2012-07-03T12:35:00-05:00 2011-12-31 020383073 WILLIAM STEELE & ASSOCIATES PC 40 STARK STREET MANCHESTER NH 03101 990 2011-01-01 046835128 PROVIDENTIA PRIMA TRUST PROV 9786546363 100 AMES POND DRIVE TEWKSBURY MA 01876 JOHN AHLE 9786546363 2012-06-27 1 MICHAEL A BARBARITA CPA P00801253 6036228881 2011 2016-02-24 21:20:13Z JOHN AHLE 100 AMES POND DRIVE TEWKSBURY MA 01876 6917669 0 X COVENANTHS.ORG X 1996 MA PROVIDENTIA PRIMA WAS ESTABLISHED TO HOLD AND MANAGE POOLED INVESTMENTS OF VARIOUS ORGANIZATIONS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501 (C) (3) 7 3 0 0 0 0 0 0 0 0 3861998 6887078 0 30591 3861998 6917669 0 0 0 0 0 0 0 0 0 700050 793693 700050 793693 3161948 6123976 129137949 147469529 145768 2173965 128992181 145295564 PROVIDENTIA PRIMA WAS ESTABLISHED TO HOLD AND MANAGE POOLED INVESTMENTS OF VARIOUS ORGANIZATIONS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501 (C) (3). 0 0 N/A 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 7 3 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X X JOHN AHLE 9786546363 100 AMES POND DRIVE TEWKSBURY MA 01876 JOHN AHLE 1.00 X X 0 357922 165006 CAROLYN KASABIAN 1.00 X 0 269457 32372 DONALD M DEHART 3.00 X X 0 0 0 RICHARD J PLAMONDON 1.00 X X 0 286815 44999 WILLIAM ADAMS 1.00 X 0 0 0 PAUL ERCOLINI 1.00 X 0 148097 33036 KEVIN HALLORAN 1.00 X 0 0 0 0 1062291 275413 0 0 1 0 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 4 3511159 3511159 3375919 3375919 3375919 3375919 OTHER 900099 30591 30591 30591 6917669 0 0 6917669 33653 33653 701258 701258 ADMINISTRATION EXPENSE 40000 40000 MISCELLANEOUS EXPENSES 18782 18782 793693 0 793693 0 1408728 5904476 88494535 100868488 39173148 40629611 61538 66954 129137949 147469529 145768 2173965 145768 2173965 X 0 0 0 0 128992181 145295564 128992181 145295564 129137949 147469529 X 6123976 10179407 X 0 1 1 X 0 X X X 0 0 0 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 14 0 0 ALTERNATIVE INVESTMENTS 40629611 F 40629611 6917669 793693 6123976 -5348658 15528065 10179407 16303383 775000 -5348658 -5348658 6123658 794011 794011 6917669 0 0 0 793693 793693 793693 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. X X X X X 0 0 0 0 0 0 0 0 0 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 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. CHANGES IN NET ASSETS OR FUND BALANCES: 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. 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 COVENANT HEALTH SYSTEMS 0 FANNY ALLEN CORPORATION 790 COLLEGE PARKWAY COLCHESTER VT 05446 222495808 HEALTH CARE SERVICES VT 501(C)(3) LINE 9 COVENANT HEALTH SYSTEMS 0 CHS WALTHAM 66 NEWTON STREET WALTHAM MA 02453 043333609 SKILLED NURSING FACILITY MA 501(C)(3) LINE 9 COVENANT HEALTH SYSTEMS 0 ST JOSEPH HOSPITAL 172 KINSLEY ST NASHUA NH 03061 020222215 ACUTE CARE HOSPITAL NH 501(C)(3) LINE 3 COVENANT HEALTH SYSTEMS 0 YOUVILLE HOSPITAL 100 AMES POND DRIVE TEWKSBURY MA 01876 023239563 FORMER REHAB HOSPITAL MA 501(C)(3) LINE 3 COVENANT HEALTH SYSTEMS 0 YOUVILLE PLACE 10 PELHAM RD LEXINGTON MA 02421 043297834 ASSISTED LIVING FACILITY MA 501(C)(3) LINE 9 COVENANT HEALTH SYSTEMS 0 ST ANDRE SKILLED NURSING AND REHAB FACILITY 407 POOL ST BIDDEFORD ME 04005 010342399 SKILLED NURSING FACILITY ME 501(C)(3) LINE 9 COVENANT HEALTH SYSTEMS 0 MI NURSING RESTORATIVE CENTER 172 LAWRENCE ST LAWRENCE MA 01841 042104851 SKILLED NURSING FACILITY MA 501(C)(3) LINE 9 COVENANT HEALTH SYSTEMS 0 ST MARY'S VILLA NURSING HOME 675 ST MARYS VILLA ROAD MOSCOW PA 18444 232057177 SKILLED NURSING FACILITY PA 501(C)(3) LINE 9 COVENANT HEALTH SYSTEMS 0 MI MANAGEMENT INC 172 LAWRENCE ST LAWRENCE MA 01841 042857794 SKILLED NURSING FACILITY MA 501(C)(3) LINE 9 COVENANT HEALTH SYSTEMS 0 MI ADULT DAY HEALTH CENTER 172 LAWRENCE ST LAWRENCE MA 01841 042921888 SKILLED NURSING FACILITY MA 501(C)(3) LINE 9 COVENANT HEALTH SYSTEMS 0 MI TRANSPORTATION 172 LAWRENCE ST LAWRENCE MA 01841 042921889 SKILLED NURSING FACILITY MA 501(C)(3) LINE 9 COVENANT HEALTH SYSTEMS 0 YOUVILLE HOUSE 1575 CAMBRIDGE ST CAMBRIDGE MA 02138 043239593 ASSISTED LIVING FACILITY MA 501(C)(3) LINE 9 COVENANT HEALTH SYSTEMS 0 YOUVILLE LIFECARE 100 AMES POND DRIVE TEWKSBURY MA 01876 042103582 MANAGEMENT SERVICES MA 501(C)(3) LINE 11A, I COVENANT HEALTH SYSTEMS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 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