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COVENANT HEALTH INVESTMENT TRUST: Form 990, tax year 2015

View the entire original 990 at ProPublica ↗

Organization
COVENANT HEALTH INVESTMENT TRUST (EIN 04-6835128)
Tax period
2015-01-01 to 2015-12-31
Filed
2016-06-24
IRS object ID
201621769349300212
Schema version
2015v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2016-06-24T10:07:02-05:00ReturnTs
Tax Period End2015-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN010494526PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1BAKER NEWMAN NOYES LLCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1650 ELM STREET SUITE 302AddressLine1Txt
CityMANCHESTERCityNm
State AbbreviationNHStateAbbreviationCd
ZIP03101ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2015-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN046835128EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1PROVIDENTIA PRIMA TRUSTBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlPROVBusinessNameControlTxt
Phone9786546363PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1100 AMES POND DRIVEAddressLine1Txt
CityTEWKSBURYCityNm
State AbbreviationMAStateAbbreviationCd
ZIP01876ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonJOHN AHLEPersonNm
Person TitleCHIEF FINANCIAL OFFICERPersonTitleTxt
Phone9786546363PhoneNum
Signature2016-05-26SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonE DREW CHENEYPreparerPersonNm
PTINP00182972PTIN
Phone8002447444PhoneNum
Preparation2016-05-31PreparationDt
FieldValueIRS element (for citing)
Tax2015TaxYr
Build TS2016-09-27 15:27:22ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerJOHN AHLEPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1100 AMES POND DRIVEAddressLine1Txt
CityTEWKSBURYCityNm
State AbbreviationMAStateAbbreviationCd
ZIP01876ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$114,903,676GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressCOVENANTHEATH.NETWebsiteAddressTxt
Type Of Organization TrustYes (X)TypeOfOrganizationTrustInd
Formation1996FormationYr
Legal Domicile StateMALegalDomicileStateCd
Activity Or MissionPROVIDENTIA PRIMA WAS ESTABLISHED TO HOLD AND MANAGE POOLED INVESTMENTS OF VARIOUS ORGANIZATIONS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501 (C) (3)ActivityOrMissionDesc
Voting Members Governing Body10VotingMembersGoverningBodyCnt
Voting Members Independent7VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers0TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$0PYContributionsGrantsAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$0PYProgramServiceRevenueAmt
CY Program Service Revenue$0CYProgramServiceRevenueAmt
PY Investment Income$13,347,118PYInvestmentIncomeAmt
CY Investment Income$10,319,410CYInvestmentIncomeAmt
PY Other Revenue$41,260PYOtherRevenueAmt
CY Other Revenue$23,803CYOtherRevenueAmt
PY Total Revenue$13,388,378PYTotalRevenueAmt
CY Total Revenue$10,343,213CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$0PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$0CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$870,581PYOtherExpensesAmt
CY Other Expenses$838,319CYOtherExpensesAmt
PY Total Expenses$870,581PYTotalExpensesAmt
CY Total Expenses$838,319CYTotalExpensesAmt
PY Revenues Less Expenses$12,517,797PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$9,504,894CYRevenuesLessExpensesAmt
Total Assets BOY$248,792,972TotalAssetsBOYAmt
Total Assets EOY$238,250,753TotalAssetsEOYAmt
Total Liabilities BOY$3,271,386TotalLiabilitiesBOYAmt
Total Liabilities EOY$243,682TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$245,521,586NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$238,007,071NetAssetsOrFundBalancesEOYAmt
MissionPROVIDENTIA PRIMA WAS ESTABLISHED TO HOLD AND MANAGE POOLED INVESTMENTS OF VARIOUS ORGANIZATIONS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501 (C) (3).MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
DescN/ADesc
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B Required0ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
Report Land Building Equipment0ReportLandBuildingEquipmentInd
Report Investments Other SecYes (1)ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other Liabilities0ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign ActivitiesYes (1)ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee0EmployeeCnt
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members10GoverningBodyVotingMembersCnt
Independent Voting Member7IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesYes (1)DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
Other WebsiteYes (X)OtherWebsiteInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1JOHN AHLEBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone9786546363PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1100 AMES POND DRIVEAddressLine1Txt
CityTEWKSBURYCityNm
State AbbreviationMAStateAbbreviationCd
ZIP01876ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (10 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
JOHN AHLE
TREASURER/SECRETARY1.0039.00Yes (X)Yes (X)$0$408,243$105,644
CAROLYN KASABIAN
TRUSTEE1.0039.00Yes (X)$0$274,848$23,417
DONALD M DEHART
CHAIR/PRESIDENT3.00Yes (X)Yes (X)$0$0$0
RICHARD J PLAMONDON
VICE PRESIDENT1.0039.00Yes (X)Yes (X)$0$322,529$30,575
WILLIAM ADAMS
TRUSTEE1.00Yes (X)$0$0$0
KEVIN HALLORAN
TRUSTEE1.00Yes (X)$0$0$0
WILLIAM DEMASO
TRUSTEE1.00Yes (X)$0$0$0
SR CATHERINE O'CONNOR
TRUSTEE1.00Yes (X)$0$0$0
ROSEMARIE CONNOLLY
TRUSTEE1.00Yes (X)$0$0$0
PAUL ARENBURG
TRUSTEE1.00Yes (X)$0$0$0
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$1,005,620TotReportableCompRltdOrgAmt
Total Other Compensation$159,636TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (4 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
NEPC LLC
255 STATE STREETBOSTONMA02109INVESTMENT ADVISOR$161,566
SILCHESTER INTERNATIONAL INVESTORS
780 3RD AVENUE 42ND FLOORNEW YORKNY10017INVESTMENT MANAGER$156,539
IRONBRIDGE CAPITAL MANAGEMENT LP
ONE PARKVIEW PL SUITE 700OAKBROOK TERRACEIL60181INVESTMENT MANAGER$119,226
STATE STREET BANK & TRUST
200 CLARENDON STREETBOSTONMA02116CUSTODIAN FEES$108,824
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K4CntrctRcvdGreaterThan100KCnt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$5,100,796TotalRevenueColumnAmt
Exclusion$5,100,796ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$109,779,077SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$104,560,463SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$5,218,614SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$5,218,614TotalRevenueColumnAmt
Exclusion$5,218,614ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescOTHERDesc
Business900099BusinessCd
Total Revenue Column$23,803TotalRevenueColumnAmt
Exclusion$23,803ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$23,803OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$10,343,213TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$10,343,213ExclusionAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$30,000TotalAmt
Management And General$30,000ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$721,392TotalAmt
Management And General$721,392ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (2 entries)

DescDescTotalTotalAmtManagement And GeneralManagementAndGeneralAmt
ADMINISTRATION EXPENSE$60,000$60,000
MISCELLANEOUS EXPENSES$26,927$26,927

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$838,319TotalAmt
Program Services$0ProgramServicesAmt
Management And General$838,319ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$2,571,059BOYAmt
EOY$5,250,061EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$200,126,410BOYAmt
EOY$175,305,765EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$42,404,159BOYAmt
EOY$57,684,583EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$3,691,344BOYAmt
EOY$10,344EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$248,792,972BOYAmt
EOY$238,250,753EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$3,271,386BOYAmt
EOY$243,682EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$3,271,386BOYAmt
EOY$243,682EOYAmt
FieldValueIRS element (for citing)
Org Does Not Follow SFAS117Yes (X)OrgDoesNotFollowSFAS117Ind

Cap Stk Tr Prin Current Funds CapStkTrPrinCurrentFundsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Pd In Cap Srpls Land Bldg Eqp Fund PdInCapSrplsLandBldgEqpFundGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp

FieldValueIRS element (for citing)
BOY$245,521,586BOYAmt
EOY$238,007,071EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$245,521,586BOYAmt
EOY$238,007,071EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$248,792,972BOYAmt
EOY$238,250,753EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$9,504,894ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$12,310,762NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets-$4,708,647OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3Yes (X)SupportingOrganization509a3Ind
Supporting Org Type1Yes (X)SupportingOrgType1Ind
Supported Organizations1SupportedOrganizationsCnt

Supported Org Information SupportedOrgInformationGrp

Supported Organization Name SupportedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1COVENANT HEALTH INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
EIN222484505EIN
Organization Type9OrganizationTypeCd
Governing Document ListedYes (1)GoverningDocumentListedInd
Support$0SupportAmt
Other Support$0OtherSupportAmt
FieldValueIRS element (for citing)
Supported Organizations Total1SupportedOrganizationsTotalCnt
Support Sum$0SupportSumAmt
Other Support Sum$0OtherSupportSumAmt

Form990 Sch A Supporting Org Form990SchASupportingOrgGrp

FieldValueIRS element (for citing)
Listed By Name Governing DocYes (1)ListedByNameGoverningDocInd
Suprt Org No IRS Determination0SuprtOrgNoIRSDeterminationInd
Supported Org Section C4560SupportedOrgSectionC456Ind
Supported Org Not Organized US0SupportedOrgNotOrganizedUSInd
Organization Change Suprt Org0OrganizationChangeSuprtOrgInd
Support Non Supported Org0SupportNonSupportedOrgInd
Payment Substantial Contribtr0PaymentSubstantialContribtrInd
Loan Disqualified Person0LoanDisqualifiedPersonInd
Controlled Disqualified Prsn0ControlledDisqualifiedPrsnInd
Disqualified Prsn Controll Int0DisqualifiedPrsnControllIntInd
Disqualified Prsn Ownr Int0DisqualifiedPrsnOwnrIntInd
Excess Business Holdings Rules0ExcessBusinessHoldingsRulesInd
Contribution Controller0ContributionControllerInd
Contribution Family0ContributionFamilyInd
Contribution35 Controlled0Contribution35ControlledInd

Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp

FieldValueIRS element (for citing)
Power Appoint Majority Dir TrstYes (1)PowerAppointMajorityDirTrstInd
Operate Benefit Non Suprt Org0OperateBenefitNonSuprtOrgInd

Form990 Schedule A Part VI Form990ScheduleAPartVIGrp

FieldValueIRS element (for citing)
Form And Line ReferencePART IV, SECTION B, LINE 2FormAndLineReferenceDesc
ExplanationTHE SUPPORTING ORGANIZATION OPERATES EXCLUSIVELY FOR THE BENEFIT, AND TO CARRY OUT SOME OR ALL THE PURPOSES, OF THE CORPORATE MEMBER (COVENANT HEALTH) AND IN THE DISCRETION OF THE CORPORATE MEMBER AND BOARD OF DIRECTORS, TO SUPPORT OTHER NOT FOR PROFIT RELIGIOUS, EDUCATIONAL AND CHARITABLE ORGANIZATIONS THAT ARE RELATED TO THE SOLE CORPORATE MEMBER.ExplanationTxt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Total Book Value Land Buildings$0TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp

FieldValueIRS element (for citing)
DescALTERNATIVE INVESTMENTSDesc
Book Value$57,684,583BookValueAmt
Method ValuationFMethodValuationCd
FieldValueIRS element (for citing)
Total Book Value Securities$57,684,583TotalBookValueSecuritiesAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART X, LINE 2:FormAndLineReferenceDesc
ExplanationCOVENANT 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.ExplanationTxt

Schedule F IRS990ScheduleF

Account Activities Outside US AccountActivitiesOutsideUSGrp

FieldValueIRS element (for citing)
RegionCENTRAL AMERICA AND THE CARIBBEANRegionTxt
Offices0OfficesCnt
Employee0EmployeeCnt
Type Of Activities ConductedINVESTMENT IN FUNDS DOMICILED IN FOREIGN JURISDICTIONSTypeOfActivitiesConductedTxt
Region Total Expenditures$15,793,329RegionTotalExpendituresAmt
FieldValueIRS element (for citing)
Subtotal Offices0SubtotalOfficesCnt
Subtotal Employees0SubtotalEmployeesCnt
Continutation Total Office0ContinutationTotalOfficeCnt
Continutation Total Employee0ContinutationTotalEmployeeCnt
Total Office0TotalOfficeCnt
Total Employee0TotalEmployeeCnt
Subtotal Spent$15,793,329SubtotalSpentAmt
Continuation Spent$0ContinuationSpentAmt
Total Spent$15,793,329TotalSpentAmt
Transfer To Foreign CorpYes (1)TransferToForeignCorpInd
Interest In Foreign Trust0InterestInForeignTrustInd
Foreign Corp OwnershipYes (1)ForeignCorpOwnershipInd
Passive Foreign Investmest Co0PassiveForeignInvestmestCoInd
Foreign Partnership0ForeignPartnershipInd
Boycott Countries0BoycottCountriesInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE F, PART IV, LINE 3:FormAndLineReferenceDesc
ExplanationTHE ORGANIZATION DID NOT HAVE AN OWNERSHIP INTEREST IN ANY FOREIGN CORPORATION THAT IS GREATER THAN THE 10% FILING THRESHOLD. ACCORDINGLY, IRS FORM(S) 5471 IS NOT REQUIRED TO BE FILED.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (3 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
JOHN AHLE
TREASURER/SECRETARY$0$404,450$0$0$0$3,793$0$70,600$0$35,044$0$513,887$0$0
CAROLYN KASABIAN
TRUSTEE$0$274,848$0$0$0$0$0$2,624$0$20,793$0$298,265$0$0
RICHARD J PLAMONDON
VICE PRESIDENT$0$319,656$0$0$0$2,873$0$7,950$0$22,625$0$353,104$0$0

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 3THE BOARD OF TRUSTEES DELEGATED MANAGEMENT DUTIES TO CARDINAL INVESTMENT MANAGEMENT, INC. (EIN 04-3391257).
FORM 990, PART VI, SECTION B, LINE 11THE 990 IS PRESENTED TO, AND REVIEWED BY, THE BOARD PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12CTHE MONITORING AND ENFORCEMENT OF COMPLIANCE WITH THE POLICY IS COMPLETED AT THE INDIVIDUAL BOARD LEVELS OF THE ENTITIES THAT ARE SHAREHOLDERS OF PROVIDENTIA PRIMA.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART XI, LINE 9:NET TRANSFER TO AFFILIATES -4,708,647.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (21 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationIndBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Txt
COVENANT HEALTH INC
100 AMES POND DRIVETEWKSBURYMA01876222484505MANAGEMENT AND HEALTH RESOURCE ORGANIZATIONMA501(C)(3)LINE 9N/A0
ST MARY'S HEALTH SYSTEM
PO BOX 7291LEWISTONME04243222504349PARENT COMPANYME501(C)(3)LINE 90COVENANT HEALTH
FANNY ALLEN CORPORATION
790 COLLEGE PARKWAYCOLCHESTERVT05446222495808HEALTH CARE SERVICESVT501(C)(3)LINE 11A, I0COVENANT HEALTH
CHS WALTHAM
66 NEWTON STREETWALTHAMMA02453043333609SKILLED NURSING FACILITYMA501(C)(3)LINE 90COVENANT HEALTH
ST JOSEPH HOSPITAL
172 KINSLEY STNASHUANH03061020222215ACUTE CARE HOSPITALNH501(C)(3)LINE 30COVENANT HEALTH
YOUVILLE HOSPITAL
100 AMES POND DRIVETEWKSBURYMA01876023239563FORMER REHAB HOSPITALMA501(C)(3)LINE 30COVENANT HEALTH
YOUVILLE PLACE
10 PELHAM RDLEXINGTONMA02421043297834ASSISTED LIVING FACILITYMA501(C)(3)LINE 90COVENANT HEALTH
ST ANDRE SKILLED NURSING AND REHAB FACILITY
407 POOL STBIDDEFORDME04005010342399SKILLED NURSING FACILITYME501(C)(3)LINE 90COVENANT HEALTH
MI NURSING RESTORATIVE CENTER
172 LAWRENCE STLAWRENCEMA01841042104851SKILLED NURSING FACILITYMA501(C)(3)LINE 90COVENANT HEALTH
ST MARY'S VILLA NURSING HOME
675 ST MARYS VILLA ROADMOSCOWPA18444232057177SKILLED NURSING FACILITYPA501(C)(3)LINE 90COVENANT HEALTH
MI MANAGEMENT INC
172 LAWRENCE STLAWRENCEMA01841042857794SKILLED NURSING FACILITYMA501(C)(3)LINE 90COVENANT HEALTH
MI ADULT DAY HEALTH CENTER
172 LAWRENCE STLAWRENCEMA01841042921888SKILLED NURSING FACILITYMA501(C)(3)LINE 90COVENANT HEALTH
MI TRANSPORTATION
172 LAWRENCE STLAWRENCEMA01841042921889SKILLED NURSING FACILITYMA501(C)(3)LINE 90COVENANT HEALTH
YOUVILLE HOUSE
1575 CAMBRIDGE STCAMBRIDGEMA02138043239593ASSISTED LIVING FACILITYMA501(C)(3)LINE 90COVENANT HEALTH
YOUVILLE LIFECARE
100 AMES POND DRIVETEWKSBURYMA01876042103582MANAGEMENT SERVICESMA501(C)(3)LINE 11A, I0COVENANT HEALTH
ST MARY'S D'YOUVILLE PAVILION
PO BOX 7291LEWISTONME04243010211558NURSING HOMEME501(C)(3)LINE 90ST MARY'S HEALTH SYSTEM
ST JOSEPH HOSPITAL
360 BROADWAYBANGORME04402010212435HOSPITALME501(C)(3)LINE 10ST JOSEPH HEALTHCARE FOUNDATION
ST JOSEPH AMBULATORY CAREINC
360 BROADWAYBANGORME04402222480373PHYSICIAN PRATICEME501(C)(3)LINE 30ST JOSEPH HEALTHCARE FOUNDATION
COMMUNITY CLINICAL SERVICES
PO BOX 7291LEWISTONME04243010409788PHYSICIAN PRATICEME501(C)(3)LINE 30ST MARY'S HEALTH SYSTEM
ST MARY'S REGIONAL MEDICAL CTR
PO BOX 7291LEWISTONME04243010211551HOSPITALME501(C)(3)LINE 30ST MARY'S HEALTH SYSTEM
MOUNT ST RITA HEALTH CENTRE
15 SUMNER BROWN ROADCUMBERLANDRI02864050342330SKILLED NURSING FACILITYRI501(C)(3)LINE 90COVENANT HEALTH
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees Sharing0PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (1)TransferToOtherOrgInd
Transfer From Other OrgYes (1)TransferFromOtherOrgInd