2014-08-11T15:12:51-05:00 2013-12-31 020383073 WILLIAM STEELE & ASSOCIATES PC 40 STARK STREET MANCHESTER NH 03101 990 2013-01-01 043333609 CHS OF WALTHAM INC CHSO 7818930240 66 NEWTON STREET WALTHAM MA 02453 CAROLYN FENN CEO 7818930240 2014-08-04 1 WILLIAM G STEELE JR CPA P00233103 6036228881 2013 2015-11-30 17:44:51Z MARISTHILL NURSING & REHABILTATION CENTER CAROLYN FENN 66 NEWTON STREET WALTHAM MA 02453 10182505 0 0928 X MARISTHILL.ORG X 1996 MA MARISTHILL IS A CATHOLIC SKILLED NURSING AND REHABILITATION FACILITY THAT CONTINUES THE HEALING MINISTRY OF CHRIST BY PROVIDING HEALTH CARE SERVICES THAT FOSTER EACH INDIVIDUAL'S PHYSICAL, SPIRITUAL, EMOTIONAL AND INTELLECTUAL WELL-BEING. 10 8 147 0 0 0 22940 21170 10242485 10137877 -37791 19064 25618 4394 10253252 10182505 0 0 0 0 5945374 5799699 0 0 0 4315150 4391567 10260524 10191266 -7272 -8761 11999662 11996011 9915763 9838555 2083899 2157456 MARISTHILL IS A CATHOLIC SKILLED NURSING AND REHABILITATION FACILITY THAT CONTINUES THE HEALING MINISTRY OF CHRIST BY PROVIDING HEALTH CARE SERVICES THAT FOSTER EACH INDIVIDUAL'S PHYSICAL, SPIRITUAL, EMOTIONAL AND INTELLECTUAL WELL-BEING. 0 0 9944310 10137877 MARISTHILL NURSING AND REHABILITATION CENTER PROVIDED 34,870 DAYS OF SKILLED NURSING SERVICES DURING 2013 OF WHICH 22,292 WERE TO MEDICAID RECIPIENTS. 9944310 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 10 0 1 147 1 0 0 0 0 0 0 0 0 0 0 X 10 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X X CAROLYN FENN CEO 7818930240 66 NEWTON STREET WALTHAM MA 02453 KENNETH FERRON TREASURER 1.00 39.00 X X 0 293473 108650 LUKE STANTON ESQ TRUSTEE 1.00 X 0 0 0 CAROL EAST MSWLCSW TRUSTEE 1.00 X 0 0 0 MARY ELIZABETH SCANLON RN TRUSTEE 1.00 X 0 0 0 MICHAEL DELANEY ESQ TRUSTEE 1.00 X 0 0 0 LISA LORGEREE CHAIR 1.00 X X 0 0 0 NANCY SMITH TRUSTEE 1.00 X 0 0 0 JOSEPH SGRO CHIEF FINANCIAL OFFICER 40.00 X X 88873 0 1112 CAROLYN FENN CEO/ADMINISTRATOR 40.00 X X 104320 0 9606 KELLY MCDADE TRUSTEE 1.00 X 0 0 0 JUDITH ALLEN TRUSTEE 1.00 X 0 0 0 SHIRLY YELLAMATY NURSING SUPERVISOR 40.00 X 116974 0 21459 310167 293473 140827 2 0 1 0 REHAB CARE INC PO BOX 277365 ATLANTA GA 30384 REHABILTATION SERVICES 797893 HEALTHCARE SERVICES 1565 MAIN STREET TEWKSBURY MA 01888 HOUSEKEEPING 342316 US FOODS PO BOX 3155 BOSTON MA 02241 FOOD SERVICE 332752 PARTNERS PHARMACY OF MA 181 CEDAR HILL ROAD MARLBORO MA 01752 PHARMACY 266945 GULF SOUTH 14 N WENTWORTH AVENUE LONDONDERRY NH 03053 MEDICAL SUPPLIES 141245 5 21170 21170 PATIENT SERVICE REVENUE 623000 10137877 10137877 10137877 19064 19064 CAFETERIA 623000 2556 2556 VENDING MACHINE 623000 1838 1838 4394 10182505 10137877 0 23458 108305 108305 4836753 4836753 19662 19662 464357 464357 370622 370622 183116 183116 39083 39083 24757 24757 10348 10348 126263 126263 89494 89494 340775 340775 806 806 343131 343131 445173 445173 65640 65640 PURCHASED SERVICES 1330297 1330297 NURSING HOME SUPPLIES A 874513 874513 MEDICAID USER FEE 515001 515001 EDUCATION AND TRAINING 3170 3170 10191266 9944310 246956 0 194966 142325 1877553 2079331 957247 935629 49497 29132 10522481 4870618 5570391 5651863 829322 924377 2520686 2233354 11999662 11996011 693584 695102 8583828 8515290 638351 628163 9915763 9838555 X 2083899 2157456 2083899 2157456 11999662 11996011 -8761 82319 0 X 0 1 X 1 0 X 5997 44938 26945 22940 21170 121990 10925173 11027802 10746498 10268103 10142271 53109847 10931170 11072740 10773443 10291043 10163441 53231837 0 0 0 53231837 35704 28185 1660 25301 19064 109914 35704 28185 1660 25301 19064 109914 10966874 11100925 10775103 10316344 10182505 53341751 0.99790 0.99790 0.00210 0.00210 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 485000 485000 6552717 2492855 4059862 3316072 2377763 938309 168692 168692 5651863 RESIDENT FUNDS 12667 DEBT SERVICE RESERVE FUND 713069 BOND ISSUE COSTS (NET) 39756 BOND UNDERWRITING COSTS (NET) 16818 BOND DISCOUNT (NET) 41221 DEBT SERVICE SINKING FUND (NET) 1347864 CAPITALIZED FINANCING COSTS (NET) 61959 2233354 DEFERRED EXPENSES 241811 MEDICAID USER FEES 128391 PROFESSIONAL LIABILITY LOSS RESERVES 22795 DUE TO AFFILIATES 192503 RESIDENT FUNDS 11667 ORIGINAL ISSUE DISCOUNT 30996 628163 X PART X, LINE 2: INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS IS THE FOLLOWING "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. THE SYSTEM HAS EVALUATED THE POSITIONS TAKEN ON ITS FILED TAX RETURNS, AND HAS CONCLUDED NO UNCERTAIN INCOME TAX POSITIONS EXIST AT DECEMBER 31, 2013." X X X X 0 1 0 0 0 0 1 0 0 KENNETH FERRON TREASURER 0 247200 0 0 0 46273 0 80685 0 27965 0 402123 0 0 PART I, LINE 1A EVERY TWO TO THREE YEARS THE COMPENSATION COMMITTEE OF OF THE COVENANT HEALTH SYSTEMS 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. THE SPECIFIC OBJECTIVES OF THE ANALYSIS ARE TO ASSESS THE COMPETITIVENESS OF THE CURRENT TOTAL CASH COMPENSATION LEVELS FOR THE SENIOR LEADERSHIP TEAM; DEVELOP MARKET COMPETITIVE SALARY RANGES FOR ALL EXECUTIVE POSITIONS AND ENSURE THAT THE ANNUAL INCENTIVE OPPROTUNITIES, IF ANY, ARE COMPETITIVE AND REASONABLE. PART I, LINE 4B THE RELATED ORGANIZATION, COVENANT HEALTH SYSTEMS, MAINTAINS A SUPPLEMENTAL EXECUTIVE RETIREMENT PROGRAM FOR CERTAIN EXECUTIVES UNDER WHICH THE ORGANIZATION MAKES A CONTRIBUTION TO A GRANTOR TRUST FOR THE BENEFIT OF THE EXECUTIVE THAT IS INTENDED TO PROVIDE A SPECIFIED LEVEL OF RETIREMENT BENEFITS AT RETIREMENT AGE COMMENSURATE WITH RETIREMENT BENEFITS PROVIDED TO EXECUTIVES IN COMPARABLE POSITIONS BY SIMILARLY SITUATED ORGANIZATIONS. AMOUNTS CONTRIBUTED TO THE GRANTOR TRUST ARE HELD FOR THE BENEFIT OF THE EXECUTIVE UNTIL HE OR SHE REACHES AGE 60, AT WHICH TIME THEY ARE RELEASED TO THE EXECUTIVE. THE FULL AMOUNT PAID INTO THE GRANTOR TRUST IS TAXABLE TO THE EXECUTIVE WHEN SO PAID, AND IS INCLUDED IN THE EXECUTIVE'S REPORTED COMPENSATION. PART I, LINE 6 THE RELATED ORGANIZATION, COVENANT HEALTH SYSTEMS, 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 PAID NO INCENTIVE COMPENSATION AWARDS IN 2013 TO KENNETH FERRON BASED ON PERFORMANCE DURING 2012. A MA HEALTH & EDUCATION FACILITIES AUTHORITY 042456011 57586DBF9 2007-10-30 7221865 TO FINANCE THE PURCHASE OF YOUVILLE PLACE 1 0 0 B MA HEALTH & EDUCATION FACILITIES AUTHORITY 042456011 57584QAA4 2012-06-27 1720000 CAPITAL EQUIPMENT AND PROJECTS 0 0 0 A 7221865 712880 55862 6117244 1 1 1 1 B 1720000 54828 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 1 0 0 0 0 0 B 0 0 0 0 0 0 0 0 0 A 0 B 0 FORM 990, PART VI, SECTION A, LINE 6 COVENANT HEALTH SYSTEMS IS THE SOLE MEMBER OF THE ORGANIZATION OF THE BOARD. AS SUCH IT RETAINS CERTAIN RESERVE RIGHTS OVER BOARD DECISIONS AND BOARD COMPOSITION. FORM 990, PART VI, SECTION A, LINE 7A COVENANT HEALTH SYSTEMS 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 SYSTEMS IS THE SOLE MEMBERS OF THE ORGANIZATION. AS SUCH IT RETAINS CERATIN RESERVE RIGHTS OVER BOARD DECISIONS AND BOARD COMPOSITION. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PROVIDED TO AND REVIEWED WITH THE BOARD PRIOR TO FILING FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A FULL-TIME OPERATIONAL INTEGRITY OFFICER THAT MONITORS ALL AREAS FOR POTENTIAL CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 EVERY TWO TO THREE YEARS THE COMPENSATION COMMITTEE OF THE COVENANT HEALTH SYSTEMS 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. THE SPECIFIC OBJECTIVES OF THE ANALYSIS ARE TO ASSESS THE COMPETITIVENESS OF THE CURRENT TOTAL CASH COMPENSATION LEVELS FOR THE SENIOR LEADERSHIP TEAM; DEVELOP MARKET COMPETITIVE SALARY RANGES FOR ALL EXECUTIVE POSITIONS AND ENSURE THAT THE ANNUAL INCENTIVE OPPORTUNITIES, IF ANY, ARE COMPETITIVE AND REASONABLE. FORM 990, PART VI, SECTION C, LINE 19 THE FORM 990 AND GOVERNING DOCUMENTS, INCLUDING THE CONFLICT OF INTEREST POLICY, AND THE FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. COVENANT HEALTH SYSTEMS 100 AMES POND DRIVE TEWKSBURY MA 01876 222484505 HEALTH CARE MANAGEMENT AND RESOURCE ORGANIZATION MA 501(C) 509(A) 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 COVENANT HEALTH SYSTEMS M 183116 COST