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Johnson Evergreen Corporation: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
Johnson Evergreen Corporation (EIN 22-3012385)
Tax period
2009-10-01 to 2010-09-30
Filed
2011-08-08
IRS object ID
201122209349300022
Schema version
2009v1.2
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

FieldValueIRS element (for citing)
Timestamp2011-08-08T09:48:19-07:00Timestamp
Tax Period End Date2010-09-30TaxPeriodEndDate
Return Type990ReturnType
Tax Period Begin Date2009-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN223012385EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1JOHNSON EVERGREEN CORPORATIONBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlJOHNNameControl
Phone8606846341Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1205 Chestnut Hill RoadAddressLine1
CityStafford SpringsCity
StateCTState
ZIP Code060760549ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJohn GrishName
TitleChief Financial OfficerTitle
Phone8606848152Phone
Date Signed2011-08-08DateSigned
FieldValueIRS element (for citing)
Tax Year2009TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonPeter J BettsNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1580 Laurel StreetAddressLine1
CityLongmeadowCity
StateMAState
ZIP Code01106ZIPCode
FieldValueIRS element (for citing)
Gross Receipts17546780GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web Sitewww.jmmc.comWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1989YearFormation
State Legal DomicileCTStateLegalDomicile
Activity Or Mission DescriptionTo develop, operate ,and maintain programs directed toward improving the efficiency of utiliztion of Health Care Facilities and Services in the State of CT, and in Hartford and Tolland Counties and surrouding areas in particular, and reducing the cost of health care to the public while maintaining a high quality of care. Evergreen is skilled nursing facility with 120 long-term-care beds, a 30-bed Subacute unit for patients in need of extensive therapy and care before returning home, and a 30-bed Memory Support unit for residents with Alzheimers's disease and similiar forms of dimentia.ActivityOrMissionDescription
Nbr Voting Members Governing Body7NbrVotingMembersGoverningBody
Nbr Independent Voting Members5NbrIndependentVotingMembers
Total Nbr Employees341TotalNbrEmployees
Total Nbr Volunteers96TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year17413ContributionsGrantsPriorYear
Contributions Grants Current Year24292ContributionsGrantsCurrentYear
Program Service Revenue Prior Year15862663ProgramServiceRevenuePriorYear
Program Service Revenue CY16970737ProgramServiceRevenueCY
Investment Income Prior Year0InvestmentIncomePriorYear
Investment Income Current Year0InvestmentIncomeCurrentYear
Other Revenue Prior Year529585OtherRevenuePriorYear
Other Revenue Current Year551751OtherRevenueCurrentYear
Total Revenue Prior Year16409661TotalRevenuePriorYear
Total Revenue Current Year17546780TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year11129604SalariesEtcPriorYear
Salaries Etc Current Year12097917SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year5061973OtherExpensePriorYear
Other Expenses Current Year6452624OtherExpensesCurrentYear
Total Expenses Prior Year16191577TotalExpensesPriorYear
Total Expenses Current Year18550541TotalExpensesCurrentYear
Revenues Less Expenses Prior Year218084RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-1003761RevenuesLessExpensesCY
Total Assets BOY15564875TotalAssetsBOY
Total Assets EOY13667265TotalAssetsEOY
Total Liabilities BOY18609131TotalLiabilitiesBOY
Total Liabilities EOY17901356TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY-3044256NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY-4234091NetAssetsOrFundBalancesEOY
Mission DescriptionTo develop, operate ,and maintain programs directed toward improving the efficiency of utiliztion of Health Care Facilities and Services in the State of CT, and in Hartford and Tolland Counties and surrouding areas in particular, and reducing the cost of health care to the public while maintaining a high quality of care. Evergreen is a Skilled Nursing Facility with 120 long term beds, a 30 bed Subacute Rehabilitation unit, and a 30 bed Memory Support unity. Services include: 24 hour nursing care, long term care, cardiac recovery, subacute rehabilitation, dental care, hospice care, respite care, iv therapies, medically complex care, mental health services, oncology/cancer care, optometry and opthalmology, orthopedic care, pain management, wound care, podiatry and other special services, postoperative care, pulmonary/respiratory care, social services and therapeutic recreation.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense15993529Expense
Grants0Grants
Revenue17522488Revenue
DescriptionNursing Home Care: Johnson Evergreen Corporation, dba Evergreen Health Care Center maintains a 180 bed SNF with 24 hour skilled nursing care for residents. During FY10 the facility maintained high occupancy and high quality care in the facility. The cost shown represent the necessary salary, supplies, and overhead essential for caring for the residnets at Evergreen. (56769 resident days)Description
Total Of Other Program Service Exp0TotalOfOtherProgramServiceExp
Total Of Other Program Service Grnt0TotalOfOtherProgramServiceGrnt
Total Of Other Program Service Rev0TotalOfOtherProgramServiceRev
Total Program Service Expense15993529TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Balance Sheet Amounts Reported1BalanceSheetAmountsReported
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109635NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees341NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Nbr Voting Governing Body Members7NbrVotingGoverningBodyMembers
Number Independent Voting Members5NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonTia RiedelNamePerson
Telephone Number8606848742TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1201 Chestnut Hill RoadAddressLine1
CityStafford SpringsCity
StateCTState
ZIP Code06076ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (12 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
Earle W Tarbell
Trustee2X000
Charles J McKeen
Trustee2X000
James Baum
Trustee2X000
Richard P Dobson
Trustee2X000
Jerry Parizek ll
Trustee2X000
Peter J Betts
Interim President5000X
Frank Shiffer
Interim Secretary/Treasurer5000X
Francis J Musso
Interim Secretary/Treasurer5000X
David Morgan
Interim COO5000X
James Fidanza
Administrator /Vice President50157444039821X
Damien R Eilerman
Nursing Supervisor40129511033931X
Janis M Kozikowski
Nursing Supervisor40135643035223X
FieldValueIRS element (for citing)
Total Reportable Comp From Org422598TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation108975TotalOtherCompensation
Number Individuals GT100 K3NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources1CompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Marcum LLPBusinessNameLine1

Address Of Contractor AddressOfContractor

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1185 Asylum StreetAddressLine1
Address Line2City Place IIAddressLine2
CityhartfordCity
StateCTState
ZIP Code06103ZIPCode
FieldValueIRS element (for citing)
Description Of ServicesAccountingDescriptionOfServices
Compensation104500Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K
Federated Campaigns0FederatedCampaigns
Membership Dues0MembershipDues
Fundraising Events0FundraisingEvents
Related Organizations0RelatedOrganizations
Government Grants0GovernmentGrants
All Other Contributions24292AllOtherContributions
Noncash Contributions0NoncashContributions
Total Contributions24292TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionResident revenuesDescription
Business Code623000BusinessCode
Total Revenue Column16970737TotalRevenueColumn
Related Or Exempt Function Income16970737RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount
FieldValueIRS element (for citing)
Total Program Service Revenue16970737TotalProgramServiceRevenue

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real0Real
Personal0Personal

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities0Securities
Other0Other
FieldValueIRS element (for citing)
Cntrbtns Rprtd Fundraising Events0CntrbtnsRprtdFundraisingEvents

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenueExclusionExclusionAmount
Miscellaneous Revenue90009913299132990$0
Discharge of Debt Chapter 119000995384525384520$0

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue551751TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column17546780TotalRevenueColumn
Related Or Exempt Function Income17522488RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total197265Total
Management And General197265ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total9367433Total
Program Services9002827ProgramServices
Management And General364606ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total100091Total
Program Services95163ProgramServices
Management And General4928ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1739332Total
Program Services1653689ProgramServices
Management And General85643ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total693796Total
Program Services661707ProgramServices
Management And General32089ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total37836Total
Management And General37836ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total40000Total
Management And General40000ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total243374Total
Program Services219374ProgramServices
Management And General24000ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total764754Total
Program Services764754ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total16401Total
Program Services14271ProgramServices
Management And General2130ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total226180Total
Program Services226180ProgramServices

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total1054488Total
Management And General1054488ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total851271Total
Program Services851271ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total53241Total
Management And General53241ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
Chapter 11 related expenses64838906483890
Food41383141383100
Patient Care and General Supplies1207137120713700
Bad Debt Expense12295712295700
Provider Tax75882875882800

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total13937Total
Program Services1540ProgramServices
Management And General12397ManagementAndGeneral
Fundraising0Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total18550541Total
Program Services15993529ProgramServices
Management And General2557012ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY1493687BOY
EOY948424EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1947043BOY
EOY1565543EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY37729BOY
EOY37119EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY111584BOY
EOY137382EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis19780337LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec9007128LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY11626662BOY
EOY10773209EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY348170BOY
EOY205588EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY15564875BOY
EOY13667265EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY2516101BOY
EOY1771335EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY4752BOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY15199990BOY
EOY15199990EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY888288BOY
EOY930031EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY18609131BOY
EOY17901356EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY-3044256BOY
EOY-4234091EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY-3044256BOY
EOY-4234091EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY15564875BOY
EOY13667265EOY
FieldValueIRS element (for citing)
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review1AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years5507CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years12062CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years0CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year17413CurrentTaxYearMinus1Year
Current Tax Year24292CurrentTaxYear
Total59274Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years13720989CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years15843568CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years15665476CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year15862663CurrentTaxYearMinus1Year
Current Tax Year16970737CurrentTaxYear
Total78063433Total

Gross Receipts From Non UBI GrossReceiptsFromNonUBI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years0CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years0CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years0CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year0CurrentTaxYearMinus1Year
Total0Total

Tax Rev Levied For Org Benefit509 TaxRevLeviedForOrgBenefit509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years0CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years0CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years0CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year0CurrentTaxYearMinus1Year
Total0Total

Value Of Svcs Fclts Furnishd By Govt ValueOfSvcsFcltsFurnishdByGovt

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years0CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years0CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years0CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year0CurrentTaxYearMinus1Year
Total0Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years13726496CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years15855630CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years15665476CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year15880076CurrentTaxYearMinus1Year
Current Tax Year16995029CurrentTaxYear
Total78122707Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years0CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years0CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years0CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year0CurrentTaxYearMinus1Year
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years0CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years0CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years0CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year0CurrentTaxYearMinus1Year
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years0CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years0CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years0CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year0CurrentTaxYearMinus1Year
Current Tax Year0CurrentTaxYear
Total0Total
FieldValueIRS element (for citing)
Public Support Total50978122707PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years0CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years482CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years0CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year0CurrentTaxYearMinus1Year
Total482Total

Post1975 UBTI Post1975UBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years0CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years0CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years0CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year0CurrentTaxYearMinus1Year
Total0Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years0CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years482CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years0CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year0CurrentTaxYearMinus1Year
Current Tax Year0CurrentTaxYear
Total482Total

Net Income From Other UBI NetIncomeFromOtherUBI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years0CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years0CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years0CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year0CurrentTaxYearMinus1Year
Total0Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years0CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years0CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years72127CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year529585CurrentTaxYearMinus1Year
Current Tax Year551751CurrentTaxYear
Total1153463Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years13726496CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years15856112CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years15737603CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year16409661CurrentTaxYearMinus1Year
Current Tax Year17546780CurrentTaxYear
Total79276652Total
FieldValueIRS element (for citing)
Public Support Percentage5090.98544PublicSupportPercentage509
Prior Year Support Percentage0.99196PriorYearSupportPercentage
Investment Income Percentage0.00001InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00001PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509
General ExplanationAs a result of Chapter 11 Reorganization, 538455 is recorded as a Gain on Discharge of Debt. Misc. revenue of 13299 is also recorded here for a total of 551,751GeneralExplanation

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Investment Cost Or Other Basis0InvestmentCostOrOtherBasis
Other Cost Or Other Basis0OtherCostOrOtherBasis
Book Value0BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Investment Cost Or Other Basis15733693InvestmentCostOrOtherBasis
Other Cost Or Other Basis0OtherCostOrOtherBasis
Depreciation6703068Depreciation
Book Value9030625BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Investment Cost Or Other Basis0InvestmentCostOrOtherBasis
Other Cost Or Other Basis0OtherCostOrOtherBasis
Depreciation0Depreciation
Book Value0BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Investment Cost Or Other Basis2520277InvestmentCostOrOtherBasis
Other Cost Or Other Basis0OtherCostOrOtherBasis
Depreciation1894733Depreciation
Book Value625544BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Investment Cost Or Other Basis1526367InvestmentCostOrOtherBasis
Other Cost Or Other Basis0OtherCostOrOtherBasis
Depreciation409327Depreciation
Book Value1117040BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings10773209TotalOfBookValueLandBuildings

Other Assets OtherAssets (2 entries)

DescriptionDescriptionBook ValueBookValue
Other Current Assets67038
Deferred Financing Costs,net138550
FieldValueIRS element (for citing)
Total Book Value Other Assets205588TotalBookValueOtherAssets
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescriptionAmountAmount
Malpractice/CGL Insurance Liability$112,241
Due to Affiliates/HFG LOC$381,807
Patient Trust Fund$72,184
Current Portion Long Term Debt$363,799
FieldValueIRS element (for citing)
Total Of Amounts930031TotalOfAmounts
Total Revenue17546780TotalRevenue
Total Expenses18550541TotalExpenses
Excess Or Deficit For Year-1003761ExcessOrDeficitForYear
Net Unrealized GL On Investments0NetUnrealizedGLOnInvestments
Donated Services And Facilities0DonatedServicesAndFacilities
Investment Expenses0InvestmentExpenses
Prior Period Adjustments0PriorPeriodAdjustments
Other$0OtherAmount
Total Adjustments0TotalAdjustments
Excess Or Deficit Per FS-1003761ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt17006786TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments0NetUnrealizedGainsInvestments
Donated Srvc And Use Of Facilities0DonatedSrvcAndUseOfFacilities
Recoveries Of Prior Year Grants0RecoveriesOfPriorYearGrants
Other Revenues0OtherRevenues
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal17006786RevenueSubtotal
Investment Expenses Not Included0InvestmentExpensesNotIncluded
Other Revenues Not Included539994OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt539994RevenueNotRptdOnFinStmt
Total Revenue Per Form99017546780TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt17900612TotExpensesEtcAuditedFinclStmt
Donated Services Use Of Facilities0DonatedServicesUseOfFacilities
Prior Year Adjustments0PriorYearAdjustments
Losses Reported0LossesReported
Other Expenses Included0OtherExpensesIncluded
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal17900612ExpensesSubtotal
Investment Expenses Not Included20InvestmentExpensesNotIncluded2
Other Expenses Not Included649929OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt649929ExpensesNotRptdOnFinStmt
Total Expenses Per Form99018550541TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
SchD_P10_S00_L00Schedule D, Part XNone
SchD_P12_S00_L04bSchedule D, Part XII, Line 4bDischarge of Debt due to Chapter 11 538455 Loss on Disposal of Assets 1539
SchD_P13_S00_L04bSchedule D, Part XIII, Line 4bChapter 11 related expenses 648390 Loss on disposal of assets 1539

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Peter J Betts
7303160000000311490761465000
Frank Shiffer
583613000000000583613000
Francis J Musso
632818000000000632818000
David Morgan
195411000000000195411000
James Fidanza
157444000000039821019726500
Janis M Kozikowski
1356430000000352230170866000
Damien R Eilerman
1295110000000339310163442000

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierSchJ_P02_S00_L00Identifier
Return ReferenceSchedule J, Part IIReturnReference
ExplanationThe amounts recorded for Peter J Betts, Frank Shiffer, and Francis Musso were paid by Johnson Memorial Corporation to Focus Management Group (an unrelated organization) for Interim Management ServicesExplanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
F990_P06_S0A_L03Form 990, Part VI, Section A, Line 3The Johnson Memorial Corporation Board hired Focus Management Group which provided an Interim CEO, and Interim CFO, an Interim COO, and an Interim Controller. Focus Management Group provides corporate turnaround consultants and have provided interim leadership previous to and during Chapter 11, which was declared on 11/04/2008 and continued through the end of this tax reporting period.
F990_P06_S0A_L06Form 990, Part VI, Section A, Line 6The Bilaws stipulate that Johnson Evergreen Corporation (dba Evergreen Health Care Center) shall have but one member, Johnson Memorial Corporation (the parent 501 c 3 corporation)
F990_P06_S0A_L07aForm 990, Part VI, Section A, Line 7aJohnson Memorial Corporation (a 501 c 3 entity) has the right to elect the Board of Trustees of The Johnson Evergreen Corporation
F990_P06_S0A_L07bForm 990, Part VI, Section A, Line 7bJohnson Memorial Corporation has the right to approve all annual budgets, significant expenditures and remove any member of the Board.
F990_P06_S0B_L11Form 990, Part VI, Section B, Line 11Board policy requires that members of the Budget and Finance Committee are provided the opportunity to review and comment to excecutive leadership before the 990 is filed. All members of the Board have access to any copy of the Form 990 and the Chief Financial Officer provides a summary of the 990 at the Board meeting following the filing of the 990.
F990_P06_S0B_L12cForm 990, Part VI, Section B, Line 12cAn annual disclosure statement is required. Executives and Board Members are required on an ongoing basis to disclose interests that may give rise to conflict of interests.
F990_P06_S0B_L15Form 990, Part VI, Section B, Line 15A Board Committee reviews compensation for the executive team annually. This includes the CEO, COO, CFO, and VP's. The committee recommends compensation for Board approval. Comparability data is reviewed and may include industry surveys, documented compensation for persons holding similiar positions in similiar organizations, and expert compensation schedules.
F990_P06_S0C_L19Form 990, Part VI, Section C, Line 19The Johnson Memorial Corporation maintains these documents in Administration and are available for viewing upon request duing normal business hours. This includes the Johnson Evergreen Corporation.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (5 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNA
Johnson Memorial Corporation
201 Chestnut Hill RoadStafford SpringsCT06076222541974Parent CorporationCT501 c 311N/A
Johnson Memorial Hospital
201 Chestnut Hill RoadStafford SpringsCT06076060646696Acute Care HospitalCT501 c 33N/A
Johnson Development Fund Inc
201 Chestnut Hill RoadStafford SpringsCT06076222541977Fund RaisingCT501 c 311N/A
Johnson Health Care Inc
201 Chestnut Hill RoadStafford SpringsCT06076222541981Occupational MedicineCT501 c 39N/A
Home and Community Health Services
101 Phoenix AvenueEnfieldCT06083060646620Visiting Nurse AssociationCT501 c 39N/A

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1Wellcare IncBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1201 Chestnut Hill RoadAddressLine1
Citystafford SpringsCity
StateCTState
ZIP Code06076ZIPCode
FieldValueIRS element (for citing)
EIN222541983EIN
Primary ActivityInactive For Profit CorporationPrimaryActivity
Legal Domicile StateCTLegalDomicileState
Direct Controlling Entity NAN/ADirectControllingEntityNA
Type Of EntityCTypeOfEntity
Percentage Ownership0PercentageOwnership
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolved
Johnson Memorial Hospital
j180000
Johnson Memorial Hospital
o1054488

Reasonable Cause Explanation ReasonableCauseExplanation

FieldValueIRS element (for citing)
ExplanationN/AExplanation