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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. 7 5 316 7 0 0 0 0 14712230 15418194 26901 61220 0 0 14739131 15479414 0 0 0 0 8450695 9096266 0 0 0 7827878 7238676 16278573 16334942 -1539442 -855528 25575514 24985465 28892592 29208371 -3317078 -4222906 X IT 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. 0 0 14689380 15418194 FAIRHAVEN 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. 14689380 1 0 0 0 0 0 0 0 0 0 1 0 0 1 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 18 0 1 316 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 5 1 1 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 MA X ATHENA HEALTH CARE 8607513900 135 SOUTH RD FARMINGTON CT 06032 X RAYMOND DENNEHY PRESIDENT 1.00 2.00 X X 0 0 0 DAVID O'DONNELL TREASURER 1.00 2.00 X X 0 0 0 GINA QUEIROS DIRECTOR 1.00 2.00 X 0 0 0 JOEL KIRCHIK DIRECTOR 1.00 2.00 X 0 0 0 MICHAEL MOORE DIRECTOR 1.00 2.00 X 0 0 0 ROBERT GREER VANTUYL DIRECTOR 1.00 2.00 X 0 0 0 JEFFREY WITHERELL DIRECTOR 1.00 2.00 X 0 0 0 THOMAS GOMES ADMINISTRATOR 40.00 X 127817 0 8110 GEORGIA WAYNE DIRECTOR OF NURSING 40.00 X 127424 0 8085 TERESA ROCK MDS NURSE 40.00 X 105347 0 6684 SUSAN BREEN PHYSICAL THERAPIST 40.00 X 101352 0 14921 461940 0 37800 4 0 0 0 HEALTHCARE SERVICES GROUP INC 3220 TILLMAN DRIVE BENSALEM PA 19020 HOUSEKEEPING AND LAUNDRY SERVICES 454512 PREFERRED PHARMACY SOLUTIONS LLC 35 AVCO ROAD HAVERHILL MA 01835 PHARMACY SERVICES 314926 PLATINUM CARE LLC 35 AVCO ROAD HAVERHILL MA 01835 MANAGEMENT COMPANY 173566 ATHENA HEALTH CARE SYSTEMS 35 AVCO ROAD HAVERHILL MA 01835 MANAGEMENT COMPANY 154938 THURSTON FOODS INC 30 THURSTON DRIVE WALLINGFORD CT 06492 FOOD & DIETRY SUPPLIES 112810 5 PROGRAM SERVICE REVENUE 623000 15418194 15418194 15418194 61220 61220 15479414 15418194 0 61220 8023046 7684496 338550 497725 476722 21003 575495 551211 24284 444288 444288 106596 106596 23578 23578 713246 505536 207710 9263 9263 178579 3012 175567 256267 256267 14086 14086 1995138 1995138 737056 737056 128026 18986 109040 MEDICAL SUPPLIES 1405087 1405087 STATE ASSSESSMENT 1055869 1055869 BAD DEBT EXPENSE 142000 142000 DUES 20484 20484 9113 9113 16334942 14689380 1645562 0 620804 568811 449485 214244 794407 698834 72501 12777 23529502 6812649 17344802 16716853 2932083 2932083 3361432 3841863 25575514 24985465 1927848 2726261 0 37854 26203946 25683458 760798 760798 28892592 29208371 X -3317078 -4222906 -3317078 -4222906 25575514 24985465 X -855528 -50303 3 X X 0 1 X 1 0 X 14809285 14800784 14740246 14712230 15418194 74480739 14809285 14800784 14740246 14712230 15418194 74480739 0 0 0 74480739 18342 19959 26985 26901 61220 153407 18342 19959 26985 26901 61220 153407 14827627 14820743 14767231 14739131 15479414 74634146 0.99790 0.99830 0.00210 0.00170 X 1958000 1958000 19966766 5702928 14263838 1519417 1024810 494607 85319 84911 408 16716853 SOFTWARE, NET 331 TRUSTEE FUNDS HELD UNDER BOND INDENTURE 1128311 ESCROW 2713221 3841863 X PART X, LINE 2: THE 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. A MASSACHUSETTS DEVELOPMENT FINANCE AGENCY - SERIES 2007A 043431814 57585AAA8 2007-10-25 1982687 PURCHASE FACILITIES 0 0 0 B MASSACHUSETTS DEVELOPMENT FINANCE AGENCY - SERIES 2007A 043431814 57585AAB6 2007-10-25 8051140 PURCHASE FACILITIES 0 0 0 C MASSACHUSETTS DEVELOPMENT FINANCE AGENCY - SERIES 2007A 043431814 57585AAC4 2007-10-25 14755407 PURCHASE FACILITIES 0 0 0 D MASSACHUSETTS DEVELOPMENT FINANCE AGENCY - SERIES 2007D 043431814 2007-10-25 2038290 PURCHASE FACILITIES 0 0 0 A 200439 1982687 1189273 793414 2007 0 0 1 1 B 801757 8051140 2867753 5183387 2007 0 0 1 1 C 1503295 14755407 14755407 2007 0 0 1 1 D 2038290 19338 2018952 2007 0 0 1 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 D 0 0 0 0 0 0 0 A 0 1 0 0 0 0 0 0 B 0 1 0 0 0 0 0 0 C 0 1 0 0 0 0 0 0 D 0 1 0 0 0 0 0 0 A 0 B 0 C 0 D 0 A MASSACHUSETTS DEVELOPMENT FINANCE AGENCY - SERIES 2010 043431818 2010-07-14 2640000 PROJECT REHAB 0 0 0 A 2640000 2640000 2010 0 0 1 1 A 0 0 0 0 0 0 0 A 0 1 0 0 0 0 0 0 A 0 JOEL KIRCHIK BOD MEMBER 11547 BOD MEMBER IS AN EMPLOYEE OF MOBILEX WHICH PROVIDES MEDICAL SERVICES TO THE ORGANIZATION. 0 FORM 990, PART VI, SECTION A, LINE 2 DIRECTOR, JOEL KIRCHIK HAS A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION ENTERED INTO A FIFTEEN-YEAR MANAGEMENT AGREEMENT, EXPIRING OCTOBER 2022, WITH PLATINUM CARE, LLC 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. PLATINUM CARE, LLC PREPARE AND FILE, ALL COST REPORTS, PAYROLL TAX AND REAL ESTATE TAX FILINGS REQUIRED. THIS AGREEMENT WAS TERMINATED EFFECTIVE MAY 1, 2018, AND A NEW MANGAEMENT AGREEMENT WAS ENTERED INTO WITH ATHENA HEALTH CARE ASSOCIATES INC. FORM 990, PART VI, SECTION B, LINE 11B A 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 19 THE ORGANIZATION'S GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE MADE AVAILABLE ON THE MSRB ELECTRONIC MUNICIPAL MARKET ACCESS (EMMA) WEBSITE. FORM 990, PART XI, LINE 9: ROUNDING 3. FORM 990, PART XII, LINE 2C: NO CHANGE IN PROCESS FROM PRIOR YEAR. ADVENTCARE INC 476 VARNUM AVE LOWELL MA 01854 321012491 MANAGEMENT COMPANY MA 501(C)(3) LINE 10 N/A 0 LAFAYETTE REHABILITATION AND SKILLED NURSING FACILITY 25 LAFAYETTE STREET MARBLEHEAD MA 01945 208745166 SKILLED NURSING FACILITY MA 501(C)(3) LINE 10 ADVENTCARE INC 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0