2013-07-08T09:21:55-05:00 2012-12-31 020383073 WILLIAM STEELE & ASSOCIATES PC 40 STARK STREET MANCHESTER NH 03101 990 2012-01-01 043419625 CHS OF WORCESTER INC CHSO 9786546363 100 AMES POND DRIVE TEWKSBURY MA 01876 JOHN AHLE 9786546363 2013-06-27 1 WILLIAM G STEELE JR CPA P00233103 6036228881 2012 2016-02-24 21:20:13Z ST MARY HEALTH CARE CENTER JOHN AHLE 100 AMES POND DRIVE TEWKSBURY MA 01876 8574665 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 2012 THE ORGANIZATION PROVIDED 38,573 DAYS OF SERVICE OF WHICH 35,412 WERE PROVIDED TO PATIENTS RECEIVING MEDICAID. 8 6 212 0 0 0 4095 1885 8657458 8513001 1500 1130 423 58649 8663476 8574665 0 0 0 0 5711913 5674068 0 0 0 2998260 2842529 8710173 8516597 -46697 58068 4191250 4218261 678882 647825 3512368 3570436 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 8384988 8571650 THE ORGANIZATION PROVIDED 38,573 DAYS OF SKILLED NURSING CARE TO ELDERLY PATIENTS FROM ALL ECONOMIC, ETHNIC AND RELIGIOUS BACKROUNDS. OF THESE DAYS THE ORGANIZATION PROVIDED 35,412 DAYS OF SKILLED SERVICES TO MEDICAID RECIPIENTS. 8384988 1 0 0 0 0 0 0 0 0 0 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 11 0 1 212 1 0 0 0 0 0 0 0 0 0 0 X 8 6 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 1.00 X X 0 0 0 THOMAS LUCASRETIRED CHS 312 1.00 X X 0 148897 11943 FRANCES MCPARTLAND 1.00 X 0 0 0 KENNETH FERRON 1.00 X 0 389749 99855 SUSAN MAEDLER 1.00 X 0 0 0 STEVEN DIORIO 1.00 X X 0 0 0 MELISSA BOYLE 1.00 X 0 0 0 RICHARD FREIJE 1.00 X 0 0 0 MICHAEL ISABELLA 40.00 X 108912 0 1938 108912 538646 113736 1 0 1 0 HEALTHCARE SERVICES GROUP INC 3220 TILLMAN DRIVE SUITE 300 BENSALEM PA 19020 HOUSEKEEPING AND LAUNDRY 306822 1 1885 1885 PATIENT SERVICE REVENU 623000 8513001 8513001 8513001 1130 1130 MISCELLANEOUS 623000 52063 52063 BAD DEBT RECOVERY 623000 6404 6404 VENDING MACHINES 623000 182 182 58649 8574665 8571650 0 1130 123783 123783 4709828 4709828 487145 487145 353312 353312 101016 101016 8856 8856 21737 21737 22591 22591 83541 83541 149991 149991 177388 177388 19806 19806 291799 291799 90300 90300 PURCHASED SERVICES 814083 814083 MEDICAID USER FEE 692271 692271 FOOD AND SUPPLIES 364480 364480 EDUCATION AND TRAINING 4670 4670 8516597 8384988 131609 0 413354 674311 403498 404600 518541 434703 37816 36961 5309724 2685587 2781174 2624137 36867 43549 4191250 4218261 597326 559587 81556 88238 678882 647825 X 3512368 3570436 3512368 3570436 4191250 4218261 58068 0 X 0 1 X 1 0 X 6028 4391 6815 4095 1885 23214 8875655 8821198 8278715 8661976 8568635 43206179 8881683 8825589 8285530 8666071 8570520 43229393 0 0 0 43229393 234 6207 3599 1500 1130 12670 234 6207 3599 1500 1130 12670 8881917 8831796 8289129 8667571 8571650 43242063 0.99970 0.99970 0.00030 0.00030 X 65300 65300 3662842 1743586 1919256 1191700 822974 368726 389882 119027 270855 2624137 PROFESSIONAL LIABILITY LOSS RESERVE 45189 RESIDENT FUNDS LIABILITY 43049 88238 X DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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, 2012." X X X X 0 1 0 0 0 0 1 0 0 THOMAS LUCASRETIRED CHS 312 0 28024 0 79231 0 41642 0 2098 0 9845 0 160840 0 79231 KENNETH FERRON 0 248748 0 92139 0 48862 0 72605 0 27250 0 489604 0 92139 PART I, LINE 3 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. 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 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 INCENTIVE COMPENSATION AWARDS IN 2012 BASED ON PERFORMANCE DURING 2011 TO MR. FERRON & MR. LUCAS OF $171,370. FORM 990, PART VI, SECTION A, LINE 6 COVENANT HEALTH SYSTEMS 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 SYSTEMS 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 SYSTEMS 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 SYSTEMS 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 THE COVENANT HEALTH SYSTEM'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 SYSTEM'S WEBSITE. COVENANT HEALTH SYSTEMS 100 AMES POND DRIVE TEWKSBURY MA 01876 222484505 HEALTHCARE MANAGEMENT AND RESOURCE ORGANIZATION MA 501 (C) 509(A)(2) 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 COVENANT HEALTH SYSTEMS M 148216 ACTUAL COST