2013-11-15T13:21:11-06:00 2012-12-31 410746749 CLIFTONLARSONALLEN LLP 300 CROWN COLONY DRIVE SUITE 310 QUINCY MA 02169 990 2012-01-01 042676008 THE HENRY C NEVINS HOME INC HENR 9786827611 10 INGALLS COURT METHUEN MA 01844 ALAN P SHAFER 9786727611 2013-11-07 1 ROBERT DILLAN P01688008 6179848100 2013-11-07 2012 2016-02-25 16:41:14Z SCOTT B DICKINSON 10 INGALLS COURT METHUEN MA 01844 14121089 0 X WWW.NEVINSFAMILY.ORG X 1979 MA PROVIDING QUALITY CARE TO THE ELDERLY 9 9 292 9 0 0 14402 12818 14132732 14053940 37906 40631 2537 3197 14187577 14110586 0 0 0 0 9561164 10048725 0 0 0 3987361 3791769 13548525 13840494 639052 270092 9552334 10017719 4970601 5098710 4581733 4919009 TO PROVIDE QUALITY NURSING CARE TO THE ELDERLY 0 0 12953293 14057137 NURSING HOME OPERATION INCLUDING ALL RELATED ELDERLY SERVICES 12953293 1 0 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 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 4 0 292 1 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 1 1 0 MA X X X SHARON WALSH 9786827611 10 INGALLS COURT METHUEN MA 01844 ATTY VICTOR L HATEM 0.40 0.60 X 0 0 0 KAREN NEMETH 0.40 0.60 X X 0 0 0 ALAN P SHAFER 0.40 0.60 X X 0 0 0 MARC D KLEIN 0.40 0.60 X X 0 0 0 JAMES J MALONEY JR 0.40 0.60 X 0 0 0 EDGAR J SIDON 0.40 0.60 X 0 0 0 JAMES H SMITH 0.40 0.60 X 0 0 0 GARY MELVILLE 0.40 0.60 X X 0 0 0 LARRY GIORDANO 0.40 0.60 X 0 0 0 SCOTT DICKINSON 40.00 X 134093 0 32457 JOYCE SHANNON 12.00 28.00 X 0 127373 18462 DEBORAH MCCARTHY 40.00 X 107576 0 10921 ANGELA NJOROGE 40.00 X 104970 0 960 346639 127373 62800 3 0 1 0 US FOOD SERVICES BOX D 3155 BOSTON MA 02241 FOOD SERVICES 384179 PARTNERS PHARMACY 70 JACKSON DR CRANFORD NJ 07016 PHARMACY SERVICES 302374 FIRESIDE STAFFING INC 17 GAUDET LANE PELHAM NH 03076 NURSING SERVICES 219868 INVACARE CORPORATION 1 INVACARE WAY ELYRIA OH 44035 HEALTHCARE SERVICES 101815 4 7613 5205 12818 NURSING HOME REVENUE 623000 14053940 14053940 14053940 40631 40631 10503 7613 10503 0 OTHER INCOME 623000 2932 2932 RESIDENT ACTIVITY INCOME 623000 265 265 3197 14110586 14057137 0 40631 166550 166550 8300913 7935842 365071 11020 10368 652 873306 821626 51680 696936 646357 50579 22002 22002 53365 53365 238159 156815 81344 9484 9484 231217 218037 13180 637920 637920 1001 1001 392 392 4840 4840 1441 1441 285676 285676 81368 81368 SUPPLIES AND EXPENSE 902853 902853 MASS. STATE USER FEE AS 733245 733245 ANCILLARIES 403492 403492 BAD DEBTS 163532 163532 21782 20372 1410 13840494 12953293 887201 0 2905525 3357371 1691781 1661181 1584810 1796107 161412 96581 8820567 6196813 2739058 2623754 96077 108491 373671 374234 9552334 10017719 1127797 1415929 19530 0 3370233 3296408 30370 22224 422671 364149 4970601 5098710 X 4501560 4838614 80173 80395 4581733 4919009 9552334 10017719 X 270092 8662 58522 X X 0 1 X 1 0 X 60107 47516 67999 24792 23321 223735 13229886 13696682 13911245 14135269 14057137 69030219 13289993 13744198 13979244 14160061 14080458 69253954 0 0 0 69253954 55497 25763 56711 37906 40631 216508 55497 25763 56711 37906 40631 216508 13345490 13769961 14035955 14197967 14121089 69470462 0.99690 0.99660 0.00310 0.00340 X 0 0 0 0 0 0 0 0 1 1912 1912 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: THE ORGANIZATION PAYS DUE TO A NUMBER OF HEALTH CARE ASSOCIATIONS. A PORTION OF THOSE DUES ARE USED FOR LOBBYING. 80173 222 80395 79882 291 80173 71050 8452 380 79882 1.00000 0 0 295146 295146 6009263 4245561 1763702 2439132 1871826 567306 77026 79426 -2400 2623754 FAIR VALUE OF INTEREST RATE SWAP 364149 364149 X 14188273 8662 69025 77687 14110586 0 14110586 13850997 10503 10503 13840494 0 13840494 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. GOLF TOURNAMENT 18116 7613 10503 10503 18116 7613 10503 10503 10503 0 X 0 0 0 0 0 0 0 0 0 SCOTT DICKINSON 134093 0 0 0 0 0 0 0 32457 0 166550 0 0 0 A MASSACHUSETTS DEVELOPMENT FINANCE AGENCY 042608195 461473209 2005-02-01 4800000 TO FINANCE COST OF ELIGIBLE PROJECTS 0 0 0 A 411296 3729928 53733 69685 3606510 2005 1 0 1 1 A 0 0 0 0 0 0 0 A 0 1 0 0 1 1 CITIZENS BANK 11.000000000000 0 0 0 0 0 PART I - BOND ISSUE PROCEEDS FROM ISSUE THE 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%. FORM 990, PART VI, SECTION B, LINE 11 THE 990 WILL BE REVIEWED BY THE EXECUTIVE COMMITTEE PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C EACH 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 15 COMPENSATION 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 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CHANGE IN FAIR VALUE OF SWAP 58,522. OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT ACCOUNTANT FORM 990, PART XII, LINE 2C: THE ORGANIZATION DID NOT CHANGE EITHER ITS OVERSIGHT OR SELECTION PROCESS DURING THE TAX YEAR. HENRY C NEVINGS HOME FOR THE AGED AND INCURABLE 12 INGALLS COURT METHUEN MA 01844 042210743 ADULT DAY HEALTH AND CHILD CARE SERVICES MA 501 (C)(3) LINE 9 0 NEVINS MANOR INC 12 INGALLS COURT METHUEN MA 01844 043265310 ELDERLY HOUSING MA 501 (C)(3) LINE 9 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0