2019-08-02T11:20:28-05:00 2018-12-31 410746749 CLIFTONLARSONALLEN LLP 300 CROWN COLONY DRIVE SUITE 310 QUINCY MA 02169 990 2018-01-01 042106771 WILLIAM B RICE EVENTIDE HOME INC WILL 7816605000 25 STONEHAVEN DRIVE SOUTH WEYMOUTH MA 02190 AMY ROSS PRESIDENT 7816605000 2019-07-23 1 JUDY DALEY P01294075 6179848100 2019-07-23 67.137.57.251 2019-07-23 10:31:59 ED P 0923F946C4CB480093980E5AA9C4B839AC66D68C AB59F5C6B83F609E1D6F53B867FD21F5A01CCFB7 2018 2020-03-31 21:24:44Z FAIRING WAY AMY ROSS 25 STONEHAVEN DRIVE SOUTH WEYMOUTH MA 02190 8273926 0 X WWW.FAIRINGWAY.ORG X 1924 MA A LIFE-CARE RETIREMENT COMMUNITY THAT PROVIDES INDIVIDUALIZED SUPPORTIVE SERVICES. 10 10 128 20 0 0 1435 2976 6899339 8118162 315580 92590 211522 0 7427876 8213728 0 0 0 0 3313098 3967189 0 0 0 7520443 7261046 10833541 11228235 -3405665 -3014507 64525820 64947843 51404104 55101374 13121716 9846469 TO MAINTAIN A UNIQUE LIFE-CARE RETIREMENT COMMUNITY THAT PROVIDES INDIVIDUALIZED AND CARING SUPPORTIVE SERVICES IN A HOME-LIKE ATMOSPHERE WHICH ALLOWS THE RESIDENTS TO MAINTAIN INDEPENDENT LIVES WITH DIGNITY. 0 0 7918954 8118162 THE HOME PROVIDES SECURE HOUSING, QUALITY NURSING CARE, MEANINGFUL ACTIVITIES, OPPORTUNITIES FOR SOCIALIZATION, AND A WIDE VARIETY OF SUPPORTIVE & REHABILITATION SERVICES TO APPROXIMATELY 50 FRAIL ELDERS UNABLE TO LIVE INDEPENDENTLY IN THE COMMUNITY, WITHOUT REGARD FOR THEIR ABILITY TO PAY. 7918954 1 0 0 1 0 0 0 0 1 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 21 0 128 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 MA X BARBARA MCLAREN 7816605000 25 STONEHAVEN DRIVE SOUTH WEYMOUTH MA 02190 AMY ROSS PRESIDENT 5.00 X X 0 0 0 JOHN SPILLANE VICE PRESIDENT 5.00 X X 0 0 0 DONALD POWELL TREASURER 5.00 X X 0 0 0 KEVIN CALLANAN CLERK 5.00 X X 0 0 0 SUSAN BELISLE DIRECTOR 5.00 X 0 0 0 RICHARD MEADE DIRECTOR 5.00 X 0 0 0 STEVEN DWYER DIRECTOR 5.00 X 0 0 0 ANNE MARCHETTA DIRECTOR 5.00 X 0 0 0 WILLIAM JACKSON DIRECTOR 5.00 X 0 0 0 KEVIN KIRBY DIRECTOR 5.00 X 0 0 0 ROBERT FOY DIRECTOR (UNTIL JAN 2018 ) 5.00 X 0 0 0 PRISCILLA URANN DIRECTOR (UNTIL MAY 2018) 5.00 X 0 0 0 JOYCE HAGLUND CHIEF EXECUTIVE OFFICER 40.00 X 166111 0 7800 KENNETH STRONG EXECUTIVE DIRECTOR 40.00 X 128179 0 3380 ANGELICA ORTIZ DIRECTOR OF NURSES 40.00 X 111903 0 3380 406193 0 14560 3 0 1 0 HEALTHCARE SERVICES GROUP PO BOX 829677 PHILADELPHIA PA 19182 FOOD SERVICES 453679 ARETE REHAB INC 110 HAVERHILL ROAD SUITE 1 AMESBURY MA 01913 REHABILITATION SERVICES 314094 UNIDINE CORPORATION 1000 WASHINGTON STREET SUITE 510 BOSTON MA 02118 FOOD SERVICES 204803 PHARMERICA PO BOX 409251 ATLANTA GA 30384 PHARMACY 153890 PARAMOUNT HEALTH SERVICES INC 3 COURTHOUSE LANE UNIT 1 CHELMSFORD MA 01824 NURSING AGENCY 132790 5 2976 2976 PUBLICLY-AIDED RESIDENTS 623000 2424439 2424439 PRIVATE RESIDENTS 623000 1854460 1854460 MEDICARE RESIDENTS 623000 1771463 1771463 INDEPENDENT LIVING SERVICE REVENU 623000 1703317 1703317 OTHER OPERATING INCOME 623000 290547 290547 73936 73936 8118162 55279 55279 97509 60198 37311 37311 37311 8213728 8118162 0 92590 305470 305470 3014514 2587520 426994 36884 27836 9048 378823 294328 84495 231498 223965 7533 174996 174996 40067 40067 54915 54915 1849 1849 20295 20295 257805 204097 53708 525826 525826 136501 121589 14912 23630 23630 894605 582324 312281 323 323 833340 414784 418556 1632475 1210520 421955 26239 26239 PATIENT CARE EXPENSES 2160106 2160106 USER FEE EXPENSE 296323 296323 BAD DEBT EXPENSE 118277 118277 LICENSES AND DUES 49751 49751 13723 13723 11228235 7918954 3309281 0 810922 1100563 74618 106499 563062 898599 102779 79055 54630100 3217488 53203906 51412612 2512334 2246544 7258199 9103971 64525820 64947843 1455649 2262750 1395688 1387049 448495 797695 17607227 17333607 30497045 33320273 51404104 55101374 X 13061816 9786569 18900 18900 41000 41000 13121716 9846469 64525820 64947843 -3014507 -260740 0 X X 0 1 X 1 0 X 1435 2976 4411 6275820 6386192 5175057 6899339 8118162 32854570 6275820 6386192 5175057 6900774 8121138 32858981 0 0 0 32858981 332842 85334 86441 66149 55279 626045 332842 85334 86441 66149 55279 626045 211522 211522 6608662 6471526 5261498 7178445 8176417 33696548 0.97510 0.97670 0.01860 0.01700 X 0 0 0 0 0 0 0 0 1 1849 1849 0 PART II-B, LINE 1: DURING 2018, THE ORGANIZATION PAID MEMBERSHIP DUES TO STATE HEALTHCARE ORGANIZATIONS OF WHICH $1,849 WAS THE PORTION RELATED TO LOBBYING. 0 0 59900 59900 59900 59900 59900 59900 50726 9174 59900 49431 3436 2001 140 50726 0.00000 0.68450 0.31550 0 0 3493296 3493296 48982584 2767145 46215439 325327 24056 301271 1794044 391438 1402606 34849 34849 0 51412612 DEVELOPMENT COSTS 1655188 SOFTWARE, NET 10129 RESERVATION DEPOSITS 797695 DEFERRED ADVERTISING COSTS, NET 2445995 LOAN AGREEMENT - ESCROWS 4130000 OTHER ASSETS 20577 ASSETS LIMITED TO USE 44387 9103971 RESIDENT REFUNDABLE ENTRANCE DEPOSIT 33320273 33320273 X PART IV, LINE 2B: RICE EVENTIDE ACCEPTED PRECONSTRUCTION DEPOSITS FOR PHASE 1 OF ITS FAIRING WAY PROJECT. PROSPECTIVE RESIDENTS ENTERED INTO AN AGREEMENT TO RESERVE A SPECIFIC UNIT IN THE COMPLETED PROJECT. FOR PHASE 2, THE $10,000/UNIT DEPOSITS ARE NONREFUNDABLE, UNLESS RICE EVENTIDE IS UNABLE TO DELIVER THE RIGHT TO OCCUPY THE RESIDENCE ON THE CLOSING DATE. THE RESERVATION DEPOSITS ARE BEING HELD BY RICE SOUTHFIELD, LLC (DISREGARDED ENTITY OF RICE EVENTIDE). PART V, LINE 4: TEMPORARILY RESTRICTED ENDOWMENT FUNDS ARE TO BE USED FOR NEW RESIDENT BEDS. THE PERMANENT ENDOWMENT FUND'S INCOME IS USED FOR THE GENERAL PURPOSES OF THE HOME. PART X, LINE 2: RICE EVENTIDE 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 IRC. RICE SOUTHFIELD IS A SINGLE MEMBER LLC. EARNINGS AND LOSSES ARE INCLUDED IN THE MEMBER'S INCOME. RICE SOUTHFIELD'S ACTIVITY IS INCLUDED ON RICE EVENTIDE'S TAX RETURN. RICE EVENTIDE FILES AS A TAX-EXEMPT ORGANIZATION. THE ORGANIZATIONS FOLLOW 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 YEARS ENDED DECEMBER 31, 2018 AND 2017. X X X 0 0 0 0 0 0 0 0 0 JOYCE HAGLUND CHIEF EXECUTIVE OFFICER 166111 0 0 0 0 0 0 0 7800 0 173911 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE EXECUTIVE DIRECTOR WILL REVIEW THE FORM 990 WITH MEMBERS OF THE BOARD'S EXECUTIVE COMMITTEE. IT WILL THEN BE DISTRIBUTED TO ALL MEMBERS OF THE BOARD OF DIRECTORS FOR APPROVAL BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A WRITTEN CONFLICT OF INTEREST POLICY THAT IS ENFORCED ANNUALLY BY DISTRIBUTION OF THE POLICY AND FOLLOW UP TO CONFIRM NO ONE IS IN CONFLICT OF THE POLICY. FORM 990, PART VI, SECTION B, LINE 15A THE PRESIDENT OF THE BOARD AND MEMBERS OF THE EXECUTIVE COMMITTEE APPROVES CEO'S SALARY. THEY REGULARLY REVIEW SALARY STUDIES DONE BY STATE HEALTHCARE ASSOCIATIONS. APPROVAL IS DOCUMENTED IN THE BOARD OF DIRECTORS' MINUTES. THE EXECUTIVE DIRECTOR DETERMINES THE COMPENSATION OF KEY EMPLOYEES AFTER REVIEWING SALARY STUDIES DONE BY STATE AND NATIONAL HEALTHCARE ASSOCIATIONS. 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 XII, LINE 2C: THE ORGANIZATION HAS NOT CHANGED EITHER ITS AUDIT OVERSIGHT PROCESS OR AUDITOR SELECTION PROCESS. RICE SOUTHFIELD LLC 25 STONEHAVEN DRIVE SOUTH WEYMOUTH MA 02190 273136975 REAL ESTATE INVESTMENT MA 1949156 10271508 WILLIAM B RICE EVENTIDE HOME INC