2020-11-18T09:15:00-06:00 2019-12-31 111986323 MARCUM LLP 53 STATE STREET BOSTON MA 02109 990 2019-01-01 222843194 OVERLOOK MASONIC HEALTH CENTER INC OVER 5082487344 88 MASONIC HOME ROAD CHARLTON MA 01507 TAMERYN CAMPBELL CEO/PRESIDENT 5082487344 2020-11-13 1 MARY ANTONETTI P00431862 6178075000 47.19.127.190 2020-11-13 11:53:29 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 889577CE2CE61D58D2CD54C99878AB3D64A7266D 2019 2021-01-29 14:40:06Z TAMERYN CAMPBELL 88 MASONIC HOME ROAD CHARLTON MA 01507 25790855 0 X HTTP://OVERLOOK-MASS.ORG X 1987 MA CHARITABLE - THE PROVISION OF LONG-TERM RESIDENTIAL AND REHABILITATIVE CARE TO RESIDENTS OF THE COMMUNITY. 10 9 424 17 0 0 345475 190513 21483512 22875495 45954 349674 2112159 2357083 23987100 25772765 15000 16949 0 0 13396301 14125404 0 0 0 11569728 12013187 24981029 26155540 -993929 -382775 145780448 147898889 12385324 11521453 133395124 136377436 TO PROVIDE THE RESIDENTS OF THE HEALTH CENTER WITH THE HIGHEST LEVEL OF COMPREHENSIVE MEDICAL CARE SERVICES WITH A CONSIDERATE AND PERSONAL TOUCH. 0 0 16988513 16949 22934078 OPERATION OF A LONG-TERM AND RESIDENTIAL CARE FACILITY IN CHARLTON, MA. TOTAL PATIENT DAYS OF CARE, TOTAL REST HOME DAYS OF CARE, AND TOTAL FIELDSTONE (ALMC) DAYS OF CARE FOR THE YEAR ENDED DECEMBER 31, 2019 AMOUNTED TO 38,969, 8,410, AND 4,416, RESPECTIVELY, FOR A TOTAL DAYS OF CARE OF 51,795. 16988513 1 1 0 0 0 0 0 0 0 1 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 130 0 1 424 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 10 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X TAMERYN CAMPBELL 5084342412 88 MASONIC HOME ROAD CHARLTON MA 01507 PAUL GLEASON DIRECTOR 1.00 5.00 X 0 0 0 MASON RUSSELL DIRECTOR 1.00 5.00 X 0 0 0 KENNETH BLAKE MHS BOARD CHAIR 1.00 4.00 X 0 0 0 ROBERT JOLLY CHAIRMAN 1.00 4.00 X X 0 0 0 JACK MULHALL VICE CHAIRMAN 1.00 1.00 X X 0 0 0 WILLIAM HOLLAND TREASURER 1.00 4.00 X X 0 0 0 DAVID PACE SECRETARY 1.00 5.00 X X 0 0 0 RONALD JACKSON CLERK 1.00 5.00 X X 0 0 0 JAMES TRACEY DIRECTOR 1.00 2.00 X 0 0 0 TAMERYN CAMPBELL PRESIDENT & CEO 40.00 3.00 X X 423399 0 66433 PAUL BOWLER PRESIDENT & CEO, BRIARWOOD 40.00 X 196069 0 25080 TED WILBUR CHIEF INFORMATION OFFICER 40.00 X 156824 0 24705 JOE SAVIDGE CHIEF FINANCIAL OFFICER 40.00 X 169043 0 22017 ROBERT ENGELL ADMINISTRATOR 40.00 X 156829 0 3760 1102164 0 141995 5 0 1 0 PREFERRED THERAPY SOLUTIONS 850 SILAS DEAN HIGHWAY WETHERSFIELD CT 06109 THERAPY/REHAB SERVICES 1058217 PROFESSIONAL NURSES HEALTH SERVICES INC 425 SUNDERLAND ROAD WORCESTER MA 06104 AGENCY RN AND LPN LABOR 475882 CUSTOM COMPUTER SPECIALISTS INC PO BOX 29786 NEW YORK NY 100879786 IT SUPPORT 274298 MARCUM LLP 185 ASYLUM STREET 17TH FLOOR HARTFORD CT 06103 AUDIT, COST REPORT, AND TAX SERVICES 118148 4 190513 190513 NET PATIENT REVENUE 623000 19395057 19395057 AFFILIATE MANAGEMENT FEE 900099 3480438 3480438 22875495 157369 157369 298500 0 298500 298500 298500 210395 18090 192305 192305 192305 FORGIVENESS OF DEBT INCOME 900099 2000000 2000000 CAFETERIA REVENUE 900099 27629 27629 GUEST MEALS REVENUE 900099 15032 15032 15922 15922 2058583 25772765 22934078 0 2648174 X 16949 16949 1244160 1244160 10456226 8608844 1847382 328986 298699 30287 1139570 1125211 14359 956462 845621 110841 1208543 1208543 138394 138394 31404 31404 69382 69382 2930260 85651 2844609 114784 2086 112698 1841395 1061260 780135 935217 826838 108379 44942 2765 42177 45569 5199 40370 60897 60897 1431884 1226720 205164 354949 313815 41134 NURSING PURCHASING SERV 1201700 1201700 DIETARY SERVICES 628750 589763 38987 EQUIP RENTAL & MAINT 618524 499760 118764 BAD DEBT EXPENSE 261044 261044 95549 16588 78961 26155540 16988513 9167027 0 492978 568076 1182785 1678438 270360 371421 63581411 45363105 18352799 18218306 19644993 22094151 105836533 104968497 145780448 147898889 2375233 2889599 2551910 1291553 7458181 7340301 12385324 11521453 X 122115265 123267000 11279859 13110436 133395124 136377436 145780448 147898889 X -382775 3038120 326967 X X 0 1 X 1 0 X 318245 192183 157742 345475 190513 1204158 13715974 24459645 20985319 21483512 22875495 103519945 14034219 24651828 21143061 21828987 23066008 104724103 0 0 0 104724103 -195275 452638 531163 573397 455869 1817792 -195275 452638 531163 573397 455869 1817792 2058583 2058583 13838944 25104466 21674224 22402384 25580460 108600478 0.96430 0.98310 0.01670 0.01690 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISC INCOME - 2019 AMOUNT: $ 2,058,583. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 19644993 805705 3140400 1481419 22109679 55155848 1664971 -1508578 35667248 19644993 54967835 178526 24740 15253 55155848 54967835 54967835 70190115 2558820 -2061246 15719854 54967835 0.40630 0.25920 0.33450 0 0 336084 336084 46416192 32070174 14346018 8456095 7771002 685093 8373040 5521929 2851111 18218306 MASONIC EDUCATION AND CHARITY TRUST INVESTMENT FUND 22094151 C 22094151 DUE FROM AFFILIATES 104707219 OTHER RECEIVABLES 249403 DUE FROM GRAND LODGE 11875 104968497 DUE TO AFFILIATES 5213888 DUE TO RESIDENTS 24582 ASSET RETIREMENT OBLIGATION 854775 PENSION LIABILITY 1247056 7340301 X 26910926 3038120 3038120 23872806 69382 1830577 1899959 25772765 26086158 0 26086158 69382 69382 26155540 PART V, LINE 4: THE ORGANIZATION HAS AN ENDOWMENT WHICH IS HELD IN THE MASONIC EDUCATION AND CHARITY TRUST. FUNDS ARE SPENT FROM THE ENDOWMENT WHEN NEEDED FOR OPERATIONS OR CAPITAL IMPROVEMENTS. PART X, LINE 2: BELOW IS AN EXCERPT FROM FOOTNOTE 2 OF THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS FOR THE MASONIC HEALTH SYSTEM OF MASSACHUSETTS, INC. MHS, HEALTH CENTER, OVNA, COMMUNITIES, AND NORTHAMPTON HAVE BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE ORGANIZATION ACCOUNTS FOR UNCERTAINTY IN INCOME TAX POSITIONS BY APPLYING A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2019 AND 2018, THERE ARE NO TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE ORGANIZATION IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS PENDING OR IN PROGRESS. PART XI, LINE 4B - OTHER ADJUSTMENTS: DONOR RESTRICTED ACTIVITY 1,830,577. 0 HARRINGTON MEMORIAL HOSPITAL 100 SOUTH STREET SOUTHBRIDGE MA 01550 042103577 501(C)(3) 10000 ASSIST IN THE CHARITABLE MISSION OF THE ORGANIZATION SALEM COMMUNITY CORPBRIARWOOD 65 BRIARWOOD CIRCLE WORCESTER MA 01606 042696489 501(C)(3) 5000 ASSIST IN THE CHARITABLE MISSION OF THE ORGANIZATION 2 PART I, LINE 2: THE ORGANIZATION IS NOT A GRANT MAKING ORGANIZATION BUT DOES MAKE CHARITABLE CONTRIBUTIONS TO OTHER TAX EXEMPT ORGANIZATIONS FOR USE IN THEIR EXEMPT PURPOSE. X 1 1 X X X X 0 0 0 0 0 0 0 0 0 TAMERYN CAMPBELL PRESIDENT & CEO 348399 0 75000 0 0 0 5600 0 60833 0 489832 0 0 0 PAUL BOWLER PRESIDENT & CEO, BRIARWOOD 182270 0 13799 0 0 0 0 0 25080 0 221149 0 0 0 TED WILBUR CHIEF INFORMATION OFFICER 142007 0 14817 0 0 0 1366 0 23339 0 181529 0 0 0 JOE SAVIDGE CHIEF FINANCIAL OFFICER 150816 0 18227 0 0 0 0 0 22017 0 191060 0 0 0 ROBERT ENGELL ADMINISTRATOR 144362 0 12467 0 0 0 1899 0 1861 0 160589 0 0 0 PART I, LINE 1A TAMERYN CAMPBELL RECEIVED A HOUSING ALLOWANCE WITH AN ESTIMATED VALUE OF $48,000 DURING THE YEAR ENDING DECEMBER 31, 2019. THIS WAS FOR THE BENEFIT OF THE ORGANIZATION AND WAS REPORTED AS NONTAXABLE BENEFIT TO TAMERYN. FORM 990, PART VI, SECTION A, LINE 6 THE MASONIC HEALTH SYSTEM OF MASSACHUSETTS, INC. IS THE SOLE MEMBER OF THE ORGANIZATION AND ELECTS THE BOARD OF DIRECTORS. THERE ARE NO CLASSES OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7A THE MASONIC HEALTH SYSTEM OF MASSACHUSETTS, INC. HAS THE POWER TO REMOVE DIRECTORS, TO FILL VACANCIES, AND TO INCREASE OR DECREASE THE SIZE OF THE BOARD. FORM 990, PART VI, SECTION A, LINE 7B THE MASONIC HEALTH SYSTEM OF MASSACHUSETTS, INC. HAS THE POWER TO REMOVE DIRECTORS, TO FILL VACANCIES, AND TO INCREASE OR DECREASE THE SIZE OF THE BOARD. FORM 990, PART VI, SECTION B, LINE 11B MANAGEMENT WORKS WITH THE ORGANIZATION'S TAX ADVISOR (CPA FIRM) TO PREPARE THE FINANCIAL INFORMATION AND COMPILE THE DISCLOSURES REQUIRED OF THE FORM 990. UPON ITS COMPLETION, SENIOR MANAGEMENT PROVIDES A DRAFT OF THE FORM 990 TO THE BOARD OF DIRECTORS PRIOR TO ITS SUBMISSION. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REGULARLY AND CONSISTENLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY VIA ANNUAL EXECUTION OF THE CONFLICT OF INTEREST POLICY. THIS CONFLICTS POLICY IS INTENDED TO SUPPLEMENT, BUT NOT REPLACE, ANY APPLICABLE STATE LAWS GOVERNING CONFLICTS OF INTEREST APPLICABLE TO NONPROFIT AND CHARITABLE CORPORATIONS. THIS CONFLICTS POLICY HAS BEEN ADOPTED BY THE BOARD OF DIRECTORS OF MASONIC HEALTH SYSTEM OF MASSACHUSETTS, INC. (MHS). THIS CONFLICTS POLICY SHALL APPLY WITH EQUAL FORCE TO ALL CORPORATIONS RELATED TO, OR AFFILIATED WITH, MHS. ON AN ANNUAL BASIS THE DIRECTORS COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE WHICH IS REVIEWED BY THE PRESIDENT'S OFFICE. IF A CONFLICT ARISES, THE INDIVIDUAL WOULD RECUSE THEMSELVES FROM ALL DISCUSSION ON THE MATTER. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION'S SOLE MEMBER, MASONIC HEALTH SYSTEM OF MASSACHUSETTS, INC. MAINTAINS AN EXECUTIVE COMMITTEE, WHICH AMONG OTHER THINGS, REVIEWS THE COMPENSATION AND TERMS OF THE AGREEMENT WITH ITS EXECTUIVE OFFICER. THE COMMITTEE REVIEWS THE COMPENSATION OF THE INDIVDIUAL IN RELATION TO THE SALARY LEVEL OF OTHER COMPARABLE POSITIONS IN THE MARKET AND THEIR PERFORMANCE. ONCE REASONABLE COMPENSATION IS DETERMINED, IT IS APPROVED BY THE BOARD. FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATION'S FORM 990 IS AVAILABLE TO THE PUBLIC UPON REQUEST AND CAN BE FOUND ONLINE VIA THE MASSACHUSETTS ATTORNEY GENERAL'S WEBSITE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S FINANCIAL STATEMENTS CONFLICT OF INTEREST POLICY, AND GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G OTHER PROFESSIONAL SERVICE FEES: PROGRAM SERVICE EXPENSES 85,651. MANAGEMENT AND GENERAL EXPENSES 2,844,609. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,930,260. FORM 990, PART XI, LINE 9: ADJUSTMENT TO MINIMUM PENSION LIABILITY 326,967. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. MASONIC HEALTH SYSTEM OF MASSACHUSETTS INC 88 MASONIC HOME ROAD CHARLTON MA 01507 043515688 PARENT MA 501(C)(3) LINE 12C, III-FI N/A 0 OVERLOOK VISITING NURSES ASSOCIATION 88 MASONIC HOME ROAD CHARLTON MA 01507 043515687 VNA MA 501(C)(3) LINE 10 MASONIC HEALTH SYSTEM OF MASSACHUSETTS 0 OVERLOOK COMMUNITES INC 88 MASONIC HOME ROAD CHARLTON MA 01507 043515686 NURSING FACILITY MA 501(C)(3) LINE 10 MASONIC HEALTH SYSTEM OF MASSACHUSETTS 0 0 0 0 1 1 0 0 0 0 1 0 1 1 1 1 0 0 0 0