2015-07-15T09:46:37-05:00 2014-12-31 010494526 BAKER NEWMAN & NOYES LLC 650 ELM STREET SUITE 302 MANCHESTER NH 03101 990 2014-01-01 043419625 CHS OF WORCESTER INC CHSO 9786546363 100 AMES POND DRIVE TEWKSBURY MA 01876 JOHN AHLE CHIEF FINANCIAL OFFICER 9786546363 2015-07-09 E DREW CHENEY P00182972 8002447444 2015-07-09 2014 2016-02-25 16:41:14Z STMARY HEALTH CARE CENTER JOHN AHLE 100 AMES POND DRIVE TEWKSBURY MA 01876 8971195 0 0928 X COVENANTHS.ORG X 1998 MA ST. MARY HEALTH CARE CENTER, A CATHOLIC REHABILITATION AND SKILLED NURSING FACILITY, WAS ESTABLISHED AS A CONTINUING EXPRESSION OF THE VISION OF ST. MARGUERITE D'YOUVILLE, FOUNDRESS OF THE SISTERS OF CHARITY OF MONTREAL, THE "GREY NUNS". IN THE SPIRIT OF MARGUERITE, WHOSE LEGACY WE SHARE, WE SEEK TO "BRING THE MIRACLE OF LOVE TO ALL" THROUGH COMPASSIONATE CARE. ST MARY HEALTH CARE DESIRES, IN PARTNERSHIP WITH OTHERS COMMITTED TO PROVIDING HOLISITC AND INCLUSIVE CARE FOR ALL, TO DEVELOP INNOVATIVE AND CREATIVE MEANS TO ENHANCE THE PHYSICAL, EMOTIONAL, SOCIAL AND SPIRITUAL WELL-BEING OF THOSE WE SERVE. DURING 2014 THE ORGANIZATION PROVIDED 39,521 DAYS OF SERVICE OF WHICH 37,096 WERE PROVIDED TO PATIENTS RECEIVING MEDICAID. 8 7 201 0 0 0 2039 1950 8227580 8863605 370 -3278 74799 105557 8304788 8967834 0 0 0 0 5785263 5501598 0 0 0 2766372 3272315 8551635 8773913 -246847 193921 3975204 4152396 619840 634889 3355364 3517507 X ST. MARY HEALTH CARE CENTER, A CATHOLIC REHABILITATION AND SKILLED NURSING FACILITY, WAS ESTABLISHED AS A CONTINUING EXPRESSION OF THE VISION OF ST. MARGUERITE D'YOUVILLE, FOUNDRESS OF THE SISTERS OF CHARITY OF MONTREAL, THE "GREY NUNS". IN THE SPIRIT OF MARGUERITE, WHOSE LEGACY WE SHARE, WE SEEK TO "BRING THE MIRACLE OF LOVE TO ALL" THROUGH COMPASSIONATE CARE. ST. MARY HEALTH CARE DESIRES, IN PARTNERSHIP WITH OTHERS COMMITTED TO PROVIDING HOLISTIC AND INCLUSIVE CARE FOR ALL, TO DEVELOP INNOVATIVE AND CREATIVE MEANS TO ENHANCE THE PHYSICAL, EMOTIONAL, SOCIAL AND SPIRITUAL WELL-BEING OF THOSE WE SERVE. 0 0 8633690 0 8965801 THE ORGANIZATION PROVIDED 39,521 DAYS OF SKILLED NURSING CARE TO ELDERLY PATIENTS FROM ALL ECONOMIC, ETHNIC AND RELIGIOUS BACKROUNDS. OF THESE DAYS THE ORGANIZATION PROVIDED 37,096 DAYS OF SKILLED SERVICES TO MEDICAID RECIPIENTS. 8633690 1 0 0 0 0 0 0 0 0 1 1 0 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 0 0 0 0 0 0 1 0 0 0 1 9 0 1 201 1 0 0 0 0 0 0 0 0 0 0 X 8 7 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 0 MA X X JOHN AHLE CFO 9786546363 100 AMES POND DRIVE TEWKSBURY MA 01876 DIANNE BRUCE CHAIR 1.00 X X 0 0 0 KENNETH FERRON TRUSTEE 1.00 39.00 X 0 302427 115847 STEVEN DIORIO VICE CHAIR 1.00 X X 0 0 0 MELISSA BOYLE TRUSTEE 1.00 X 0 0 0 RICHARD FREIJE TRUSTEE 1.00 X 0 0 0 RAUL SOCHA TRUSTEE 1.00 X 0 0 0 DAN TINSLEY TRUSTEE 1.00 X 0 0 0 RITA VAZQUEZ-TORRES TRUSTEE 1.00 X 0 0 0 MICHAEL ISABELLA ADMINISTRATOR 40.00 X 112375 0 0 112375 302427 115847 1 0 1 0 HEALTHCARE SERVICES GROUP INC 3220 TILLMAN DRIVE SUITE 300 BENSALEM PA 19020 HOUSEKEEPING AND LAUNDRY 272954 1 1950 1950 PATIENT SERVICE REVENU 623000 8863605 8863605 8863605 83 83 3361 -3361 -3361 -3361 MISCELLANEOUS 623000 105557 105557 105557 8967834 8965801 0 83 114607 114607 4625564 4625564 10128 10128 406121 406121 345178 345178 102120 102120 16814 16814 21289 21289 23268 23268 60540 60540 157148 157148 174913 174913 11378 11378 3374 3374 1042 1042 296088 296088 176791 176791 PURCHASED SERVICES 839466 839466 MEDICAID USER FEE 708803 708803 FOOD AND SUPPLIES 679281 679281 8773913 8633690 140223 0 490501 275937 405513 0 455269 1322888 37468 30193 5692876 3212440 2542675 2480436 43778 42942 3975204 4152396 546883 561111 72957 73778 619840 634889 X 3323587 3517507 31777 0 3355364 3517507 3975204 4152396 X 193921 -31778 X 0 1 X 1 0 X 6815 4095 1885 2039 1950 16784 8278715 8661976 8568635 8300349 8965201 42774876 8285530 8666071 8570520 8302388 8967151 42791660 0 0 0 42791660 3599 1500 1130 2400 83 8712 3599 1500 1130 2400 83 8712 8289129 8667571 8571650 8304788 8967234 42800372 0.99980 0.99970 0.00020 0.00030 X 31777 31777 41000 9223 31777 1.00000 0 0 176830 176830 4075782 2147598 1928184 1214108 933029 281079 226156 131813 94343 2480436 PROFESSIONAL LIABILITY LOSS RESERVE 31336 RESIDENT FUNDS LIABILITY 42442 73778 X PART V, LINE 4: FUNDS ARE USED TO PROVIDE SERVICES,SUPPLIES AND FACILITIES TO RESIDENTS & THE POOR IN THE COMMUNITY 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, 2014. UNDER INTERNAL REVENUE SERVICE REGULATIONS, THE SYSTEM'S TAX YEARS FROM 2011 THROUGH 2014 ARE OPEN AND SUBJECT TO EXAMINATION. X X X X 0 0 0 0 0 0 0 1 0 KENNETH FERRON TRUSTEE 0 256130 0 0 0 46297 0 85079 0 30768 0 418274 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 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. PART I, LINE 7 THE RELATED ORGANIZATION, COVENANT HEALTH, MAINTAINS AN INCENTIVE COMPENSATION PLAN FOR EXECUTIVES THAT IS ADMINISTERED BY THE 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 THAT ARE SET AT THE BEGINNING OF THE YEAR. THE ENTITLEMENT TO AWARDS FOR A PARTICULAR YEAR IS NOT DETERMINED UNTIL EARLY THE FOLLOWING YEAR. THE ORGANIZATION DID NOT PAY INCENTIVE COMPENSATION AWARDS IN 2014 BASED ON THE SYSTEM'S PERFORMANCE DURING 2013. FORM 990, PART VI, SECTION A, LINE 6 COVENANT HEALTH IS THE SOLE MEMBER OF THE ORGANIZATION. AS SUCH IT RETAINS CERTAIN RESERVE RIGHTS CONCERNING 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 CONCERNING CORPORATE DECISIONS AND BOARD COMPOSITION. FORM 990, PART VI, SECTION A, LINE 7B COVENANT HEALTH IS THE SOLE MEMBER OF THE ORGANIZATION. AS SUCH IT RETAINS CERTAIN RESERVE RIGHTS OVER BOARD DECISIONS AND BOARD COMPOSITION. FORM 990, PART VI, SECTION A, LINE 8B COVENANT HEALTH IS THE SOLE MEMBER OF THE ORGANIZATION. AS SUCH IT RETAINS CERTAIN RESERVE RIGHTS OVER BOARD DECISIONS AND BOARD COMPOSITION. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PROVIDED TO THE BOARD FOR REVIEW PRIOR TO ITS BEING FILED FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REQUIRES CONFLICT OF INTEREST STATEMENTS TO BE SIGNED BY BOARD MEMBERS AND KEY EMPLOYEES REMINDING THEM OF THE DUTIES AND OBLIGATIONS TO REPORT REAL OR POTENTIAL CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 EVERY TWO TO THREE YEARS THE COMPENSATION COMMITTEE OF COVENANT HEALTH'S 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 CURRENT TOTAL CASH COMPENSATION LEVELS OF THE SENIOR LEADERSHIP TEAM, DEVELOP MARKET BASED COMPETITIVE SALARY RANGES FOR ALL EXECUTIVE POSITIONS AND ENSURE THAT ANNUAL INCENTIVE OPPORTUNITIES, IF THERE ARE ANY, ARE COMPETITIVE AND REASONABLE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, FINANCIAL STATEMENTS AND THE FORM 990 AVAILABLE TO THE PUBLIC UPON REQUEST. THE FORM 990 IS ALSO POSTED ON COVENANT HEALTH'S WEBSITE. FORM 990, PART XI, LINE 9: ROUNDINGS -1. RECLASS TEMPORARILY RESTRICTED NET ASSETS -31,777. COVENANT HEALTH 100 AMES POND DRIVE TEWKSBURY MA 01876 222484505 HEALTHCARE MANAGEMENT AND RESOURCE ORGANIZATION MA 501 (C) 9 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0