2012-06-26T12:15:42-05:00 2011-12-31 410746749 CLIFTONLARSONALLEN LLP 300 CROWN COLONY DRIVE SUITE 310 QUINCY MA 02169 990 2011-01-01 237090088 PENACOOK PLACE INC PENA 9783740707 150 WATER STREET HAVERHILL MA 01830 JULIAN RICH 9783740707 2012-05-22 1 BARBARA J MORRISON P00173340 6179848100 2012-05-22 2011 2016-02-24 21:20:13Z JULIAN RICH 150 WATER STREET HAVERHILL MA 01830 13234201 0 X WWW.PENACOOKPLACE.ORG X 1969 MA OPERATION OF A 160 BED NURSING HOME FACILITY 20 20 303 5 0 0 105111 98238 13109590 13114969 25227 20994 0 0 13239928 13234201 0 0 0 0 9267702 9340174 0 0 1204 3858135 3910745 13125837 13250919 114091 -16718 6921192 6562789 4957672 4607231 1963520 1955558 X TO PROMOTE THE HIGHEST POSSIBLE QUALITY OF LIFE FOR OUR RESIDENTS IN A CLEAN, SAFE AND ATTRACTIVE ENVIRONMENT. TO CARE FOR OUR RESIDENTS AS WE WOULD WANT TO BE CARED FOR-THE GOLDEN RULE OF PENACOOK PLACE. TO MEET OR EXCEED THE EXPECTATIONS OF OUR RESIDENTS, AS WELL AS OTHERS WITH WHOM WE COME IN CONTACT. TO SHOW HOSPITALITY, COURTESY, COOPERATION AND RESPECT TO ALL RESIDENTS, FAMILY MEMBERS, FELLOW EMPLOYEES, VOLUNTEERS AND VISITORS. TO BE AN INTEGRAL, CONTRIBUTING PART OF THE GREATER HAVERHILL BUSINESS, EDUCATIONAL AND CULTURAL COMMUNITIES. 0 0 11993776 13114969 PENACOOK PLACE, INC. IS A NOT FOR PROFIT FACILITY PROVIDING SERVICE TO PRIVATE AND PUBLICLY AIDED PATIENTS AS LEVELS II & III. IT OPERATES A 160 BED NURSING HOME FACILITY. 11993776 1 1 0 0 0 0 0 0 0 0 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 33 0 303 1 0 0 0 0 0 0 0 0 0 0 X 20 20 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X CHARLES CARROZZA 9783740707 150 WATER STREET HAVERHILL MA 01830 HOWARD H BROWN 2.00 X 0 0 0 FRANK NOVAK 2.00 X 0 0 0 RONALD GOLDBERG MD 2.00 X 18000 0 0 JANIS CORDISCHI 2.00 X 0 0 0 ROBERT BARANELLO 2.00 X 0 0 0 JOE MCCARRON 2.00 X 0 0 0 KALISTER GREEN-BYRD 2.00 X 0 0 0 ELAINE DALTON 2.00 X 0 0 0 LUCINDA NOLET 2.00 X 0 0 0 C CARY REA 2.00 X 0 0 0 JOHN G ALBERT 2.00 X 0 0 0 DIANE LOVALLO 2.00 X 0 0 0 WILLIAM J KLUEBER 2.00 X 0 0 0 THOMAS L MORTIMER 2.00 X 0 0 0 FRANCIS W CLEARY JR 2.00 X 0 0 0 MARJORIE A BREWER 2.00 X 0 0 0 JOAN HULL 2.00 X 0 0 0 JULIAN RICH 31.60 X 170486 0 0 CHARLES CARROZZA 31.20 X 83849 0 0 RICHARD SUNDELL 2.00 X 0 0 0 CINDY M RYAN 2.00 X 0 0 0 LISA SALTERIO 41.90 X 117060 0 0 MARK KAUFMAN 40.00 X 101024 0 0 490419 0 0 3 0 1 0 MORRISON MANAGEMENT SPECIALIST PO BOX 102289 ATLANTA GA 30368 DIETARY SERVICES 617055 1 98238 98238 PATIENT REVENUE 623000 13114969 13114969 13114969 20994 20994 13234201 13114969 0 20994 235805 235805 7492856 6936486 556370 1043046 953385 89661 568467 519601 48866 12815 12815 40000 40000 3265 3265 573881 511859 60818 1204 14245 14245 775042 655033 120009 563047 494075 68972 11382 7426 3956 15402 15402 1788 1788 288600 288600 94540 94540 USER FEE 867037 867037 FOOD 406265 406265 EXTINGUISHMENT OF DEBT 197039 197039 BAD DEBTS 24507 24507 21890 21890 13250919 11993776 1255939 1204 283073 597624 441668 253581 1877964 1824831 231698 254283 8346673 5843133 2640072 2503540 532401 746590 914316 382340 6921192 6562789 1451372 1365556 3505000 3241675 1300 4957672 4607231 X 1904520 1905558 59000 50000 1963520 1955558 6921192 6562789 X -16718 8756 X 0 1 1 X 0 X 104636 120916 114724 105111 98238 543625 11295644 11802514 12315685 13109591 13114968 61638402 11400280 11923430 12430409 13214702 13213206 62182027 0 0 0 62182027 87138 75528 35017 25227 20994 243904 87138 75528 35017 25227 20994 243904 11487418 11998958 12465426 13239929 13234200 62425931 0.99610 0.99470 0.00390 0.00530 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 30859 30859 6059350 4067900 1991450 2212265 1766353 445912 44199 8880 35319 2503540 FUNDED RESERVE 160001 DEPOSITS 45042 SOFTWARE, NET 1714 BOND ISSUE COSTS, NET 175583 382340 13234201 13250919 -16718 8756 8756 -7962 13234201 0 13234201 0 13234201 13250919 0 13250919 0 13250919 X 0 0 0 0 0 0 0 0 0 JULIAN RICH 153158 0 17328 0 0 0 0 0 0 0 170486 0 0 0 MASSACHUSETTS DEVELOPMENT FINANCE AGENCY 043431814 NONEAVAIL 2011-11-10 3258000 TO REDEEM MDFA REVENUEREFUNDING BONDS, ISSUED MARCH 1, 2000 0 0 0 3148155 3258000 109845 2011 1 0 1 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 1 0 0 0 0 X ROBERT BARANELLO BOARD MEMBER 40000 COMPANY OWNED BY HIM PROVIDED CONSULTING SERVICES REGARDING MEDICAL RECORDS AND OTHER EDUCATIONAL SERVICES. 0 FORM 990, PART VI, SECTION B, LINE 11 CFO INITIALLY REVIEWS THE FORM 990 AND THEN REVIEWS IT WITH THE PRESIDENT/CEO OF THE ORGANIZATION, BOTH PARTIES APPROVE THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C AT THE SEPTEMBER BOARD OF DIRECTOR'S MEETING, EVERY BOARD MEMBER IS GIVEN A COPY OF THE CONFLICT OF INTEREST STATEMENT TO READ AND SIGN. ALL BOARD MEMBERS ARE REQUIRED TO SIGN. THE POLICY OUTLINES THE RESTRICTIONS IMPOSED UPON THE BOARD IF ANY CONFLICT SHOULD EXIST. ALL STAFF MEMBERS ARE PRESENTED INFORMATION REGARDING ORGANIZATIONAL INTEGRITY UPON HIRE AND DURING THEIR ANNUAL ORIENTATION. CONFLICT OF INTEREST IS INCLUDED IN OUR O.I. PROGRAM AND STAFF IS REQUIRED TO REVIEW AS PART OF THEIR CONTINUED EMPLOYMENT. FORM 990, PART VI, SECTION B, LINE 15 A PERSONNEL COMMITTEE WAS ESTABLISHED AS A SUB-COMMITTEE OF THE BOARD OF DIRECTORS. THE FOCUS OF THIS GROUP IS TO REVIEW AND EVALUATE THE PRESIDENT/CEO ON AN ANNUAL BASIS, THE PERSONNEL COMMITTEE RECEIVES INPUT FROM ALL BOARD MEMBERS AND DEPARTMENT HEADS. THE PERSONNEL COMMITTEE THEN MAKES THEIR RECOMMENDATION TO THE FULL BOARD FOR FINAL APPROVAL. THIS PROCESS IS CONDUCTED ANNUALLY AND TAKES PLACE STARTING IN JANUARY OF EACH YEAR TO EVALUATE THE PERFORMANCE OF THE PRESIDENT/CEO FOR YEAR JUST COMPLETED. THE LAST TIME THIS PROCESS WAS CONDUCTED WAS JANUARY 2011 FOR THE 2010 CALENDAR YEAR. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE TO THE PUBLIC, UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 8,756.