2016-08-24T14:45:42-05:00 2015-12-31 410746749 CLIFTONLARSONALLEN LLP 300 CROWN COLONY DRIVE SUITE 310 QUINCY MA 02169 990 2015-01-01 237090088 PENACOOK PLACE INC PENA 9783740707 150 WATER STREET HAVERHILL MA 01830 THOMAS L MORTIMER CHAIR 9783740707 2016-08-09 1 JUDY DALEY P01294075 6179848100 2016-08-04 2015 2016-12-15 16:53:06Z DAVID BECKER 150 WATER STREET HAVERHILL MA 01830 11846497 0 X WWW.PENACOOKPLACE.ORG X 1969 MA THE ORGANIZATION'S MISSION IS 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, VOL 14 13 292 24 0 0 146094 51202 11170781 11486410 9792 30927 32536 112121 11359203 11680660 0 0 0 0 7928659 7596176 0 0 0 3778690 4077696 11707349 11673872 -348146 6788 5840957 5469877 4776949 4424449 1064008 1045428 X THE ORGANIZATION'S MISSION IS 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. 0 0 10531284 11598531 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. 10531284 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 0 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 0 0 0 0 1 10 0 1 292 1 0 0 0 0 0 0 0 0 0 0 X 14 13 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X CHARLES CARROZZA 9783740707 150 WATER STREET HAVERHILL MA 01830 DAVID BECKER PRESIDENT/CEO 38.00 X X 150337 0 26256 THOMAS L MORTIMER CHAIR 2.00 X X 0 0 0 JOHN G ALBERT VICE CHAIR 2.00 X X 0 0 0 RICHARD SUNDELL TREASURER 2.00 X X 0 0 0 CINDY M RYAN CLERK 2.00 X X 0 0 0 JANIS CORDISCHI MEMBER 2.00 X 0 0 0 ELAINE DALTON MEMBER 2.00 X 0 0 0 ANDREW DESROSIERS MEMBER 2.00 X 0 0 0 ROBIN HYNDS MEMBER 2.00 X 0 0 0 WILLIAM KLUEBER MEMBER 2.00 X 0 0 0 DIANE LOVALLO MEMBER 2.00 X 0 0 0 FRANK NOVAK 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 CHARLES CARROZZA CFO 36.00 X 95984 0 16763 LINDA CASHMAN RN 53.00 X 117963 0 20602 364284 0 63621 2 0 1 0 MORRISON MANAGEMENT SPECIALIST PO BOX 102289 ATLANTA GA 30368 DIETARY SERVICES 648109 REHABCARE 7733 FORSYTH BLVD ST LOUIS MO 63105 REHABILITATION 551853 COVENANT HEALTH SYSTEMS 100 AMES POND DR STE 102 TEWKSBURY MA 01876 CONSULTING 161180 3 51202 51202 PATIENT SERVICE REVENUE 623000 11486410 11486410 11486410 15764 15764 181000 165837 15163 15163 15163 OTHER INCOME 623000 112121 112121 112121 11680660 11598531 0 30927 289340 289340 6228258 5924750 303508 599123 544382 54741 479455 434448 45007 161180 161180 4865 4865 38400 38400 3780 3780 1112402 947242 165160 5974 5974 697924 608212 89712 290822 290822 1019 1019 2001 2001 117286 117286 309722 309722 134259 1353 132906 USER FEE 757940 757940 FOOD 375863 375863 BAD DEBTS 48891 48891 LICENSE & DUES 14576 5381 9195 792 792 11673872 10531284 1142588 0 821161 933617 417013 208531 1218918 1119290 256575 173514 9354110 6922900 2613107 2431210 163055 261085 351128 342630 5840957 5469877 1577113 1551904 2617738 2429059 419933 0 36165 317486 126000 126000 4776949 4424449 X 1016200 1045428 47808 0 1064008 1045428 5840957 5469877 6788 -25368 0 X 0 1 X 1 0 X 98238 108791 94313 146094 51202 498638 13114968 12930057 11821777 11170781 11486410 60523993 13213206 13038848 11916090 11316875 11537612 61022631 0 0 0 61022631 20994 2743 8483 9792 15764 57776 20994 2743 8483 9792 15764 57776 32536 112121 144657 13234200 13041591 11924573 11359203 11665497 61225064 0.99670 0.99840 0.00090 0.00110 X FORM 990, SCH.A, PART III, SECTION B, LINE 12: OTHER INCOME OF $112,121 RELATED TO PROGRAM SERVICES. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 2094 2094 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 59000 50000 59000 50000 0.00000 0.00000 0.00000 0 0 30859 30859 6591410 4723334 1868076 2709941 2179856 530085 21900 19710 2190 2431210 TRUSTEE FUNDS HELD UNDER BOND INDENTURE 160325 DEPOSITS 45042 SOFTWARE, NET 4319 BOND ISSUE COSTS, NET 132944 342630 DUE TO THIRD-PARTY PAYORS 60000 ASSET RETIREMENT OBLIGATION 66000 126000 X 11655292 -25368 -25368 11680660 0 11680660 11673872 0 11673872 0 11673872 PART V, LINE 4: DONOR RESTRICTIONS MET ON DONOR-RESTRICTED CONTRIBUTIONS AS OF 12/31/2015 FOR THE PURCHASE OF EQUIPMENT. ENDOWMENT FUNDS ARE $0 AS OF 12/31/2015. 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. SHOULD THAT STATUS BE CHALLENGED IN THE FUTURE, THE ENTITY'S 2012 THROUGH 2015 TAX YEARS ARE OPEN FOR EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES. X X X 0 0 0 0 0 0 0 0 0 DAVID BECKER PRESIDENT/CEO 150337 0 0 0 0 0 26256 0 0 0 176593 0 0 0 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 SPOUSE OF BOARD MEMBER SPOUSE OF BOARD MEMBER - FRANK NOVAK 20352 SALARY 0 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 11 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.