2025-11-14T13:51:05-06:00 2024-12-31 010494526 Baker Newman & Noyes PO Box 507 Portland ME 04112 990 2024-01-01 237090088 Penacook Place Inc PENA 9783740707 150 Water Street Haverhill MA 01830 Devon Cormier President & CEO 9783740707 2025-11-13 1 0 Connor Smart P02285543 2078792100 2025-11-13 2024 2025-03-06 01:10:19Z Devon Cormier 150 Water Street Haverhill MA 01830 12622540 0 X www.penacookplace.org X 1969 MA To promote the highest possible quality of life for our residents. 6 6 261 7 0 0 53353 2515 14363931 12619907 249 118 133614 0 14551147 12622540 0 0 0 0 11155858 9642198 0 0 0 6971612 6027620 18127470 15669818 -3576323 -3047278 4628196 4212004 10096684 12727770 -5468488 -8515766 X To promote the highest possible quality of life for our residents in a clean, safe, and attractive environment. To care for our residents as we would want to be cared for - the Golden Rule of Penacook Place. To meet or exceed the expectations of our residents, as well as others with whom we come in contact. To show hospitality, courtesy, cooperation, and respect to all residents, family members, fellow employees, volunteers, and visitors. 0 0 14757245 0 12619907 Penacook Place is an independent, non-profit, 160 bed nursing home and rehabilitation facility located in Haverhill, MA that strives to offer the finest care and best quality of life for its residents. The facility's team of professionals is specially trained to meet the medical, social, psychological, and therapeutic needs of those they serve. Their dedicated caregivers are highly trained and compassionate, and help make Penacook Place a warm and welcoming facility. 14757245 1 0 0 1 0 0 0 0 0 1 1 0 0 0 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 0 1 0 0 0 1 9 0 1 261 1 0 0 0 0 0 0 0 0 0 0 0 0 X 6 6 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 MA X X The Organization 9783740707 150 Water Street Haverhill MA 01830 Janis Cordischi Member 2.00 0.00 X 0 0 0 Rev John Delaney Member 2.00 3.00 X 0 0 0 Caitlin Masys Member 2.00 0.00 X 0 0 0 John Sarro Member 2.00 0.00 X 0 0 0 Gregory Shaw Member 2.00 0.00 X 0 0 0 Thomas L Mortimer Chair 2.00 0.00 X X 0 0 0 William Klueber Treasurer (end 6/2024) 2.00 0.00 X X 0 0 0 Devon Cormier President 42.00 0.00 X 139654 0 20651 Judithann Riopelle Board Secretary; Chaplain 42.00 0.00 X 71740 0 1287 Kenny Senfuma LPN Licensed Practical Nurse 40.00 0.00 X 177178 0 13468 Synodia Bote LPN Licensed Practical Nurse 40.00 0.00 X 111050 0 25549 Nicole Danielle Beane LPN Nurse Manager 40.00 0.00 X 117204 0 20680 Vanessa Anne Bretton Director of Nursing 40.00 0.00 X 115528 0 42609 Gale L Staples LPN 40.00 0.00 X 105398 0 29077 837752 0 153321 9 0 1 0 Performance Healthcare Service 47 River Street 9 Wellesley MA 02481 Janitorial services 690431 US Foods Inc 9399 W Higgins Road 500 Rosemont IL 60018 Food distribution services 478495 CIM Nursing Solutions 99 Eustis Avenue Lowell MA 01850 Nursing services 432265 Covenant Health Inc 40 Shattuck Road 317 Andover MA 01810 Management and consulting 359091 4 2515 2515 Patient services 623000 12619907 12619907 12619907 118 118 12622540 12619907 0 118 233332 223599 9733 7397591 7076639 320952 97757 95259 2498 1215465 1184404 31061 698053 680214 17839 359091 359091 32411 32411 16500 16500 903403 838759 64644 6825 6337 488 265432 246439 18993 6805 6318 487 394887 366630 28257 540 501 39 20 19 1 91712 91712 280207 280207 118044 109597 8447 Medical care/supplies 1779134 1779134 Medicaid user fee 1092651 1092651 Nutrition and dining 542570 542570 Provision for bad debts 121568 121568 15820 14688 1132 15669818 14757245 912573 0 315789 789100 53237 8311 1893395 1309328 40943 126885 10632220 8837420 2009429 1794800 315403 183580 4628196 4212004 2517800 2511964 2417571 2417571 5161313 7798235 10096684 12727770 X -5521151 -8524327 52663 8561 -5468488 -8515766 4628196 4212004 -3047278 0 X X 0 1 X 1 1 1 X 18611 8209 5989 53353 2515 88677 11398800 12354081 14131657 14363931 12619907 64868376 11417411 12362290 14137646 14417284 12622422 64957053 0 0 0 64957053 150 298 181 249 118 996 150 298 181 249 118 996 133614 133614 11417561 12362588 14137827 14551147 12622540 65091663 0.99790 0.99790 0.00000 X 0 0 0 0 0 1 0 0 0 0 0 Part II-B, Line 1: During the year covered by this tax return, Penacook Place was a member of various associations and industry groups that provide services and benefits to their members such as access to professional networks, and support, training, and educational resources. It is possible that a portion of dues paid to these associations contributed to lobbying activities meant to advance causes related to and in furtherance of the associations' members' exempt functions. At the time of filing this Form 990, Penacook Place has not been able to determine what portion of membership dues paid, if any, was expended on lobbying purposes. However, of its various membership affiliations, Penacook Place feels that only dues paid to maintain its membership with Mass Senior Care would have been partially available for lobbying purposes. While Penacook Place is unable to determine an exact amount of dues paid in 2024 or the portion that may have been available for lobbying, for transparency and disclosure purpose, Penacook Place has elected to disclose these relationships here on this Form 990, Schedule C, supplemental information. Penacook Place does not engage directly in any lobbying or political activity. 52663 250 44352 8561 42892 49913 40142 52663 84000 2750 43858 42892 134000 50000 84000 134000 10000 10000 134000 0.00000 0.00000 1.00000 0 0 30859 30859 7757954 6299758 1458196 2843407 2537662 305745 1794800 Estimated third-party payor settlements 60000 Asset retirement obligations 66000 Professional loss liability reserve 43507 Medicaid obligations 272599 Resident funds and deposits 108933 Due to related organizations 7247196 7798235 X Part V, Line 4: The Organization's Endowment Funds are used to provide services, supplies, and facilities to residents and the poor in the community. Part X, Line 2: Covenant and its member organizations are considered not-for-profit corporations as described in Section 501(c)(3) of the Internal Revenue Code and are exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. Tax-exempt organizations could be required to record an obligation for income taxes as the result of a tax position they have historically taken on various tax exposure items including unrelated business income or tax status. Under guidance issued by the Financial Accounting Standards Board, assets and liabilities are established for uncertain tax positions taken or positions expected to be taken in income tax returns when such positions are judged to not meet the "more-likely-than-not" threshold, based upon the technical merits of the position. Estimated interest and penalties, if applicable, related to uncertain tax positions are included as a component of income tax expense. The System has evaluated the position taken on its filed tax returns. The System has concluded no uncertain income tax positions exist at December 31, 2024. X X X X 0 0 0 0 0 0 0 1 0 Kenny Senfuma LPN Licensed Practical Nurse 176691 0 0 0 487 0 3120 0 10348 0 190646 0 0 0 Devon Cormier President 135461 0 4000 0 193 0 1567 0 19084 0 160305 0 0 0 Vanessa Anne Bretton Director of Nursing 115266 0 0 0 262 0 3213 0 39396 0 158137 0 0 0 Part I, Line 3 Any compensation paid to the trustees, directors, officers or key employees of the Organization is subject to the oversight and decisions of Covenant Health, a related tax-exempt organization. Every two-to-three years the Compensation Committee of the Covenant Health Board of Directors engages an external consultant to provide competitive market data from various survey sources, which is then used to develop recommendations for changes to the compensation program. Since 2003, the Compensation Committee has engaged a human resources consultant to conduct this analysis. Objectives of the analysis are to assess the compositeness of the total cash compensation levels of the senior leadership team, develop market based competitive salary ranges for all executive positions, and ensure that the annual incentive opportunities, if there are any, are competitive and reasonable. Part I, Line 7 A Compensation Committee recommends the variable pay award that may be issued to qualifying employees and officers. The payment of the award is discretionary and is subject to meeting the pre-determined goals of the Organization. Form 990, Part VI, Section A, line 2 Board members Thomas Mortimer and Greg Shaw share a business relationship. Form 990, Part VI, Section A, line 6 Covenant Health Inc. is the sole corporate member of the Organization. Form 990, Part VI, Section A, line 7a As the sole corporate member of the Organization, Covenant Health, Inc. retains the ability to elect and remove the Organization's board of directors with or without cause. Form 990, Part VI, Section A, line 7b As the sole corporate member of the Organization, Covenant Health, Inc. has the following powers and rights over the Organization and its subsidiaries as outlined in the Organization's bylaws: 1. To approve any change in the written statements of philosophy and mission; 2. To amend and to repeal the organizing and governing documents; 3. To elect the Board of Directors or remove them with or without cause; 4. To appoint and remove the president; 5. To ratify the Board of Director's election of the Chair of the Board; 6. To approve all plans of merger, consolidation, reorganization, dissolution, or the sale, lease assignment, or transfer of substantially all of the assets, or the purchase or acquisition of an interest in any corporation, partnership, joint venture, or other entity; 7. To approve all long-range strategic plans before implementation; 8. To approve the acquisition, sale, or encumbrance of any real estate valued in excess of an amount set by the Member in writing; 9. To approve all capital budgets and non-budgeted expenses in excess of an amount set by the Member in writing; 10. To approve all debt in excess of limits set by the Member in writing; 11. To appoint the auditors; 12. To approve the sale, assignment, or transfer of any equity interest or membership interest in any subsidiary; 13. To approve any reclassification or other change of any capital stock or other equity security; and, 14. To approve the issuance of, or the creation of any obligation to issue, any equity security. Form 990, Part VI, Section B, line 11b The Form 990 is provided to the governing body for their review and approval prior to filing. Form 990, Part VI, Section B, line 12c This process is the responsibility of the Compliance Officer. A conflict of interest disclosure form is submitted to all leadership, board members, board committee members, employed physicians, medical directors and certain employees in key positions annually to be completed. Reminders are sent to all persons of interest to ensure that all conflict of interest disclosure forms are completed and collected. Form 990, Part VI, Section B, line 15 Any compensation paid to the trustees, directors, officers or key employees of the Organization is subject to the oversight and decisions of Covenant Health, a related tax-exempt organization. Every two-to-three years the Compensation Committee of the Covenant Health Board of Directors engages an external consultant to provide competitive market data from various survey sources, which is then used to develop recommendations for changes to the compensation program. Since 2003, the Compensation Committee has engaged a human resources consultant to conduct this analysis. Objectives of the analysis are to assess the compositeness of the total cash compensation levels of the senior leadership team, develop market based competitive salary ranges for all executive positions, and ensure that the annual incentive opportunities, if there are any, are competitive and reasonable. Form 990, Part VI, Section C, line 19 The Organization's Form 990, governing documents, conflict of interest policy, and financial statements are made available to the public upon request. The Organization's Form 990 is also made available on the website of its parent organization, Covenant Health, at the following web address: https://www.covenanthealth.net/financial-information/financial-information Form 990, Part XII, Line 2c: The audit process has not changed from the previous year. Alternative Health Services 360 Broadway Bangor ME 04402 010422885 Home health and hospice ME 501(c)(3) Line 10 St Joseph Healthcare Foundation 0 Bangor Nursing & Rehabilitation Center 103 Texas Avenue Bangor ME 04401 010538534 Nursing home and restorative facility ME 501(c)(3) Line 10 Covenant Health Inc 0 CHS of Waltham Inc dba Maristhill Nursing & Rehab Center 66 Newton Street Waltham MA 02453 043333609 Nursing home and restorative facility MA 501(c)(3) Line 10 Covenant Health Inc 0 CHS of Worcester Inc dba St Mary Care Center 39 Queen Street Worchester MA 01610 043419625 Nursing home and restorative facility MA 501(c)(3) Line 10 Covenant Health Inc 0 Community Clinical Services PO Box 7291 Lewiston ME 04243 010409788 Physician practice ME 501(c)(3) Line 10 St Mary's Health System 1 Covenant Health Foundation Inc 40 Shattuck Road 317 Andover MA 01810 800199674 Charitable foundation MA 501(c)(3) Line 12a, I Covenant Health Inc 0 Covenant Health Investment Trust 40 Shattuck Road 317 Andover MA 01810 046835128 Investment trust MA 501(c)(3) Line 12a, I Covenant Health Inc 0 Covenant Health Inc 40 Shattuck Road 317 Andover MA 01810 222484505 Health care management and resource organization MA 501(c)(3) Line 10 N/A 0 Fanny Allen Corporation Inc 40 Shattuck Road 317 Andover MA 01810 222495808 Charitable foundation VT 501(c)(3) Line 12a, I Covenant Health Inc 0 Fanny Allen Holdings Inc 40 Shattuck Road 317 Andover MA 01810 030181052 Real estate holding company VT 501(c)(3) Line 12a, I Covenant Health Inc 0 Helping Hands of St Marguerite Inc 799 Concord Avenue Cambridge MA 02138 800199674 Private home-care health services MA 501(c)(3) Line 10 Covenant Health Inc 0 M & J Company 360 Broadway Bangor ME 04402 222480150 Lease holding company ME 501(c)(2) St Joseph Healthcare Foundation 0 Mary Immaculate Guild Inc 172 Lawrence Street Lawrence MA 01841 463073987 Supporting grants and donations MA 501(c)(3) Line 12a, I Covenant Health Inc 0 MI Adult Day Health Care Center Inc 189 Maple Street Lawrence MA 01841 042921888 Adult day care services MA 501(c)(3) Line 10 Covenant Health Inc 0 MI Management Inc 172 Lawrence Street Lawrence MA 01841 042857794 Assisted living services MA 501(c)(3) Line 12a, I Covenant Health Inc 0 MI Nursing Restorative Center Inc 172 Lawrence Street Lawrence MA 01841 042104851 Nursing home and restorative facility MA 501(c)(3) Line 10 Covenant Health Inc 0 MI Residential Community Inc 189 Maple Street Lawrence MA 01841 042647207 HUD low income housing MA 501(c)(3) Line 10 Covenant Health Inc 0 MI Transportation Inc 189 Maple Street Lawrence MA 01841 042921889 Elderly transportation services MA 501(c)(3) Line 10 Covenant Health Inc 0 Mount St Rita Health Centre 15 Sumner Brown Road Cumberland RI 02864 050342330 Nursing home RI 501(c)(3) Line 10 Covenant Health Inc 0 Neighborhood Housing Initiative PO Box 7291 Lewiston ME 04243 010539730 Affordable housing services ME 501(c)(3) Line 10 St Mary's Health System 0 Souhegan Nursing Association 24 North River Road Milford NH 03055 020222795 Home health and hospice NH 501(c)(3) Line 10 St Joseph Hospital of Nashua NH Inc 0 St Joseph Ambulatory Care Inc 360 Broadway Bangor ME 04402 222480373 Physician practice ME 501(c)(3) Line 10 St Joseph Healthcare Foundation 0 St Andre Health Care 407 Pool Street Biddeford ME 04005 010342399 Nursing home and restorative facility ME 501(c)(3) Line 10 Covenant Health Inc 0 St Joseph Healthcare Foundation 360 Broadway Bangor ME 04402 222480149 Healthcare foundation ME 501(c)(3) Line 10 Covenant Health Inc 0 St Joseph Hospital 360 Broadway Bangor ME 04402 010212435 Hospital and health care facility ME 501(c)(3) Line 3 St Joseph Healthcare Foundation 0 St Joseph Manor Health Care 215 Thatcher Street Brockton MA 02302 042565937 Nursing home and restorative facility MA 501(c)(3) Line 10 Covenant Health Inc 0 St Joseph's Hospital of Nashua NH Inc 172 Kinsley Street Nashua NH 03061 020222215 Hospital and health care facility NH 501(c)(3) Line 3 Covenant Health Inc 0 St Mary's D'Youville Pavilion PO Box 7291 Lewiston ME 04243 010211558 Nursing home and restorative facility ME 501(c)(3) Line 10 St Mary's Health System 0 St Mary's Health System PO Box 7291 Lewiston ME 04243 222504349 Hospital and health care facility ME 501(c)(3) Line 12a, I Covenant Health Inc 0 St Mary's Regional Medical Center PO Box 7291 Lewiston ME 04243 010211551 Hospital and health care facility ME 501(c)(3) Line 3 St Mary's Health System 0 St Mary's Residences PO Box 7291 Lewiston ME 04243 222504356 Low income housing ME 501(c)(3) Line 10 St Mary's Health System 0 St Mary's Villa Nursing Home Inc 675 St Marys Villa Road Moscow PA 18444 232057177 Nursing home and restorative facility PA 501(c)(3) Line 10 Covenant Health Inc 0 The Surgicenter at St Joseph Hospital Inc 172 Kinsley Street Nashua NH 03061 020222215 Healthcare and surgery center NH 501(c)(3) Line 10 St Joseph Hospital of Nashua NH Inc 0 Youville Hospital and Rehabilitation Center Inc 1575 Cambridge Street Cambridge MA 02138 043239563 Hospital and health care facility MA 501(c)(3) Line 10 Youville Lifecare Inc 0 Youville House Inc 1573 Cambridge Street Cambridge MA 02138 043239593 Assisted living services MA 501(c)(3) Line 10 Youville Lifecare Inc 0 Youville Lifecare Inc 1575 Cambridge Street Cambridge MA 02138 042103582 Hospital and health care facility MA 501(c)(3) Line 10 Covenant Health Inc 0 Youville Place 10 Pelham Road Lexington MA 02421 043297834 Assisted living services MA 501(c)(3) Line 10 Covenant Health Inc 0 Campus Holding PO Box 7291 Lewiston ME 04240 010406049 Holding company ME N/A C 0 Covenant Health Insurance LTD PO Box 69 Grand Cayman CJ KY1-1102 043360127 Self-insurance company CJ N/A C 0 GNM Corporation 172 Kinsley Street Nashua NH 03060 020400550 Real estate holding company NH N/A C 0 SJ Physicians Services 172 Kinsley Street Nashua NH 03060 020522234 Physician practice NH N/A C 0 St Joseph Corporate Services Inc 172 Kinsley Street Nashua NH 03060 020405197 Holding company NH N/A C 0 Strauss Incorporated 360 Broadway Bangor ME 04402 010391369 Repairs and transcriptions ME N/A C 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0