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CHS OF WALTHAM INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
CHS OF WALTHAM INC (EIN 04-3333609)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-07-15
IRS object ID
201141999349300324
Schema version
2010v3.2
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)
Timestamp2011-07-15T12:11:11-05:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1WILLIAM STEELE & ASSOCIATES PCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line140 STARK STREETAddressLine1
CityMANCHESTERCity
StateNHState
ZIP Code03101ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN043333609EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1CHS OF WALTHAM INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCHSONameControl
Phone7818930240Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line166 NEWTON STREETAddressLine1
CityWALTHAMCity
StateMAState
ZIP Code02453ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameCAROLYN FENNName
TitleCEO/ADMINISTRATORTitle
Phone7818930240Phone
Date Signed2011-07-13DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameMICHAEL A BARBARITAName
Phone6036228881Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

FieldValueIRS element (for citing)
Business Name Line1MARISTHILL NUSING HOMEBusinessNameLine1
FieldValueIRS element (for citing)
Name Of Principal Officer PersonCAROLYN FENNNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line166 NEWTON STREETAddressLine1
CityWALTHAMCity
StateMAState
ZIP Code02453ZIPCode
FieldValueIRS element (for citing)
Gross Receipts11115417GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Group Exemption Number0928GroupExemptionNumber
Organization501c3XOrganization501c3
Web SiteMARISTHILL.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1996YearFormation
State Legal DomicileMAStateLegalDomicile
Activity Or Mission DescriptionMARISTHILL IS A CATHOLIC SKILLED NURSING AND REHABILITATION FACILITY THAT CONTINUES THE HEALING MINISTRY OF CHRIST BY PROVIDING HEALTH CARE SERVICES THAT FOSTER EACH INDIVIDUAL'S PHYSICAL,SPIRITUAL, EMOTIONAL AND INTELLECTUAL WELL-BEING.ActivityOrMissionDescription
Nbr Voting Members Governing Body9NbrVotingMembersGoverningBody
Nbr Independent Voting Members8NbrIndependentVotingMembers
Total Nbr Employees164TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year28596ContributionsGrantsPriorYear
Contributions Grants Current Year27590ContributionsGrantsCurrentYear
Program Service Revenue Prior Year10916975ProgramServiceRevenuePriorYear
Program Service Revenue CY11038749ProgramServiceRevenueCY
Investment Income Prior Year21304InvestmentIncomePriorYear
Investment Income Current Year17238InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year17348OtherRevenueCurrentYear
Total Revenue Prior Year10966875TotalRevenuePriorYear
Total Revenue Current Year11100925TotalRevenueCurrentYear
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 Year5868560SalariesEtcPriorYear
Salaries Etc Current Year6286134SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year4681061OtherExpensePriorYear
Other Expenses Current Year4504014OtherExpensesCurrentYear
Total Expenses Prior Year10549621TotalExpensesPriorYear
Total Expenses Current Year10790148TotalExpensesCurrentYear
Revenues Less Expenses Prior Year417254RevenuesLessExpensesPriorYear
Revenues Less Expenses CY310777RevenuesLessExpensesCY
Total Assets BOY9956254TotalAssetsBOY
Total Assets EOY10351680TotalAssetsEOY
Total Liabilities BOY8422652TotalLiabilitiesBOY
Total Liabilities EOY8446659TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY1533602NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY1905021NetAssetsOrFundBalancesEOY
Mission DescriptionMARISTHILL IS A CATHOLIC SKILLED NURSING AND REHABILITATION FACILITY THAT CONTINUES THE HEALING MINISTRY OF CHRIST BY PROVIDING HEALTH CARE SERVICES THAT FOSTER EACH INDIVIDUAL'S PHYSICAL, SPIRITUAL, EMOTIONAL AND INTELLECTUAL WELL-BEING.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense10649210Expense
Revenue11017954Revenue
DescriptionMARISTHILL NURSING AND REHABILITATION CENTER PROVIDED 42,618 DAYS OF SKILLED NURSING SERVICES DURING 2010 OF WHICH 28,627 WERE TO MEDICAID RECIPIENTSDescription
Total Program Service Expense10649210TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities1FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
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 Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109613NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees164NumberOfEmployees
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
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members9NbrVotingGoverningBodyMembers
Number Independent Voting Members8NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
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
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1CAROLYN FENNBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number7818930240TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line166 NEWTON STREETAddressLine1
CityWALTHAMCity
StateMAState
ZIP Code02453ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (10 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
KENNETH FERRON
TREASURER1.00XX029924096315
LUKE STANTON ESQ
DIRECTOR1.00X000
CAROL EAST MSWLCSW
DIRECTOR1.00X000
MARY ELIZABETH SCANLON
DIRECTOR1.00X000
MICHAEL J DELANEY ESQ
DIRECTOR1.00X000
LISA LORGEREE
CHAIR3.00XX000
MARIE LABOLLITA SC
SECRETARY1.00XX000
BRENDA CAPELLO
DIRECTOR1.00X000
CAROLYN FENN
CEO/ADMINISTRATOR40.00XX9621100
JOSEPH SGRO
CFO40.00X8290800
FieldValueIRS element (for citing)
Total Reportable Comp From Org179119TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs299240TotalReportableCompFrmRltdOrgs
Total Other Compensation96315TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
PEOPLEFIRST REHAB
PO BOX 277365ATLANTAGA30384REHABILITATION SERVICES527900
BLUE CROSS BLUE SHIELD
PO BOX 4701WOBURNMA01888HEALTH INSURER384605
NEHM CORPORATION
1565 MAIN STREETTEWKSBURYMA01876HOUSEKEEPING315984
US FOODS
PO BOX 3155BOSTONMA02241FOOD SERVICE294027
NEIGHBORHOOD HEALTH PLAN
PO BOX 4106WOBURNMA01888HEALTH INSURER274132
FieldValueIRS element (for citing)
Number Of Contractors GT100 K5NumberOfContractorsGT100K
All Other Contributions27590AllOtherContributions
Total Contributions27590TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPROGRAM SERVICE REVENUDescription
Business Code623000BusinessCode
Total Revenue Column11017954TotalRevenueColumn
Related Or Exempt Function Income11017954RelatedOrExemptFunctionIncome

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column20795TotalRevenueColumn
Related Or Exempt Function Income20795RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue11038749TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column17238TotalRevenueColumn
Exclusion$17,238ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events31840GrossIncomeFundraisingEvents
Fundraising Direct Expenses14492FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column17348TotalRevenueColumn
Exclusion$17,348ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column11100925TotalRevenueColumn
Related Or Exempt Function Income11038749RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$34,586ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total179119Total
Program Services179119ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total5248094Total
Program Services5248094ProgramServices

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total8805Total
Program Services8805ProgramServices

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total470216Total
Program Services470216ProgramServices

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total379900Total
Program Services379900ProgramServices

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total128424Total
Management And General128424ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total24250Total
Program Services24250ProgramServices

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total12514Total
Management And General12514ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total330294Total
Program Services330294ProgramServices

Interest Interest

FieldValueIRS element (for citing)
Total352788Total
Program Services352788ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total330099Total
Program Services330099ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total93603Total
Program Services93603ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServices
PURCHASED SERVICES14690731469073
FOOD AND SUPPLIES971641971641
PROVIDER TAX687328687328
BAD DEBTS104000104000

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total10790148Total
Program Services10649210ProgramServices
Management And General140938ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY588988BOY
EOY1088563EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY953250BOY
EOY505175EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1101818BOY
EOY1251461EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY47756BOY
EOY33831EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis9281267LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec3674473LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY5280833BOY
EOY5606794EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY663034BOY
EOY740912EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY1320575BOY
EOY1124944EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY9956254BOY
EOY10351680EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY708950BOY
EOY759579EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY7048758BOY
EOY7018389EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY664944BOY
EOY668691EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY8422652BOY
EOY8446659EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY1533602BOY
EOY1905021EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY1533602BOY
EOY1905021EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY9956254BOY
EOY10351680EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses310777ReconcilationRevenueExpenses
Reconcilation Other Changes60642ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
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 Years19010CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years17211CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years32861CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year5997CurrentTaxYearMinus1Year
Current Tax Year44938CurrentTaxYear
Total120017Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years9470884CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years10142791CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years11133664CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year10925173CurrentTaxYearMinus1Year
Current Tax Year11027802CurrentTaxYear
Total52700314Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years9489894CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years10160002CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years11166525CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year10931170CurrentTaxYearMinus1Year
Current Tax Year11072740CurrentTaxYear
Total52820331Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total50952820331PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years61208CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years54486CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years22158CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year35704CurrentTaxYearMinus1Year
Current Tax Year28185CurrentTaxYear
Total201741Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years61208CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years54486CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years22158CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year35704CurrentTaxYearMinus1Year
Current Tax Year28185CurrentTaxYear
Total201741Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years9551102CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years10214488CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years11188683CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year10966874CurrentTaxYearMinus1Year
Current Tax Year11100925CurrentTaxYear
Total53022072Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99620PublicSupportPercentage509
Prior Year Support Percentage0.99580PriorYearSupportPercentage
Investment Income Percentage0.00380InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00420PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

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)
Other Cost Or Other Basis485000OtherCostOrOtherBasis
Book Value485000BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis5579220OtherCostOrOtherBasis
Depreciation1892363Depreciation
Book Value3686857BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis2521898OtherCostOrOtherBasis
Depreciation1767237Depreciation
Book Value754661BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis695149OtherCostOrOtherBasis
Depreciation14873Depreciation
Book Value680276BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings5606794TotalOfBookValueLandBuildings

Other Assets OtherAssets (7 entries)

DescriptionDescriptionBook ValueBookValue
EST, 3RD PARTY SETTLEMENT46357
RESIDENT TRUST FUND23952
DEBT SERVICE RESERVE FUND712883
BOND ISSUE COSTS (NET)48387
BOND UNDERWRITING COSTS (NET)19702
BOND DISCOUNT (NET)48287
ALL OTHER ASSETS225376
FieldValueIRS element (for citing)
Total Book Value Other Assets1124944TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (6 entries)

DescriptionDescriptionAmountAmount
DEFERRED EXPENSES$222,911
MEDICAID USER FEES$171,710
PROFESSIONAL LIABILITY LOSS RESERVES$50,854
DUE TO AFFILIATES$198,031
DUE TO 3RD PARTY PAYER$1,233
RESIDENT FUNDS$23,952
FieldValueIRS element (for citing)
Total Of Amounts668691TotalOfAmounts
Total Revenue11100925TotalRevenue
Total Expenses10790148TotalExpenses
Excess Or Deficit For Year310777ExcessOrDeficitForYear
Net Unrealized GL On Investments60642NetUnrealizedGLOnInvestments
Total Adjustments60642TotalAdjustments
Excess Or Deficit Per FS371419ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt11161566TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments60642NetUnrealizedGainsInvestments
Revenue Not Rptd F99060642RevenueNotRptdF990
Revenue Subtotal11100924RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form99011100924TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt10790148TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal10790148ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99010790148TotalExpensesPerForm990

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event140TH ANNIVERSARY DINNERNameOfEvent1
Gross Receipts Event131840GrossReceiptsEvent1
Gross Revenue Event131840GrossRevenueEvent1
Food And Beverage Event112031FoodAndBeverageEvent1
Other Direct Expenses Event12461OtherDirectExpensesEvent1
Gross Receipts Total31840GrossReceiptsTotal
Gross Revenue Total Events31840GrossRevenueTotalEvents
Food And Beverage Total Events12031FoodAndBeverageTotalEvents
Other Direct Expenses Total Events2461OtherDirectExpensesTotalEvents
Direct Expense Summary Events14492DirectExpenseSummaryEvents
Net Income Summary17348NetIncomeSummary

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Compensation SurveyXCompensationSurvey
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 Payments1AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII

FieldValueIRS element (for citing)
Name PersonKENNETH FERRONNamePerson
Base Compensation Filing Org0BaseCompensationFilingOrg
Comp Based On Related Orgs266282CompBasedOnRelatedOrgs
Bonus Filing Org0BonusFilingOrg
Bonus Related Orgs0BonusRelatedOrgs
Other Compensation Filing Org0OtherCompensationFilingOrg
Other Compensation Related Orgs32958OtherCompensationRelatedOrgs
Deferred Comp Filing Org0DeferredCompFilingOrg
Deferred Comp Related Orgs71189DeferredCompRelatedOrgs
Nontaxable Benefits Filing Org0NontaxableBenefitsFilingOrg
Nontaxable Benefits Related Orgs25126NontaxableBenefitsRelatedOrgs
Total Compensation Filing Org0TotalCompensationFilingOrg
Total Compensation Related Orgs395555TotalCompensationRelatedOrgs
Comp Report Prior990 Filing Org0CompReportPrior990FilingOrg
Comp Report Prior990 Related Orgs0CompReportPrior990RelatedOrgs

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
Return ReferencePART I, LINE 7ReturnReference
ExplanationTHE RELATED ORGANIZATION, COVENANT HEALTH SYSTEM, MAINTAINS AN INCENTIVE COMPENSATION PLAN FOR EXECUTIVES THAT IS ADMINISTERED BY THAT ORGANIZATION'S COMPENSATION COMMITTEE. THE PLAN PROVIDES EXECUTIVES WITH THE OPPORTUNITY TO EARN REASONABLE INCENTIVE COMPENSATION BASED ON THE PERFORMANCE OF THE ORGANIZATION AND THE PERFORMANCE OF THE INDIVIDUAL EXECUTIVE, AS MEASURED AGAINST GOALS ESTABLISHED AT THE BEGINNING OF THE YEAR. THE ENTITLEMENT TO AWARDS FOR A PARTICULAR YEAR IS NOT DETERMINED UNTIL EARLY THE FOLLOWING YEAR. THE ORGANIZATION PAID NO INCENTIVE COMPENSATION AWARDS IN 2010 BASED ON PERFORMANCE IN 2009.Explanation

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1MA HEALTH & EDUCATION FACILITIES AUTHORITYBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN042456011IssuerEIN
CUSIP Number57586DBF9CUSIPNumber
Date Issued2007-10-30DateIssued
Issue Price7221865IssuePrice
Description Of PurposeTO FINANCE THE PURCHASE OF YOUVILLE PLACEDescriptionOfPurpose
Defeased1Defeased
On Behalf Of Issuer0OnBehalfOfIssuer
Pool Financing0PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Total Proceeds7221865TotalProceeds
Amount In Reserve Fund712880AmountInReserveFund
Issuance Costs From Proceeds55862IssuanceCostsFromProceeds
Capital Expenditures6117244CapitalExpenditures
Year Of Subst Completion2008YearOfSubstCompletion
Current Refunding1CurrentRefunding
Advance Refunding1AdvanceRefunding
Final Allocation Made1FinalAllocationMade
Adequate Books And Recds Maintaind1AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements0AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty0MngmentCntrctBondFinancdPrprty
Any Research Agreements0AnyResearchAgreements
Bond Counsel Routinely Engaged0BondCounselRoutinelyEngaged
Prcntge Prvt Business Use By Others0.00000PrcntgePrvtBusinessUseByOthers
Percentage Of Prvt Business Re UBI0.00000PercentageOfPrvtBusinessReUBI
Total Private Business Use0.00000TotalPrivateBusinessUse
Post Issuance Compliance Procdrs1PostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Form8038 T Filed1Form8038TFiled
Variable Rate Issue0VariableRateIssue
Hedge Identified In Books And Recds0HedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGIC
Gross Proceeds Invested0GrossProceedsInvested
Exception To Rebate0ExceptionToRebate

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (9 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION A, LINE 6COVENANT HEALTH SYSTEMS IS THE SOLE MEMBER OF THE ORGANIZATION. AS SUCH IT RETAINS CERTAIN RESERVE RIGHTS OVER CORPORATE DECISIONS AND COMPOSITION OF THE BOARD.
FORM 990, PART VI, SECTION A, LINE 7ACOVENANT HEALTH SYSTEMS IS THE SOLE MEMBER OF THE ORGANIZATION. AS SUCH IT RETAINS CERTAIN RESERVE RIGHTS OVER CORPORATE DECISIONS AND VOARD COMPOSITION.
FORM 990, PART VI, SECTION A, LINE 7BCOVENANT HEALTH SYSTEMS IS THE SOLE MEMBER OF THE BOARD. AS SUCH IT RETAINS CERTAIN RESERVE RIGHTS OVER BOARD DECISIONS AND BORAD COMPOSITION.
FORM 990, PART VI, SECTION B, LINE 11THE FORM 990 IS PROVIDED TO AND REVIEWED WITH THE BOARD PRIOR TO FILING.
THE ORGANIZATION HAS A FULL-TIME OPERATIONAL INTEGRITY OFFICER THAT MONITORS ALL AREAS FOR POTENTIAL CONFLICTS OF INTERETS.FORM 990, PART VI, SECTION B, LINE 12C
EVERY TWO TO THREE YEARS THE COMPENSATION COMMITTEE OF THE COVENANT HEALTH SYSTEMS BOARD OF DIRECTORS ENGAGES AN EXTERNAL CONSULTANT TO PROVIDE COMPETITIVE MARKET DATA FROM VARIOUS SURVEY SOURCES, WHICH IS USED TO DEVELOP RECOMMENDATIONS FOR CHANGES TO THE COMPENSATION PROGRAM. SINCE 2003 THE COMPENSATION COMMITTEE HAS ENGAGED MERCER HUMAN RESOURCES CONSULTING TO CONDUCT THIS ANALYSIS. THE SPECIFIC OBJECTIVES OF THE ANALYSIS ARE TO ASSESS THE COMPETITIVENESS OF THE CURRENT TOTAL CASH COMPENSATION LEVELS FOR THE SENIOR LEADERSHIP TEAM; DEVELOP MARKET COMPETITIVE SALARY RANGES FOR ALL EXECUTIVE POSITIONS AND ENSURE THAT THE ANNUAL INCENTIVE OPPORTUNITIES, IF ANY, ARE COMPETITIVE AND REASONABLE.FORM 990, PART VI, SECTION B, LINE 15
THE FORM 990 IS MADE AVAILABLE TO THE PUBLIC UPON REQUEST. THE FORM 990 IS ALSO POSTED ON COVENANT HEALTH SYSTEMS' WEBSITE.FORM 990, PART VI, SECTION C, LINE 18
THE FORM 990 AND GOVERNING DOCUMENTS, INCLUDING THE CONFLICT OF INTEREST POLICY, AND THE FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.FORM 990, PART VI, SECTION C, LINE 19
CHANGES IN NET ASSETS OR FUND BALANCES:NET UNREALIZED GAINS ON INVESTMENTS: 60,642.FORM 990, PART XI, LINE 5:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1COVENANT HEALTH SYSTEMSBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1100 AMES POND DRIVEAddressLine1
CityTEWKSBURYCity
StateMAState
ZIP Code01876ZIPCode
FieldValueIRS element (for citing)
EIN222484505EIN
Primary ActivitiesHEALTH CARE MANAGEMENT AND RESOURCE ORGANIZATIONPrimaryActivities
Legal Domicile StateMALegalDomicileState
Exempt Code Section501(C)ExemptCodeSection
Public Charity Status509(A)PublicCharityStatus
Controlled Org0ControlledOrg
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 Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable

Name Of Other Organization NameOfOtherOrganization

FieldValueIRS element (for citing)
Business Name Line1COVENANT HEALTH SYSTEMBusinessNameLine1
FieldValueIRS element (for citing)
Transaction TypeLTransactionType
Amount Involved128424AmountInvolved
Method Of Amt DeterminationCASHMethodOfAmtDetermination