AS A TAX-EXEMPT ENTITY. SHOULD THAT STATUS BE CHALLENGED IN THE FUTURE, ITS 2016 THROUGH 2019 TAX YEARS ARE OPEN FOR EXAMINATION BY THE FEDERAL AND STATE TAXING AUTHORITIES. 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 YEAR ENDED DECEMBER 31, 2019. THE ORGANIZATION EVALUATES TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN IN ITS TAX RETURNS TO DETERMINE WHETHER THE TAX POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED BY THE APPLICABLE TAX AUTHORITY. TAX POSITIONS NOT DEEMED TO MEET THE MORE LIKELY THAN NOT THRESHOLD, ALONG WITH ACCRUED INTEREST AND PENALTY THEREON WOULD BE RECORDED AS AN EXPENSE IN THE CURRENT YEAR FINANCIAL STATEMENTS. AT DECEMBER 31, 2019, MANAGEMENT BELIEVES THAT IT HAS NO UNCERTAIN TAX POSITIONS WITH ANY OF ITS OPEN TAX YEARS. PART V, LINE 4: CHELSEA JEWISH NORTH SHORE FOUNDATION TRANSFERRED AN ENDOWMENT FUND TO THE ORGANIZATION DURING 2019. THE BOARD OF DIRECTORS HAS CLASSIFIED THIS ENDOWMENT AND RELATED APPRECIATION/DEPRECIATION IN ACCORDANCE WITH MASSACHUSETTS GENERAL LAW UNDER SECTION 180A. UNDER MASSACHUSETTS LAW, UNLESS EXPLICITLY STATED OTHERWISE BY THE DONOR, THE REALIZED AND UNREALIZED APPRECIATION ON INVESTMENTS OF PERMANENTLY RESTRICTED ASSETS OF MASSACHUSETTS PUBLIC CHARITIES SHOULD, UNTIL APPROPRIATED PURSUANT TO PROPER GOVERNING BOARD ACTION, BE CLASSIFIED IN THE FINANCIAL STATEMENTS AS NET ASSETS WITH DONOR RESTRICTIONS. ANNUALLY, THE ORGANIZATION USES THE NET APPRECIATION OF THE ENDOWMENT FOR ITS RESTRICTED PURPOSE IN ACCORDANCE WITH THE DONOR'S RESTRICTION. THE ORGANIZATION INVESTS ENDOWMENT FUNDS IN CASH AND CASH EQUIVALENTS. THIS POLICY IS DESIGNED TO PRESERVE THE VALUE OF THE PORTFOLIO. X X 0 0 0 0 0 0 0 0 0 BARRY BERMAN CEO AND TREASURER 0 677517 0 0 0 0 0 0 0 75257 0 752774 0 0 ADAM BERMAN PRESIDENT 0 349563 0 0 0 0 0 0 0 51303 0 400866 0 0 ELIZABETH MULLEN COO AND CLERK 0 229257 0 0 0 0 0 0 0 28058 0 257315 0 0 JEFFREY LANDA CFO 0 285500 0 0 0 0 0 0 0 31390 0 316890 0 0 A MASS DEVELOPMENT FINANCE AGENCY 043431814 57584YSL4 2019-06-20 11760087 TO REFUND OLD BONDS, FUND CAPITAL EXPENDITURE, AND FUND COSTS OF ISSUANCE 0 0 0 A 11760087 11236629 186845 37927 298686 2020 1 0 1 1 A 0 0 0 0 0 0 1 A 0 1 0 0 1 1 M&T BANK 7.000000000000 0 0 0 0 1 A 1 SCHEDULE K SUPPLENTAL INFORMATION THIS ORGANIZATION IS REPORTING THEIR RESPECTIVE SHARE OF THE $54,725,000 BOND ISSUED ON 06/20/2019. THE FOUR ORGANIZATIONS INVOLVED IN THE ISSUANCE ARE: JEWISH REHABILITATION CENTER FOR AGED OF THE NORTH SHORE, INC. (EIN 04-2106768), CHELSEA JEWISH NORTH SHORE ASSISTED LIVING, INC. (EIN - 04-3274643), CHELSEA JEWISH GREEN HOUSE, INC. (EIN 04-3326727) AND CHELSEA JEWISH COMMUNITY, INC. (EIN 27-1756594). JEFFREY BRUDNICK (LOUIS J BRUDNICK & SONS) JEFFREY BRUDNICK IS A DIRECTOR OF THE BOARD OF CHELSEA JEWISH LIFECARE 89142 INSURANCE BROKER/AGENT 0 FORM 990, PART VI, SECTION A, LINE 2 ADAM BERMAN, PRESIDENT, AND BARRY BERMAN, TREASURER, HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION ENTERED INTO A MANAGEMENT AGREEMENT WITH CHELSEA JEWISH LIFECARE EFFECTIVE JANUARY 1,2017. CHELSEA JEWISH LIFECARE, INC. PROVIDED MANAGEMENT SERVICES WHICH INCLUDED THE FOLLOWING RESPONSIBILITIES: 1) KEY PERSONNEL MANAGEMENT 2) PERSONNEL OVERSIGHT (EMPLOYEES & ADMINISTRATION) 3) FINANCIAL RESPONSIBILITIES 4) MANAGEMENT REPORTS 5) REGULATORY COMPLIANCE 6) QUALITY ASSURANCE 7) PURCHASING & CONTRACTING 8) BANK ACCOUNTS FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE CORPORATION IS A RELATED ORGANIZATION, CHELSEA JEWISH LIFECARE, INC. FORM 990, PART VI, SECTION A, LINE 7A THE APPROVAL OF THE MEMBER, CHELSEA JEWISH LIFECARE, INC., IS REQUIRED TO ELECT OR REMOVE DIRECTORS OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7B THE APPROVAL OF THE MEMBER, CHELSEA JEWISH LIFECARE, INC., IS REQUIRED BEFORE THE BOARD OF DIRECTOR'S ACTION ON ANY OF THE FOLLOWING BECOMES EFFECTIVE: (A) TO AMEND OR TO REPEAL THE ARTICLES OF ORGANIZATION OR THE BYLAWS OF THE CORPORATION; (B) TO APPROVE ALL PLANS OF MERGER, CONSOLIDATION, REORGANIZATION OR DISSOLUTION OF THE CORPORATION OR ANY SUBSIDIARY OF THE CORPORATION, OR THE SALE, LEASE, ASSIGNMENT OR TRANSFER OF SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION, OR THE PURCHASE OR ACQUISITION BY THE CORPORATION OF THE CORPORATION OF AN INTEREST IN ANY CORPORATION, PARTNERSHIP, JOINT VENTURE OR OTHER ENTITY, WHETHER NEWLY CREATED OR PREVIOUSLY EXISTING, WHICH INTEREST, IN THE CASE OF A FOR-PROFIT ENTITY, REPRESENTS TWENTY-FIVE PERCENT (25%) OR MORE OF THE VOTING POWER THEREOF OR EQUITY INTEREST THEREIN, OR, IN THE CASE OF A NON-PROFIT ENTITY, REPRESENTS TWENTY-FIVE PERCENT (25%) OR MORE OF THE VOTING POWER THEREOF OR MEMBERSHIP INTEREST THEREIN; (C) TO APPROVE ALL GIFTS, GRANTS, DONATIONS OR SIMILAR TRANSFERS OF FUNDS OF THE CORPORATION TO ANY ENTITY OTHER THAN THE MEMBER OR ITS SUBSIDIARIES; (D) TO ELECT OR REMOVE DIRECTORS OF THE CORPORATION; (E) TO APPROVE THE FORMATION OF ANY SUBSIDIARY OF THE CORPORATION; AND (F) TO APPOINT THE CORPORATION'S AUDITORS. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION'S MANAGEMENT TEAM WILL CONDUCT A REVIEW OF THE FORM 990 AFTER IT HAS BEEN FINALIZED, INCLUDING READING AND REVIEWING THE KEY INFORMATION. MANAGEMENT WILL REPORT TO THE BOARD IF THERE ARE ANY MAJOR DEVIATIONS FROM THE PROVIDED DATA. A COMPLETE COPY OF THE FORM 990 IS PROVIDED TO THE BOARD PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ON AN ANNUAL BASIS, ALL BOARD MEMBERS ARE INSTRUCTED TO INFORM THE REST OF THE BOARD IF ANY CONFLICT OF INTEREST EXISTS PERTAINING TO THEIR MEMBERSHIP ON THE BOARD. ANY POTENTIAL CONFLICT OF INTEREST IS THEN DISCUSSED AND ASSESSED BY THE REMAINING BOARD MEMBERS. IF A CONFLICT EXISTS, IT MUST BE DISCLOSED AND HELD TO A HIGHER LEVEL OF SCRUTINY IN ORDER TO VERIFY THAT ALL TRANSACTIONS ARE AT ARMS-LENGTH. ANY BOARD MEMBER DEEMED TO HAVE A CONFLICT OF INTEREST WILL ABSTAIN FROM PARTICIPATING IN THE BOARD'S DELIBERATIONS AND DECISIONS IN THE TRANSACTION. FORM 990, PART VI, SECTION B, LINE 15 THE CEO IS PAID FROM A RELATED ORGANIZATION. PRIOR TO MAJOR SALARY ADJUSTMENTS FOR THE CEO, A RELATED ORGANIZATION'S BOARD OF DIRECTORS ARRANGES FOR A SALARY STUDY TO BE PERFORMED. THE STUDY INCLUDES THE EXECUTIVE SALARIES OF COMPARABLY-SIZED COMPANIES IN THE INDUSTRY. THE BOARD OF DIRECTORS THEN CONSIDERS THE FINDINGS OF THE STUDY IN SETTING THE CEO'S COMPENSATION. 2019 WAS THE MOST RECENT YEAR IN WHICH THE PROCESS INCLUDED REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION. FORM 990, PART VI, SECTION B, LINE 15B: OFFICERS AND KEY EMPLOYEES ARE PAID FROM A RELATED ORGANIZATION. COMPENSATION FOR KEY EMPLOYEES IS DETERMINED THROUGH THE USE OF SALARY STUDIES OR OTHER DATA AND ADJUSTED BASED ON THE EMPLOYEE'S YEARS OF EXPERIENCE AND RESPONSIBILITIES BY A RELATED ORGANIZATION'S BOARD OF DIRECTORS. 2019 WAS THE MOST RECENT YEAR IN WHICH THE PROCESS INCLUDED REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN FAIR VALUE OF INTEREST RATE SWAP -102,867. LOSS ON EXTINGUISHMENT OF DEBT -328,488. EQUITY TRANSFER FROM AFFILIATED NONPROFIT ENTITY 1,950,346. CHELSEA JEWISH LIFECARE INC 165 CAPTAINS ROW CHELSEA MA 02150 510141617 MANAGEMENT MA 501(C)(3) LINE 7 N/A 0 CHELSEA JEWISH COMMUNITY INC 165 CAPTAINS ROW CHELSEA MA 02150 271756594 MANAGEMENT, HOMECARE, PERSONAL CARE, HOSPICE, THERAPY MA 501(C)(3) LINE 10 CHELSEA JEWISH LIFECARE INC 0 CHELSEA JEWISH CHARITABLE FOUNDATION INC 240 LYNNFIELD STREET PEABODY MA 01960 261244471 FUNDRAISING & SUPPORT MA 501(C)(3) LINE 12B, II CHELSEA JEWISH LIFECARE INC 0 CHELSEA JEWISH GREEN HOUSE INC 165 CAPTAINS ROW CHELSEA MA 02150 043326727 ASSISTED LIVING & NURSING HOME MA 501(C)(3) LINE 10 CHELSEA JEWISH LIFECARE INC 0 CHELSEA JEWISH NORTH SHORE FOUNDATION INC 240 LYNNFIELD STREET PEABODY MA 01960 223102199 FUNDRAISING & SUPPORT MA 501(C)(3) LINE 7 CHELSEA JEWISH LIFECARE INC 0 CHELSEA JEWISH NURSING HOME INC 17 LAFAYETTE AVENUE CHELSEA MA 02150 042200583 NURSING HOME MA 501(C)(3) LINE 10 CHELSEA JEWISH LIFECARE INC 0 JEWISH REHABILITATION CENTER FOR AGED OF THE NORTH SHORE INC 240 LYNNFIELD STREET PEABODY MA 01960 042106768 SKILLED NURSING & ADH MA 501(C)(3) LINE 10 CHELSEA JEWISH LIFECARE INC 0 ADMIRAL'S HILL ASSISTED LIVING CORP II 165 CAPTAINS ROW CHELSEA MA 02150 043538833 ASSISTED LIVING MA 501(C)(3) LINE 10 CHELSEA JEWISH LIFECARE INC 0 JGS LIFECARE CORPORATION 770 CONVERSE STREET LONGMEADOW MA 01106 042129128 GERIATRIC/NURSIGN PROVIDER MA 501(C)(3) LINE 7 CHELSEA JEWISH LIFECARE INC 0 JGS ADMINISTRATIVE SERVICES 770 CONVERSE STREET LONGMEADOW MA 01106 043295014 ADMIN SUPPORT TO JEWISH GERIATRIC SERVICES MA 501(C)(3) LINE 10 JGS LIFECARE CORPORATION 0 JEWSIH NURSING HOME OF WESTERN MA INC 770 CONVERSE STREET LONGMEADOW MA 01106 043138403 SKILLED NURSING FACILITY MA 501(C)(3) LINE 10 JGS LIFECARE CORPORATION 0 JGS HOUSING SERVICES INC 770 CONVERSE STREET LONGMEADOW MA 01106 043321157 ASSISTED LIVING MA 501(C)(3) LINE 10 JGS LIFECARE CORPORATION 0 SPECTRUM HOME HEALTH & HOSPICE 770 CONVERSE STREET LONGMEADOW MA 01106 043237982 HOME HEALTH & HOSPICE CARE MA 501(C)(3) LINE 10 JGS LIFECARE CORPORATION 0 SPECTRUM HOME CARE INC 770 CONVERSE STREET LONGMEADOW MA 01106 043399549 NON-CERTIFIED HOME HEALTH AGENCY MA 501(C)(3) LINE 10 JGS LIFECARE CORPORATION 0 WINTHROP APARTMENTS LLC 165 CAPTAINS ROW CHELSEA MA 02150 463739775 REAL ESTATE MA N/A 0 0 0 0 1 1 0 0 0 0 0 0 0 1 1 1 0 0 1