2012-11-15T15:05:33-06:00 2011-12-31 410746749 CLIFTONLARSONALLEN LLP 300 CROWN COLONY DRIVE SUITE 310 QUINCY MA 02169 990 2011-01-01 042676008 THE HENRY C NEVINS HOME INC HENR 9786827611 10 INGALLS COURT METHUEN MA 01844 ALAN P SHAFER 9786727611 2012-11-14 1 BARBARA MORRISON P00173340 6179848100 2012-11-14 2011 2016-02-24 21:20:13Z SCOTT B DICKINSON 10 INGALLS COURT METHUEN MA 01844 14197967 0 X WWW.NEVINSFAMILY.ORG X 1979 MA PROVIDING QUALITY CARE TO THE ELDERLY 9 9 280 25 0 0 60264 14402 13901780 14132732 56711 37906 7078 2537 14025833 14187577 0 0 0 0 8956853 9561164 0 0 0 4607979 3987361 13564832 13548525 461001 639052 9027410 9552334 5009020 4970601 4018390 4581733 TO PROVIDE QUALITY NURSING CARE TO THE ELDERLY 0 0 12656704 14135269 NURSING HOME OPERATION INCLUDING ALL RELATED ELDERLY SERVICES 12656704 1 0 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 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 12 0 280 1 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 MA X X JEANNE M SCOTT 9786827611 10 INGALLS COURT METHUEN MA 01844 ATTY VICTOR L HATEM 1.00 X 0 0 0 KAREN NEMETH 1.00 X X 0 0 0 ALAN P SHAFER 1.00 X X 0 0 0 MARC D KLEIN 1.00 X X 0 0 0 JAMES J MALONEY JR 1.00 X 0 0 0 EDGAR J SIDON 1.00 X 0 0 0 JAMES H SMITH 1.00 X 0 0 0 GARY MELVILLE 1.00 X X 0 0 0 LARRY GIORDANO 1.00 X 0 0 0 SCOTT DICKINSON 40.00 X 140546 0 27720 DEBORAH MCCARTHY 40.00 X 108614 0 10347 249160 0 38067 2 0 1 0 LANDVIEW THERAPY 57 WINGATE STREET HAVERHILL MA 01832 THERAPY SERVICES 382982 PARTNERS PHARMACY 70 JACKSON DR CRANFORD NJ 07016 PHARMACY SERVICES 339258 US FOOD SERVICES BOX D 3155 BOSTON MA 02241 FOOD SERVICES 334686 3 5859 8543 14402 NURSING HOME REVENUE 623000 14132732 14132732 14132732 37906 37906 10390 5859 10390 0 MISC. REVENUE-RELATED- 623000 2537 2537 2537 14187577 14135269 0 37906 169898 169898 7927956 7547614 380342 2200 2058 142 848596 793652 54944 612514 572855 39659 29561 29561 56865 56865 168714 100515 68199 6519 6519 221193 208925 12268 640877 640877 1435 1435 5523 5523 2954 2954 282520 282520 79193 79193 SUPPLIES AND EXPENSE 886856 886856 MASS. STATE USER FEE AS 759063 759063 ANCILLARIES 584463 584463 BAD DEBTS 238076 238076 23549 22799 750 13548525 12656704 891821 0 2401134 2905525 1252659 1691781 1886286 1584810 340314 0 71607 161412 8660151 5921093 2920222 2739058 102044 96077 53144 373671 9027410 9552334 1164236 1127797 19530 3440172 3370233 49582 30370 355030 422671 5009020 4970601 X 3938508 4501560 79882 80173 4018390 4581733 9027410 9552334 X 639052 -75709 X X 0 1 1 X 0 X 61416 60107 47516 67999 24792 261830 12825681 13229886 13696682 13911245 14135269 67798763 12887097 13289993 13744198 13979244 14160061 68060593 0 0 0 68060593 58557 55497 25763 56711 37906 234434 58557 55497 25763 56711 37906 234434 12945654 13345490 13769961 14035955 14197967 68295027 0.99660 0.99620 0.00340 0.00370 X 79882 291 80173 71050 8452 380 79882 0.00000 0.00000 1.00000 0 0 295146 295146 4695322 3220171 1475151 2317864 1773621 544243 1351819 927301 424518 2739058 FAIR VALUE OF INTEREST RATE SWAP 422671 422671 14187577 13548525 639052 -8067 -67642 -75709 563343 14122258 -8067 -57252 -65319 14187577 0 14187577 13558915 10390 10390 13548525 0 13548525 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE ORGANIZATION IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE ORGANIZATION'S 2008 THROUGH 2011 TAX YEARS ARE OPEN FOR EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN FAIR VALUE OF SWAP -67,642. PART XII, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN FAIR VALUE OF SWAP -67,642. DIRECT FUNDRAISING EXPENSES ON TAX RETURN 10,390. PART XIII, LINE 2D - OTHER ADJUSTMENTS: DIRECT FUNDRAISING EXPENSES ON TAX RETURN 10,390. GOLF TOURNAMENT 16249 5859 10390 6138 329 3923 16249 5859 10390 6138 329 3923 10390 0 X 0 0 0 0 0 0 0 0 0 SCOTT DICKINSON 140546 0 0 0 0 0 0 0 27720 0 168266 0 0 0 MASSACHUSETTS DEVELOPMENT FINANCE AGENCY 042608195 461473209 2005-02-01 4800000 TO FINANCE COST OF ELIGIBLE PROJECTS 0 0 0 3558446 3729905 53622 69662 48176 2005 1 0 1 1 0 0 0 0 1 0 1 1 CITIZENS BANK 11.000000000000 0 0 0 0 0 PART I - BOND ISSUE PROCEEDS FROM ISSUE THE PROCEEDS FROM THE ISSUE DO NOT AGREE WITH THE ISSUE AMOUNT BECAUSE THE PROCEEDS WERE SPLIT WITH A RELATED PARTY 77.75% AND 22.25%. FORM 990, PART VI, SECTION B, LINE 11 THE 990 WILL BE REVIEWED BY THE EXECUTIVE COMMITTEE PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C EACH DIRECTOR, OFFICER, EMPLOYEE, AND MEMBER OF A COMMITTEE WITH BOARD-DELEGATED POWERS, SHALL COMPLETE, SIGN AND DELIVER TO THE CHAIR OF THE BOARD A CONFLICTS OF INTEREST POLICY ANNUAL STATEMENT AT THE TIME OF HIS OR HER INITIAL ELECTION OR APPOINTMENT AND ANNUALLY THEREAFTER. THE CONFLICTS OF INTEREST POLICY ANNUAL STATEMENT SHALL BE IN SUCH FOR AS IS DEEMED APPROPRIATE BY THE PRESIDENT WITH ADVICE FROM THE NEVIN'S COUNSEL AS NEEDED. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION REVIEW FOR CEO, EXECUTIVE DIRECTOR, OTHER OFFICERS AND KEY EMPLOYEES IS APPROVED BY INDENEPENDENT PERSONS WITH THE USE OF COMPARABILITY DATA AND APPROVED BY THE BOARD OF DIRECTORS. THIS WAS LAST PERFORMED DURING 2009 AND NOTED IN THE BOARD OF DIRECTORS MINUTES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -8,067. CHANGE IN FAIR VALUE OF SWAP -67,642. TOTAL TO FORM 990, PART XI, LINE 5: -75,709. FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS NOT CHANGED EITHER ITS OVERSIGHT OR SELECTION PROCESS DURING THE TAX YEAR. HENRY C NEVINGS HOME FOR THE AGED AND INCURABLE 12 INGALLS COURT METHUEN MA 01844 042210743 ADULT DAY HEALTH AND CHILD CARE SERVICES MA 501 (C)(3) LINE 9 0 NEVINS MANOR INC 12 INGALLS COURT METHUEN MA 01844 043265310 ELDERLY HOUSING MA 501 (C)(3) LINE 9 0 0 0 0 1 0 0 0 0 0 1 1 0 0 0 0 0 0 0