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MASONICARE HEALTH CENTER: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
MASONICARE HEALTH CENTER (EIN 06-0655131)
Tax period
2011-10-01 to 2012-09-30
Filed
2013-08-14
IRS object ID
201342269349302914
Schema version
2011v1.5
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)
Timestamp2013-08-14T11:56:10-07:00Timestamp
Tax Period End Date2012-09-30TaxPeriodEndDate
Return Type990ReturnType
Tax Period Begin Date2011-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN060655131EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Masonicare Health CenterBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlMASONameControl
Phone2036787857Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO Box 70AddressLine1
CityWallingfordCity
StateCTState
ZIP Code06492ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameR Scott ThelenName
TitleAsst. TreasurerTitle
Date Signed2013-08-14DateSigned
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Gross Receipts64668266GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
All Affiliates IncludedfalseAllAffiliatesIncluded
Organization501c3XOrganization501c3
Web SiteWWW.MASONICARE.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1889YearFormation
State Legal DomicileCTStateLegalDomicile
Activity Or Mission DescriptionProvide comprehensive medical services to the elderly.ActivityOrMissionDescription
Nbr Voting Members Governing Body16NbrVotingMembersGoverningBody
Nbr Independent Voting Members16NbrIndependentVotingMembers
Total Nbr Employees1016TotalNbrEmployees
Total Gross UBI708TotalGrossUBI
Contributions Grants Prior Year95601ContributionsGrantsPriorYear
Contributions Grants Current Year334362ContributionsGrantsCurrentYear
Program Service Revenue Prior Year62583232ProgramServiceRevenuePriorYear
Program Service Revenue CY62725086ProgramServiceRevenueCY
Investment Income Prior Year162InvestmentIncomePriorYear
Investment Income Current Year708InvestmentIncomeCurrentYear
Other Revenue Prior Year1369976OtherRevenuePriorYear
Other Revenue Current Year1608110OtherRevenueCurrentYear
Total Revenue Prior Year64048971TotalRevenuePriorYear
Total Revenue Current Year64668266TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year39944918SalariesEtcPriorYear
Salaries Etc Current Year41982438SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year21745570OtherExpensePriorYear
Other Expenses Current Year22578121OtherExpensesCurrentYear
Total Expenses Prior Year61690488TotalExpensesPriorYear
Total Expenses Current Year64560559TotalExpensesCurrentYear
Revenues Less Expenses Prior Year2358483RevenuesLessExpensesPriorYear
Revenues Less Expenses CY107707RevenuesLessExpensesCY
Total Assets BOY44160660TotalAssetsBOY
Total Assets EOY46721064TotalAssetsEOY
Total Liabilities BOY6419992TotalLiabilitiesBOY
Total Liabilities EOY6239454TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY37740668NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY40481610NetAssetsOrFundBalancesEOY
Mission DescriptionProvide comprehensive medical services to the elderly.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense55798172Expense
Revenue62725086Revenue
DescriptionMasonicare Health Center is multi-level care facility. In 2012, it operated at a 98.1% occupancy rate providing 182,958 patient days. The independent living units operated at a 100% occupancy rate. Masonicare Health Center provides services in the following areas: long-term care, acute care, geriatric medical psychiatric services, hospital based outpatient services and independent living apartments.Description
Total Program Service Expense55798172TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredfalseScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109665NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees1016NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Form990-T FiledfalseForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Form8886 T FiledfalseForm8886TFiled
Non Deductible ContributionsfalseNonDeductibleContributions
Non Deductible DisclosurefalseNonDeductibleDisclosure
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Quid Pro Quo DisclosurefalseQuidProQuoDisclosure
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Number Of8282 Filed0NumberOf8282Filed
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Form8899 FiledfalseForm8899Filed
Form1098 C FiledfalseForm1098CFiled
Excess Business HoldingsfalseExcessBusinessHoldings
Taxable DistributionsfalseTaxableDistributions
Distribution To DonorfalseDistributionToDonor
Filed Lieu1041falseFiledLieu1041
Licensed More Than One StatefalseLicensedMoreThanOneState
Indoor Tanning ServicesfalseIndoorTanningServices
Form720 FiledfalseForm720Filed
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members16NbrVotingGoverningBodyMembers
Number Independent Voting Members16NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Policies Reference ChaptersfalsePoliciesReferenceChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OtherfalseCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Written Policy Or ProcedurefalseWrittenPolicyOrProcedure
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonR Scott ThelenNamePerson
Telephone Number2036787857TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line122 Masonic AvenueAddressLine1
CityWallingfordCity
StateCTState
ZIP Code06492ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (23 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
Arthur W Davies
Member1.00000
Gwen M Rochette
Member1.00000
Albert H Cheng
Member1.00000
William Morrow
Member1.00000X
Stephen P Shapiro
Treasurer1.00000X
Howard W Orr
Member1.00000X
Richard Ruggiano
Member1.00000X
John R Hall
Member1.00000X
Sherwin M Borsuk MD
Member1.00000X
Barbara F Lott
Member1.00000X
R Scott Thelen
Asst. Tres.40.00032753823924XX
Stephen B McPherson
Asst Secretary40.00087008917866XX
Michael B Dodge
Member1.00000X
Mark D Winne
Secretary1.00000XX
William R Deickler
Vice Chairman1.00000XX
Robert A Simon
Chairman1.00000XX
William Piper
26.0027988915070923856X
Jon-Paul Venoit
0.002296420667625043X
Jon Ernstoff
Chief Med Officer20.0020280000X
Melinda Schoen
VP Nursing40.00160020020013X
Thomas Gutner
Asst to President40.001444748279010440X
Marty Deflorio
Dir-Pharmacy40.0011332403630X
Lenore Consiglio
Dir-Admissions40.0012298804448X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1046459TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1637802TotalReportableCompFrmRltdOrgs
Total Other Compensation129220TotalOtherCompensation
Number Individuals GT100 K21NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Twin Med
11333 GreenstoneSanta Fe SpringsCA90870Medical Supplies438334
Morrison Management Specialist
PO Box 102289AtlantaGA30268Dietary Management3073299
Mckesson Drug
1801 Royal LaneDallasTX75229Medical Supplies2009822
Hess Corporation
PO Box 905423CharlotteNC28290Fuel556367
Breitner Transcription
1017 Turnpike SuiteCantonMA02021Transcription Servic363471
FieldValueIRS element (for citing)
Number Of Contractors GT100 K26NumberOfContractorsGT100K
All Other Contributions334362AllOtherContributions
Total Contributions334362TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Skilling nursing6230004287482342874823
Resident fees-apartments62300019620061962006
Home for aged62300042029864202986
Geriatric med psychiatric62300091583699158369
Acute hospital62300034165853416585

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column1110317TotalRevenueColumn
Related Or Exempt Function Income1110317RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue62725086TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column708TotalRevenueColumn
Unrelated Business Revenue708UnrelatedBusinessRevenue

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
Other,net1027058$1,027,058
I/C rents120756$120,756
Dietary346854$346,854

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column113442TotalRevenueColumn
Exclusion$113,442ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue1608110TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column64668266TotalRevenueColumn
Related Or Exempt Function Income62725086RelatedOrExemptFunctionIncome
Unrelated Business Revenue708UnrelatedBusinessRevenue
Exclusion$1,608,110ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1290725Total
Management And General1290725ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total29624697Total
Program Services29267844ProgramServices
Management And General356853ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total8815471Total
Program Services8812629ProgramServices
Management And General2842ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total0Total

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total2251545Total
Program Services2251545ProgramServices

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total2859324Total
Management And General2859324ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total68836Total
Program Services-546ProgramServices
Management And General69382ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total29439Total
Management And General29439ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total673697Total
Program Services662359ProgramServices
Management And General11338ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total0Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total118057Total
Program Services95051ProgramServices
Management And General23006ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total0Total

Travel Travel

FieldValueIRS element (for citing)
Total0Total

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total1162Total
Program Services1162ProgramServices

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total48780Total
Program Services43657ProgramServices
Management And General5123ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total701959Total
Program Services701959ProgramServices

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total2787240Total
Program Services2762940ProgramServices
Management And General24300ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total552394Total
Program Services17966ProgramServices
Management And General534428ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Supplies Other1888236187438513851
Provider Tax19698671969867
Pharmacy20265532026553
Purchased Services28893122767888121424

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total5963265Total
Program Services4512780ProgramServices
Management And General1450485ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total64560559Total
Program Services55798172ProgramServices
Management And General8762387ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY2070BOY
EOY3586EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
EOY0EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY10754834BOY
EOY14386017EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY184919BOY
EOY201304EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY279337BOY
EOY270883EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis84738982LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec53532014LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY32385228BOY
EOY31206968EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
EOY0EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY554272BOY
EOY652306EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY44160660BOY
EOY46721064EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY2249478BOY
EOY2277856EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY4170514BOY
EOY3961598EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY6419992BOY
EOY6239454EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY37740668BOY
EOY40481610EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY37740668BOY
EOY40481610EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY44160660BOY
EOY46721064EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses107707ReconcilationRevenueExpenses
Reconcilation Other Changes2633235ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteefalseAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredfalseFederalGrantAuditRequired
Federal Grant Audit PerformedfalseFederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule D IRS990ScheduleD

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis61359182OtherCostOrOtherBasis
Depreciation37874937Depreciation
Book Value23484245BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis3869023OtherCostOrOtherBasis
Depreciation1961038Depreciation
Book Value1907985BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis13411665OtherCostOrOtherBasis
Depreciation11518670Depreciation
Book Value1892995BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis6099112OtherCostOrOtherBasis
Depreciation2177369Depreciation
Book Value3921743BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings31206968TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (7 entries)

DescriptionDescriptionAmountAmount
General Reserve$187,983
Estimated Third Party$292,789
Deposits$171,192
Deferred Patient Revenue$72,253
Custodial Liabilities$624,011
Asbestos Removal$656,027
Accrued employee compensation$1,957,343
FieldValueIRS element (for citing)
Total Of Amounts3961598TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierPart XI, Line 8Identifier
Return ReferencePart XI, Line 8: Other Changes in Net Assets or Fund BalancesReturnReference
ExplanationIntercompany $2633235Explanation

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent150XPcent150
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare

Discounted Other DiscountedOther

FieldValueIRS element (for citing)
OtherXOther
Discounted Other Percentage150.000000000DiscountedOtherPercentage
FieldValueIRS element (for citing)
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CarefalseAmountsBudgetedForCharityCare
Expenses Exceeded BudgetfalseExpensesExceededBudget
Unable To Provide CarefalseUnableToProvideCare
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Workforce Development WorkforceDevelopment

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served550PersonsServed

Other Other

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served33PersonsServed

Total Total

FieldValueIRS element (for citing)
Number Of Activities Or Programs2NumberOfActivitiesOrPrograms
Persons Served583PersonsServed
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Amount Reimbursed By Medicare16605192AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare16921865CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-316673MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
OtherXOther
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CarefalseProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number0FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1Masonicare Health CenterBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line122 Masonic AvenueAddressLine1
CityWallingfordCity
StateCTState
ZIP Code06492ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Masonicare Health CenterBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
CHNA ConductedtrueCHNAConducted
Community DefinitionXCommunityDefinition
How Data ObtainedXHowDataObtained
Community Health NeedsXCommunityHealthNeeds
Consulting ProcessXConsultingProcess
Take Into AccounttrueTakeIntoAccount
Other FacilitiesfalseOtherFacilities
CHNA Widely AvailabletrueCHNAWidelyAvailable
On RequestXOnRequest
Other MethodXOtherMethod
Adopt Implement StrategyXAdoptImplementStrategy
Execute Implement StrategyXExecuteImplementStrategy
Develop Community PlanXDevelopCommunityPlan
Prioritize Health NeedsXPrioritizeHealthNeeds
Other Needs AddressedXOtherNeedsAddressed
All Needs AddressedtrueAllNeedsAddressed
Eligibility Criteria ExplainedtrueEligibilityCriteriaExplained
Uses FPG FreetrueUsesFPGFree
FPG Free Percent150.0000FPGFreePercent
Uses FPG DiscountedtrueUsesFPGDiscounted
FPG Discount Percent150.0000FPGDiscountPercent
Explains BasistrueExplainsBasis
Income LevelXIncomeLevel
Explains Application MethodtrueExplainsApplicationMethod
Includes Publicity MeasurestrueIncludesPublicityMeasures
Available On RequestXAvailableOnRequest
Actions On NonpaymenttrueActionsOnNonpayment
Collection ActivitiestrueCollectionActivities
LawsuitXLawsuit
Lien On ResidenceXLienOnResidence
Notified All PatientsXNotifiedAllPatients
Nondiscrim Emergency Care PolicyfalseNondiscrimEmergencyCarePolicy
No Emergency CareXNoEmergencyCare
Amounts Generally BilledfalseAmountsGenerallyBilled
Gross ChargesfalseGrossCharges

Form990 Schedule H Part VI Form990ScheduleHPartVI (9 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Part V - Explanation of Number of Facility Typeskilled nursing and rehabilitation unitsindependent living unitsresidential care unitsoutpatient speciality clinics
Part VI - Affilated Health Care System Roles and PromotionMasonicare of Wallingford, Connecticut, is the state's leading provider of healthcare and retirement living communities for seniors. We are not-for-profit and have more that 100 years of experience behind us. We're recognized for the quality, compassionate care and steadfast support we provide to our residents and patients. Masonicare encompasses a broad range of healthcare and senior living options: Skilled nursing and rehabilitation facilities- Masonicare Health Center in Wallingford and Masonicare at Newtown.Independent living options - A continuing care retirement community, Masonicare at Ashlar Village, and the Johnson, Wells, and Hawkins Apartments for individuals 55 and over located in Wallingford.Assisted living communities - Pond Ridge in Wallingford and Lockwood Lodge in Newtown.A residential care home - the Leslie G. Wright Residence in Wallingford. Masonicare Home Health & Hospice, a statewide home healthcare and hospice provider that touches 3,000 patients each month through its 8 offices. Masonicare offers free education programs and services to individuals and families throughout Connecticut that include:Lunch and Learn - this program is designed to provide seniors and others with education on health and wellness. Speakers are typically medical professionals from throughout the Masonicare continuum. Masonicare has coordinated with the senior centers and libraries in the towns of Enfield, Hamden, Meriden, Monroe, Newtown, North Haven, Southbury, Trumbull, Wallingford and Woodbury.Masonicare Community Services - is a statewide outreach program available to all Connecticut residents and offers information and guidance on a variety of programs and services including:- ConnPace (Connecticut's pharmaceutical program)- Medicare, Medicaid (Title 19), and Medicare Part D- Benefits eligibility- Caregiver assistance programs- State and Federal programs- Housing OptionsThese services are available over the phone or in the comfort of the resident's home.The Masonicare Help Line - is a toll free phone service assisting seniors and families with a broad range of questions about senior healthcare, retirement living and much more. In addition, we offer assistance in locating and utilizing service agencies and programs in Connecticut. Masonicare frequently holds blood pressure screenings and senior health fairs throughout the state, and makes its facilities available to many community organizations including the Commission on Aging, Senior Resources - Agency on Aging, M-Team, Healthy Wallingford, the Alzheimer's Association, Heritage Quilters and the Wallingford Education Foundation.
Part VI - Community InformationMasonicare Health Center (MHC) is part of the consolidated group of affiliates, Masonicare. MHC offers a wide variety of services that include:a. 382 skilled nursing and rehabilitation unitsb. 93 independent living unitsc. 86 residential care unitsd. 21 outpatient speciality clinics (Ambulatory Care Services)e. 30 acute Medical Hospital Bedsf. 29 acute psychiatric hospital bedsMHC is licensed as a chronic disease hospital and as such does not have emergency or surgical services. The revenues for the hospital portion of the business represent approximately 24% of the program service revenues of MHC.Masonicare, the parent company of Masonicare Health Center (MHC), serves the entire state of Connecticut through its separate affiliates. MHC, located in Wallingford CT services the greater Wallingford area. MHC is centrally located in the state providing easy access to the surrounding towns. Its outpatient specialty clinics provide easy access and high quality services to the town of Wallingford and the surrounding towns.As a non-profit 501(c)(3) organization, Masonicare is proud to provide free education programs and services to individuals and families throughout Connecticut. For the year ended Sep.30,2011 Masonicare and all of its affiliates across our continuum donated 3,008 hours of their time to benefit the community through home visits and educational programs. These donated staff hours had a monetary value of $99,190 and touched 9,085 members of the community. Masonicare also has 8 home health and hospice branches throughout the state that service the entire state of Connecticut.
Part VI - Needs AssessmentMasonicare's Community Health Needs assessment responses were collected over a three month period, Jan 1st - Mar 30th 2011. During this time 175 questionnaires were collected and entered into a database for analysis. The result did not determine any novel needs but instead affirmed the need for continuation and augmentation of our current progerams. The top needs when ranked 1st, 2nd and 3rd were 1) quality, affordable healthcare 2) transportation for those who no longer drive and/or are unable to use public transportation & home care for those with limitation in their daily activities of living 3) transportation for those who no longer drive and /or are unable to use public transporation
Part V, Line 6i - Describe Other Needs IdentifiedAfter the survey it was decided that the following events would be implemented in the new fiscal year.Wednesday blood pressure clinic from 1:00 to 3:00Quarterly expert wellness presentation at Masonic Healthcare CenterSemi-annual Prevention and Screening Fair where Masonicare's community benefit services are highlighted and promoted during Grand Masters DayCreate a resource list/brochure of local benefits resourcesIncrease partnerships with local agencies to host wellness eventsInclude more screenings at resource and health fairsNumber of Hospital Faciltiy - 0
Part V, Line 5c - Description of Making Needs Assessment Widely AvailableSurveys were handed out and available at Masonic Health Center and the Medical Office Building waiting room. Surveys could be taken online at Survey MonkeyNumber of Hospital Faciltiy - 0
Part V, Line 3 - Account Input from Person Who Represent the CommunityFor our Community Health Questionnaire convenience sampling was used. Within the Masonicare Community there were two stations set up in plain sight of visitors. At this sight there were blank questionnaires available and a blue lock box in which they could return complete questionnaires. the two locations were at the main entrance of the Masonicare Health Center and the Medical Office Building waiting room. The boxes were checked regularly. Additionally, Masonicare volunteers were asked to fill out a questionnaire and return them to the volunteer coordinator. The intercept technique was also employed to collect responses. A representative would stand in the vicinity of the main entrance for the Health Center and ask passing residents or visitors to take a few moments and fill out the survey.Another method used to collect responses was through the online survey tool, Survey Monkey. At the physical collection stations we left slips of paper that provided the survey website. If people were in a rush and could not fill out a hard copy, we asked that they access the site and complete the questionnaire at their convenience.The final way responses were collected was by a representative traveling to two different Senior Centers within the community, Wallingford Senior Center and Meriden Senior Center. Once again, the intercept techniques was used. All physical responses were collected and manually entered into the Survey Monkey database. Any surveys that were illegible or filled out incorrectly were not used. The only piece of information used from incorrectly filled out surveys was the answers to the demographic questions and the additional comments if any were given. If there were no additional comments the questionnaire was completely disregarded, no demographic information or any other information was used.Number of Hospital Faciltiy - 0
Part III, Line 9b - Provisions On Collection Practices For Qualified PatientsMasonicare Health Center provides care to patients who meet certain criteria under the charity care policy without charge, or at amounts less than established rates. It does not pursue collection of amounts determined to be charity care and these amounts are not reported as net patient service revenues.
Part I, Line 3c - Charity Care Eligibility Criteria (FPG Is Not Used)150% of FPG are used to determine the income threshold that a patient must meet or fall below to qualify for discounted medical care.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptiontrueInitialContractException
Rebuttable Presumption ProcedurefalseRebuttablePresumptionProcedure

Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgs
William Piper
2132881148486626835682333179155068350295395159059
Thomas Gutner
144474827901044015491482790
Stephen B McPherson
5087216500029636817866887955
R Scott Thelen
29327632500176223924351462
Melinda Schoen
16002020013180033
Jon-Paul Venoit
19568176107300027000396356925042253925468229215
Jon Ernstoff
202800202800

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierSch J, Part I, Line 8Identifier
Return ReferencePart I, Line 8: Amounts reported on 990 VII pursuant to initial contract exemption described in RegsReturnReference

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Part IV, Question 24a-TEe Bond IssueMasonicare Healthcare Center is a member of the Masonicare obligated group that is responsible for the repayment of the Series C and Series E Bonds issued by Masonicare, Inc. In 2007&2011. The current outstanding bond balance is $106,680,000.
Form 990, Part III, Line 1In furtherance of our traditional Masonic values, the mission of Masonicare Health Center is to enhance the quality of life by providing health, social and spiritual care throughout an individual's lifetime with emphasis on the needs of older persons.Masonicare Health Center will be recognized as an organization committed to establishing healthcare centers for excellence in all of its affiliates through the development of an integrated, person-centered healthcare system. Dedicated to our values and in partnership with our communities, we are committed to meeting the total needs of those we serve...mind, body and spirit.
Form 990, Part VI, Line 19: Other Organization Documents Publicly AvailableThe Financial Statements are publicly available through EMMA and public securities markets. The charter and related documents are on file with the Connectiuct T Secretary of State's office. The conflict of interest policy is available upon request.Form 990, Part VI, Line 19
Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of ConflictsAnnually, officers, directors and senior employees are required to complete a conflict of interest disclosure . The results of the officers' and directors disclosures are first reviewed by the board chairman and then reported at he board meetings. Any officer or director shall not make or second motions or vote (other than abstain) on matters if a conflict of interest exists, whether of not the officer or director had an opportunity to make a written disclosure the formalized process. Senior employee disclosures are reported the president and Chief Executive Officer. The entire process is coordinated by the Corporate Compliance Officer. All respondents are advised of their continuing duyt to disclose any possible conflict of interest that may arise during the course of service.Form 990, Part VI, Line 12c
Form 990, Part VI, Line 11: Form 990 Review ProcessMasonicare management reviews the tax return for completeness and accuracy. It is also reviewed by the chief executive officer and chairman of the board. The review process is then discussed with the full board. After responding to comments/questions, changes are made as appropriate and the return is finalized and filed.Form 990, Part VI, Line 11
Form 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or ShareholdersPursuant to the Charter of the organization, Masonicare Corporation, as the sole corporate member, has certain reserved powers to take or approve certain actions of the governing body. These powers include the prior approval of amendments to the organization's certificate of incorporation and bylaws, approval of long range plans, budgets and material changes in budgets, mission statements and policies (including investment policies) as well as sales or transfer of assets, mergers and/or dissolutions and Certificate of Need applications. The sole corporate member's powers also include the appointment and removal of directors MHC, the company's board chair MHC.Form 990, Part VI, Line 7b
Form 990, Part VI, Line 7a: How Members or Shareholders Elect Governing BodyMasonicare Corporation, as a sole corporate member, annually appoints the members of the governing body.Form 990, Part VI, Line 7a
Form 990, Part VI, Line 6: Explanation of Classes of Members or ShareholderThe organization has a sole corporate member, Masonicare Corporation, with the right to appoint the members of the governing body and to participate in the organization's governance.Form 990, Part VI, Line 6

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (8 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
Masonicare at Home Inc
PO Box 70WallingfordCT06492202377783Provide companion/homemaker/personalcare services to elderlyCT501(c)(3)9NAfalse
Keystone Indemnity Company Ltd
126 College Street Suite 400BurlingtonVT05401060371612Provide insurance services to Masonicare affiliatesVT501(c)(3)11aNAfalse
Masonicare Partners HomeHealth & Hospice
111 Founders Plaza Suite 200East HartfordCT06108260758992Provide home health services to clients of all agesCT501(c)(3)9NAfalse
Masonicare Home Health and Hospice Inc
33 North Plains RoadWallingfordCT06492061101924Provided home health services to clients of all agesCT501(c)(3)9NAfalse
Masonicare at Ashlar Village Inc
PO Box 70WallingfordCT06492061050830Continuing care retirement and assisted living communityCT501(c)(3)9NAfalse
Masonicare at Newtown Inc
PO Box 70WallingfordCT06492061070285Provide skilled nursing/assisted living services to elderlyCT501(c)(3)9NAfalse
Masonic Charity Foundation of CT
PO Box 70WallingfordCT06492061435920Provide planned giving and development support to affiliatesCT501(c)(3)7NAfalse
Masonicare Inc
PO Box 70WallingfordCT06492061435919Parent holding and support organization for affilate corps.CT501(c)(3)11cNAfalse

Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntity
Masonic Behavioral Health
PO Box 70WallingfordCT06492061468972Patient CareCTNAC corp
Masonicare Primary Care Physicians PC
PO Box 70WallingfordCT06492061491820Physician medical practiceCTNAC corp
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgtrueOtherTransferFromOtherOrg