2013-08-01T13:53:16-05:00 2012-12-31 020383073 WILLIAM STEELE & ASSOCIATES PC 40 STARK STREET MANCHESTER NH 03101 990 2012-01-01 042104851 MI NURSING RESTORATIVE CENTER INC MINU 9786856321 172 LAWRENCE STREET LAWRENCE MA 01841 GERARD FOLEY 9786856321 2013-07-10 1 WILLIAM G STEELE JR CPA P00233103 6036228881 2012 2016-02-24 21:20:13Z GERARD FOLEY 172 LAWRENCE STREET LAWRENCE MA 01841 20139092 0 X MIHCS.COM X 1875 MA THE MISSION OF MI NURSING RESTORATIVE CENTER, INC. IS TO RESPOND WITH COMPASSIONATE CARE AND DIGNITY TO THE HEALTH, SOCIAL AND SPIRITUAL NEEDS OF WELL, SICK, AND FRAIL ELDERS. MI ALSO OFFERS AND EXTENDS SUPPORTIVE PRESENCE AND PROGRAMS TO THE FAMILIES OF RESIDENTS. THE QUALITY OF OUR SERVICES ARE ACHIEVED THROUGH EMBRACING CORE VALUES THAT INCLUDE COMPASSION, COMPETENCE AND COLLABORATION 15 14 473 0 0 0 38520 3304 20618322 19903248 152263 173627 111329 58913 20920434 20139092 0 0 0 0 13002467 12874723 0 0 0 6088678 6164322 19091145 19039045 1829289 1100047 23332865 25281374 2110226 2208240 21222639 23073134 X THE MISSION OF MI NURSING RESTORATIVE CENTER, INC. IS TO RESPOND WITH COMPASSIONATE CARE AND DIGNITY TO THE HEALTH, SOCIAL AND SPIRITUAL NEEDS OF WELL, SICK, AND FRAIL ELDERS. MI ALSO OFFERS AND EXTENDS SUPPORTIVE PRESENCE AND PROGRAMS TO THE FAMILIES OF RESIDENTS. THE QUALITY OF OUR SERVICES ARE ACHIEVED THROUGH EMBRACING CORE VALUES THAT INCLUDE COMPASSION, COMPETENCE AND COLLABORATION. 0 0 16638561 19962161 THE PROVISION OF ELDERCARE THROUGH THE OPERATION OF A 250 BED SKILLED NURSING FACILITY, THE PROVISION OF 81,462 RESIDENT DAYS OF SKILLED NURSING CARE, REHABILIATION SERVICES, DIETARY, LAUNDRY AND HOUSEKEEPING SERVICES AND NUMEROUS SOCIAL ACTIVITIES. MEDICAID DAYS REPRESENT 61,159 OF THE 81,462 TOTAL RESIDENT DAYS. 16638561 1 0 0 0 0 0 0 0 0 0 1 1 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 1 0 0 0 0 0 1 0 0 0 1 23 0 1 473 1 0 0 0 0 0 0 0 0 0 0 X 15 14 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X X PAMELA STRELETSKY 9786856321 172 LAWRENCE STREET LAWRENCE MA 01841 FRED SHAHEEN 1.00 X 0 0 0 JOHN NICEFORO JR MD 1.00 X X 0 0 0 KELLY SULLIVAN ESQ 1.00 X X 0 0 0 MARGARET SHAHEEN 1.00 X 0 0 0 MATTHEW CAFFREY ESQ 1.00 X 0 0 0 RAISA CARRASCO-VELEZ 1.00 X 0 0 0 SR SUSAN FORGET SGM 1.00 X 0 0 0 HON JOHN E FENTON JR 1.00 X 0 0 0 KAREN MILLER 1.00 X X 0 0 0 MARY LOUISE RETELLE 1.00 X 0 0 0 MARY ALICE ROCK 1.00 X 0 0 0 EFRAIN ROLON 1.00 X 0 0 0 REV WILLIAM WATERS OSA 1.00 X 0 0 0 ROSEMARIE A CONNOLLY 1.00 X 0 0 0 GERARD J FOLEY 40.00 X 206020 0 37714 206020 0 37714 4 0 1 0 PEOPLEFIRST REHABILITATION SERVICES PO BOX 277365 ATLANTA GA 30384 REHABILITAION SERVICES 660374 REHABCARE 7733 FORSYTH BLVD STE 2300 ST LOUIS MO 63105 REHABILITAION SERVICES 613989 COVENANT HEALTH SYSTEMS 100 AMES POND SUITE 102 TEWKSBURY MA 01876 HEALTH CARE MGMT CO. 309708 UNIDINE CORP PO BOX 60479 CHARLOTTE NC 28260 FOOD SERVICE MGMT 301803 KDSA CONSULTING LLC 145 MILK ST METHUEN MA 01844 IT MANAGEMENT SERVICES 193153 6 3304 3304 PATIENT SERVICE REVENU 623000 19903248 19903248 19903248 173627 173627 MISCELLANEOUS REVENUE 623000 58913 58913 58913 20139092 19962161 0 173627 313382 261674 51708 10530543 8793003 1737540 1227600 1025046 202554 803198 670670 132528 232281 232281 16019 16019 27854 27854 11693 11693 222190 222190 170389 170389 402762 402762 10535 10535 716423 716423 143074 143074 PURCHASED SERVICES 2059893 2059893 SUPPLIES 1740528 1740528 BAD DEBTS 240000 240000 MEDICAID USER FEE 136344 136344 34337 34337 19039045 16638561 2400484 0 6418865 2621496 5017331 2456193 1615652 137230 169391 19864424 14085415 6094429 5779009 8162181 9075862 63967 1002633 23332865 25281374 1431860 1543869 678366 664371 2110226 2208240 X 21212639 23070114 10000 3020 21222639 23073134 23332865 25281374 X 1100047 757424 -6976 X 0 1 X 1 0 X 66851 66851 36391 38520 3304 211917 19126517 19020645 20236630 20729651 19965465 99078908 19193368 19087496 20273021 20768171 19968769 99290825 0 0 0 99290825 151731 7868 4462 152263 173627 489951 151731 7868 4462 152263 173627 489951 19345099 19095364 20277483 20920434 20142396 99780776 0.99510 0.99630 0.00490 0.00370 X 104779 104779 12796473 8394431 4402042 6963172 5690984 1272188 5779009 OTHER INVESTMENTS 9075862 F 9075862 DEFFERED EXPENSES 529766 RESIDENT FUNDS LIABILITY 73955 PROFESSIONAL LIABILITY LOSS RESERVE 60650 664371 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 0 0 0 0 0 0 1 0 GERARD J FOLEY 206020 0 0 0 0 0 11347 0 26367 0 243734 0 0 0 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 MARKETS DATA FROM VARIOUS 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 EVELS 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 7 THE RELATED ORGANIZATION, COVENANT HEALTH SYSTEM, MAINTAINS AN INCENTIVE COMPENSATION PLAN FOR EXECUTIVES THAT IS ADMINISTERED BY THAT 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 ESTABLISHED AT THE BEGINNING OF THE YEAR. THE ENTITLEMENT TO AWARDS FOR A PARTICULAR YEAR IS NOT DETERMINED UNTIL EARLY THE FOLLOWING YEAR. AMOUNTS PAID IN 2012 UNDER THE PLAN ARE REPORTED ON SCHEDULE J, PART II, COLUMN (B)(II). FRED SHAHEEN DIRECTOR 209229 FOOD SUPPLIES ARE PURCHASED FROM SHAHEEN BROTHERS, INC. FRED SHAHEEN IS AN OWNER OF THE COMPANY. SHAHEEN BROTHERS, INC. IS ONE OF SEVERAL VENDORS USED BY THE ORGANIZATION AND ALL TRANSACTIONS ARE CONDUCTED AT FAIR MARKET VALUE. 0 MARGARET SHAHEEN DIRECTOR 0 MARGARET IS THE WIFE OF AN OWNER OF SHAHEEN BROTHERS, INC. SHAHEEN BROTHERS, INC. TRANSACTIONS ARE LISTED ABOVE. 0 FORM 990, PART VI, SECTION A, LINE 2 FRED SHAHEEN, DIRECTOR AND MARGARET SHAHEEN, DIRECTOR, ARE IN LAWS. FORM 990, PART VI, SECTION A, LINE 6 COVENANT HEALTH SYSTEMS IS THE SOLE MEMBER OF THE ORGANIZATION. ACORDINGLY, IT RETAINS CERTAIN RESERVE RIGHTS OVER CORPORATE DECISIONS AND BOARD COMPOSITION. FORM 990, PART VI, SECTION A, LINE 7A COVENANT HEALTH SYSTEMS IS THE SOLE MEMBER OF THE OPRGANIZATION. 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 MEMBER OF THE ORGANIZATION. ACCORDINGLY IT RETAINS CERTAIN RESERVE RIGHTS OVER CORPORATE DECISIONS AND BOARD COMPOSITION. FORM 990, PART VI, SECTION B, LINE 11 FORM 990 IS PROVIDED TO THE BOARD MEMBERS AND REVIEWED AT THAT TIME. FORM 990, PART VI, SECTION B, LINE 12C THIS PROCESS IS THE RESPONSIBILITY OF THE COMPLIANCE OFFICER. A FORM IS SUBMITTED TO ALL LEADERSHIP, BOARD MEMBERS, BOARD COMMITTEE MEMBERS, EMPLOYED PHYSICIANS, MEDICAL DIRECTORS AND CERTAIN EMPLOYEES IN KEY POSITIONS ANNUALLY TO BE COMPLETED. REMINDERS ARE SENT OUT TO MAKE CERTAIN THAT ALL CONFLICT OF INTEREST FORMS ARE RETURNED. 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. 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. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION PROVIDES FORM 990 AND ACCESS TO GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS UPON REQUEST. THE FORM 990 IS POSTED ON COVENANT HEALTH SYSTEMS' WEBSITE ALSO. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CHANGE IN TEMPORARILY RESTRICTED NET ASSETS -6,976. MI RESIDENTIAL COMMUNITY III INC 193 MAPLE ST LAWRENCE MA 01841 042686043 PROVIDER OF LOW INCOME HOUSING (HUD) TO ELDERLY AND DISABLED RESIDENTS MA 501 (C) (3) 509 (A)(2) COVENANT HEALTH SYSTEMS 0 MI TRANSPORTATION INC 189 MAPLE ST LAWRENCE MA 01841 042921889 PROVIDER OF TRANSPORTATION SERVICES TO ELDERLY, SICK AND SIABLES RESIDENTS MA 501 (C) (3) 509 (A)(2) COVENANT HEALTH SYSTEMS 0 COVENANT HEALTH SYSTEMS INC 100 AMES POND SUITE 102 TEWKSBURY MA 01876 222484505 HEALTHCARE MANAGEMENT AND RESOURCE ORGANIZATION MA 501 (C) (3) 509 (A)(2) 0 MI MANAGEMENT INC 172 LAWRENCE ST LAWRENCE MA 01841 042857794 PROVIDER OF ASSISTED LIVING SERVICES TO THE ELDERLY MA 501 (C) (3) 509 (A)(3) COVENANT HEALTH SYSTEMS 0 MI ADULT DAY HEALTH CARE CENTER INC 189 MAPLE ST LAWRENCE MA 01841 042921888 ADULT DAY CARE FOR ELDERLY, SICK AND HANDICAPPED MA 501 (C) (3) 509 (A)(2) COVENANT HEALTH SYSTEMS 0 MI RESIDENTIAL COMMUNITY II INC 191 MAPLE ST LAWRENCE MA 01841 042679954 PROVIDER OF LOW INCOME HOUSING (HUD) TO ELDERLY AND SIABLED RESIDENTS MA 501 (C) (3) 509 (A)(2) COVENANT HEALTH SYSTEMS 0 MI RESIDENTIAL COMMUNITY INC 189 MAPLE ST LAWRENCE MA 01841 042647207 PROVIDER OF ASSISTED LIVING SERVICES TO THE ELDERLY MA 501 (C) (3) 509 (A)(2) COVENANT HEALTH SYSTEMS 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 COVENANT HEALTH SYSTEMS M 232281 CASH