2017-11-15T09:24:36-06:00 2016-12-31 410746749 CLIFTONLARSONALLEN LLP 300 CROWN COLONY DRIVE SUITE 310 QUINCY MA 02169 990 2016-01-01 043274643 CHELSEA JEWISH NORTH SHORE ASSISTED LIVING INC CHEL 9784715100 240 LYNNFIELD STREET PEABODY MA 01960 BARRY BERMAN TREASURER 9784715100 2017-11-14 1 JUDY DALEY P01294075 6179848100 2017-11-13 67.137.57.251 2017-11-14 09:00:23 ES P 499B49BEE9E95068E93680D69C996EB6A62D8814 BDBF5572340FAAE6A27F900DDE1A70A54F7FF7ED 2016 2017-02-10 21:41:12Z HARRIETT & RALPH KAPLAN ESTATES BARRY BERMAN 240 LYNNFIELD STREET PEABODY MA 01960 8148438 0 X WWW.CHELSEAJEWISH.ORG X 1995 MA THE ORGANIZATION'S MISSION IS TO ENRICH THE LIFE OF EACH OF OUR RESIDENTS AND PROGRAM PARTICIPANTS SO THAT EACH MAY CONTINUE TO LIVE HIS OR HER LIFE WITH A SENSE OF MEANING AND PURPOSE. WE PROVIDE ASSISTED LIVING UNITS FOR OUR TENANTS. 9 6 154 13 0 0 0 0 8187338 8147040 0 0 1364 1074 8188702 8148114 0 0 0 0 3466408 3630208 0 0 0 3726359 3869040 7192767 7499248 995935 648866 18597480 14323656 15071330 14379055 3526150 -55399 TO ENRICH THE LIFE OF EACH OF OUR RESIDENTS AND PROGRAM PARTICIPANTS SO THAT EACH MAY CONTINUE TO LIVE HIS OR HER LIFE WITH A SENSE OF MEANING AND PURPOSE. WE PROVIDE ASSISTED LIVING UNITS FOR OUR TENANTS. 0 0 6292242 8148114 ASSISTED LIVING - OPERATION OF A 130-UNIT ASSISTED LIVING FACILITY IN PEABODY, MA. 32 UNITS WERE SPECIALLY DESIGNED AND DESIGNATED FOR CARE SPECIALIZING IN MEMORY ISSUES. 6292242 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 16 0 1 154 1 0 0 0 0 0 0 0 0 0 0 X 9 6 1 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 MA X JEFFREY M LANDA CFO 9784715100 240 LYNNFIELD STREET PEABODY MA 01960 ADAM BERMAN PRESIDENT 1.00 39.00 X X 0 305651 27058 BARRY BERMAN TREASURER 1.00 39.00 X X 0 610459 32880 JOEL MAZER CHAIR 1.00 3.00 X X 0 0 0 ELIZABETH MULLEN CLERK 1.00 39.00 X X 0 206839 17166 SUSAN BRUDNICK DIRECTOR 1.00 3.00 X 0 0 0 CHARLOTTE FLORENCE DIRECTOR 1.00 3.00 X 0 0 0 SHARON FORMAN DIRECTOR 1.00 3.00 X 0 0 0 SHELLY KATZ DIRECTOR 1.00 3.00 X 0 0 0 ROBERT RICHMAN DIRECTOR 1.00 3.00 X 0 0 0 KIM JOYCE CFO (UNTIL 05/31/16) 1.00 39.00 X 0 210415 15936 MEGIN HEMMERLING EXECUTIVE DIRECTOR 40.00 0.00 X 123894 0 15170 JEFF GOPEN ED, FORMER 0.00 0.00 X 0 150000 0 123894 1483364 108210 1 1 1 0 LANDMARK STRUCTURE CORP 282 MONTVALE AVENUE WOBURN MA 01801 CONSTRUCTION 165294 1 PROGRAM SERVICE INCOME 623000 7978966 7978966 OTHER INCOME 623000 168074 168074 8147040 1398 324 1074 1074 8148114 8148114 0 0 139064 139064 3099670 3032824 66846 13376 12585 791 129650 126854 2796 248448 233747 14701 982808 982808 22360 22360 299959 299959 29164 29164 66890 66890 377000 377000 13678 13678 7460 7460 379520 379520 554745 554745 140057 140057 FOOD 632582 632582 SUPPLIES 277708 277708 BAD DEBTS 66000 66000 LICENSE, DUES, & SUBSCR 15393 15393 3716 3716 7499248 6292242 1207006 0 472707 427366 62670 59330 21177 16018 20260656 7629483 12420300 12631173 5620626 1189769 18597480 14323656 546459 821637 187989 203319 13082358 11874090 1254524 1480009 15071330 14379055 X 3526150 -55399 3526150 -55399 18597480 14323656 X 648866 -4230415 X 0 1 X 1 0 X 7991528 7740080 8246911 8190785 8148438 40317742 7991528 7740080 8246911 8190785 8148438 40317742 0 0 0 40317742 51 33 55 139 51 33 55 139 7991579 7740113 8246966 8190785 8148438 40317881 1.00000 1.00000 0.00000 X 1771258 1771258 15745480 5900194 9845286 2052253 1729289 322964 691665 691665 12631173 DUE FROM RELATED PARTY 574253 DEPOSITS 6243 SECURITY DEPOSITS 605912 SOFTWARE, NET 3361 1189769 SECURITY DEPOSITS 595618 DUE TO RELATED PARTIES 14753 FAIR VALUE OF INTEREST RATE SWAPS 80361 DEFERRED MANAGEMENT FEES - RELATED PARTY 789277 1480009 X PART X, LINE 2: THE ORGANIZATION IS A 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. THE ORGANIZATION FILES AS A TAX-EXEMPT ORGANIZATION. 1 0 0 0 0 0 0 0 0 ADAM BERMAN PRESIDENT 0 305651 0 0 0 0 0 0 0 27058 0 332709 0 0 BARRY BERMAN TREASURER 0 610459 0 0 0 0 0 0 0 32880 0 643339 0 0 ELIZABETH MULLEN CLERK 0 206839 0 0 0 0 0 0 0 17166 0 224005 0 0 KIM JOYCE CFO (UNTIL 05/31/16) 0 85915 0 0 0 124500 0 0 0 15936 0 226351 0 0 JEFF GOPEN ED, FORMER 0 0 0 0 0 150000 0 0 0 0 0 150000 0 0 PART I, LINE 4A KIM JOYCE, CFO (UNTIL 05/31/2016), RECEIVED A SEVERANCE PAYMENT OF $124,500 FROM A RELATED ENTITY IN 2016. JEFF GOPEN, FORMER EXECUTIVE DIRECTOR, RECEIVED A SEVERANCE PAYMENT OF $150,000 FROM A RELATED ENTITY IN 2016. A MASS DEVELOPMENT FINANCE AGENCY 043431814 57583UBR8 2011-04-29 15446112 TO REFUND OLD BONDS AND REPLACE EXISTING FACILITY. 0 0 0 A 3152890 15446112 230600 189401 15026111 2012 1 0 1 1 A 0 0 0 0 0 0 0 A 0 1 0 0 1 1 M&T BANK 5.000000000000 0 0 0 0 0 A 0 SCHEDULE K SUPPLENTAL INFORMATION THIS ORGANIZATION IS REPORTING THEIR RESPECTIVE SHARE OF THE $50M BOND ISSUED ON 04/29/11. SEE JEWISH REHABILITATION CENTER FOR AGED OF THE NORTH SHORE, INC. (EIN 04-2106768) FOR THE REMAINING PORTION. JEFFREY BRUNICK LOUIS J BRUDNICK SPOUSE ON THE BOARD OF DIRECTORS. INSURANCE BROKER/AGENT OF THE ORGANIZATION'S INSURANCE COMPANY. 0 FORM 990, PART VI, SECTION A, LINE 2 ADAM BERMAN, PRESIDENT, AND BARRY BERMAN, TREASURER, HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION ENTERED INTO A MANAGEMENT AGREEMENT WITH CHELSEA JEWISH COMMUNITY, INC., A SUBSIDIARY OF CHELSEA JEWISH LIFECARE, INC., EFFECTIVE DECEMBER 1, 2014. CHELSEA JEWISH COMMUNITY, INC. PROVIDED MANAGEMENT SERVICES WHICH INCLUDED THE FOLLOWING RESPONSIBILITIES: 1) KEY PERSONNEL MANAGEMENT 2) PERSONNEL OVERSIGHT (EMPLOYEES & ADMINISTRATION) 3) FINANCIAL RESPONSIBILITIES 4) MANAGEMENT REPORTS 5) REGULATORY COMPLIANCE 6) QUALITY ASSURANCE 7) PURCHASING & CONTRACTING 8) BANK ACCOUNTS FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION'S MANAGEMENT REVIEWS THE CPA-PREPARED FORM 990 PRIOR TO ITS FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ON AN ANNUAL BASIS, ALL BOARD MEMBERS ARE INSTRUCTED TO INFORM THE REST OF THE BOARD IF ANY CONFLICT OF INTEREST EXISTS PERTAINING TO THEIR MEMBERSHIP ON THE BOARD. ANY POTENTIAL CONFLICT OF INTEREST IS THEN DISCUSSED AND ASSESSED BY THE REMAINING BOARD MEMBERS. IF A CONFLICT EXISTS, IT MUST BE DISCLOSED AND HELD TO A HIGHER LEVEL OF SCRUTINY IN ORDER TO VERIFY THAT ALL TRANSACTIONS ARE AT ARMS-LENGTH. ANY BOARD MEMBER DEEMED TO HAVE A CONFLICT OF INTEREST WILL ABSTAIN FROM PARTICIPATING IN THE BOARD'S DELIBERATIONS AND DECISIONS IN THE TRANSACTION. FORM 990, PART VI, SECTION B, LINE 15 THE CEO IS PAID FROM A RELATED ORGANIZATION. PRIOR TO MAJOR SALARY ADJUSTMENTS FOR THE CEO, A RELATED ORGANIZATION'S BOARD OF DIRECTORS ARRANGES FOR A SALARY STUDY TO BE PERFORMED. THE STUDY INCLUDES THE EXECUTIVE SALARIES OF COMPARABLY-SIZED COMPANIES IN THE INDUSTRY. THE BOARD OF DIRECTORS THEN CONSIDERS THE FINDINGS OF THE STUDY IN SETTING THE CEO'S COMPENSATION. 2014 WAS THE MOST RECENT YEAR IN WHICH THE PROCESS INCLUDED REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: EQUITY TRANSFER - RELATED PARTY -4,281,180. CHANGE IN FAIR VALUE OF INTEREST RATE SWAPS 50,765. CHELSEA JEWISH NORTH SHORE INC 240 LYNNFIELD STREET PEABODY MA 01960 261244471 MANAGEMENT MA 501(C)(3) LINE 12B, II CHELSEA JEWISH LIFECARE INC 0 CHELSEA JEWISH NORTH SHORE FOUNDATION INC 240 LYNNFIELD STREET PEABODY MA 01960 223102199 FUNDRAISING MA 501(C)(3) LINE 7 CHELSEA JEWISH NORTH SHORE INC 0 JEWISH REHABILITATION CENTER FOR THE AGED OF THE NORTH SHORE INC 240 LYNNFIELD STREET PEABODY MA 01960 042106768 SKILLED NURSING CARE MA 501(C)(3) LINE 10 CHELSEA JEWISH NORTH SHORE INC 0 CHELSEA JEWISH LIFECARE INC 165 CAPTAINS ROW CHELSEA MA 02150 510141617 FUNDRAISING MA 501(C)(3) LINE 7 N/A 0 0 0 0 1 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0