2016-08-05T06:36:47-05:00 2015-12-31 010494526 BAKER NEWMAN & NOYES LLC 650 ELM STREET SUITE 302 MANCHESTER NH 03101 990 2015-01-01 042104851 MI NURSING RESTORATIVE CENTER INC MINU 9786856321 172 LAWRENCE STREET LAWRENCE MA 01841 GERARD FOLEY PRESIDENT/CEO 9786856321 2016-07-25 E DREW CHENEY P00182972 8002447444 2016-07-25 2015 2016-12-15 16:53:06Z GERARD FOLEY 172 LAWRENCE STREET LAWRENCE MA 01841 19696615 0 X MIHCS.COM X 1875 MA THE MISSION OF MI NURSING RESTORATIVE CENTER, INC. IS TO RESPOND WITH COMPASSIONATE CARE AND DIGNITY TO THE HEALTH, SOCIAL AND SPIRITUAL NEEDS OF WELL, SICK, AND FRAIL ELDERS. MI ALSO OFFERS AND EXTENDS SUPPORTIVE PRESENCE AND PROGRAMS TO THE FAMILIES OF RESIDENTS. THE QUALITY OF OUR SERVICES ARE ACHIEVED THROUGH EMBRACING CORE VALUES THAT INCLUDE COMPASSION, COMPETENCE AND COLLABORATION. 15 14 495 0 0 0 4281572 4771 19395741 19377701 311045 295640 34620 18503 24022978 19696615 0 0 0 0 12828400 12889110 0 0 0 5728665 5427599 18557065 18316709 5465913 1379906 32170216 33304510 1664943 1959002 30505273 31345508 X THE MISSION OF MI NURSING RESTORATIVE CENTER, INC. IS TO RESPOND WITH COMPASSIONATE CARE AND DIGNITY TO THE HEALTH, SOCIAL AND SPIRITUAL NEEDS OF WELL, SICK, AND FRAIL ELDERS. MI ALSO OFFERS AND EXTENDS SUPPORTIVE PRESENCE AND PROGRAMS TO THE FAMILIES OF RESIDENTS. THE QUALITY OF OUR SERVICES ARE ACHIEVED THROUGH EMBRACING CORE VALUES THAT INCLUDE COMPASSION, COMPETENCE AND COLLABORATION. 0 0 16457940 19396204 THE PROVISION OF ELDERCARE THROUGH THE OPERATION OF A 231 BED SKILLED NURSING FACILITY, THE PROVISION OF 80,147 RESIDENT DAYS OF SKILLED NURSING CARE, REHABILIATION SERVICES, DIETARY, LAUNDRY AND HOUSEKEEPING SERVICES AND NUMEROUS SOCIAL ACTIVITIES. MEDICAID DAYS REPRESENT 66,859 OF THE 80,147 TOTAL RESIDENT DAYS. 16457940 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 28 0 1 495 1 0 0 0 0 0 0 0 0 0 0 X 15 14 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X X GERARD FOLEY 9786856321 172 LAWRENCE STREET LAWRENCE MA 01841 FRED SHAHEEN DIRECTOR EX COMM 1.00 X 0 0 0 JOHN NICEFORO JR MD CHAIRPERSON THUR 4/15/15 1.00 X X 0 0 0 KELLY SULLIVAN ESQ CLERK 1.00 X X 0 0 0 MARGARET SHAHEEN CHAIRPERSON 1.00 X 0 0 0 REV WILLIAM DONNELLY OSA DIRECTOR 4/15 TO 9/15 1.00 X 0 0 0 RAISA CARRASCO-VELEZ DIRECTOR 1.00 X 0 0 0 SR SUZANNE FORGET SGM DIRECTOR 1.00 X 0 0 0 REV PETER GORI OSA JCD DIRECTOR AS OF 4/15/15 1.00 X 0 0 0 KAREN MILLER TREASURER 1.00 X X 0 0 0 MARY LOUISE RETELLE DIRECTOR 1.00 X 0 0 0 MARY ALICE ROCK DIRECTOR 1.00 X 0 0 0 EFRAIN ROLON DIRECTOR 1.00 X 0 0 0 MICHAEL MILLER ESQ DIRECTOR AS OF 4/15/15 1.00 X 0 0 0 ROSEMARIE A CONNOLLY DIRECTOR 1.00 X 0 0 0 GERARD J FOLEY PRESIDENT/CEO 20.00 20.00 X X 236919 0 54470 ARLINE EL-ASHKAR MSN RN DIRECTOR 1.00 X 0 0 0 DEBORAH L TURIANOMD VICE CHAIRPERSON 1.00 X 0 0 0 STEWART GOFF ADMINISTRATOR 39.00 1.00 X 135556 0 50039 JEANNE LEYDON ADMINISTRATOR 8.00 32.00 X 132980 0 27953 CHRISTINE PIERRE DIRECTOR OF NURSING 39.00 1.00 X 109639 0 38929 615094 0 171391 4 0 1 0 REHABCARE 7733 FORSYTH BLVD STE 2300 ST LOUIS MO 63105 REHABILITATION SERVICES 866127 COVENANT HEALTH 100 AMES POND SUITE 102 TEWKSBURY MA 01876 HEALTH CARE MGMT CO. 407489 OMNICARE PO BOX 78000 DETROIT MI 482781668 PHARMACEUTICALS 337890 MCKESSON PO BOX 630693 CINCINNATI OH 452630693 MEDICAL SUPPLIES 279486 4 4771 4771 PATIENT SERVICE REVENUE 623000 19377701 19377701 19377701 295640 295640 MISCELLANEOUS REVENUE 623000 18503 18503 18503 19696615 19396204 0 295640 236919 208489 28430 10690347 9407505 1282842 64473 56736 7737 1094947 963553 131394 802424 706133 96291 236673 236673 42438 42438 32964 32964 17360 17360 202393 202393 212566 212566 347290 347290 4409 4409 648855 648855 193393 193393 PURCHASED SERVICES 1650955 1650955 SUPPLIES 1644400 1644400 MEDICAID USER FEE 137154 137154 EDUCATION & TRAINING 56749 56749 18316709 16457940 1858769 0 2197942 1727586 1470390 236138 2080271 1836294 153542 186694 21439476 16136667 5618427 5302809 19996141 23185288 653503 829701 32170216 33304510 956886 1246572 708057 712430 1664943 1959002 X 30505273 31345508 30505273 31345508 32170216 33304510 1379906 -539671 0 X 0 1 X 1 0 X 38520 3304 3998 4281572 4771 4332165 20729651 19965465 19283914 19430361 19396204 98805595 20768171 19968769 19287912 23711933 19400975 103137760 0 0 0 103137760 152263 173627 202308 311045 295640 1134883 152263 173627 202308 311045 295640 1134883 20920434 20142396 19490220 24022978 19696615 104272643 0.98910 0.99200 0.01090 0.00800 X 1020 1020 3020 2000 1020 3020 3020 10000 6980 3020 104779 104779 14034052 9648381 4385671 7300645 6488286 812359 5302809 OTHER INVESTMENTS 23185288 F 23185288 DEFERRED EXPENSES 529777 RESIDENT FUNDS LIABILITY 66710 PROFESSIONAL LIABILITY LOSS RESERVE 63657 DUE TO MEDICAID 52286 712430 X PART X, LINE 2: COVENANT AND ITS MEMBER ORGANIZATIONS ARE CONSIDERED NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE, EXCEPT AS NOTED BELOW. TAX-EXEMPT ORGANIZATIONS COULD BE REQUIRED TO RECORD AN OBLIGATION FOR INCOME TAXES AS THE RESULT OF A TAX POSITION THEY HAVE HISTORICALLY TAKEN ON VARIOUS TAX EXPOSURE ITEMS INCLUDING UNRELATED BUSINESS INCOME OR TAX STATUS. UNDER GUIDANCE ISSUED BY THE FINANCIAL ACCOUNTING STANDARDS BOARD, ASSETS AND LIABILITIES ARE ESTABLISHED FOR UNCERTAIN TAX POSITIONS TAKEN OR POSITIONS EXPECTED TO BE TAKEN IN INCOME TAX RETURNS WHEN SUCH POSITIONS ARE JUDGED TO NOT MEET THE "MORE-LIKELY-THAN-NOT" THRESHOLD, BASED UPON THE TECHNICAL MERITS OF THE POSITION. ESTIMATED INTEREST AND PENALTIES, IF APPLICABLE, RELATED TO UNCERTAIN TAX POSITIONS ARE INCLUDED AS A COMPONENT OF INCOME TAX EXPENSE. THE SYSTEM HAS EVALUATED THE POSITION TAKEN ON ITS FILED TAX RETURNS. THE SYSTEM HAS CONCLUDED NO UNCERTAIN INCOME TAX POSITIONS EXIST AT DECEMBER 31, 2015. UNDER INTERNAL REVENUE SERVICE REGULATIONS, THE SYSTEM'S TAX YEARS FROM 2012 THROUGH 2015 ARE OPEN AND SUBJECT TO EXAMINATION. X X X X 0 0 0 0 0 0 0 1 0 GERARD J FOLEY PRESIDENT/CEO 221100 0 15819 0 0 0 21704 0 32766 0 291389 0 0 0 STEWART GOFF ADMINISTRATOR 125318 0 10000 0 238 0 13904 0 36135 0 185595 0 0 0 JEANNE LEYDON ADMINISTRATOR 122910 0 9812 0 258 0 12694 0 15259 0 160933 0 0 0 PART I, LINE 3 EVERY TWO TO THREE YEARS THE COMPENSATION COMMITTEE OF THE COVENANT HEALTH'S BOARD OF DIRECTORS ENGAGES AN EXTERNAL CONSULTANT TO PROVIDE COMPETITIVE MARKETS DATA FROM VARIOUS SOURCES, WHICH IS USED TO DEVELOP RECOMMENDATIONS FOR CHANGES TO THE COMPENSATION PROGRAM. SINCE 2003, THE COMPENSATION COMMITTEE HAS ENGAGED MERCER HUMAN RESOURCES CONSULTING TO CONDUCT THIS ANALYSIS. OBJECTIVES ARE TO ASSESS THE COMPOSITENESS OF THE CURRENT TOTAL CASH COMPENSATION LEVELS OF THE SENIOR LEADERSHIP TEAM, DEVELOP MARKET BASED COMPETITIVE SALARY RANGES FOR ALL EXECUTIVE POSITIONS AND ENSURE THAT THE ANNUAL INCENTIVE OPPORTUNITIES, IF THERE ARE ANY, ARE COMPETITIVE AND REASONABLE. PART I, LINE 7 THE RELATED ORGANIZATION, COVENANT HEALTH, MAINTAINS AN INCENTIVE COMPENSATION PLAN FOR EXECUTIVES THAT IS ADMINISTERED BY THAT ORGANIZATION'S COMPENSATION COMMITTEE. THE PLAN PROVIDES EXECUTIVES WITH THE OPPORTUNITY TO EARN REASONABLE INCENTIVE COMPENSATION BASED ON THE PERFORMANCE OF THE ORGANIZATION AND THE PERFORMANCE OF THE INDIVIDUAL EXECUTIVE, AS MEASURED AGAINST GOALS ESTABLISHED AT THE BEGINNING OF THE YEAR. THE ENTITLEMENT TO AWARDS FOR A PARTICULAR YEAR IS NOT DETERMINED UNTIL EARLY THE FOLLOWING YEAR. AMOUNTS PAID UNDER THE PLAN ARE REPORTED ON SCHEDULE J, PART II, COLUMN (B)(II). FRED SHAHEEN DIRECTOR 214932 FOOD SUPPLIES ARE PURCHASED FROM SHAHEEN BROTHERS, INC. FRED SHAHEEN IS AN OWNER OF THE COMPANY. SHAHEEN BROTHERS, INC. IS ONE OF SEVERAL VENDORS USED BY THE ORGANIZATION AND ALL TRANSACTIONS ARE CONDUCTED AT FAIR MARKET VALUE. 0 MARGARET SHAHEEN DIRECTOR MARGARET IS THE WIFE OF AN OWNER OF SHAHEEN BROTHERS, INC. SHAHEEN BROTHERS, INC. TRANSACTIONS ARE LISTED ABOVE. 0 FORM 990, PART VI, SECTION A, LINE 2 FRED SHAHEEN, DIRECTOR AND MARGARET SHAHEEN, DIRECTOR, ARE IN LAWS. FORM 990, PART VI, SECTION A, LINE 6 COVENANT HEALTH IS THE SOLE MEMBER OF THE ORGANIZATION. ACCORDINGLY, IT RETAINS CERTAIN RESERVE RIGHTS OVER CORPORATE DECISIONS AND BOARD COMPOSITION. FORM 990, PART VI, SECTION A, LINE 7A COVENANT HEALTH IS THE SOLE MEMBER OF THE ORGANIZATION. AS SUCH IT RETAINS CERTAIN RESERVE RIGHTS OVER CORPORATE DECISIONS AND BOARD COMPOSITION. FORM 990, PART VI, SECTION A, LINE 7B COVENANT HEALTH IS THE SOLE MEMBER OF THE ORGANIZATION. ACCORDINGLY IT RETAINS CERTAIN RESERVE RIGHTS OVER CORPORATE DECISIONS AND BOARD COMPOSITION. FORM 990, PART VI, SECTION B, LINE 11 FORM 990 IS PROVIDED TO THE BOARD MEMBERS AND REVIEWED AT THAT TIME. FORM 990, PART VI, SECTION B, LINE 12C THIS PROCESS IS THE RESPONSIBILITY OF THE COMPLIANCE OFFICER. A FORM IS SUBMITTED TO ALL LEADERSHIP, BOARD MEMBERS, BOARD COMMITTEE MEMBERS, EMPLOYED PHYSICIANS, MEDICAL DIRECTORS AND CERTAIN EMPLOYEES IN KEY POSITIONS ANNUALLY TO BE COMPLETED. REMINDERS ARE SENT OUT TO MAKE CERTAIN THAT ALL CONFLICT OF INTEREST FORMS ARE RETURNED. FORM 990, PART VI, SECTION B, LINE 15 EVERY TWO TO THREE YEARS THE COMPENSATION COMMITTEE OF THE COVENANT HEALTH BOARD OF DIRECTORS ENGAGES AN EXTERNAL CONSULTANT TO PROVIDE COMPETITIVE MARKET DATA FROM VARIOUS SURVEY SOURCES, WHICH IS USED TO DEVELOP RECOMMENDATIONS FOR CHANGES TO THE COMPENSATION PROGRAM. SINCE 2003, THE COMPENSATION COMMITTEE HAS ENGAGED MERCER HUMAN RESOURCES CONSULTING TO CONDUCT THIS ANALYSIS. OBJECTIVES ARE TO ASSESS THE COMPOSITENESS OF THE TOTAL CASH COMPENSATION LEVELS OF THE SENIOR LEADERSHIP TEAM, DEVELOP MARKET BASED COMPETITIVE SALARY RANGES FOR ALL EXECUTIVE POSITIONS AND ENSURE THAT THE ANNUAL INCENTIVE OPPORTUNITIES, IF THERE ARE ANY, ARE COMPETITIVE AND REASONABLE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION PROVIDES FORM 990 AND ACCESS TO GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS UPON REQUEST. THE FORM 990 IS POSTED ON COVENANT HEALTH'S WEBSITE ALSO. MI RESIDENTIAL COMMUNITY III INC 193 MAPLE ST LAWRENCE MA 01841 042686043 PROVIDER OF LOW INCOME HOUSING (HUD) TO ELDERLY AND DISABLED RESIDENTS MA 501 (C) (3) LINE 9 COVENANT HEALTH 0 MI TRANSPORTATION INC 189 MAPLE ST LAWRENCE MA 01841 042921889 PROVIDER OF TRANSPORTATION SERVICES TO ELDERLY, SICK AND DISABLED RESIDENTS MA 501 (C) (3) LINE 9 COVENANT HEALTH 0 COVENANT HEALTH INC 100 AMES POND SUITE 102 TEWKSBURY MA 01876 222484505 HEALTHCARE MANAGEMENT AND RESOURCE ORGANIZATION MA 501 (C) (3) LINE 9 0 MI MANAGEMENT INC 172 LAWRENCE ST LAWRENCE MA 01841 042857794 PROVIDER OF ASSISTED LIVING SERVICES TO THE ELDERLY MA 501 (C) (3) LINE 11A, I COVENANT HEALTH 0 MI ADULT DAY HEALTH CARE CENTER INC 189 MAPLE ST LAWRENCE MA 01841 042921888 ADULT DAY CARE FOR ELDERLY, SICK AND HANDICAPPED MA 501 (C) (3) LINE 9 COVENANT HEALTH 0 MI RESIDENTIAL COMMUNITY II INC 191 MAPLE ST LAWRENCE MA 01841 042679954 PROVIDER OF LOW INCOME HOUSING (HUD) TO ELDERLY AND DISABLED RESIDENTS MA 501 (C) (3) LINE 9 COVENANT HEALTH 0 MI RESIDENTIAL COMMUNITY INC 189 MAPLE ST LAWRENCE MA 01841 042647207 PROVIDER OF ASSISTED LIVING SERVICES TO THE ELDERLY MA 501 (C) (3) LINE 9 COVENANT HEALTH 0 MARY IMMACULATE GUILD INC 172 LAWRENCE ST LAWRENCE MA 01841 463073987 PROVIDER OF SERVICES TO MI AND AFFILIATED ORGANIZATIONS MA 501 (C) (3) LINE 11A, I MI NURSING RESTORATIVE CENTER INC 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 MI GUILD INC P 4644 CASH