STRATEGY STUDIO / NONPROFIT PEOPLE SEARCH

HENRY C NEVINS HOME INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
HENRY C NEVINS HOME INC (EIN 04-2676008)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-11-15
IRS object ID
201303199349306660
Schema version
2012v2.1
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)
Timestamp2013-11-15T13:21:11-06:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN410746749EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1CLIFTONLARSONALLEN LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1300 CROWN COLONY DRIVE SUITE 310AddressLine1
CityQUINCYCity
StateMAState
ZIP Code02169ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN042676008EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1THE HENRY C NEVINS HOME INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlHENRNameControl
Phone9786827611Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line110 INGALLS COURTAddressLine1
CityMETHUENCity
StateMAState
ZIP Code01844ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameALAN P SHAFERName
TitleTREASURERTitle
Phone9786727611Phone
Date Signed2013-11-07DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameROBERT DILLANName
PTINP01688008PTIN
Phone6179848100Phone
Date Prepared2013-11-07DatePrepared
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonSCOTT B DICKINSONNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line110 INGALLS COURTAddressLine1
CityMETHUENCity
StateMAState
ZIP Code01844ZIPCode
FieldValueIRS element (for citing)
Gross Receipts14121089GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.NEVINSFAMILY.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1979YearFormation
State Legal DomicileMAStateLegalDomicile
Activity Or Mission DescriptionPROVIDING QUALITY CARE TO THE ELDERLYActivityOrMissionDescription
Nbr Voting Members Governing Body9NbrVotingMembersGoverningBody
Nbr Independent Voting Members9NbrIndependentVotingMembers
Total Nbr Employees292TotalNbrEmployees
Total Nbr Volunteers9TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year14402ContributionsGrantsPriorYear
Contributions Grants Current Year12818ContributionsGrantsCurrentYear
Program Service Revenue Prior Year14132732ProgramServiceRevenuePriorYear
Program Service Revenue CY14053940ProgramServiceRevenueCY
Investment Income Prior Year37906InvestmentIncomePriorYear
Investment Income Current Year40631InvestmentIncomeCurrentYear
Other Revenue Prior Year2537OtherRevenuePriorYear
Other Revenue Current Year3197OtherRevenueCurrentYear
Total Revenue Prior Year14187577TotalRevenuePriorYear
Total Revenue Current Year14110586TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year9561164SalariesEtcPriorYear
Salaries Etc Current Year10048725SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year3987361OtherExpensePriorYear
Other Expenses Current Year3791769OtherExpensesCurrentYear
Total Expenses Prior Year13548525TotalExpensesPriorYear
Total Expenses Current Year13840494TotalExpensesCurrentYear
Revenues Less Expenses Prior Year639052RevenuesLessExpensesPriorYear
Revenues Less Expenses CY270092RevenuesLessExpensesCY
Total Assets BOY9552334TotalAssetsBOY
Total Assets EOY10017719TotalAssetsEOY
Total Liabilities BOY4970601TotalLiabilitiesBOY
Total Liabilities EOY5098710TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY4581733NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY4919009NetAssetsOrFundBalancesEOY
Mission DescriptionTO PROVIDE QUALITY NURSING CARE TO THE ELDERLYMissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense12953293Expense
Revenue14057137Revenue
DescriptionNURSING HOME OPERATION INCLUDING ALL RELATED ELDERLY SERVICESDescription
Total Program Service Expense12953293TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities1FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10964NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees292NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members9NbrVotingGoverningBodyMembers
Number Independent Voting Members9NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body0Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy0WhistleblowerPolicy
Document Retention Policy0DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledMAStatesWhereCopyOfReturnIsFiled
Own WebsiteXOwnWebsite
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1SHARON WALSHBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number9786827611TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line110 INGALLS COURTAddressLine1
CityMETHUENCity
StateMAState
ZIP Code01844ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (13 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
ATTY VICTOR L HATEM
DIRECTOR0.400.60X000
KAREN NEMETH
CHAIRPERSON0.400.60X000X
ALAN P SHAFER
TREASURER0.400.60X000X
MARC D KLEIN
CLERK0.400.60X000X
JAMES J MALONEY JR
DIRECTOR0.400.60X000
EDGAR J SIDON
DIRECTOR0.400.60X000
JAMES H SMITH
DIRECTOR0.400.60X000
GARY MELVILLE
DIRECTOR0.400.60X000X
LARRY GIORDANO
DIRECTOR0.400.60X000
SCOTT DICKINSON
CEO/ADMINISTRATOR40.00134093032457X
JOYCE SHANNON
PRESIDENT12.0028.00012737318462X
DEBORAH MCCARTHY
DON40.00107576010921X
ANGELA NJOROGE
LPN40.001049700960X
FieldValueIRS element (for citing)
Total Reportable Comp From Org346639TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs127373TotalReportableCompFrmRltdOrgs
Total Other Compensation62800TotalOtherCompensation
Number Individuals GT100 K3NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (4 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
US FOOD SERVICES
BOX D 3155BOSTONMA02241FOOD SERVICES384179
PARTNERS PHARMACY
70 JACKSON DRCRANFORDNJ07016PHARMACY SERVICES302374
FIRESIDE STAFFING INC
17 GAUDET LANEPELHAMNH03076NURSING SERVICES219868
INVACARE CORPORATION
1 INVACARE WAYELYRIAOH44035HEALTHCARE SERVICES101815
FieldValueIRS element (for citing)
Number Of Contractors GT100 K4NumberOfContractorsGT100K
Fundraising Events7613FundraisingEvents
All Other Contributions5205AllOtherContributions
Total Contributions12818TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionNURSING HOME REVENUEDescription
Business Code623000BusinessCode
Total Revenue Column14053940TotalRevenueColumn
Related Or Exempt Function Income14053940RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue14053940TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column40631TotalRevenueColumn
Exclusion$40,631ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events10503GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events7613CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses10503FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
OTHER INCOME62300029322932
RESIDENT ACTIVITY INCOME623000265265
FieldValueIRS element (for citing)
Total Other Revenue3197TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column14110586TotalRevenueColumn
Related Or Exempt Function Income14057137RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$40,631ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total166550Total
Management And General166550ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total8300913Total
Program Services7935842ProgramServices
Management And General365071ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total11020Total
Program Services10368ProgramServices
Management And General652ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total873306Total
Program Services821626ProgramServices
Management And General51680ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total696936Total
Program Services646357ProgramServices
Management And General50579ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total22002Total
Management And General22002ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total53365Total
Management And General53365ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total238159Total
Program Services156815ProgramServices
Management And General81344ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total9484Total
Program Services9484ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total231217Total
Program Services218037ProgramServices
Management And General13180ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total637920Total
Program Services637920ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total1001Total
Program Services1001ProgramServices

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total392Total
Program Services392ProgramServices

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total4840Total
Program Services4840ProgramServices

Interest Interest

FieldValueIRS element (for citing)
Total1441Total
Program Services1441ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total285676Total
Program Services285676ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total81368Total
Management And General81368ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServices
SUPPLIES AND EXPENSE902853902853
MASS. STATE USER FEE AS733245733245
ANCILLARIES403492403492
BAD DEBTS163532163532

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total21782Total
Program Services20372ProgramServices
Management And General1410ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total13840494Total
Program Services12953293ProgramServices
Management And General887201ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY2905525BOY
EOY3357371EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1691781BOY
EOY1661181EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1584810BOY
EOY1796107EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY161412BOY
EOY96581EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis8820567LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec6196813LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY2739058BOY
EOY2623754EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY96077BOY
EOY108491EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY373671BOY
EOY374234EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY9552334BOY
EOY10017719EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1127797BOY
EOY1415929EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY19530BOY
EOY0EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY3370233BOY
EOY3296408EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY30370BOY
EOY22224EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY422671BOY
EOY364149EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY4970601BOY
EOY5098710EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY4501560BOY
EOY4838614EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY80173BOY
EOY80395EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY4581733BOY
EOY4919009EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY9552334BOY
EOY10017719EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses270092ReconcilationRevenueExpenses
Reconciliation Unrealized Invest8662ReconciliationUnrealizedInvest
Reconcilation Other Changes58522ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement SeparateXFinancialStatementSeparate
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years60107CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years47516CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years67999CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year24792CurrentTaxYearMinus1Year
Current Tax Year23321CurrentTaxYear
Total223735Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years13229886CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years13696682CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years13911245CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year14135269CurrentTaxYearMinus1Year
Current Tax Year14057137CurrentTaxYear
Total69030219Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years13289993CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years13744198CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years13979244CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year14160061CurrentTaxYearMinus1Year
Current Tax Year14080458CurrentTaxYear
Total69253954Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total50969253954PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years55497CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years25763CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years56711CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year37906CurrentTaxYearMinus1Year
Current Tax Year40631CurrentTaxYear
Total216508Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years55497CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years25763CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years56711CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year37906CurrentTaxYearMinus1Year
Current Tax Year40631CurrentTaxYear
Total216508Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years13345490CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years13769961CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years14035955CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year14197967CurrentTaxYearMinus1Year
Current Tax Year14121089CurrentTaxYear
Total69470462Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99690PublicSupportPercentage509
Prior Year Support Percentage0.99660PriorYearSupportPercentage
Investment Income Percentage0.00310InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00340PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$1,912OtherActivitiesAmount
Total Lobbying Expenditures IIB1912TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF LOBBYING ACTIVITIES:Identifier
Return ReferencePART II-B, LINE 1:ReturnReference
ExplanationTHE ORGANIZATION PAYS DUE TO A NUMBER OF HEALTH CARE ASSOCIATIONS. A PORTION OF THOSE DUES ARE USED FOR LOBBYING.Explanation

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance80173BeginningOfYearBalance
Investment Earnings Or Losses222InvestmentEarningsOrLosses
End Of Year Balance80395EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance79882BeginningOfYearBalance
Investment Earnings Or Losses291InvestmentEarningsOrLosses
End Of Year Balance80173EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance71050BeginningOfYearBalance
Contributions8452Contributions
Investment Earnings Or Losses380InvestmentEarningsOrLosses
End Of Year Balance79882EndOfYearBalance
FieldValueIRS element (for citing)
Term Endowment EOY Balance1.00000TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis295146OtherCostOrOtherBasis
Book Value295146BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis6009263OtherCostOrOtherBasis
Depreciation4245561Depreciation
Book Value1763702BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis2439132OtherCostOrOtherBasis
Depreciation1871826Depreciation
Book Value567306BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis77026OtherCostOrOtherBasis
Depreciation79426Depreciation
Book Value-2400BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings2623754TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionFAIR VALUE OF INTEREST RATE SWAPDescription
Amount$364,149Amount
FieldValueIRS element (for citing)
Total Of Amounts364149TotalOfAmounts
Footnote In Part XIIIXFootnoteInPartXIII
Tot Revenue Etc Audited Fincl Stmt14188273TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments8662NetUnrealizedGainsInvestments
Other Revenues69025OtherRevenues
Revenue Not Rptd F99077687RevenueNotRptdF990
Revenue Subtotal14110586RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form99014110586TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt13850997TotExpensesEtcAuditedFinclStmt
Other Expenses Included10503OtherExpensesIncluded
Expenses Not Rptd F99010503ExpensesNotRptdF990
Expenses Subtotal13840494ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99013840494TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS:PART V, LINE 4:THE ORGANIZATION HAS TEMPORARILY RESTRICTED NET ASSETS TO BE USED FOR DIETARY RENOVATIONS.
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: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'S 2009 THROUGH 2012 TAX YEARS ARE OPEN FOR EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES.
PART XI, LINE 2D - OTHER ADJUSTMENTS:CHANGE IN FAIR VALUE OF SWAP 58,522. DIRECT FUNDRAISING EXPENSES ON TAX RETURN 10,503.
PART XII, LINE 2D - OTHER ADJUSTMENTS:DIRECT FUNDRAISING EXPENSES ON TAX RETURN 10,503.

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1GOLF TOURNAMENTNameOfEvent1
Gross Receipts Event118116GrossReceiptsEvent1
Charitable Contributions Event17613CharitableContributionsEvent1
Gross Revenue Event110503GrossRevenueEvent1
Other Direct Expenses Event110503OtherDirectExpensesEvent1
Gross Receipts Total18116GrossReceiptsTotal
Charitable Contributions Total7613CharitableContributionsTotal
Gross Revenue Total Events10503GrossRevenueTotalEvents
Other Direct Expenses Total Events10503OtherDirectExpensesTotalEvents
Direct Expense Summary Events10503DirectExpenseSummaryEvents
Net Income Summary0NetIncomeSummary

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII

FieldValueIRS element (for citing)
Name PersonSCOTT DICKINSONNamePerson
TitleCEO/ADMINISTRATORTitle
Base Compensation Filing Org134093BaseCompensationFilingOrg
Comp Based On Related Orgs0CompBasedOnRelatedOrgs
Bonus Filing Org0BonusFilingOrg
Bonus Related Orgs0BonusRelatedOrgs
Other Compensation Filing Org0OtherCompensationFilingOrg
Other Compensation Related Orgs0OtherCompensationRelatedOrgs
Deferred Comp Filing Org0DeferredCompFilingOrg
Deferred Comp Related Orgs0DeferredCompRelatedOrgs
Nontaxable Benefits Filing Org32457NontaxableBenefitsFilingOrg
Nontaxable Benefits Related Orgs0NontaxableBenefitsRelatedOrgs
Total Compensation Filing Org166550TotalCompensationFilingOrg
Total Compensation Related Orgs0TotalCompensationRelatedOrgs
Comp Report Prior990 Filing Org0CompReportPrior990FilingOrg
Comp Report Prior990 Related Orgs0CompReportPrior990RelatedOrgs

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1MASSACHUSETTS DEVELOPMENT FINANCE AGENCYBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN042608195IssuerEIN
CUSIP Number461473209CUSIPNumber
Date Issued2005-02-01DateIssued
Issue Price4800000IssuePrice
Description Of PurposeTO FINANCE COST OF ELIGIBLE PROJECTSDescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer0OnBehalfOfIssuer
Pool Financing0PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Amount Retired411296AmountRetired
Total Proceeds3729928TotalProceeds
Amount In Reserve Fund53733AmountInReserveFund
Issuance Costs From Proceeds69685IssuanceCostsFromProceeds
Other Spent Proceeds3606510OtherSpentProceeds
Year Of Subst Completion2005YearOfSubstCompletion
Current Refunding1CurrentRefunding
Advance Refunding0AdvanceRefunding
Final Allocation Made1FinalAllocationMade
Adequate Books And Recds Maintaind1AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements0AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty0MngmentCntrctBondFinancdPrprty
Any Research Agreements0AnyResearchAgreements
Bond Iss Meet Prvt Security Pay Test0BondIssMeetPrvtSecurityPayTest
Change In Use Bond Financed Prop0ChangeInUseBondFinancedProp
Non Qualified Bond Remed Procdrs0NonQualifiedBondRemedProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T Filed0Form8038TFiled
Rebate Not Due Yet1RebateNotDueYet
Exception To Rebate0ExceptionToRebate
No Rebate Due0NoRebateDue
Variable Rate Issue1VariableRateIssue
Hedge Identified In Books And Recds1HedgeIdentifiedInBooksAndRecds

Name Of Hedge Provider NameOfHedgeProvider

FieldValueIRS element (for citing)
Business Name Line1CITIZENS BANKBusinessNameLine1
FieldValueIRS element (for citing)
Term Of Hedge11.000000000000TermOfHedge
Superintegrated Hedge0SuperintegratedHedge
Hedge Terminated0HedgeTerminated
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGIC
Gross Proceeds Invested0GrossProceedsInvested
Written Proc To Monitor Reqs0WrittenProcToMonitorReqs

Form990 Schedule K Part VI Form990ScheduleKPartVI

FieldValueIRS element (for citing)
IdentifierPART I - BOND ISSUEIdentifier
Return ReferencePROCEEDS FROM ISSUEReturnReference
ExplanationTHE PROCEEDS FROM THE ISSUE DO NOT AGREE WITH THE ISSUE AMOUNT BECAUSE THE PROCEEDS WERE SPLIT WITH A RELATED PARTY 77.75% AND 22.25%.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION B, LINE 11THE 990 WILL BE REVIEWED BY THE EXECUTIVE COMMITTEE PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12CEACH DIRECTOR, OFFICER, EMPLOYEE, AND MEMBER OF A COMMITTEE WITH BOARD-DELEGATED POWERS, SHALL COMPLETE, SIGN AND DELIVER TO THE CHAIR OF THE BOARD A CONFLICTS OF INTEREST POLICY ANNUAL STATEMENT AT THE TIME OF HIS OR HER INITIAL ELECTION OR APPOINTMENT AND ANNUALLY THEREAFTER. THE CONFLICTS OF INTEREST POLICY ANNUAL STATEMENT SHALL BE IN SUCH FOR AS IS DEEMED APPROPRIATE BY THE PRESIDENT WITH ADVICE FROM THE NEVIN'S COUNSEL AS NEEDED.
FORM 990, PART VI, SECTION B, LINE 15COMPENSATION REVIEW FOR CEO, EXECUTIVE DIRECTOR, OTHER OFFICERS AND KEY EMPLOYEES IS APPROVED BY INDENEPENDENT PERSONS WITH THE USE OF COMPARABILITY DATA AND APPROVED BY THE BOARD OF DIRECTORS. THIS WAS LAST PERFORMED DURING 2012 AND NOTED IN THE BOARD OF DIRECTORS MINUTES.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST.
FORM 990, PART XI, LINE 9:CHANGE IN FAIR VALUE OF SWAP 58,522.CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XII, LINE 2C:THE ORGANIZATION DID NOT CHANGE EITHER ITS OVERSIGHT OR SELECTION PROCESS DURING THE TAX YEAR.OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT ACCOUNTANT

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusControlled OrgControlledOrg
HENRY C NEVINGS HOME FOR THE AGED AND INCURABLE
12 INGALLS COURTMETHUENMA01844042210743ADULT DAY HEALTH AND CHILD CARE SERVICESMA501 (C)(3)LINE 90
NEVINS MANOR INC
12 INGALLS COURTMETHUENMA01844043265310ELDERLY HOUSINGMA501 (C)(3)LINE 90
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org1LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg