2017-10-31T11:56:53-05:00 2016-12-31 410746749 CLIFTONLARSONALLEN LLP 300 CROWN COLONY DRIVE SUITE 310 QUINCY MA 02169 990 2016-01-01 237090088 PENACOOK PLACE INC PENA 9783740707 150 WATER STREET HAVERHILL MA 01830 SCOTT WHEELER PRESIDENT & CEO 9783740707 2017-10-18 1 JUDY DALEY P01294075 6179848100 2017-08-31 67.137.57.251 2017-10-18 14:56:54 ED P 499B49BEE9E95068E93680D69C996EB6A62D8814 54D5E4BA1470F8C36BA6B05316F79CBB30854ABE 2016 2021-01-29 14:40:06Z SCOTT WHEELER 150 WATER STREET HAVERHILL MA 01830 10609669 0 X WWW.PENACOOKPLACE.ORG X 1969 MA 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. TO BE AN INTEGRAL, CONTRIBUTING PART OF THE GREATER HAVERHILL BUSINESS, EDUCATIONAL AND CULTURAL COMMUNITIES. 12 12 269 24 0 0 51202 53378 11486410 10526438 30927 18149 112121 11704 11680660 10609669 0 0 0 0 7596176 7183283 0 0 0 4077696 4068951 11673872 11252234 6788 -642565 5469877 5247059 4424449 4827823 1045428 419236 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, VOLUNTE 0 0 10090183 10538142 PENACOOK PLACE IS AN INDEPENDENT, NOT-FOR-PROFIT, 160-BED HAVERHILL NURSING HOME AND REHABILITATION FACILITY 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, COMPASSIONATE, AND HELP MAKE PENACOOK PLACE A WARM AND WELCOMING FACILITY. 10090183 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 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 0 0 0 0 0 0 1 22 0 1 269 1 0 0 0 0 0 0 0 0 0 0 X 12 12 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X SCOTT WHEELER 9783740707 150 WATER STREET HAVERHILL MA 01830 SCOTT WHEELER PRESIDENT & CEO 38.00 X X 34808 0 2532 THOMAS L MORTIMER CHAIR 2.00 X X 0 0 0 WILLIAM KLUEBER TREASURER 2.00 X X 0 0 0 FRANK NOVAK CLERK 2.00 X X 0 0 0 JOHN G ALBERT MEMBER 2.00 X 0 0 0 JANIS CORDISCHI MEMBER 2.00 X 0 0 0 ANDREW DESROSIERS MEMBER 2.00 X 0 0 0 DIANE LOVALLO MEMBER 2.00 X 0 0 0 CINDY M RYAN MEMBER 2.00 X 0 0 0 JOHN SARRO MEMBER 2.00 X 0 0 0 DR DAN TOLLMAN MEMBER 2.00 X 0 0 0 ROBIN HYNDS EXEC. COMM 2.00 X 0 0 0 DAVID M BECKER PRESIDENT & CEO, RETIRED 38.00 X X 95141 0 6975 CHARLES CARROZZA CFO 38.00 X 106782 0 7768 LISA SALTERIO DON 41.00 X 101957 0 7417 338688 0 24692 2 0 0 0 MORRISON MANAGEMENT SPECIALIST PO BOX 102289 ATLANTA GA 30368 DIETARY SERVICES 694109 REHABCARE 7733 FORSYTH BOULEVARD ST LOUIS MO 63105 REHABILITATION 571421 COVENANT HEALTH SYSTEMS 100 AMES POND DRIVE STE 102 TEWKSBURY MA 01876 CONSULTING 154558 3 53378 53378 PATIENT SERVICE REVENUE 623000 10526438 10526438 10526438 18149 18149 OTHER INCOME 623000 11704 11704 11704 10609669 10538142 0 18149 X 254006 254006 5784707 5316648 468059 659699 607076 52623 484871 447181 37690 159900 159900 56746 56746 53600 53600 6165 6165 3000 3000 1162617 909682 252935 10374 10374 621420 510140 111280 253157 253157 3128 3128 2164 2164 111225 111225 298596 298596 99844 1436 98408 USER FEE 714003 714003 FOOD 379892 379892 BAD DEBTS 113181 113181 LICENSE AND DUES 17336 17336 2603 2603 11252234 10090183 1162051 0 933617 923108 208531 517846 1119290 1249009 173514 136441 9406795 7205427 2431210 2201368 261085 0 342630 219287 5469877 5247059 1551904 1972640 0 47604 2429059 2129093 317486 552486 126000 126000 4424449 4827823 X 1045428 374452 0 44784 1045428 419236 5469877 5247059 -642565 16373 0 X 0 1 X 1 0 X 108791 94313 146094 51202 53378 453778 12930057 11821777 11170781 11486410 10526438 57935463 13038848 11916090 11316875 11537612 10579816 58389241 0 0 0 58389241 2743 8483 9792 15764 18149 54931 2743 8483 9792 15764 18149 54931 32536 112121 11704 156361 13041591 11924573 11359203 11665497 10609669 58600533 0.99640 0.99670 0.00090 0.00090 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 6165 6165 0 PART II-B, LINE 1: THE ORGANIZATION PAYS DUES TO VARIOUS MEMBERSHIP ORGANIZATIONS. THESE ORGANIZATIONS MAY CONDUCT LOBBYING ACTIVITIES ON BEHALF OF THEIR MEMBERS. HOWEVER, THE ORGANIZATION DOES NOT DIRECTLY PARTICIPATE IN THESE LOBBYING ACTIVITIES. 47808 30586 78394 31269 47808 31269 47808 61763 54469 84963 31269 50000 61763 50000 61763 30859 30859 6624445 4898603 1725842 2729591 2284924 444667 21900 21900 0 2201368 DUE TO THIRD-PARTY PAYORS 60000 ASSET RETIREMENT OBLIGATION 66000 126000 X 10609669 0 10609669 0 10609669 11252234 0 11252234 0 11252234 PART V, LINE 4: ENDOWMENT FUNDS ARE $0 AS OF 12/31/2016. PART X, LINE 2: THE ORGANIZATION IS A NOT-FOR-PROFIT 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. A MASSACHUSETTS DEVELOPMENT FINANCE AGENCY 043431814 2011-11-10 3258000 TO REDEEM MDFA REVENUE REFUNDING BONDS, ISSUED MARCH 1, 2000. 0 0 0 A 3258000 65160 3192840 2011 1 0 1 1 A 0 0 0 0 0 0 1 A 0 1 0 0 1 0 0 0 1 A 1 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE SHALL HAVE THE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE CORPORATION, SUBJECT TO LIMITATIONS THAT MAY BE PROVIDED BY RESOLUTION OF THE BOARD OF DIRECTORS. EXECUTIVE COMMITTEE IS MADE UP OF THE CHAIR, VICE CHAIR, 2ND VICE CHAIR, TREASURER, CLERK AND IMMEDIATE PAST CHAIR. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION DELEGATES THE DIETARY DEPARTMENT'S MANAGEMENT DUTIES TO AN OUTSIDE MANAGEMENT COMPANY'S CONSULTANTS - DIETARY MANAGER AND DIETICIAN. THESE MANAGERS/CONSULTANTS HAVE RESPONSIBILITIES INCLUDING THE ABILITY TO HIRE, FIRE, AND SUPERVISE EMPLOYEES; THE DEPARTMENT'S BUDGET; AND OVERALL DAY TO DAY MANAGEMENT OF THE ORGANIZATION'S DIETARY DEPARTMENT. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION'S CFO PERFORMS THE INITIAL REVIEWS THE FORM 990 AND THEN WITH THE ORGANIZATION'S PRESIDENT/CEO. AFTER THE CFO AND PRESIDENT/CEO REVIEW THE FORM 990, A COMPLETE COPY OF THE RETURN IS PROVIDED TO THE BOARD OF DIRECTORS FOR REVIEW BEFORE IT IS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C AT THE SEPTEMBER BOARD OF DIRECTOR'S MEETING, EVERY BOARD MEMBER IS GIVEN A COPY OF THE CONFLICT OF INTEREST STATEMENT TO READ AND SIGN. ALL BOARD MEMBERS ARE REQUIRED TO SIGN. THE POLICY OUTLINES THE RESTRICTIONS IMPOSED UPON THE BOARD IF ANY CONFLICT SHOULD EXIST. ALL STAFF MEMBERS ARE PRESENTED INFORMATION REGARDING ORGANIZATIONAL INTEGRITY UPON HIRE AND DURING THEIR ANNUAL ORIENTATION. CONFLICT OF INTEREST IS INCLUDED IN OUR O.I. PROGRAM AND STAFF IS REQUIRED TO REVIEW AS PART OF THEIR CONTINUED EMPLOYMENT. FORM 990, PART VI, SECTION B, LINE 15 A PERSONNEL COMMITTEE WAS ESTABLISHED AS A SUB-COMMITTEE OF THE BOARD OF DIRECTORS. THE FOCUS OF THIS GROUP IS TO REVIEW AND EVALUATE THE PRESIDENT/CEO ON AN ANNUAL BASIS. INDUSTRY COMPENSATION DATA AVAILABLE THROUGH LEADING AGE AND THE STATE ARE REVIEWED. THE PERSONNEL COMMITTEE THEN MAKES THEIR RECOMMENDATION TO THE FULL BOARD FOR FINAL APPROVAL. THIS PROCESS IS CONDUCTED ANNUALLY AND TAKES PLACE STARTING IN JANUARY OF EACH YEAR TO EVALUATE THE PERFORMANCE OF THE PRESIDENT/CEO FOR THE YEAR JUST COMPLETED. DEPARTMENT HEADS PERFORM ANNUAL REVIEWS OF THEIR STAFF. THE PRESIDENT/CEO PERFORMS ANNUAL REVIEWS OF ALL DEPARTMENT HEADS. THESE REVIEWS ARE COMPLETED ANNUALLY ON THE EMPLOYEE'S ANNIVERSARY DATE. 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 IX, LINE 11G OTHER PROFESSIONAL FEES : PROGRAM SERVICE EXPENSES 909,682. MANAGEMENT AND GENERAL EXPENSES 252,935. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,162,617.