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FAIRHAVEN HEALTHCARE CENTER INC: Form 990, tax year 2019

View the entire original 990 at ProPublica ↗

Organization
FAIRHAVEN HEALTHCARE CENTER INC (EIN 20-8745264)
Tax period
2019-01-01 to 2019-12-31
Filed
2020-10-27
IRS object ID
202023019349300212
Schema version
2019v5.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2020-10-27T08:25:52-05:00ReturnTs
Tax Period End2019-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN410746749PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1CLIFTONLARSONALLEN LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1300 CROWN COLONY DRIVE SUITE 310AddressLine1Txt
CityQUINCYCityNm
State AbbreviationMAStateAbbreviationCd
ZIP02169ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2019-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN208745264EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1FAIRHAVEN HEALTHCARE CENTER INCBusinessNameLine1Txt
Business Name Line2C/O ATHENA HEALTH CARE ASSOCIATESBusinessNameLine2Txt
FieldValueIRS element (for citing)
Business Name ControlFAIRBusinessNameControlTxt
Phone9784583388PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1476 VARNUM AVEAddressLine1Txt
CityLOWELLCityNm
State AbbreviationMAStateAbbreviationCd
ZIP01854ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonRAYMOND DENEHEYPersonNm
Person TitlePRESIDENTPersonTitleTxt
Phone9784583388PhoneNum
Signature2020-10-26SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonJONATHAN LANGFIELDPreparerPersonNm
PTINP00562148PTIN
Phone6179848100PhoneNum
Preparation2020-10-20PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address75.144.160.101IPv4AddressTxt
FieldValueIRS element (for citing)
IP2020-10-26IPDt
IP Tm12:43:34IPTm
IP TimezoneEDIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device Id54D8D927FE1959EFDE9C130AEE0794B2E6AD1686AtSubmissionCreationDeviceId
At Submission Filing Device Id8691CE57B3CA54F67807ABE18706F5E1A699ECB4AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2019TaxYr
Build TS2021-01-29 14:40:06ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerRAYMOND DENEHEYPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1476 VARNUM AVEAddressLine1Txt
CityLOWELLCityNm
State AbbreviationMAStateAbbreviationCd
ZIP01854ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$15,143,251GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.FAIRHAVEN-NURSING.COMWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2007FormationYr
Legal Domicile StateMALegalDomicileStateCd
Activity Or MissionIT IS THE MISSION OF FAIRHAVEN HEALTHCARE CENTER, INC. TO PROVIDE ELDERS WITH DYNAMIC, MEANINGFUL AND SUPPORTIVE LIVING ENVIRONMENTS, INTEGRATING QUALITY CARE, EDUCATION AND RESEARCH, RESPECT FOR INDIVIDUALITY AND THE HUMAN SPIRIT, AND INNOVATIVE APPPROACHES TO MEET THE EVER CHANGING NEEDS OF THE COMMUNITIES WE SERVE.ActivityOrMissionDesc
Voting Members Governing Body7VotingMembersGoverningBodyCnt
Voting Members Independent5VotingMembersIndependentCnt
Total Employee298TotalEmployeeCnt
Total Volunteers8TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$0PYContributionsGrantsAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$15,418,194PYProgramServiceRevenueAmt
CY Program Service Revenue$15,073,050CYProgramServiceRevenueAmt
PY Investment Income$61,220PYInvestmentIncomeAmt
CY Investment Income$70,201CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$15,479,414PYTotalRevenueAmt
CY Total Revenue$15,143,251CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$9,096,266PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$9,407,606CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$7,238,676PYOtherExpensesAmt
CY Other Expenses$7,715,547CYOtherExpensesAmt
PY Total Expenses$16,334,942PYTotalExpensesAmt
CY Total Expenses$17,123,153CYTotalExpensesAmt
PY Revenues Less Expenses-$855,528PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$1,979,902CYRevenuesLessExpensesAmt
Total Assets BOY$24,985,465TotalAssetsBOYAmt
Total Assets EOY$23,100,413TotalAssetsEOYAmt
Total Liabilities BOY$29,208,371TotalLiabilitiesBOYAmt
Total Liabilities EOY$29,270,544TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY-$4,222,906NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY-$6,170,131NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionIT IS THE MISSION OF FAIRHAVEN HEALTHCARE CENTER, INC. TO PROVIDE ELDERS WITH DYNAMIC, MEANINGFUL AND SUPPORTIVE LIVING ENVIRONMENTS, INTEGRATING QUALITY CARE, EDUCATION AND RESEARCH, RESPECT FOR INDIVIDUALITY AND THE HUMAN SPIRIT, AND INNOVATIVE APPROACHES TO MEET THE EVER CHANGING NEEDS OF THE COMMUNITIES WE SERVE.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$15,237,592ExpenseAmt
Revenue$15,073,050RevenueAmt
DescFAIRHAVEN HEALTHCARE CENTER IS A 169-BED, JCAHO ACCREDITED AND MEDICARE CERTIFIED HEALTHCARE FACILITY OFFERING TRADITIONAL SKILLED NURSING CARE, SHORT-TERM REHABILITATION, PLUS A VARIETY OF SPECIALIZED TREATMENT PROGRAMS.Desc
Total Program Service Expenses$15,237,592TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B Required0ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other AssetsYes (1)ReportOtherAssetsInd
Report Other Liabilities0ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J Required0ScheduleJRequiredInd
Tax Exempt BondsYes (1)TaxExemptBondsInd
Invest Tax Exempt Bonds0InvestTaxExemptBondsInd
Escrow Account0EscrowAccountInd
On Behalf Of Issuer0OnBehalfOfIssuerInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam MemYes (1)BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document21IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee298EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members7GoverningBodyVotingMembersCnt
Independent Voting Member5IndependentVotingMemberCnt
Family Or Business RlnYes (1)FamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesYes (1)DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy0ConflictOfInterestPolicyInd
Whistleblower Policy0WhistleblowerPolicyInd
Document Retention Policy0DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldMAStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1ATHENA HEALTH CAREBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone8607513900PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1135 SOUTH RDAddressLine1Txt
CityFARMINGTONCityNm
State AbbreviationCTStateAbbreviationCd
ZIP06032ZIPCd
FieldValueIRS element (for citing)
No Listed Persons CompensatedYes (X)NoListedPersonsCompensatedInd

Form990 Part VII Section A Form990PartVIISectionAGrp (11 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeInd
RAYMOND DENNEHY
PRESIDENT1.002.00Yes (X)Yes (X)$0$0$0
DAVID O'DONNELL
TREASURER1.002.00Yes (X)Yes (X)$0$0$0
JOHN REGAN
SECRETARY1.002.00Yes (X)Yes (X)$0$0$0
PATRICIA TORTELLA
DIRECTOR1.002.00Yes (X)$0$0$0
JOEL KIRCHIK
DIRECTOR1.002.00Yes (X)$0$0$0
MICHAEL MOORE
DIRECTOR1.002.00Yes (X)$0$0$0
JEFFREY WITHERELL
DIRECTOR1.002.00Yes (X)$0$0$0
EMILY GETCHELL
DNS40.00$135,990$0$8,210Yes (X)
MICHAEL TAKESIAN
ADMINISTRATOR40.00$120,008$0$7,245Yes (X)
DEBORAH LISIECKI
REHAB DIRECTOR40.00$109,264$0$6,596Yes (X)
SUSAN BREEN
PHYSICAL THERAPIST40.00$104,278$0$6,295Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$469,540TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$28,346TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K4IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K0TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
PARTNERS PHARMACY
6 THOMPSON RDEAST WINDSORCT06088PHARMACY SERVICES$416,977
ATHENA HEALTH CARE SYSTEMS
35 AVCO ROADHAVERHILLMA01835MANAGEMENT COMPANY$363,796
GERIATRIC MEDICAL
28 TORRICE DR 6220WOBURNMA01801NURSING SUPPLIES$291,545
CLEAN FACILITY
846 LEXINGTON STREET 6WALTHAMMA02452HOUSEKEEPING AND LAUNDRY SERVICES$282,840
THURSTON FOODS INC
30 THURSTON DRIVEWALLINGFORDCT06492FOOD & DIETRY SUPPLIES$242,723
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K5CntrctRcvdGreaterThan100KCnt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescPROGRAM SERVICE REVENUEDesc
Business623000BusinessCd
Total Revenue Column$15,073,050TotalRevenueColumnAmt
Related Or Exempt Func Income$15,073,050RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$15,073,050TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$70,201TotalRevenueColumnAmt
Exclusion$70,201ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$15,143,251TotalRevenueColumnAmt
Related Or Exempt Func Income$15,073,050RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$70,201ExclusionAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$8,309,011TotalAmt
Program Services$7,968,281ProgramServicesAmt
Management And General$340,730ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$495,085TotalAmt
Program Services$474,783ProgramServicesAmt
Management And General$20,302ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$603,510TotalAmt
Program Services$578,762ProgramServicesAmt
Management And General$24,748ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$448,881TotalAmt
Management And General$448,881ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$182,769TotalAmt
Management And General$182,769ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$43,217TotalAmt
Management And General$43,217ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$896,886TotalAmt
Program Services$624,760ProgramServicesAmt
Management And General$272,126ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$11,879TotalAmt
Management And General$11,879ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$224,011TotalAmt
Program Services$38,546ProgramServicesAmt
Management And General$185,465ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$228,082TotalAmt
Program Services$228,082ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$5,125TotalAmt
Management And General$5,125ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$1,803,705TotalAmt
Program Services$1,803,705ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$739,150TotalAmt
Program Services$739,150ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$171,473TotalAmt
Program Services$20,129ProgramServicesAmt
Management And General$151,344ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES$1,632,629$1,632,629
STATE ASSSESSMENT$1,128,765$1,128,765
BAD DEBTS$177,377$177,377
DUES$19,258$19,258

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$2,340TotalAmt
Management And General$2,340ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$17,123,153TotalAmt
Program Services$15,237,592ProgramServicesAmt
Management And General$1,885,561ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$568,811BOYAmt
EOY$449,215EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$214,244BOYAmt
EOY$140EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$698,834BOYAmt
EOY$486,112EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$12,777BOYAmt
EOY$92,696EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$23,670,801LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$7,581,035LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$16,716,853BOYAmt
EOY$16,089,766EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$2,932,083BOYAmt
EOY$2,932,083EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$3,841,863BOYAmt
EOY$3,050,401EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$24,985,465BOYAmt
EOY$23,100,413EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$2,726,261BOYAmt
EOY$2,775,029EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$37,854BOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$25,683,458BOYAmt
EOY$25,734,717EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$760,798BOYAmt
EOY$760,798EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$29,208,371BOYAmt
EOY$29,270,544EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY-$4,222,906BOYAmt
EOY-$6,170,131EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY-$4,222,906BOYAmt
EOY-$6,170,131EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$24,985,465BOYAmt
EOY$23,100,413EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$1,979,902ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$32,348NetUnrlzdGainsLossesInvstAmt
Prior Period Adjustments$331PriorPeriodAdjustmentsAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2Yes (X)PubliclySupportedOrg509a2Ind

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$14,800,784CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$14,740,246CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$14,712,230CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$15,418,194CurrentTaxYearMinus1YearAmt
Current Tax Year$15,073,050CurrentTaxYearAmt
Total$74,744,504TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$14,800,784CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$14,740,246CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$14,712,230CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$15,418,194CurrentTaxYearMinus1YearAmt
Current Tax Year$15,073,050CurrentTaxYearAmt
Total$74,744,504TotalAmt

Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Substantial Contributors Amt SubstantialContributorsAmtGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$74,744,504PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$19,959CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$26,985CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$26,901CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$61,220CurrentTaxYearMinus1YearAmt
Current Tax Year$70,201CurrentTaxYearAmt
Total$205,266TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$19,959CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$26,985CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$26,901CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$61,220CurrentTaxYearMinus1YearAmt
Current Tax Year$70,201CurrentTaxYearAmt
Total$205,266TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$14,820,743CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$14,767,231CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$14,739,131CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$15,479,414CurrentTaxYearMinus1YearAmt
Current Tax Year$15,143,251CurrentTaxYearAmt
Total$74,949,770TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.99730PublicSupportCY509Pct
Public Support PY5090.99790PublicSupportPY509Pct
Investment Income CY0.00270InvestmentIncomeCYPct
Investment Income PY0.00210InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,958,000OtherCostOrOtherBasisAmt
Book Value$1,958,000BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$19,978,538OtherCostOrOtherBasisAmt
Depreciation$6,269,808DepreciationAmt
Book Value$13,708,730BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,568,119OtherCostOrOtherBasisAmt
Depreciation$1,145,083DepreciationAmt
Book Value$423,036BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$166,144OtherCostOrOtherBasisAmt
Depreciation$166,144DepreciationAmt
Book Value$0BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$16,089,766TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (2 entries)

DescDescBook ValueBookValueAmt
ESCROW$2,567,318
TRUSTEE FUNDS HELD UNDER BOND INDEN$483,083
FieldValueIRS element (for citing)
Total Book Value Other Assets$3,050,401TotalBookValueOtherAssetsAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART X, LINE 2:FormAndLineReferenceDesc
ExplanationTHE ORGANIZATION IS A MASSACHUSETTS NONPROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE.ExplanationTxt

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (4 entries)

Bond ReferenceBondReferenceCdBond Issuer EINBondIssuerEINCUSIPCUSIPNumBond IssuedBondIssuedDtIssue PriceIssuePriceAmtPurposePurposeDescDefeasedDefeasedIndOn Behalf Of IssuerOnBehalfOfIssuerIndPool FinancingPoolFinancingInd
MASSACHUSETTS DEVELOPMENT FINANCE AGENCY - SERIES 2007A
A04343181457585AAA82007-10-25$1,982,687PURCHASE FACILITIES000
MASSACHUSETTS DEVELOPMENT FINANCE AGENCY - SERIES 2007A
B04343181457585AAB62007-10-25$8,051,140PURCHASE FACILITIES000
MASSACHUSETTS DEVELOPMENT FINANCE AGENCY - SERIES 2007A
C04343181457585AAC42007-10-25$14,755,407PURCHASE FACILITIES000
MASSACHUSETTS DEVELOPMENT FINANCE AGENCY - SERIES 2007D
D0434318142007-10-25$2,038,290PURCHASE FACILITIES000

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (4 entries)

Bond ReferenceBondReferenceCdRetiredRetiredAmtTotal ProceedsTotalProceedsAmtIssuance Costs From ProceedsIssuanceCostsFromProceedsAmtCapital ExpendituresCapitalExpendituresAmtSubstantial CompletionSubstantialCompletionYrRefunding Tax Exempt BondsRefundingTaxExemptBondsIndRefunding Taxable BondsRefundingTaxableBondsIndFinal Allocation MadeFinalAllocationMadeIndAdequate Books And Rec MaintAdequateBooksAndRecMaintIndIn Reserve FundInReserveFundAmt
A$200,439$1,982,687$1,189,273$793,414200700Yes (1)Yes (1)
B$801,757$8,051,140$5,183,387200700Yes (1)Yes (1)$2,867,753
C$1,503,295$14,755,407$14,755,407200700Yes (1)Yes (1)
D$2,038,290$2,018,952200700Yes (1)Yes (1)$19,338

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (4 entries)

Bond ReferenceBondReferenceCdOwning Bond Financed PropertyOwningBondFinancedPropertyIndAny Lease ArrangementsAnyLeaseArrangementsIndMgmt Contract Bond Fincd PropMgmtContractBondFincdPropIndAny Research AgreementsAnyResearchAgreementsIndBond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestIndChange In Use Bond Financed PropChangeInUseBondFinancedPropIndProcs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd
A0000000
B0000000
C0000000
D0000000

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (4 entries)

Bond ReferenceBondReferenceCdForm8038 T FiledForm8038TFiledIndRebate Not Due YetRebateNotDueYetIndException To RebateExceptionToRebateIndNo Rebate DueNoRebateDueIndVariable Rate IssueVariableRateIssueIndHedge Identified In Bks And RecHedgeIdentifiedInBksAndRecIndGross Proceeds Invested In GICGrossProceedsInvestedInGICIndWritten Proc To Monitor ReqsWrittenProcToMonitorReqsInd
A0Yes (1)000000
B0Yes (1)000000
C0Yes (1)000000
D0Yes (1)000000

Procedures Corrective Action ProceduresCorrectiveActionGrp (4 entries)

Bond ReferenceBondReferenceCdProcedures Corrective ActionProceduresCorrectiveActionInd
A0
B0
C0
D0

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1MASSACHUSETTS DEVELOPMENT FINANCE AGENCY - SERIES 2010BusinessNameLine1Txt
FieldValueIRS element (for citing)
Bond Issuer EIN043431818BondIssuerEIN
Bond Issued2010-07-14BondIssuedDt
Issue Price$2,640,000IssuePriceAmt
PurposePROJECT REHABPurposeDesc
Defeased0DefeasedInd
On Behalf Of Issuer0OnBehalfOfIssuerInd
Pool Financing0PoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Total Proceeds$2,640,000TotalProceedsAmt
Capital Expenditures$2,640,000CapitalExpendituresAmt
Substantial Completion2010SubstantialCompletionYr
Refunding Tax Exempt Bonds0RefundingTaxExemptBondsInd
Refunding Taxable Bonds0RefundingTaxableBondsInd
Final Allocation MadeYes (1)FinalAllocationMadeInd
Adequate Books And Rec MaintYes (1)AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed Property0OwningBondFinancedPropertyInd
Any Lease Arrangements0AnyLeaseArrangementsInd
Mgmt Contract Bond Fincd Prop0MgmtContractBondFincdPropInd
Any Research Agreements0AnyResearchAgreementsInd
Bond Iss Meet Prvt Sec Pymt Test0BondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed Prop0ChangeInUseBondFinancedPropInd
Procs Nonqualified Bond Remdtd0ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T Filed0Form8038TFiledInd
Rebate Not Due YetYes (1)RebateNotDueYetInd
Exception To Rebate0ExceptionToRebateInd
No Rebate Due0NoRebateDueInd
Variable Rate Issue0VariableRateIssueInd
Hedge Identified In Bks And Rec0HedgeIdentifiedInBksAndRecInd
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGICInd
Written Proc To Monitor Reqs0WrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Procedures Corrective Action0ProceduresCorrectiveActionInd

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp

Name Of Interested NameOfInterested

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1JOEL KIRCHIKBusinessNameLine1Txt
FieldValueIRS element (for citing)
Relationship DescriptionBOD MEMBERRelationshipDescriptionTxt
Transaction$3,932TransactionAmt
TransactionBOD MEMBER IS AN EMPLOYEE OF MOBILEX WHICH PROVIDES MEDICAL SERVICES TO THE ORGANIZATION.TransactionDesc
Sharing Of Revenues0SharingOfRevenuesInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 2DIRECTOR, JOEL KIRCHIK HAS A BUSINESS RELATIONSHIP.
FORM 990, PART VI, SECTION A, LINE 3IN MAY 1, 2018 THE ORGANIZATION HAS ENTERED INTO A MANAGEMENT AGREEMENT, WITH ATHENA HEALTH CARE ASSOCIATES INC TO MANAGE THE OPERATIONS OF FAIRHAVEN HEALTHCARE CENTER, INC. ACTING THROUGH THE NURSING FACILITY EMPLOYEES, TO SUPERVISE, DIRECT AND CONTROL THE DAY-TO-DAY BUSINESS ACTIVITIES AND MANAGEMENT OF THE NURSING FACILITY. ATHENA HEALTH CARE ASSOCIATES INC PREPARE AND FILE, ALL COST REPORTS, PAYROLL TAX AND REAL ESTATE TAX FILINGS REQUIRED.
FORM 990, PART VI, SECTION B, LINE 11BA COMPLETE COPY OF THE FORM 990 TAX RETURN (INCLUDING ALL REQUIRED SCHEDULES) IS PROVIDED TO EACH PERSON WHO IS A VOTING MEMBER OF THE BOARD OF DIRECTORS AT THE TIME THE FORM 990 IS PROVIDED, EITHER IN PAPER OR ELECTRONIC FORM, BEFORE IT IS FILED WITH THE IRS.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION'S GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE MADE AVAILABLE ON THE MSRB ELECTRONIC MUNICIPAL MARKET ACCESS (EMMA) WEBSITE.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationIndBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Txt
ADVENTCARE INC
476 VARNUM AVELOWELLMA01854321012491MANAGEMENT COMPANYMA501(C)(3)LINE 10N/A0
LAFAYETTE REHABILITATION AND SKILLED NURSING FACILITY
25 LAFAYETTE STREETMARBLEHEADMA01945208745166SKILLED NURSING FACILITYMA501(C)(3)LINE 100ADVENTCARE INC
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees Sharing0PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd