2023-11-15T15:05:33-06:00 2022-12-31 111986323 MARCUM LLP 555 LONG WHARF DRIVE NEW HAVEN CT 06511 990 2022-01-01 222843194 OVERLOOK MASONIC HEALTH CENTER INC OVER 5082487344 88 MASONIC HOME ROAD CHARLTON MA 01507 NICHOLAS PUGLIESE CFO 5082487344 2023-11-15 1 NICHOLAS PUGLIESE 999009999 0 MARY ANTONETTI P00431862 2037819600 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z TAMERYN CAMPBELL 88 MASONIC HOME ROAD CHARLTON MA 01507 35628603 0 X HTTP://OVERLOOK-MASS.ORG X 1987 MA THE PROVISION OF LONG-TERM RESIDENTIAL AND REHABILITATIVE CARE TO RESIDENTS OF THE COMMUNITY. 9 8 428 16 0 0 3662222 710568 22320762 24911681 2070324 1199142 382991 2660317 28436299 29481708 0 0 0 0 16773834 17393844 0 0 0 12601685 12901587 29375519 30295431 -939220 -813723 148489436 144756884 12005864 13214174 136483572 131542710 TO PROVIDE THE RESIDENTS OF THE HEALTH CENTER WITH THE HIGHEST LEVEL OF COMPREHENSIVE MEDICAL CARE SERVICES WITH A CONSIDERATE AND PERSONAL TOUCH. 0 0 21067544 24911681 OPERATION OF A LONG-TERM CARE FACILITY IN CHARLTON, MA. TOTAL PATIENT DAYS OF CARE FOR 2022 TOTALED 38,021. OPERATION OF A POST ACUTE FACILITY IN CHARLTON, MA. TOTAL PATIENT CARE DAYS FOR 2022 TOTALED 5,424. OPERATION OF A RESIDENTIAL ENHANCED LIVING FACILITY IN CHARLTON, MA. TOTAL PATIENT CARE DAYS FOR 2022 TOTALED 9,408. OPERATION OF A MEMORY CARE RESIDENTIAL UNIT AND ADULT DAY CARE MEMORY PROGRAM FACILITY IN CHARLTON, MA. FIELDSTONE MEMORY CARE RESIDENTIAL UNIT TOTAL PATIENT CARE DAYS TOTALED 4,992. VISTA ADULT DAY PROGRAM TOTALED 1,989 DAYS OF CARE. 21067544 1 1 0 0 0 0 0 0 1 1 1 0 0 1 1 1 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 1 0 0 0 1 123 0 1 428 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X TAMERYN CAMPBELL 5084342412 88 MASONIC HOME ROAD CHARLTON MA 01507 RICHARD MAGGIO GRAND MASTER 0.15 1.15 X 0 0 0 KENNETH BLAKE MHS BOARD CHAIR 0.15 1.30 X 0 0 0 MASON RUSSELL GRAND TREASURER 0.15 1.30 X 0 0 0 ROBERT JOLLY CHAIR 0.15 0.30 X X 0 0 0 JACK MULHALL VICE CHAIR 0.15 0.15 X X 0 0 0 JAMES TRACY TREASURER 0.15 1.15 X X 0 0 0 LAWRENCE BETHUNE SECRETARY 0.15 1.30 X X 0 0 0 ROBERT SCHREMSER CLERK 0.15 1.30 X X 0 0 0 TAMERYN CAMPBELL PRESIDENT & CEO 40.00 1.30 X X 572431 0 71506 JOE SAVIDGE CHIEF FINANCIAL OFFICER (TO 4/1/22) 40.00 1.30 X 90283 0 4874 SHAWN M BERTRAM COO 40.00 1.30 X 279091 0 32217 TED WILBUR CHIEF INFORMATION OFFICER 40.00 1.30 X 175029 0 13085 STEPHANIE GRAVES-HARRISON HOSPITAL LIASON 46.36 0.00 X 156110 0 20195 CANDACE CHAMBERLAIN DIRECTOR OF NURSING 40.00 0.00 X 137293 0 14088 CHRISTINA KILLIZLI-SALAMEH CP&CO 40.00 0.00 X 135172 0 0 MARY BOULETTE LPN 50.52 0.00 X 120506 0 26387 DONNA BRADLEY DIR. OF EMPLOYEE RELATIONS&BENEFITS 40.00 0.00 X 122264 0 13566 1788179 0 195918 20 0 1 0 PREFERRED THERAPY SOLUTIONS PO BOX 69363 BALTIMORE MD 21264 THERAPY 896197 PRO EMS SOLUTIONS INC 31 SMITH PLACE CAMBRIDGE MA 02138 COVID TESTING, LAB PROCESSING, AND REPOR 421155 CUSTOM COMPUTER SPECIALISTS INC PO BOX 29786 NEW YORK NY 100879786 IT SUPPORT 332868 PROFESSIONAL NURSES HEALTH SERVICES INC 425 SUNDERLAND ROAD WORCESTER MA 01604 AGENCY NURSES 312803 BLACKSTONE VALLEY HOMECARE SPECIALISTS I 2 APPLE TREE DRIVE MILLBURY MA 01527 AGENCY NURSES 294185 9 710568 710568 NET PATIENT REVENUE 623000 21492228 21492228 AFFILIATE MANAGEMENT FEE 900099 3419453 3419453 24911681 105309 105309 304200 0 304200 304200 304200 7240728 6146895 1093833 1093833 1093833 OTHER PAYER REVENUE 623000 2311837 2311837 OTHER TENANT REVENUE 623000 39862 39862 CABLE TV ACCESS 900099 2073 2073 2345 2345 2356117 29481708 24911681 0 3859459 1238517 1238517 13192752 10968985 2223767 256074 224939 31135 1477620 1317445 160175 1228881 1021575 207306 1859563 1859563 68042 68042 75836 75836 100866 100866 2513341 2513341 164043 164043 1814845 1421303 393542 1030194 1030194 15462 1499 13963 18838 18838 56939 56939 1382259 1337889 44370 471360 471360 NURSING PURCHASING SERV 1913613 1913613 DIETARY SERVICES 825693 825693 EQUIP RENTAL & MAINT 355113 330280 24833 BAD DEBT EXPENSE 113842 113842 121738 88927 32811 30295431 21067544 9227887 0 308500 136517 1563757 948226 413285 239608 66192843 49503256 16827583 16689587 28847669 20321245 100528642 106421701 148489436 144756884 2519075 3131549 1134222 963192 8352567 9119433 12005864 13214174 X 120114185 117031994 16369387 14510716 136483572 131542710 148489436 144756884 X -813723 -4373715 246576 X X 0 1 X 1 0 X 345475 190513 306839 3662222 710568 5215617 21483512 22875495 23306946 22320762 24911681 114898396 21828987 23066008 23613785 25982984 25622249 120114013 0 0 0 120114013 573397 455869 360651 413879 409509 2213305 573397 455869 360651 413879 409509 2213305 1822398 2058583 92989 80111 2356117 6410198 24224782 25580460 24067425 26476974 28387875 128737516 0.93300 0.96200 0.01720 0.01940 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISC INCOME - 2018 AMOUNT: $ 1,822,398. 2019 AMOUNT: $ 2,058,583. 2020 AMOUNT: $ 92,989. 2021 AMOUNT: $ 80,111. 2022 AMOUNT: $ 2,356,117. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 33737 33737 1 X 28863197 235221 -3119963 5647847 20330608 24287640 3210357 2749728 1384528 28863197 22109679 329674 2868492 1020205 24287640 19644993 805705 3140400 1481419 22109679 55155848 1664971 -1508578 35667248 19644993 0.28580 0.28186 0.43234 0 0 381084 381084 47134693 35015905 12118788 11041415 8487294 2554121 7635651 6000057 1635594 16689587 MASONIC EDUCATION AND CHARITY TRUST INVESTMENT FUND 20321245 C 20321245 DUE FROM AFFILIATES 104294492 OTHER RECEIVABLES 1790669 DUE FROM GRAND LODGE 336540 106421701 DUE TO AFFILIATES 7314431 DUE TO RESIDENTS 44083 ASSET RETIREMENT OBLIGATION 953584 PENSION LIABILITY 807335 9119433 X 24893285 -4373715 -113842 -4487557 29380842 100866 100866 29481708 30080723 0 30080723 100866 113842 214708 30295431 PART IV, LINE 2B: PERSONS ADMITTED TO THE HEALTH CENTER WHO DO NOT WISH TO APPOINT A RESPONSIBLE PARTY TO MANAGE THEIR ASSETS MAY, IF THEY WISH, HAVE THE HEALTH CENTER ASSUME THE RESPONSIBILITY OF MANAGING THEIR ASSETS ON THEIR BEHALF. ASSETS THAT ARE TRANSFERRED TO THE HEALTH CENTER UNDER THIS ARRANGEMENT ARE CO-MINGLED WITH THE ASSETS OF OTHER RESIDENTS AND PLACED IN AN INVESTMENT TRUST ACCOUNT PURSUANT TO A REVOCABLE TRUST AGREEMENT. ALL SUCH FUNDS HAVE BEEN PLACED IN A MONEY MARKET ACCOUNT IN THE HEALTH CENTER'S NAME AT A BANK. ALL RECEIPTS FROM RESIDENTS DURING THEIR PERIOD OF RESIDENCY AND ALL CHARGES FOR ROOM AND BOARD AND MEDICAL CARE ARE CREDITED AND/OR CHARGED TO THEIR INDIVIDUAL ACCOUNTS. INTEREST IS CALCULATED MONTHLY ON THE TOTAL TRUST ACCOUNT AND CREDITED TO EACH RESIDENT IN ACCORDANCE WITH HIS/HER PRO RATA BALANCE. THESE FUNDS, AND CORRESPONDING LIABILITIES, ARE RECORDED ON THE CONSOLIDATED BALANCE SHEETS AND ARE INCLUDED IN CASH AND EQUIVALENTS AND ACCOUNTS PAYABLE. THE RESIDENT PORTIONS OF EACH OF THESE RESPECTIVE ACCOUNTS WERE $44,083 AND $33,737 AT DECEMBER 31, 2022 AND 2021, RESPECTIVELY. PART V, LINE 4: THE ORGANIZATION HAS AN ENDOWMENT WHICH IS HELD IN THE MASONIC EDUCATION AND CHARITY TRUST. FUNDS ARE SPENT FROM THE ENDOWMENT WHEN NEEDED FOR OPERATIONS OR CAPITAL IMPROVEMENTS. PART X, LINE 2: BELOW IS AN EXCERPT FROM FOOTNOTE 2 OF THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS FOR THE MASONIC HEALTH SYSTEM OF MASSACHUSETTS, INC. MHS, HEALTH CENTER, OVNA AND COMMUNITIES HAVE BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE ORGANIZATION ACCOUNTS FOR UNCERTAINTY IN INCOME TAX POSITIONS BY APPLYING A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2022 AND 2021, THERE ARE NO TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE ORGANIZATION IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS PENDING OR IN PROGRESS. PART XI, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT EXPENSE -113,842. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 113,842. X 0 0 X X X 0 0 0 0 0 0 0 0 0 TAMERYN CAMPBELL PRESIDENT & CEO 394593 0 175000 0 2838 0 6100 0 65406 0 643937 0 0 0 SHAWN M BERTRAM COO 261903 0 16288 0 900 0 0 0 32217 0 311308 0 0 0 TED WILBUR CHIEF INFORMATION OFFICER 161014 0 12604 0 1411 0 3537 0 9548 0 188114 0 0 0 STEPHANIE GRAVES-HARRISON HOSPITAL LIASON 144581 0 0 0 11529 0 1367 0 18828 0 176305 0 0 0 CANDACE CHAMBERLAIN DIRECTOR OF NURSING 128072 0 8663 0 558 0 0 0 14088 0 151381 0 0 0 PART I, LINE 1A TAMERYN CAMPBELL RECEIVED A HOUSING ALLOWANCE FROM A RELATED ORGANIZATION (OC) WITH AN ESTIMATED VALUE OF $50,640 DURING THE YEAR ENDING DECEMBER 31, 2022. THIS WAS REPORTED AS A NONTAXABLE BENEFIT TO TAMERYN. FORM 990, PART VI, SECTION A, LINE 6 THE MASONIC HEALTH SYSTEM OF MASSACHUSETTS, INC. IS THE SOLE MEMBER OF THE ORGANIZATION AND ELECTS THE BOARD OF DIRECTORS. THERE ARE NO CLASSES OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7A THE MASONIC HEALTH SYSTEM OF MASSACHUSETTS, INC. HAS THE POWER TO REMOVE DIRECTORS, TO FILL VACANCIES, AND TO INCREASE OR DECREASE THE SIZE OF THE BOARD. FORM 990, PART VI, SECTION A, LINE 7B THE MASONIC HEALTH SYSTEM OF MASSACHUSETTS, INC. HAS THE POWER TO REMOVE DIRECTORS, TO FILL VACANCIES, AND TO INCREASE OR DECREASE THE SIZE OF THE BOARD. FORM 990, PART VI, SECTION B, LINE 11B MANAGEMENT WORKS WITH THE ORGANIZATION'S TAX ADVISOR (CPA FIRM) TO PREPARE THE FINANCIAL INFORMATION AND COMPILE THE DISCLOSURES REQUIRED OF THE FORM 990. UPON ITS COMPLETION, SENIOR MANAGEMENT PROVIDES A DRAFT OF THE FORM 990 TO THE BOARD OF DIRECTORS PRIOR TO ITS SUBMISSION. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REGULARLY AND CONSISTENLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY VIA ANNUAL EXECUTION OF THE CONFLICT OF INTEREST POLICY. THIS CONFLICTS POLICY IS INTENDED TO SUPPLEMENT, BUT NOT REPLACE, ANY APPLICABLE STATE LAWS GOVERNING CONFLICTS OF INTEREST APPLICABLE TO NONPROFIT AND CHARITABLE CORPORATIONS. THIS CONFLICTS POLICY HAS BEEN ADOPTED BY THE BOARD OF DIRECTORS OF MASONIC HEALTH SYSTEM OF MASSACHUSETTS, INC. (MHS). THIS CONFLICTS POLICY SHALL APPLY WITH EQUAL FORCE TO ALL CORPORATIONS RELATED TO, OR AFFILIATED WITH, MHS. ON AN ANNUAL BASIS THE DIRECTORS COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE WHICH IS REVIEWED BY THE PRESIDENT'S OFFICE. IF A CONFLICT ARISES, THE INDIVIDUAL WOULD RECUSE THEMSELVES FROM ALL DISCUSSION ON THE MATTER. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION'S SOLE MEMBER, MASONIC HEALTH SYSTEM OF MASSACHUSETTS, INC. MAINTAINS AN EXECUTIVE COMMITTEE, WHICH AMONG OTHER THINGS, REVIEWS THE COMPENSATION AND TERMS OF THE AGREEMENT WITH ITS EXECUTIVE OFFICER. THE COMMITTEE REVIEWS THE COMPENSATION OF THE INDIVDIUAL IN RELATION TO THE SALARY LEVEL OF OTHER COMPARABLE POSITIONS IN THE MARKET AND THEIR PERFORMANCE. ONCE REASONABLE COMPENSATION IS DETERMINED, IT IS APPROVED BY THE BOARD. FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATION'S FORM 990 IS AVAILABLE TO THE PUBLIC UPON REQUEST AND CAN BE FOUND ONLINE VIA THE MASSACHUSETTS ATTORNEY GENERAL'S WEBSITE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S FINANCIAL STATEMENTS CONFLICT OF INTEREST POLICY, AND GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: ADJUSTMENT TO MINIMUM PENSION LIABILITY 240,411. TRANSFER OF UNCLAIMED PROPERTY FROM MHS 6,165. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. MASONIC HEALTH SYSTEM OF MASSACHUSETTS INC 88 MASONIC HOME ROAD CHARLTON MA 01507 043515688 PARENT MA 501(C)(3) LINE 12C, III-FI N/A 0 OVERLOOK VISITING NURSES ASSOCIATION 88 MASONIC HOME ROAD CHARLTON MA 01507 043515687 VNA MA 501(C)(3) LINE 10 MASONIC HEALTH SYSTEM OF MASSACHUSETTS 1 OVERLOOK COMMUNITIES INC 88 MASONIC HOME ROAD CHARLTON MA 01507 043515686 NURSING FACILITY MA 501(C)(3) LINE 10 MASONIC HEALTH SYSTEM OF MASSACHUSETTS 1 0 0 0 1 1 0 0 0 0 1 0 1 0 1 0 0 0 0 0 MASONIC HEALTH SYSTEM OF MASSACHUSETTS N 71751 CASH MASONIC HEALTH SYSTEM OF MASSACHUSETTS D 73753605 CASH OVERLOOK VISITING NURSE ASSOCIATION E 168616 CASH OVERLOOK VISITING NURSE ASSOCIATION D 2635022 CASH OVERLOOK VISITING NURSE ASSOCIATION J 159000 CASH OVERLOOK VISITING NURSE ASSOCIATION L 1092083 CASH OVERLOOK COMMUNITIES N 1611157 CASH OVERLOOK COMMUNITIES D 28321439 CASH OVERLOOK COMMUNITIES J 2799428 CASH OVERLOOK COMMUNITIES L 613007 CASH