2016-11-15T13:52:10-06:00 2015-12-31 410746749 CLIFTONLARSONALLEN LLP 300 CROWN COLONY DRIVE SUITE 310 QUINCY MA 02169 990 2015-01-01 800687948 SOUTH COVE MANOR NURSING AND REHABILITATION CENTER INC SOUT 6174230590 288 WASHINGTON STREET QUINCY MA 02169 WENDY LEE PRESIDENT & CEO 6174230590 2016-11-14 1 JUDY DALEY P01294075 6179848100 2016-10-04 2015 2017-02-10 21:41:12Z WENDY LEE 288 WASHINGTON STREET QUINCY MA 02169 15281857 0 X WWW.SOUTHCOVEMANOR.COM X 2011 MA TO PROVIDE INDIVIDUALIZED REHABILITATION AND NURSING CARE THAT REFLECTS ASIAN CULTURAL VALUES. 15 14 212 26 0 0 546712 194355 8306384 14618745 462251 464690 789 4067 9316136 15281857 0 0 0 0 4999407 8729324 0 0 31547 3818473 6236696 8817880 14966020 498256 315837 25711778 27002929 22840634 23865406 2871144 3137523 X THE ORGANIZATION'S MISSION IS TO PROVIDE INDIVIDUALIZED REHABILITATION AND NURSING CARE THAT REFLECTS ASIAN CULTURAL VALUES. THE ORGANIZATION'S CORE VALUES INCLUDE: 1. RESPECTING THE PEOPLE WE SERVE, THEIR TRADITIONS, AND THEIR PREFERENCES, 2. PROVIDING EXCELLENT, LEADING EDGE CARE AND SERVICES, 3. INVESTING IN OUR EMPLOYEES, AND 4. SERVING OUR COMMUNITY. 0 0 11769557 14622812 NURSING & REHABILITATION SERVICES - THE ORGANIZATION'S MISSION IS TO PROVIDE INDIVIDUALIZED NURSING AND REHABILITATION CARE THAT REFLECTS ASIAN CULTURAL VALUES THROUGH THE OPERATION OF A 141-BED LONG-TERM CARE FACILITY IN QUINCY, MASSACHUSETTS. 11769557 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 1 1 1 0 0 1 13 0 1 212 0 0 0 0 0 0 0 0 0 0 0 X 15 14 1 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 0 0 MA X SCOTT HANSON DIRECTOR OF FINANCE 6174230590 288 WASHINGTON STREET QUINCY MA 02169 RICHARD LUI CHAIRMAN OF THE BOARD 1.00 2.00 X X 0 0 0 MAY CHIN RN VICE PRESIDENT 1.00 2.00 X X 0 0 0 JASON QU MD TREASURER 1.00 2.00 X X 0 0 0 HEMMIE CHANG ESQ CLERK 1.00 2.00 X X 0 0 0 EDWARD CHENG DIRECTOR 1.00 2.00 X 0 0 0 THOMAS CHIN DIRECTOR 1.00 2.00 X 0 0 0 STANLEY ELKERTON DIRECTOR 1.00 2.00 X 0 0 0 LEONARD LAI DIRECTOR 1.00 2.00 X 0 0 0 SUSAN LUO DIRECTOR 1.00 2.00 X 0 0 0 PAUL MACKINNON DIRECTOR 1.00 2.00 X 0 0 0 LISA MUI DIRECTOR 1.00 2.00 X 0 0 0 ALICE L ROSE RN DIRECTOR 1.00 2.00 X 0 0 0 HELEN CHIN SCHLICHTE DIRECTOR 1.00 2.00 X 0 0 0 DAVID T TING DIRECTOR 1.00 2.00 X 0 0 0 HON HOI YEE DIRECTOR 1.00 2.00 X 0 0 0 WENDY LEE PRESIDENT & CEO (AS OF 10/08/15) 40.00 2.00 X 38368 0 7586 RICHARD WONG PRESIDENT & CEO (THRU 11/06/15) 40.00 2.00 X 211938 0 12597 SCOTT HANSON DIRECTOR OF FINANCE 40.00 2.00 X 114186 0 12794 LI CHIN ADMINISTRATOR 40.00 0.00 X 139912 0 27905 504404 0 60882 3 0 1 0 CLIFTONLARSONALLEN LLP 300 CROWN COLONY DRIVE QUINCY MA 02169 ACCOUNTING SERVICES 186684 1 194355 194355 NET PATIENT SERVICE REVENUE 623000 14618745 14618745 14618745 464690 464690 OTHER REVENUE 623000 4067 4067 4067 15281857 14622812 0 464690 565286 565286 6836512 6194214 642298 100759 85020 15739 489569 464467 25102 737198 622043 115155 66800 66800 160222 160222 1204899 1013202 173507 18190 25069 25069 157186 157186 1673381 1673381 683 683 15641 15641 639507 639507 238096 238096 126116 31226 94890 USER FEES 856838 856838 DIETARY 471596 471596 PROVISION FOR BAD DEBTS 218632 218632 MEDICAL SUPPLIES 216515 216515 165515 120290 31868 13357 14966020 11769557 3164916 31547 2062269 3590165 671052 1350025 366154 266113 1782950 1205850 18600277 18600277 113158 98132 2054638 348644 1866037 1705994 249881 186373 25711778 27002929 1170802 1285770 19000000 18963217 2669832 3616419 22840634 23865406 X 1833938 2871410 1037206 266113 2871144 3137523 25711778 27002929 X 315837 -265458 216000 X 0 1 X 1 0 X 861836 2561500 1416608 546712 194355 5581011 8307173 14622812 22929985 861836 2561500 1416608 8853885 14817167 28510996 300500 1022500 122220 1445220 0 300500 1022500 122220 1445220 27065776 50406 464038 462251 464690 1441385 50406 464038 462251 464690 1441385 861836 2611906 1880646 9316136 15281857 29952381 0.90360 0.84320 0.04810 0.06660 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 351031 71661 279370 1703607 276983 1426624 1705994 DUE TO RELATED PARTIES 2689266 OTHER LIABILITIES 927153 3616419 X 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. SHOULD THE STATUS OF THE ORGANIZATION BE CHALLENGED IN THE FUTURE, ITS 2012 THROUGH 2015 TAX YEARS ARE OPEN FOR EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES. X X X X 0 0 0 0 0 0 0 0 0 RICHARD WONG PRESIDENT & CEO (THRU 11/06/15) 164438 0 47500 0 0 0 0 0 12597 0 224535 0 0 0 LI CHIN ADMINISTRATOR 139912 0 0 0 0 0 0 0 27905 0 167817 0 0 0 FORM 990, SCH.J, PART II, LINE 1: RICHARD WONG, PRESIDENT & CEO, RETIRED FROM THE ORGANIZATION ON NOVEMBER 6, 2015. DURING THE CALENDAR YEAR, MR. WONG RECEIVED A PERFORMANCE BONUS OF $47,500 FOR HIS SERVICES FROM 2014 AND 2015. A MASSACHUSETTS DEVELOPMENT FINANCE AGENCY 043431814 2012-10-30 19000000 LAND ACQUISITION AND FACILITY CONSTRUCTION AND FURNISHING 0 0 0 A 19000000 19000000 2015 0 0 1 1 A 0 0 0 0 0 0 0 A 0 0 1 0 1 0 0 0 1 A 0 HEMMIE CHANG CLERK & DIRECTOR 47654 ATTORNEY FOR FOLEY & HOAG, THE ORGANIZATION'S LEGAL PROVIDER. MS. CHANG DID NOT PROVIDE ANY DIRECT LEGAL SERVICES TO THE ORGANIZATION. 0 X 3 45493 FMV 0 0 0 PART I, COLUMN (B): THREE DONORS CONTRIBUTED STOCK TO THE ORGANIZATION DURING THE YEAR. FORM 990, PART VI, SECTION A, LINE 1 THE MANAGEMENT/COMPENSATION COMMITTEE IS MADE OF BOARD DIRECTORS. FORM 990, PART VI, SECTION A, LINE 2 A FAMILY RELATIONSHIP EXISTS BETWEEN MAY CHIN, VICE PRESIDENT; THOMAS CHIN, DIRECTOR; AND HELEN CHIN SCHLICHTE, DIRECTOR. A BUSINESS RELATIONSHIP EXISTS WITH HEMMIE CHANG WHO WORKS FOR THE ORGANIZATION'S LEGAL FIRM, FOLEY AND HOAG. FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION'S AUDIT COMMITTEE REVIEWS AND APPROVES THE DRAFT FORM 990. THE COMPLETE FORM 990 IS PRESENTED TO THE BOARD OF DIRECTORS AFTER FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY IS PART OF THE ORGANIZATION'S BY-LAWS AND IS DISCUSSED BY THE BOARD OF DIRECTORS AND TOP MANAGEMENT PERSONNEL AT THE FIRST BOARD MEETING EACH YEAR REGARDING ANY/ALL SIGNIFICANT TRANSACTIONS. THE CONFLICT OF INTEREST POLICY COVERS DIRECTORS, OFFICERS, AND EMPLOYEES. ANY CONFLICTS OF INTEREST ARE DISCLOSED TO THE BOARD PRIOR TO APPROVAL OR RATIFICATION OF THE CONTRACT OR TRANSACTION BY MAJORITY VOTE OF THE DISINTERESTED PERSONS. FORM 990, PART VI, SECTION B, LINE 15A THE PROCESS FOR DETERMINING THE COMPENSATION OF THE CEO AND TOP MANAGEMENT INCLUDES THE USE OF A COMPENSATION COMMITTEE, FORM 990S OF OTHER ORGANIZATIONS, COMPENSATION SURVEYS, AND THE APPROVAL OF THE BOARD OR COMPENSATION COMMITTEE. 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 216,000. SOUTH COVE NURSING FACILITIES FOUNDATION INC 288 WASHINGTON STREET QUINCY MA 02169 046406242 NURSING AND CARE FACILITIES MA 501(C)(3) LINE 11A, I SOUTH COVE MANOR NURSING AND REHABILITATION CENTER INC 1 SOUTH COVE MANOR NURSING AND REHABILITATION CENTER QALICB INC 288 WASHINGTON STREET QUINCY MA 02169 352419744 TO SUPPORT ACTIVITIES OF SOUTH COVE MANOR NURSING AND REHAB CENTER, INC. MA 501(C)(3) LINE 9 SOUTH COVE MANOR NURSING AND REHABILITATION CENTER INC 1 SOUTH COVE MANOR INC 288 WASHINGTON STREET QUINCY MA 02169 042820772 NURSING HOME MA N/A C 0 0 0 1 1 1 0 0 0 0 0 1 0 0 1 1 0 0 0 0 SOUTH COVE MANOR NURSING & REHAB CENTER QALICB INC C 216000 FMV SOUTH COVE MANOR NURSING & REHAB CENTER QALICB INC D 36725 FMV SOUTH COVE NURSING FACILITIES FOUNDATION INC E 2725992 FMV SOUTH COVE MANOR NURSING & REHAB CENTER QALICB INC K 690187 FMV SOUTH COVE MANOR NURSING & REHAB CENTER QALICB INC K 1215734 FMV