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CHS OF WALTHAM INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
CHS OF WALTHAM INC (EIN 04-3333609)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-07-30
IRS object ID
201212129349300416
Schema version
2011v1.2
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)
Timestamp2012-07-30T09:02:10-05:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN020383073EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1WILLIAM STEELE & ASSOCIATES PCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line140 STARK STREETAddressLine1
CityMANCHESTERCity
StateNHState
ZIP Code03101ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN043333609EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1CHS OF WALTHAM INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCHSONameControl
Phone7818930240Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line166 NEWTON STREETAddressLine1
CityWALTHAMCity
StateMAState
ZIP Code02453ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameCAROLYN FENNName
TitleCEOTitle
Phone7818930240Phone
Date Signed2012-07-23DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameMICHAEL A BARBARITA CPAName
PTINP00801253PTIN
Phone6036228881Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

FieldValueIRS element (for citing)
Business Name Line1MARISTHILL NURSING & REHABILTATIONBusinessNameLine1
Business Name Line2CENTERBusinessNameLine2
FieldValueIRS element (for citing)
Name Of Principal Officer PersonCAROLYN FENNNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line166 NEWTON STREETAddressLine1
CityWALTHAMCity
StateMAState
ZIP Code02453ZIPCode
FieldValueIRS element (for citing)
Gross Receipts10795553GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Group Exemption Number0928GroupExemptionNumber
Organization501c3XOrganization501c3
Web SiteMARITHILL.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1996YearFormation
State Legal DomicileMAStateLegalDomicile
Activity Or Mission DescriptionMARISTHILL IS A CATHOLIC SKILLED NURSING AND REHABILITATION FACILITY THAT CONTINUES THE HEALING MINISTRY OF CHRIST BY PROVIDING HEALTH CARE SERVICES THAT FOSTER EACH INDIVIDUAL'S PHYSICAL, SPIRITUAL, EMOTIONAL AND INTELLECTUAL WELL-BEING.ActivityOrMissionDescription
Nbr Voting Members Governing Body10NbrVotingMembersGoverningBody
Nbr Independent Voting Members8NbrIndependentVotingMembers
Total Nbr Employees162TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year27590ContributionsGrantsPriorYear
Contributions Grants Current Year26945ContributionsGrantsCurrentYear
Program Service Revenue Prior Year11038749ProgramServiceRevenuePriorYear
Program Service Revenue CY10747752ProgramServiceRevenueCY
Investment Income Prior Year17238InvestmentIncomePriorYear
Investment Income Current Year16060InvestmentIncomeCurrentYear
Other Revenue Prior Year17348OtherRevenuePriorYear
Other Revenue Current Year4796OtherRevenueCurrentYear
Total Revenue Prior Year11100925TotalRevenuePriorYear
Total Revenue Current Year10795553TotalRevenueCurrentYear
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 Year6286134SalariesEtcPriorYear
Salaries Etc Current Year6216478SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year4504014OtherExpensePriorYear
Other Expenses Current Year4526338OtherExpensesCurrentYear
Total Expenses Prior Year10790148TotalExpensesPriorYear
Total Expenses Current Year10742816TotalExpensesCurrentYear
Revenues Less Expenses Prior Year310777RevenuesLessExpensesPriorYear
Revenues Less Expenses CY52737RevenuesLessExpensesCY
Total Assets BOY10351680TotalAssetsBOY
Total Assets EOY10254605TotalAssetsEOY
Total Liabilities BOY8446659TotalLiabilitiesBOY
Total Liabilities EOY8302897TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY1905021NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY1951708NetAssetsOrFundBalancesEOY
Mission DescriptionMARISTHILL IS A CATHOLIC SKILLED NURSING AND REHABILITATION FACILITY THAT CONTINUES THE HEALING MINISTRY OF CHRIST BY PROVIDING HEALTH CARE SERVICES THAT FOSTER EACH INDIVIDUAL'S PHYSICAL, SPIRITUAL, EMOTIONAL AND INTELLECTUAL WELL-BEING.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense10569932Expense
Revenue10747752Revenue
DescriptionMARISTHILL NURSING AND REHABILITATION CENTER PROVIDED 40,062 DAYS OF SKILLED NURSING SERVICES DURING 2011 OF WHICH 27,764 WERE TO MEDICAID RECIPIENTS.Description
Total Program Service Expense10569932TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
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
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10968NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees162NumberOfEmployees
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 Members10NbrVotingGoverningBodyMembers
Number Independent Voting Members8NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledMAStatesWhereCopyOfReturnIsFiled
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1CAROLYN FENN CEOBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number7818930240TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line166 NEWTON STREETAddressLine1
CityWALTHAMCity
StateMAState
ZIP Code02453ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (11 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
KENNETH FERRON
TREASURER1.00XX0285362191638
LUKE STANTON ESQ
TRUSTEE1.00X000
CAROL EAST MSWLCSW
TRUSTEE1.00X000
MARY ELIZABETH SCANLON RN
TRUSTEE1.00X000
MICHAEL DELANEY ESQ
TRUSTEE1.00X000
LISA LORGEREE
CHAIR1.00XX000
MARIE LABOLLITA SC
SECRETARY1.00XX000
JOSEPH SGRO
CHIEF FINANCIAL OFFICER40.00XX8871401064
CAROLYN FENN
CEO/ADMINISTRATOR40.00XX10133606537
KELLY MCDADE
TRUSTEE1.00X000
JUDITH ALLEN
TRUSTEE1.00X000
FieldValueIRS element (for citing)
Total Reportable Comp From Org190050TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs285362TotalReportableCompFrmRltdOrgs
Total Other Compensation199239TotalOtherCompensation
Number Individuals GT100 K1NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
PEOPLE FIRST REHABILITATION
PO BOX 277365ATLANTAGA30384REHABILTATION SERVICES697518
US FOODS
PO BOX 3155BOSTONMA02241FOOD SERVICE337791
PARTNERS PHARMACY OF MA
181 CEDAR HILL ROADMARLBOROMA01752PHARMACY243670
NEHM CORPORATION
1565 MAIN STREETTEWKSBURYMA01888HOUSEKEEPING210656
GULF SOUTH
14 N WENTWORTH AVENUELONDONDERRYNH03053MEDICAL SUPPLIES159750
FieldValueIRS element (for citing)
Number Of Contractors GT100 K5NumberOfContractorsGT100K
All Other Contributions26945AllOtherContributions
Total Contributions26945TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPATIENT SERVICE REVENUDescription
Business Code623000BusinessCode
Total Revenue Column10747752TotalRevenueColumn
Related Or Exempt Function Income10747752RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue10747752TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column16060TotalRevenueColumn
Exclusion$16,060ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
MEDICAID USER FEE6230002712$2,712
VENDING MACHINE6230001967$1,967
MISCELLANEOUS623000117$117
FieldValueIRS element (for citing)
Total Other Revenue4796TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column10795553TotalRevenueColumn
Related Or Exempt Function Income10747752RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$20,856ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total190050Total
Program Services190050ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total5134289Total
Program Services5134289ProgramServices

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total20763Total
Program Services20763ProgramServices

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total480087Total
Program Services480087ProgramServices

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total391289Total
Program Services391289ProgramServices

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total126588Total
Management And General126588ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total8597Total
Management And General8597ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total37699Total
Management And General37699ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total18689Total
Program Services18689ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total99223Total
Program Services99223ProgramServices

Occupancy Occupancy

FieldValueIRS element (for citing)
Total361438Total
Program Services361438ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total3795Total
Program Services3795ProgramServices

Interest Interest

FieldValueIRS element (for citing)
Total349317Total
Program Services349317ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total387811Total
Program Services387811ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total93369Total
Program Services93369ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServices
PURCHASED SERVICES13090691309069
NURSING HOME SUPPLIES A954833954833
MEDICAID USER FEE598602598602
BAD DEBT EXPENSE139403139403

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total37905Total
Program Services37905ProgramServices

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total10742816Total
Program Services10569932ProgramServices
Management And General172884ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY1088563BOY
EOY306600EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY505175BOY
EOY1570324EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1251461BOY
EOY1017054EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY33831BOY
EOY55716EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis9539591LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec4046406LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY5606794BOY
EOY5493185EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY740912BOY
EOY744779EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY1124944BOY
EOY1066947EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY10351680BOY
EOY10254605EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY759579BOY
EOY670945EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY7018389BOY
EOY6986207EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY668691BOY
EOY645745EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY8446659BOY
EOY8302897EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY1905021BOY
EOY1951708EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY1905021BOY
EOY1951708EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY10351680BOY
EOY10254605EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses52737ReconcilationRevenueExpenses
Reconcilation Other Changes-6050ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
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 Years17211CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years32861CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years5997CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year44938CurrentTaxYearMinus1Year
Current Tax Year26945CurrentTaxYear
Total127952Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years10142791CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years11133664CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years10925173CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year11027802CurrentTaxYearMinus1Year
Current Tax Year10746498CurrentTaxYear
Total53975928Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years10160002CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years11166525CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years10931170CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year11072740CurrentTaxYearMinus1Year
Current Tax Year10773443CurrentTaxYear
Total54103880Total

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 Total50954103880PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years54486CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years22158CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years35704CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year28185CurrentTaxYearMinus1Year
Current Tax Year1660CurrentTaxYear
Total142193Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years54486CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years22158CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years35704CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year28185CurrentTaxYearMinus1Year
Current Tax Year1660CurrentTaxYear
Total142193Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years10214488CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years11188683CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years10966874CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year11100925CurrentTaxYearMinus1Year
Current Tax Year10775103CurrentTaxYear
Total54246073Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99740PublicSupportPercentage509
Prior Year Support Percentage0.99620PriorYearSupportPercentage
Investment Income Percentage0.00260InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00380PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis485000OtherCostOrOtherBasis
Book Value485000BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis6042919OtherCostOrOtherBasis
Depreciation2077699Depreciation
Book Value3965220BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis2643400OtherCostOrOtherBasis
Depreciation1937672Depreciation
Book Value705728BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis368272OtherCostOrOtherBasis
Depreciation31035Depreciation
Book Value337237BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings5493185TotalOfBookValueLandBuildings

Other Assets OtherAssets (7 entries)

DescriptionDescriptionBook ValueBookValue
RESIDENT FUNDS23093
DEBT SERVICE RESERVE FUND712941
BOND ISSUE COSTS (NET)46027
BOND UNDERWRITING COSTS (NET)18740
BOND DISCOUNT (NET)45931
DEBT SERVICE SINKING FUND (NET)190381
CAPITALIZED FINANCING COSTS (NET)29834
FieldValueIRS element (for citing)
Total Book Value Other Assets1066947TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (6 entries)

DescriptionDescriptionAmountAmount
DEFERED EXPENSES$229,211
MEDICAID USER FEES$146,103
PROFESSIONAL LIABILITY LOSS RESERVES$50,001
DUE TO AFFILIATES$196,807
DUE TO 3RD PARTY PAYER$630
RESIDENT FUNDS$22,993
FieldValueIRS element (for citing)
Total Of Amounts645745TotalOfAmounts

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
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 Orgs1CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII

FieldValueIRS element (for citing)
Name PersonKENNETH FERRONNamePerson
Base Compensation Filing Org0BaseCompensationFilingOrg
Comp Based On Related Orgs258208CompBasedOnRelatedOrgs
Bonus Filing Org0BonusFilingOrg
Bonus Related Orgs0BonusRelatedOrgs
Other Compensation Filing Org0OtherCompensationFilingOrg
Other Compensation Related Orgs27154OtherCompensationRelatedOrgs
Deferred Comp Filing Org0DeferredCompFilingOrg
Deferred Comp Related Orgs166434DeferredCompRelatedOrgs
Nontaxable Benefits Filing Org0NontaxableBenefitsFilingOrg
Nontaxable Benefits Related Orgs25204NontaxableBenefitsRelatedOrgs
Total Compensation Filing Org0TotalCompensationFilingOrg
Total Compensation Related Orgs477000TotalCompensationRelatedOrgs
Comp Report Prior990 Filing Org0CompReportPrior990FilingOrg
Comp Report Prior990 Related Orgs0CompReportPrior990RelatedOrgs

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanation
PART I, LINE 4BTHE 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 6THE 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 NO INCENTIVE COMPENSATION AWARDS IN 2011 BASED ON PERFORMANCE DURING 2010.

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1MA HEALTH & EDUCATION FACILITIES AUTHORITYBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN042456011IssuerEIN
CUSIP Number57586DBF9CUSIPNumber
Date Issued2007-10-30DateIssued
Issue Price7221865IssuePrice
Description Of PurposeTO FINANCE THE PURCHASE OF YOUVILLE PLACEDescriptionOfPurpose
Defeased1Defeased
On Behalf Of Issuer0OnBehalfOfIssuer
Pool Financing0PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Total Proceeds7221865TotalProceeds
Amount In Reserve Fund712880AmountInReserveFund
Issuance Costs From Proceeds55862IssuanceCostsFromProceeds
Capital Expenditures6117244CapitalExpenditures
Current Refunding1CurrentRefunding
Advance Refunding1AdvanceRefunding
Final Allocation Made1FinalAllocationMade
Adequate Books And Recds Maintaind1AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements0AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty0MngmentCntrctBondFinancdPrprty
Any Research Agreements0AnyResearchAgreements
Prcntge Prvt Business Use By Others0.00000PrcntgePrvtBusinessUseByOthers
Percentage Of Prvt Business Re UBI0.00000PercentageOfPrvtBusinessReUBI
Total Private Business Use0.00000TotalPrivateBusinessUse
Post Issuance Compliance Procdrs1PostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Form8038 T Filed1Form8038TFiled
Variable Rate Issue0VariableRateIssue
Hedge Identified In Books And Recds0HedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGIC
Gross Proceeds Invested0GrossProceedsInvested
Exception To Rebate0ExceptionToRebate

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 6COVENANT HEALTH SYSTEMS IS THE SOLE MEMBER OF THE ORGANIZATION OF THE BOARD. AS SUCH IT RETAINS CERTAIN RESERVE RIGHTS OVER BOARD DECISIONS AND BOARD COMPOSITION.
FORM 990, PART VI, SECTION A, LINE 7ACOVENANT HEALTH SYSTEMS IS THE SOLE MEMBER OF THE ORGANIZATION. AS SUCH IT RETAINS CERTAIN RESERVE RIGHTS OVER CORPORATE DECISIONS AND BOARD COMPOSITION.
FORM 990, PART VI, SECTION A, LINE 7BCOVENANT HEALTH SYSTEMS IS THE SOLE MEMBERS OF THE ORGANIZATION. AS SUCH IT RETAINS CERATIN RESERVE RIGHTS OVER BOARD DECISIONS AND BOARD COMPOSITION.
FORM 990, PART VI, SECTION B, LINE 11THE FORM 990 IS PROVIDED TO AND REVIEWED WITH THE BOARD PRIOR TO FILING
FORM 990, PART VI, SECTION B, LINE 12CTHE ORGANIZATION HAS A FULL-TIME OPERATIONAL INTEGRITY OFFICER THAT MONITORS ALL AREAS FOR POTENTIAL CONFLICTS OF INTEREST.
FORM 990, PART VI, SECTION B, LINE 15EVERY 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. THE SPECIFIC OBJECTIVES OF THE ANALYSIS ARE TO ASSESS THE COMPETITIVENESS OF THE CURRENT TOTAL CASH COMPENSATION LEVELS FOR THE SENIOR LEADERSHIP TEAM; DEVELOP MARKET COMPETITIVE SALARY RANGES FOR ALL EXECUTIVE POSITIONS AND ENSURE THAT THE ANNUAL INCENTIVE OPPORTUNITIES, IF ANY, ARE COMPETITIVE AND REASONABLE.
FORM 990, PART VI, SECTION C, LINE 19THE FORM 990 AND GOVERNING DOCUMENTS, INCLUDING THE CONFLICT OF INTEREST POLICY, AND THE FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART XI, LINE 5:NET UNREALIZED LOSSES ON INVESTMENTS: -6,050.CHANGES IN NET ASSETS OR FUND BALANCES:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1COVENANT HEALTH SYSTEMSBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1100 AMES POND DRIVEAddressLine1
CityTEWKSBURYCity
StateMAState
ZIP Code01876ZIPCode
FieldValueIRS element (for citing)
EIN222484505EIN
Primary ActivitiesHEALTH CARE MANAGEMENT AND RESOURCE ORGANIZATIONPrimaryActivities
Legal Domicile StateMALegalDomicileState
Exempt Code Section501(C)ExemptCodeSection
Public Charity Status509(A)PublicCharityStatus
Controlled Org0ControlledOrg
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 Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
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 Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
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

Transactions Related Orgs Table TransactionsRelatedOrgsTable

Name Of Other Organization NameOfOtherOrganization

FieldValueIRS element (for citing)
Business Name Line1COVENANT HEALTH SYSTEMSBusinessNameLine1
FieldValueIRS element (for citing)
Transaction TypeLTransactionType
Amount Involved126588AmountInvolved
Method Of Amt DeterminationCOSTMethodOfAmtDetermination