2018-11-14T12:35:59-06:00 2017-12-31 410746749 CLIFTONLARSONALLEN LLP 300 CROWN COLONY DRIVE SUITE 310 QUINCY MA 02169 990 2017-01-01 042106771 WILLIAM B RICE EVENTIDE HOME INC WILL 7816605000 25 STONEHAVEN DRIVE SOUTH WEYMOUTH MA 02190 AMY ROSS PRESIDENT 7816605000 2018-11-14 1 IVY BECKHAM P01294075 6179848100 2018-11-08 67.137.57.251 2018-11-14 10:34:30 ES P 1A53DBAE8AE3BFC29E9AECF52760C2CD4F90396B 73165959F041044F9DC26414D498D34F5ABB8EC7 2017 2019-02-21 02:37:17Z FAIRING WAY JOYCE HAGLUND 25 STONEHAVEN DRIVE SOUTH WEYMOUTH MA 02190 8861728 0 X WWW.FAIRINGWAY.ORG X 1924 MA 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. 11 11 127 20 0 0 0 1435 5175057 6899339 2270156 315580 0 211522 7445213 7427876 0 0 0 0 3888001 3313098 0 0 0 4272032 7520443 8160033 10833541 -714820 -3405665 68081122 64525820 51655017 51404104 16426105 13121716 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 9899659 7110861 THE HOME PROVIDES SECURE HOUSING, QUALITY NURSING CARE, MEANINGFUL ACTIVITIES, OPPORTUNITIES FOR SOCIALIZATION, AND A WIDE VARIETY OF SUPPORTIVE SERVICES TO APPROXIMATELY 50 FRAIL ELDERS UNABLE TO LIVE INDEPENDENTLY IN THE COMMUNITY, WITHOUT REGARD FOR THEIR ABILITY TO PAY AS WELL AS 104 BELOW MARKET INDEPENDENT SENIOR APARTMENT HOMES WITH SERVICES AVAILABLE ALLOWING SENIORS TO AGE IN PLACE ON THE CAMPUS. 9899659 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 23 0 127 1 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 MA X JOYCE HAGLUND 7816605000 25 STONEHAVEN DRIVE SOUTH WEYMOUTH MA 02190 DONALD POWELL PRESIDENT 5.00 X X 0 0 0 AMY ROSS VICE PRESIDENT & 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 JOHN SPILLANE 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 ROBERT FOY DIRECTOR 5.00 X 0 0 0 PRISCILLA URANN DIRECTOR 5.00 X 0 0 0 MICHAEL MCFARLAND DIRECTOR (UNTIL 12/2017) 1.00 X 0 0 0 RUTH DOBBIE DIRECTOR (UNTIL 05/2017) 1.00 X 0 0 0 ROBERT DOLBEC DIRECTOR (UNTIL 03/2017) 1.00 X 0 0 0 SHEILA MCINTYRE DIRECTOR (UNTIL 05/2017) 1.00 X 0 0 0 CHARLES RIPPBERGER MD DIRECTOR (UNTIL 01/2017) 1.00 X 0 0 0 JOYCE HAGLUND CHIEF EXECUTIVE OFFICER 40.00 X 162248 0 10521 JANICE FARIA BUSINESS/HR MANAGER 40.00 X 106854 0 15600 BERNADETTE O'CONNOR REGISTERED NURSE 40.00 X 100615 0 6916 369717 0 33037 3 0 1 0 UNIDINE CORPORATION 1000 WASHINGTON STREET SUITE 510 BOSTON MA 02118 FOOD SERVICE CONTRACTOR 595276 PARAMOUNT HEALTH SERVICES INC 3 COURTHOUSE LANE UNIT 1 CHELMSFORD MA 01824 NURSING AGENCY 227655 THERAPY RESOURCES MANAGEMENT 1 FATHER DEVALLES BLVD SUITE 401 FALL RIVER MA 02723 THERAPY SERVICES 152682 ARETE REHAB INC 110 HAVERHILL ROAD SUITE 1 AMESBURY MA 01913 THERAPY SERVICES 152383 4 1435 1435 PUBLICLY-AIDED RESIDENTS 623000 2693426 2693426 OTHER OPERATING INCOME 623000 1488377 1488377 MEDICARE RESIDENTS 623000 1302515 1302515 PRIVATE RESIDENTS 623000 1231577 1231577 ANCILLARY INCOME 623000 183444 183444 6899339 66149 66149 1683283 1433852 249431 249431 249431 MASSSAVE REBATE 900099 155000 155000 INSURANCE REFUNDS 623000 36647 36647 BAD DEBT RECOVERY 623000 2311 2311 17564 17564 211522 7427876 7110861 0 315580 172769 105821 66948 2628512 2257924 370588 49786 41740 8046 226187 193607 32580 235844 208171 27673 621175 621175 63503 63503 73238 73238 1047 1047 20995 20995 137552 137552 474213 474213 131278 127818 3460 27950 27950 684840 684840 379 379 825 825 1057999 1057999 1626740 1626740 29212 29212 PATIENT CARE EXPENSES 2110981 2110981 NURSING USER FEE 265337 265337 BAD DEBT EXPENSE 101349 101349 LICENSES AND DUES 45554 45554 46276 46276 10833541 9899659 933882 0 3083401 810922 174938 74618 399380 563062 68896 102779 55003834 1799928 53083279 53203906 3112218 2512334 8159010 7258199 68081122 64525820 1515437 1455649 1280986 1395688 264975 448495 22732536 17607227 25861083 30497045 51655017 51404104 X 16366205 13061816 18900 18900 41000 41000 16426105 13121716 68081122 64525820 -3405665 101276 0 X X 0 1 X 1 0 X 10643 1435 12078 5901237 6275820 6386192 7367507 6899339 32830095 5911880 6275820 6386192 7367507 6900774 32842173 0 0 0 32842173 176369 157684 85334 86441 66149 571977 176369 157684 85334 86441 66149 571977 211522 211522 6088249 6433504 6471526 7453948 7178445 33625672 0.97670 0.97710 0.01700 0.02290 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: BAD DEBT RECOVERY - 2017 AMOUNT: $ 2,311. INSURANCE REFUNDS - 2017 AMOUNT: $ 36,647. MASSSAVE REBATE - 2017 AMOUNT: $ 155,000. OTHER INCOME - 2017 AMOUNT: $ 17,564. 0 0 0 0 0 0 0 0 1 1047 1047 0 PART II-B, LINE 1: DURING 2017, THE ORGANIZATION PAID MEMBERSHIP DUES TO STATE HEALTHCARE ORGANIZATIONS OF WHICH $1,047 WAS THE PORTION RELATED TO LOBBYING. 0 0 59900 59900 59900 59900 50726 9174 59900 49431 3436 2001 140 50726 47012 4658 2172 67 49431 0.68450 0.31550 0 0 3493296 3493296 49410240 1542713 47867527 311833 7796 304037 1753616 214570 1539046 34849 34849 0 53203906 INVESTMENT INTEREST RECEIVABLE 4549 DEFERRED ADVERTISING COSTS, NET 2637096 OTHER ASSETS & RESERVATION DEPOSITS 464826 LOAN AGREEMENT - ESCROWS 4130000 CONSTRUCTION IN PROGRESS 4845 SOFTWARE, NET 16883 7258199 RESIDENT REFUNDABLE ENTRANCE DEPOSIT 30497045 30497045 X 7406881 0 7406881 20995 20995 7427876 10812546 0 10812546 20995 20995 10833541 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: THE ORGANIZATION 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. THE ORGANIZATION FILES AS A TAX-EXEMPT ORGANIZATION. X X X 0 0 0 0 0 0 0 0 0 JOYCE HAGLUND CHIEF EXECUTIVE OFFICER 162248 0 0 0 0 0 7800 0 2721 0 172769 0 0 0 FORM 990, PART VI, SECTION A, LINE 4 THE ORGANIZATION CHANGED THE NUMBER OF BOARD OF DIRECTORS IN FY 2017. FORM 990, PART VI, SECTION B, LINE 11B THE CEO 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 CEO 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 1633312 7854804 WILLIAM B RICE EVENTIDE HOME INC