2017-11-09T08:45:55-06:00 2016-12-31 410746749 CLIFTONLARSONALLEN LLP 300 CROWN COLONY DRIVE SUITE 310 QUINCY MA 02169 990 2016-01-01 042106771 WILLIAM B RICE EVENTIDE HOME INC WILL 7816605000 25 STONE HAVEN DRIVE SOUTH WEYMOUTH MA 02190 DONALD POWELL PRESIDENT 7816605000 2017-10-20 1 JUDY DALEY P01294075 6179848100 2017-10-20 67.137.57.251 2017-10-20 14:55:37 ED P 499B49BEE9E95068E93680D69C996EB6A62D8814 59D64C9552D6079BF474F8B7BAF6DF689AA58653 2016 2021-01-29 14:40:06Z X FAIRING WAY DONALD POWELL 25 STONE HAVEN DRIVE SOUTH WEYMOUTH MA 02190 11104624 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. 12 12 187 25 0 0 0 0 6361508 5175057 413063 2270156 24684 0 6799255 7445213 0 0 0 0 4498466 3888001 0 0 0 2953900 4272032 7452366 8160033 -653111 -714820 43994126 68081122 27016633 51655017 16977493 16426105 X 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. 1 1 7536490 5175057 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. 7536490 1 0 0 1 0 0 0 0 1 1 1 0 0 1 1 0 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 6 0 1 187 1 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 MA X JANICE FARIA 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 BRIAN GOTTA VICE PRESIDENT (THRU 03/2016) 5.00 X X 0 0 0 MICHAEL MCFARLAND CLERK 5.00 X X 0 0 0 SUSAN BELISLE DIRECTOR 5.00 X 0 0 0 KEVIN CALLANAN DIRECTOR 5.00 X 0 0 0 RUTH DOBBIE DIRECTOR 5.00 X 0 0 0 ROBERT DOLBEC DIRECTOR 5.00 X 0 0 0 ROBERT FOY DIRECTOR 5.00 X 0 0 0 WILLIAM JACKSON DIRECTOR 5.00 X 0 0 0 SHEILA MCINTYRE DIRECTOR 5.00 X 0 0 0 CHARLES RIPPBERGER MD DIRECTOR 5.00 X 0 0 0 PRISCILLA URANN DIRECTOR 5.00 X 0 0 0 JOYCE HAGLUND EXECUTIVE DIRECTOR 40.00 X 164418 0 11695 PAULA O'CONNOR DIRECTOR OF NURSES 40.00 X 108737 0 17883 273155 0 29578 2 0 1 0 COMMONWEALTH OF MASSACHUSETTS ONE ASHBURTON PLACE 11TH FLR BOSTON MA 02108 NURSING USER FEES 327443 DELLBROOK CONTRUCTION 1 ADAMS PLACE QUINCY MA 02169 CONTRUCTION 221774 2 PUBLICLY-AIDED RESIDENTS 623000 2804004 2804004 PRIVATE RESIDENTS 623000 1537146 1537146 ANCILLARY INCOME 623000 481803 481803 MEDICARE RESIDENTS 623000 309369 309369 OTHER OPERATING INCOME 623000 42735 42735 5175057 86441 86441 951612 4891514 960347 2699064 -8735 2192450 2183715 2183715 7445213 5175057 0 2270156 176113 176113 3056889 2944066 112823 27029 24273 2756 343226 308223 35003 284744 255705 29039 43749 43749 11415 11415 116220 116220 995 995 25175 25175 66960 66960 440431 440431 84262 79972 4290 625592 625592 535814 535814 440139 440139 40537 40537 PATIENT CARE EXPENSES 1391193 1391193 USER FEE EXPENSE 305717 305717 205 ADAMS STREET EXPENS 113483 113483 LICENSES AND DUES 29215 29215 1135 1135 8160033 7536490 623543 0 316725 3083401 298854 174938 554559 399380 114116 68896 53468004 384725 5150225 53083279 3301926 3112218 34257721 8159010 43994126 68081122 3323868 1515437 0 1280986 1783693 264975 18213636 22732536 3695436 25861083 27016633 51655017 X 16917593 16366205 18900 18900 41000 41000 16977493 16426105 43994126 68081122 -714820 163432 0 X X 0 1 X 1 0 X 9497 10643 20140 6010482 5901237 6275820 6386192 7367507 31941238 6019979 5911880 6275820 6386192 7367507 31961378 0 0 0 31961378 243762 176369 157684 85334 86441 749590 243762 176369 157684 85334 86441 749590 6263741 6088249 6433504 6471526 7453948 32710968 0.97710 0.96890 0.02290 0.03110 X 0 0 0 0 0 0 0 0 1 995 995 0 PART II-B, LINE 1: DURING 2016, THE ORGANIZATION PAID MEMBERSHIP DUES TO STATE HEALTHCARE ORGANIZATIONS OF WHICH $995 WAS THE PORTION RELATED TO LOBBYING. 0 0 59900 59900 50726 9174 59900 49431 3436 2001 140 50726 47012 4658 2172 67 49431 45695 2577 1227 33 47012 0.00000 0.68450 0.31550 0 0 2543296 2543296 49193115 307457 48885658 1696744 42419 1654325 34849 34849 0 53083279 INVESTMENT INTEREST RECEIVABLE 4177 DEFERRED ADVERTISING COSTS, NET 2595108 OTHER ASSETS & RESERVATION DEPOSITS 278086 LOAN AGREEMENT - ESCROWS 4552663 ENTRANCE DEPOSIT RECEIVABLES 728977 8159010 RESIDENT REFUNDABLE ENTRANCE DEPOSIT 25861083 25861083 X 7407765 -12273 -12273 7420038 25175 25175 7445213 8122585 0 8122585 25175 12273 37448 8160033 PART IV, LINE 2B: RICE EVENTIDE ACCEPTED PRECONSTRUCTION DEPOSITS FOR ITS FAIRING WAY PROJECT. PROSPECTIVE RESIDENTS MAY ENTER INTO ONE OF TWO TYPES OF AGREEMENTS TO RESERVE EITHER A POSITION ON A PRIORITY LIST OR RESERVE A SPECIFIC UNIT IN THE COMPLETED PROJECT. THE PRIORITY LIST DEPOSITS ARE FULLY REFUNDABLE UPON REQUEST AT ANY TIME. THE 10% UNIT DEPOSITS ARE ALSO REFUNDABLE UPON REQUEST AT ANY TIME PLUS ACCUMULATE INTEREST INCOME EARNED ON THE DEPOSIT, LESS AN ADMINISTRATIVE FEE. 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. PART XI, LINE 2D - OTHER ADJUSTMENTS: 205 ADAMS STREET EXPENSES -12,273. PART XII, LINE 4B - OTHER ADJUSTMENTS: 205 ADAMS STREET EXPENSES 12,273. X X X 0 0 0 0 0 0 0 0 0 JOYCE HAGLUND EXECUTIVE DIRECTOR 154418 0 10000 0 0 0 4982 0 6713 0 176113 0 0 0 FORM 990, PART III, LINE 2 DURING 2016, THE ORGANIZATION ADDED 104 UNITS OF INDEPENDENT LIVING. FORM 990, PART III, LINE 3 DURING 2016, THE ORGANIZATION MOVED TO A NEW FACILITY WITH 50 SKILLED NURSING FACILITY BEDS. 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 EXECUTIVE DIRECTOR'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 2543296 WILLIAM B RICE EVENTIDE HOME INC