COVENANT HEALTH INVESTMENT TRUST: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- COVENANT HEALTH INVESTMENT TRUST (EIN 04-6835128)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-07-03
- IRS object ID
- 201241859349300624
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-07-03T12:35:00-05:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 020383073 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WILLIAM STEELE & ASSOCIATES PC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 40 STARK STREET | AddressLine1 |
| City | MANCHESTER | City |
| State | NH | State |
| ZIP Code | 03101 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 046835128 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PROVIDENTIA PRIMA TRUST | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | PROV | NameControl |
| Phone | 9786546363 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 AMES POND DRIVE | AddressLine1 |
| City | TEWKSBURY | City |
| State | MA | State |
| ZIP Code | 01876 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JOHN AHLE | Name |
| Title | CHIEF FINANCIAL OFFICER | Title |
| Phone | 9786546363 | Phone |
| Date Signed | 2012-06-27 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | MICHAEL A BARBARITA CPA | Name |
| PTIN | P00801253 | PTIN |
| Phone | 6036228881 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | JOHN AHLE | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 AMES POND DRIVE | AddressLine1 |
| City | TEWKSBURY | City |
| State | MA | State |
| ZIP Code | 01876 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 6917669 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | COVENANTHS.ORG | WebSite |
| Type Of Organization Trust | X | TypeOfOrganizationTrust |
| Year Formation | 1996 | YearFormation |
| State Legal Domicile | MA | StateLegalDomicile |
| Activity Or Mission Description | PROVIDENTIA PRIMA WAS ESTABLISHED TO HOLD AND MANAGE POOLED INVESTMENTS OF VARIOUS ORGANIZATIONS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501 (C) (3) | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 7 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 3 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 0 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 0 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 3861998 | InvestmentIncomePriorYear |
| Investment Income Current Year | 6887078 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 0 | OtherRevenuePriorYear |
| Other Revenue Current Year | 30591 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 3861998 | TotalRevenuePriorYear |
| Total Revenue Current Year | 6917669 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 0 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 0 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 700050 | OtherExpensePriorYear |
| Other Expenses Current Year | 793693 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 700050 | TotalExpensesPriorYear |
| Total Expenses Current Year | 793693 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 3161948 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 6123976 | RevenuesLessExpensesCY |
| Total Assets BOY | 129137949 | TotalAssetsBOY |
| Total Assets EOY | 147469529 | TotalAssetsEOY |
| Total Liabilities BOY | 145768 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 2173965 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 128992181 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 145295564 | NetAssetsOrFundBalancesEOY |
| Mission Description | PROVIDENTIA PRIMA WAS ESTABLISHED TO HOLD AND MANAGE POOLED INVESTMENTS OF VARIOUS ORGANIZATIONS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501 (C) (3). | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Description | N/A | Description |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 0 | ReportLandBldgEquip |
| Report Invest Oth Securities | 1 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 7 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 3 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Other Website | X | OtherWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JOHN AHLE | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 9786546363 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 AMES POND DRIVE | AddressLine1 |
| City | TEWKSBURY | City |
| State | MA | State |
| ZIP Code | 01876 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (7 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation |
|---|---|---|---|---|---|---|
| JOHN AHLE | ||||||
| TREASURER/SECRETARY | 1.00 | X | X | 0 | 357922 | 165006 |
| CAROLYN KASABIAN | ||||||
| TRUSTEE | 1.00 | X | 0 | 269457 | 32372 | |
| DONALD M DEHART | ||||||
| CHAIR/PRESIDENT | 3.00 | X | X | 0 | 0 | 0 |
| RICHARD J PLAMONDON | ||||||
| VICE PRESIDENT | 1.00 | X | X | 0 | 286815 | 44999 |
| WILLIAM ADAMS | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| PAUL ERCOLINI | ||||||
| TRUSTEE | 1.00 | X | 0 | 148097 | 33036 | |
| KEVIN HALLORAN | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1062291 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 275413 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (4 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| SILCHESTER INTERNATIONAL INVESTORS | |||||
| 780 3RD AVENUE 42ND FLOOR | NEW YORK | NY | 10017 | INVESTMENT MANAGER | 126048 |
| STATE STREET BANK & TRUST | |||||
| 200 CLARENDON STREET | BOSTON | MA | 02116 | CUSTODIAN FEES | 112672 |
| IRONBRIDGE CAPITAL MANAGEMENT LP | |||||
| ONE PARKVIEW PLAZA SUITE 600 | OAKBROOK TERRACE | IL | 60181 | INVESTMENT MANAGER | 111737 |
| OAKBROOK INVESTMENTS LLC | |||||
| 2300 CABOT DRIVE SUITE 300 | LISLE | IL | 60532 | INVESTMENT MANAGER | 101975 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 4 | NumberOfContractorsGT100K |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 3511159 | TotalRevenueColumn |
| Exclusion | $3,511,159 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 3375919 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 3375919 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 3375919 | TotalRevenueColumn |
| Exclusion | $3,375,919 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | OTHER | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 30591 | TotalRevenueColumn |
| Exclusion | $30,591 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 30591 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 6917669 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $6,917,669 | ExclusionAmount |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 33653 | Total |
| Management And General | 33653 | ManagementAndGeneral |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 701258 | Total |
| Management And General | 701258 | ManagementAndGeneral |
Other Expenses OtherExpenses (2 entries)
| DescriptionDescription | TotalTotal | Management And GeneralManagementAndGeneral |
|---|---|---|
| ADMINISTRATION EXPENSE | 40000 | 40000 |
| MISCELLANEOUS EXPENSES | 18782 | 18782 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 793693 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 793693 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1408728 | BOY |
| EOY | 5904476 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 88494535 | BOY |
| EOY | 100868488 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 39173148 | BOY |
| EOY | 40629611 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 61538 | BOY |
| EOY | 66954 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 129137949 | BOY |
| EOY | 147469529 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 145768 | BOY |
| EOY | 2173965 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 145768 | BOY |
| EOY | 2173965 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Do Not Follow SFAS117 | X | DoNotFollowSFAS117 |
Cap Stck Trst Prin Current Funds CapStckTrstPrinCurrentFunds
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Paid In Cap Srpls Land Bldg Eqp Fund PaidInCapSrplsLandBldgEqpFund
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 128992181 | BOY |
| EOY | 145295564 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 128992181 | BOY |
| EOY | 145295564 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 129137949 | BOY |
| EOY | 147469529 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 6123976 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 10179407 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | X | SupportingOrganization509a3 |
| Supporting Org509a3 Type1 | X | SupportingOrg509a3Type1 |
| Certification Checkbox | X | CertificationCheckbox |
| Contrib By Controlling Individual | 0 | ContribByControllingIndividual |
| Contribution By Related Party | 0 | ContributionByRelatedParty |
| Contrib By35 Controlled Entity | 0 | ContribBy35ControlledEntity |
Supported Org Information SupportedOrgInformation (14 entries)
| EINEIN | Type Of OrganizationTypeOfOrganization | Listed In Governing DocListedInGoverningDoc | Supported Organization NotifiedSupportedOrganizationNotified | Organized In USOrganizedInUS | AmountAmount |
|---|---|---|---|---|---|
| COVENANT HEALTH SYSTEMS | |||||
| 222484505 | 9 | 1 | 1 | 1 | $0 |
| ST MARY'S HEALTH SYSTEM INC | |||||
| 222504349 | 9 | 1 | 1 | 1 | $0 |
| FANNY ALLEN CORPORATION | |||||
| 222495808 | 9 | 1 | 1 | 1 | $0 |
| CHS OF WALTHAM INC | |||||
| 043333609 | 9 | 1 | 1 | 1 | $0 |
| ST JOSEPH HOSPITAL | |||||
| 020222215 | 3 | 1 | 1 | 1 | $0 |
| YOUVILLE HOSPITAL | |||||
| 043239563 | 3 | 1 | 1 | 1 | $0 |
| YOUVILLE PLACE INC | |||||
| 043297834 | 9 | 1 | 1 | 1 | $0 |
| ST ANDRE HEALTH CARE FACILITY | |||||
| 010342399 | 9 | 1 | 1 | 1 | $0 |
| MI NURSINGRESTORATIVE CENTER INC | |||||
| 042104851 | 9 | 1 | 1 | 1 | $0 |
| ST MARY'S VILLA NURSING HOME INC | |||||
| 232057177 | 9 | 1 | 1 | 1 | $0 |
| MI MANAGEMENT INC | |||||
| 042857794 | 9 | 1 | 1 | 1 | $0 |
| MI ADULT DAY HEALTH CENTER INC | |||||
| 042921888 | 9 | 1 | 1 | 1 | $0 |
| MI TRANSPORTATION INC | |||||
| 042921889 | 9 | 1 | 1 | 1 | $0 |
| YOUVILLE HOUSE INC | |||||
| 043239593 | 9 | 1 | 1 | 1 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Number Of Supported Orgs | 14 | TotalNumberOfSupportedOrgs |
| Sum Of Amounts | 0 | SumOfAmounts |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 0 | TotalOfBookValueLandBuildings |
Other Securities OtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | ALTERNATIVE INVESTMENTS | Description |
| Book Value | 40629611 | BookValue |
| Method Of Valuation | F | MethodOfValuation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 40629611 | TotalOfBookValueSecurities |
| Total Revenue | 6917669 | TotalRevenue |
| Total Expenses | 793693 | TotalExpenses |
| Excess Or Deficit For Year | 6123976 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | -5348658 | NetUnrealizedGLOnInvestments |
| Other | $15,528,065 | OtherAmount |
| Total Adjustments | 10179407 | TotalAdjustments |
| Excess Or Deficit Per FS | 16303383 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 775000 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | -5348658 | NetUnrealizedGainsInvestments |
| Revenue Not Rptd F990 | -5348658 | RevenueNotRptdF990 |
| Revenue Subtotal | 6123658 | RevenueSubtotal |
| Other Revenues Not Included | 794011 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 794011 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 6917669 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 0 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 0 | ExpensesSubtotal |
| Other Expenses Not Included | 793693 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 793693 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 793693 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| PART XI, LINE 8 - OTHER ADJUSTMENTS: | TRANSFER TO AFFILIATES 15,527,670. ROUNDING 395. TOTAL TO SCHEDULE D, PART XI, LINE 8: 15,528,065. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | INVESTMENT EXPENSES INCLUDED IN REVENUE 793,693. ROUNDING 318. |
| PART XIII, LINE 4B - OTHER ADJUSTMENTS: | INVESTMENT EXPENSES INCLUDED IN REVENUE 793,693. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (4 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JOHN AHLE | |||||||||||||
| 0 | 334045 | 0 | 0 | 0 | 23877 | 0 | 132988 | 0 | 32018 | 0 | 522928 | 0 | 0 |
| CAROLYN KASABIAN | |||||||||||||
| 0 | 255058 | 0 | 0 | 0 | 14399 | 0 | 6369 | 0 | 26003 | 0 | 301829 | 0 | 0 |
| RICHARD J PLAMONDON | |||||||||||||
| 0 | 233164 | 0 | 30283 | 0 | 23368 | 0 | 23171 | 0 | 21828 | 0 | 331814 | 0 | 0 |
| PAUL ERCOLINI | |||||||||||||
| 0 | 111993 | 0 | 15503 | 0 | 20601 | 0 | 5347 | 0 | 27689 | 0 | 181133 | 0 | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (5 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | THE BOARD OF TRUSTEES DELEGATED MANAGEMENT DUTIES TO CARDINAL INVESTMENT MANAGEMENT, INC. (EIN 04-3391257). | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE 990 IS PRESENTED TO, AND REVIEWED BY, THE BOARD PRIOR TO FILING. | |
| FORM 990, PART VI, SECTION B, LINE 12C | THE MONITORING AND ENFORCEMENT OF COMPLIANCE WITH THE POLICY IS COMPLETED AT THE INDIVIDUAL BOARD LEVELS OF THE ENTITIES THAT ARE SHAREHOLDERS OF PROVIDENTIA PRIMA. | |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. | |
| FORM 990, PART XI, LINE 5: | NET UNREALIZED LOSSES ON INVESTMENTS: -5,348,658. TRANSFER TO AFFILIATES 15,527,670. ROUNDING 395. TOTAL TO FORM 990, PART XI, LINE 5: 10,179,407. | CHANGES IN NET ASSETS OR FUND BALANCES: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (15 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| COVENANT HEALTH SYSTEM INC | |||||||||||
| 100 AMES POND DRIVE | TEWKSBURY | MA | 01876 | 222484505 | MANAGEMENT AND HEALTH RESOURCE ORGANIZATION | MA | 501(C)(3) | LINE 9 | N/A | 0 | |
| ST MARY'S HEALTH SYSTEM | |||||||||||
| PO BOX 7291 | LEWISTON | ME | 04243 | 222504349 | PARENT COMPANY | ME | 501(C)(3) | LINE 9 | 0 | COVENANT HEALTH SYSTEMS | |
| FANNY ALLEN CORPORATION | |||||||||||
| 790 COLLEGE PARKWAY | COLCHESTER | VT | 05446 | 222495808 | HEALTH CARE SERVICES | VT | 501(C)(3) | LINE 9 | 0 | COVENANT HEALTH SYSTEMS | |
| CHS WALTHAM | |||||||||||
| 66 NEWTON STREET | WALTHAM | MA | 02453 | 043333609 | SKILLED NURSING FACILITY | MA | 501(C)(3) | LINE 9 | 0 | COVENANT HEALTH SYSTEMS | |
| ST JOSEPH HOSPITAL | |||||||||||
| 172 KINSLEY ST | NASHUA | NH | 03061 | 020222215 | ACUTE CARE HOSPITAL | NH | 501(C)(3) | LINE 3 | 0 | COVENANT HEALTH SYSTEMS | |
| YOUVILLE HOSPITAL | |||||||||||
| 100 AMES POND DRIVE | TEWKSBURY | MA | 01876 | 023239563 | FORMER REHAB HOSPITAL | MA | 501(C)(3) | LINE 3 | 0 | COVENANT HEALTH SYSTEMS | |
| YOUVILLE PLACE | |||||||||||
| 10 PELHAM RD | LEXINGTON | MA | 02421 | 043297834 | ASSISTED LIVING FACILITY | MA | 501(C)(3) | LINE 9 | 0 | COVENANT HEALTH SYSTEMS | |
| ST ANDRE SKILLED NURSING AND REHAB FACILITY | |||||||||||
| 407 POOL ST | BIDDEFORD | ME | 04005 | 010342399 | SKILLED NURSING FACILITY | ME | 501(C)(3) | LINE 9 | 0 | COVENANT HEALTH SYSTEMS | |
| MI NURSING RESTORATIVE CENTER | |||||||||||
| 172 LAWRENCE ST | LAWRENCE | MA | 01841 | 042104851 | SKILLED NURSING FACILITY | MA | 501(C)(3) | LINE 9 | 0 | COVENANT HEALTH SYSTEMS | |
| ST MARY'S VILLA NURSING HOME | |||||||||||
| 675 ST MARYS VILLA ROAD | MOSCOW | PA | 18444 | 232057177 | SKILLED NURSING FACILITY | PA | 501(C)(3) | LINE 9 | 0 | COVENANT HEALTH SYSTEMS | |
| MI MANAGEMENT INC | |||||||||||
| 172 LAWRENCE ST | LAWRENCE | MA | 01841 | 042857794 | SKILLED NURSING FACILITY | MA | 501(C)(3) | LINE 9 | 0 | COVENANT HEALTH SYSTEMS | |
| MI ADULT DAY HEALTH CENTER | |||||||||||
| 172 LAWRENCE ST | LAWRENCE | MA | 01841 | 042921888 | SKILLED NURSING FACILITY | MA | 501(C)(3) | LINE 9 | 0 | COVENANT HEALTH SYSTEMS | |
| MI TRANSPORTATION | |||||||||||
| 172 LAWRENCE ST | LAWRENCE | MA | 01841 | 042921889 | SKILLED NURSING FACILITY | MA | 501(C)(3) | LINE 9 | 0 | COVENANT HEALTH SYSTEMS | |
| YOUVILLE HOUSE | |||||||||||
| 1575 CAMBRIDGE ST | CAMBRIDGE | MA | 02138 | 043239593 | ASSISTED LIVING FACILITY | MA | 501(C)(3) | LINE 9 | 0 | COVENANT HEALTH SYSTEMS | |
| YOUVILLE LIFECARE | |||||||||||
| 100 AMES POND DRIVE | TEWKSBURY | MA | 01876 | 042103582 | MANAGEMENT SERVICES | MA | 501(C)(3) | LINE 11A, I | 0 | COVENANT HEALTH SYSTEMS | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 1 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (14 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| MI NURSING RESTORATIVE CENTER INC | ||
| R | 1250000 | CASH |
| MI MANAGEMENT INC | ||
| R | 250000 | CASH |
| MI ADULT DAY HEALTH CARE CENTER INC | ||
| R | 250000 | CASH |
| MI TRANSPORTATION INC | ||
| R | 250000 | CASH |
| ST MARY'S VILLA NURSING HOME INC | ||
| R | 1500000 | CASH |
| ST JOSEPH'S HOSPITAL OF NASHUA NH | ||
| R | 8000000 | CASH |
| YOUVILLE HOUSE INC | ||
| Q | 190367 | CASH |
| ST MARY'S REGIONAL MEDICAL CENTER | ||
| Q | 2010371 | CASH |
| ST MARY'S VILLA NURSING HOME INC | ||
| R | 300000 | CASH |
| COVENANT HEALTH SYSTEMS INC | ||
| R | 1224205 | CASH |
| COVENANT HEALTH SYSTEMS INC | ||
| Q | 750000 | CASH |
| ST JOSEPH'S HOSPITAL OF NASHUA NH | ||
| R | 2000000 | CASH |
| YOUVILLE HOUSE INC | ||
| R | 1690367 | CASH |
| ST JOSEPH HOSPITAL - BANGOR ME | ||
| R | 1764837 | CASH |