2012-07-30T09:02:10-05:00 2011-12-31 020383073 WILLIAM STEELE & ASSOCIATES PC 40 STARK STREET MANCHESTER NH 03101 990 2011-01-01 043333609 CHS OF WALTHAM INC CHSO 7818930240 66 NEWTON STREET WALTHAM MA 02453 CAROLYN FENN 7818930240 2012-07-23 1 MICHAEL A BARBARITA CPA P00801253 6036228881 2011 2016-02-24 21:20:13Z MARISTHILL NURSING & REHABILTATION CENTER CAROLYN FENN 66 NEWTON STREET WALTHAM MA 02453 10795553 0 0928 X MARITHILL.ORG X 1996 MA MARISTHILL 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. 10 8 162 0 0 0 27590 26945 11038749 10747752 17238 16060 17348 4796 11100925 10795553 0 0 0 0 6286134 6216478 0 0 0 4504014 4526338 10790148 10742816 310777 52737 10351680 10254605 8446659 8302897 1905021 1951708 MARISTHILL 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. 0 0 10569932 10747752 MARISTHILL NURSING AND REHABILITATION CENTER PROVIDED 40,062 DAYS OF SKILLED NURSING SERVICES DURING 2011 OF WHICH 27,764 WERE TO MEDICAID RECIPIENTS. 10569932 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 8 0 1 162 1 0 0 0 0 0 0 0 0 0 0 X 10 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X X CAROLYN FENN CEO 7818930240 66 NEWTON STREET WALTHAM MA 02453 KENNETH FERRON 1.00 X X 0 285362 191638 LUKE STANTON ESQ 1.00 X 0 0 0 CAROL EAST MSWLCSW 1.00 X 0 0 0 MARY ELIZABETH SCANLON RN 1.00 X 0 0 0 MICHAEL DELANEY ESQ 1.00 X 0 0 0 LISA LORGEREE 1.00 X X 0 0 0 MARIE LABOLLITA SC 1.00 X X 0 0 0 JOSEPH SGRO 40.00 X X 88714 0 1064 CAROLYN FENN 40.00 X X 101336 0 6537 KELLY MCDADE 1.00 X 0 0 0 JUDITH ALLEN 1.00 X 0 0 0 190050 285362 199239 1 0 1 0 PEOPLE FIRST REHABILITATION PO BOX 277365 ATLANTA GA 30384 REHABILTATION SERVICES 697518 US FOODS PO BOX 3155 BOSTON MA 02241 FOOD SERVICE 337791 PARTNERS PHARMACY OF MA 181 CEDAR HILL ROAD MARLBORO MA 01752 PHARMACY 243670 NEHM CORPORATION 1565 MAIN STREET TEWKSBURY MA 01888 HOUSEKEEPING 210656 GULF SOUTH 14 N WENTWORTH AVENUE LONDONDERRY NH 03053 MEDICAL SUPPLIES 159750 5 26945 26945 PATIENT SERVICE REVENU 623000 10747752 10747752 10747752 16060 16060 MEDICAID USER FEE 623000 2712 2712 VENDING MACHINE 623000 1967 1967 MISCELLANEOUS 623000 117 117 4796 10795553 10747752 0 20856 190050 190050 5134289 5134289 20763 20763 480087 480087 391289 391289 126588 126588 8597 8597 37699 37699 18689 18689 99223 99223 361438 361438 3795 3795 349317 349317 387811 387811 93369 93369 PURCHASED SERVICES 1309069 1309069 NURSING HOME SUPPLIES A 954833 954833 MEDICAID USER FEE 598602 598602 BAD DEBT EXPENSE 139403 139403 37905 37905 10742816 10569932 172884 0 1088563 306600 505175 1570324 1251461 1017054 33831 55716 9539591 4046406 5606794 5493185 740912 744779 1124944 1066947 10351680 10254605 759579 670945 7018389 6986207 668691 645745 8446659 8302897 X 1905021 1951708 1905021 1951708 10351680 10254605 X 52737 -6050 X 0 1 1 X 0 X 17211 32861 5997 44938 26945 127952 10142791 11133664 10925173 11027802 10746498 53975928 10160002 11166525 10931170 11072740 10773443 54103880 0 0 0 54103880 54486 22158 35704 28185 1660 142193 54486 22158 35704 28185 1660 142193 10214488 11188683 10966874 11100925 10775103 54246073 0.99740 0.99620 0.00260 0.00380 X 485000 485000 6042919 2077699 3965220 2643400 1937672 705728 368272 31035 337237 5493185 RESIDENT FUNDS 23093 DEBT SERVICE RESERVE FUND 712941 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 1066947 DEFERED EXPENSES 229211 MEDICAID USER FEES 146103 PROFESSIONAL LIABILITY LOSS RESERVES 50001 DUE TO AFFILIATES 196807 DUE TO 3RD PARTY PAYER 630 RESIDENT FUNDS 22993 645745 X X X X 0 1 0 0 0 0 1 0 0 KENNETH FERRON 0 258208 0 0 0 27154 0 166434 0 25204 0 477000 0 0 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 NO INCENTIVE COMPENSATION AWARDS IN 2011 BASED ON PERFORMANCE DURING 2010. MA HEALTH & EDUCATION FACILITIES AUTHORITY 042456011 57586DBF9 2007-10-30 7221865 TO FINANCE THE PURCHASE OF YOUVILLE PLACE 1 0 0 7221865 712880 55862 6117244 1 1 1 1 0 0 0 0 0.00000 0.00000 0.00000 1 1 0 0 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 COVENANT 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 7A COVENANT 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 7B COVENANT 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 11 THE FORM 990 IS PROVIDED TO AND REVIEWED WITH THE BOARD PRIOR TO FILING FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A FULL-TIME OPERATIONAL INTEGRITY OFFICER THAT MONITORS ALL AREAS FOR POTENTIAL CONFLICTS OF INTEREST. 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. 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 19 THE FORM 990 AND GOVERNING DOCUMENTS, INCLUDING THE CONFLICT OF INTEREST POLICY, AND THE FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -6,050. COVENANT HEALTH SYSTEMS 100 AMES POND DRIVE TEWKSBURY MA 01876 222484505 HEALTH CARE MANAGEMENT AND RESOURCE ORGANIZATION MA 501(C) 509(A) 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 COVENANT HEALTH SYSTEMS L 126588 COST