2014-11-17T13:30:43-06:00 2013-12-31 410746749 CLIFTONLARSONALLEN LLP 300 CROWN COLONY DRIVE SUITE 310 QUINCY MA 02169 990 2013-01-01 237090088 PENACOOK PLACE INC PENA 9783740707 150 WATER STREET HAVERHILL MA 01830 DAVID BECKER PRESIDENT/CEO 9783740707 2014-11-06 1 ROBERT DILLAN P01688008 6179848100 2014-11-05 2013 2015-11-30 17:44:51Z DAVID BECKER 150 WATER STREET HAVERHILL MA 01830 11924573 0 X WWW.PENACOOKPLACE.ORG X 1969 MA TO PROMOTE THE HIGHEST POSSIBLE QUALITY OF LIFE FOR OUR RESIDENTS IN A CLEAN, SAFE, AND ATTRACTIVE ENVIRONMENT. TO CARE FOR OUR RESIDENTS AS WE WOULD WANT TO BE CARED FOR-THE GOLDEN RULE OF PENACOOK PLACE. TO MEET OR EXCEED THE EXPECTATIONS OF OUR RESIDENTS, AS WELL AS OTHERS WITH WHOM WE COME IN CONTACT. TO SHOW HOSPITALITY, COURTESY, COOPERATION AND RESPECT TO ALL RESIDENTS, FAMILY MEMBERS, FELLOW EMPLOYEES, VOLUNTEERS AND VISITORS. TO BE AN INTEGRAL, CONTRIBUTING PART OF THE GREATER HAVERHILL BUSINESS, EDUCATIONAL AND CULTURAL COMMUNITIES. 16 15 314 24 0 0 108791 94313 12930057 11821777 2743 8483 0 0 13041591 11924573 0 0 0 0 9442453 8803606 0 0 0 3534179 3753485 12976632 12557091 64959 -632518 6331384 5769094 4305977 4353507 2025407 1415587 X TO PROMOTE THE HIGHEST POSSIBLE QUALITY OF LIFE FOR OUR RESIDENTS IN A CLEAN, SAFE AND ATTRACTIVE ENVIRONMENT. TO CARE FOR OUR RESIDENTS AS WE WOULD WANT TO BE CARED FOR-THE GOLDEN RULE OF PENACOOK PLACE. TO MEET OR EXCEED THE EXPECTATIONS OF OUR RESIDENTS, AS WELL AS OTHERS WITH WHOM WE COME IN CONTACT. TO SHOW HOSPITALITY, COURTESY, COOPERATION AND RESPECT TO ALL RESIDENTS, FAMILY MEMBERS, FELLOW EMPLOYEES, VOLUNTEERS AND VISITORS. TO BE AN INTEGRAL, CONTRIBUTING PART OF THE GREATER HAVERHILL BUSINESS, EDUCATIONAL AND CULTURAL COMMUNITIES. 0 0 10886123 11821777 PENACOOK PLACE, INC. IS A NOT-FOR-PROFIT FACILITY PROVIDING SERVICE TO PRIVATE AND PUBLICLY AIDED PATIENTS. IT OPERATES A 160 BED NURSING HOME FACILITY. 10886123 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 25 0 314 1 0 0 0 0 0 0 0 0 0 0 X 16 15 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X X CHARLES CARROZZA 9783740707 150 WATER STREET HAVERHILL MA 01830 WILLIAM J KLUEBER CHAIR 2.00 X X 0 0 0 JULIAN RICH PRESIDENT/CEO 38.00 X X 171284 0 30149 RONALD GOLDBERG MD MEMBER/MEDICAL DIRECTOR 2.00 X 0 0 0 HOWARD H BROWN MEMBER 2.00 X 0 0 0 FRANK NOVAK MEMBER 2.00 X 0 0 0 JANIS CORDISCHI MEMBER 2.00 X 0 0 0 KALISTER GREEN-BYRD MEMBER 2.00 X 0 0 0 ELAINE DALTON MEMBER 2.00 X 0 0 0 JOHN G ALBERT MEMBER 2.00 X 0 0 0 DIANE LOVALLO MEMBER 2.00 X 0 0 0 THOMAS L MORTIMER 1ST VICE CHAIR 2.00 X X 0 0 0 JOAN HULL 2ND VICE CHAIR 2.00 X X 0 0 0 RICHARD SUNDELL TREASURER 2.00 X X 0 0 0 CINDY MRYAN IMMEDIATE PAST CHAIR, CLERK 2.00 X X 0 0 0 DAVID BECKER PRESIDENT/CEO 38.00 X X 19856 0 0 C CAREY REA MEMBER 2.00 X 0 0 0 LUCINDA NOLET MEMBER 2.00 X 0 0 0 CHARLES CARROZZA CHIEF FINANCIAL OFFICER 37.50 X 87224 0 16710 LISA SALTERIO D.O.N. 41.00 X 100998 0 19898 LINDA CASHMAN RN 46.00 X 100259 0 18235 479621 0 84992 3 0 1 0 MORRISON MANAGEMENT SPECIALIST PO BOX 102289 ATLANTA GA 30368 DIETARY SERVICES 533987 CONVENANT HEALTH SYSTEMS 100 AMES POND DR STE 102 TEWKSBURY MA 01876 CONSULTING 261072 2 94313 94313 PATIENT REVENUE 623000 11821777 11821777 11821777 8483 8483 11924573 11821777 0 8483 285931 285931 7143818 6634859 508959 829806 743769 86037 544051 487040 57011 261072 261072 7660 7660 38400 38400 3560 3560 573886 415515 158371 21588 21588 710050 603114 106936 408443 408443 9414 9414 6276 6276 1950 1950 287161 287161 115422 2885 112537 USER FEE 850432 850432 FOOD 382225 382225 BAD DEBTS 50562 50562 LICENSE AND DUES 16630 16630 8754 8754 12557091 10886123 1670968 0 333018 1092556 1474346 359356 1345107 1242523 242913 158131 8646962 6350561 2343651 2296401 213478 255413 378871 364714 6331384 5769094 1243592 1322658 3039927 2829849 22458 0 75000 0 126000 4305977 4353507 X 1963644 1384318 61763 31269 2025407 1415587 6331384 5769094 -632518 22698 0 X 0 1 X 1 0 X 114724 105111 98238 108791 94313 521177 12315685 13109591 13114968 12930057 11821777 63292078 12430409 13214702 13213206 13038848 11916090 63813255 0 0 0 63813255 35017 25227 20994 2743 8483 92464 35017 25227 20994 2743 8483 92464 12465426 13239929 13234200 13041591 11924573 63905719 0.99860 0.99750 0.00140 0.00250 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3630 3630 0 PART II-B, LINE 1: THE ORGANIZATION PAYS DUES TO VARIOUS MEMBERSHIP ORGANIZATONS. THESE ORGANIZATIONS MAY CONDUCT LOBBYING ACTIVITIES ON BEHALF OF THEIR MEMBERS. HOWEVER, THE ORGANIZATION DOES NOT DIRECTLY PARTICIPATE IN THESE LOBBYING ACTIVITIES. 30859 30859 6184806 4382233 1802573 2409397 1957378 452019 21900 10950 10950 2296401 FUNDED RESERVE 160187 DEPOSITS 45042 SOFTWARE, NET 2370 BOND ISSUE COSTS, NET 157115 364714 ASSET RETIREMENT OBLIGATION 66000 DUE TO THIRD-PARTY PAYORS 60000 126000 X 11947271 22698 22698 11924573 0 11924573 12557091 0 12557091 0 12557091 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. THE ORGANIZATION FILES AS A TAX-EXEMPT ORGANIZATION. SHOULD THAT STATUS BE CHALLENGED IN THE FUTURE, THE ENTITY'S 2010 THROUGH 2013 TAX YEARS ARE OPEN FOR EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES. X X X 0 0 0 0 0 0 0 0 0 JULIAN RICH PRESIDENT/CEO 171284 0 0 0 0 0 0 0 30149 0 201433 0 0 0 A MASSACHUSETTS DEVELOPMENT FINANCE AGENCY 043431814 2011-11-10 3258000 TO REDEEM MDFA REVENUE REFUNDING BONDS, ISSUED MARCH 1, 2000 0 0 0 A 3258000 65160 3192840 2011 1 0 1 1 A 0 0 0 0 0 0 1 A 0 1 0 0 1 0 0 0 1 A 1 SPOUSE OF FRANK NOVAK SPOUSE OF BOARD MEMBER FRANK NOVAK 55948 NURSE SALARY 0 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE SHALL HAVE THE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE CORPORATION, SUBJECT TO LIMITATIONS THAT MAY BE PROVIDED BY RESOLUTION OF THE BOARD OF DIRECTORS. EXECUTIVE COMMITTEE IS MADE UP OF CHAIR, VICE CHAIR, 2ND VICE CHAIR, TREASURER, CLERK AND IMMEDIATE PAST CHAIR. FORM 990, PART VI, SECTION A, LINE 3 DIETARY MANAGER AND DIETICIAN ARE FROM A MANAGEMENT COMPANY. THESE MANAGERS HAVE THE RESPONSIBILITY TO HIRE, FIRE AND SUPERVISE, RESPONSIBLE FOR THE DEPARTMENT'S BUDGET AND OVERALL MANAGEMENT OF THE DIETARY FUNCTION OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11 CFO INITIALLY REVIEWS THE FORM 990 AND THEN REVIEWS IT WITH THE PRESIDENT/CEO OF THE ORGANIZATION. AFTER THE CFO AND PRESIDENT/CEO REVIEW THE FORM, A COPY OF THE RETURN IS PROVIDED TO THE BOARD OF DIRECTORS FOR REVIEW BEFORE IT IS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C MEMBERS OF THE BOARD OF DIRECTORS SHALL NOT HAVE ANY UNDISCLOSED CONFLICTS OF INTEREST WITH THE CORPORATION. WHERE AN INDIVIDUAL DIRECTOR, OFFICER, KEY EMPLOYEE OR AGENT BELIEVES THAT HE OR SHE OR AN IMMEDIATE FAMILY MEMBER MIGHT HAVE OR DOES HAVE A REAL OR APPARENT CONFLICT OF INTEREST, HE OR SHE SHOULD, IN ADDITION TO FILING THE NOTICE OF DISCLOSURE REQUIRED, ABSTAIN FROM MAKING MOTIONS, VOTING, EXECUTING AGREEMENTS, OR TAKING ANY OTHER SIMILAR DIRECT ACTION ON BEHALF OF THE CORPORATION. SUCH BOARD OF DIRECTOR'S MEMBER SHALL NOT BE COUNTED IN DETERMINING THE QUORUM FOR ANY ACTION ON SUCH MATTER. THE MINUTES OF THE MEETING SHALL REFLECT THE DISCLOSURE OF THE INTEREST, THE ABSTENTION FROM VOTING, AND THE QUORUM SITUATION. FORM 990, PART VI, SECTION B, LINE 15 A PERSONNEL COMMITTEE WAS ESTABLISHED AS A SUB-COMMITTEE OF THE BOARD OF DIRECTORS. THE FOCUS OF THIS GROUP IS TO REVIEW AND EVALUATE THE PRESIDENT/CEO ON AN ANNUAL BASIS, THE PERSONNEL COMMITTEE RECEIVES INPUT FROM ALL BOARD MEMBERS AND DEPARTMENT HEADS. INDUSTRY COMPENSATION DATA AVAILABLE THROUGH LEADING AGE AND THE STATE ARE REVIEWED. THE PERSONNEL COMMITTEE THEN MAKES THEIR RECOMMENDATION TO THE FULL BOARD FOR FINAL APPROVAL. THIS PROCESS IS CONDUCTED ANNUALLY AND TAKES PLACE STARTING IN JANUARY OF EACH YEAR TO EVALUATE THE PERFORMANCE OF THE PRESIDENT/CEO FOR THE YEAR JUST COMPLETED. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.