2024-11-13T10:23:18-06:00 2023-12-31 410746749 CLIFTONLARSONALLEN LLP 4334 MUNSON STREET SUITE 200 CANTON OH 44718 990 2023-01-01 042510563 D'YOUVILLE SENIOR CARE INC DYOU 9785691000 981 VARNUM AVENUE LOWELL MA 01854 MICHAEL FERRICK CEO 9785691000 2024-11-08 1 1 JENNIFER COLEMAN P00743188 3304972000 2023 2024-10-15 13:58:12Z MICHAEL FERRICK 981 VARNUM AVENUE LOWELL MA 01854 26343129 0 X WWW.DYOUVILLE.ORG X 1960 MA FOUNDED BY THE SISTERS OF CHARITY OF OTTAWA AND SPONSORED BY THE CARMELITE SISTERS FOR THE AGED AND INFIRM, D'YOUVILLE LIFE AND WELLNESS COMMUNITY CONTINUES THE HEALING MINISTRY OF JESUS CHRIST BY IDENTIFYING AND RESPONDING TO THE NEEDS OF THE COMMUNITY WITH PROFESSIONAL AND COMPASSIONATE CARE IN A HOME LIKE SETTING. 17 16 0 26 0 0 1724656 119808 23548102 24412523 165830 357314 319318 212460 25757906 25102105 0 0 0 0 14932863 15784387 0 0 4274 19359546 11050698 34292409 26835085 -8534503 -1732980 19615633 21566945 12755201 16250436 6860432 5316509 X FOUNDED BY THE SISTERS OF CHARITY OF OTTAWA AND SPONSORED BY THE CARMELITE SISTERS FOR THE AGED AND INFIRM, D'YOUVILLE LIFE AND WELLNESS COMMUNITY CONTINUES THE HEALING MINISTRY OF JESUS CHRIST BY IDENTIFYING AND RESPONDING TO THE NEEDS OF THE COMMUNITY WITH PROFESSIONAL AND COMPASSIONATE CARE IN A HOME LIKE SETTING. 0 0 24687897 24624983 SENIOR CARE - THE ORGANIZATION FURTHERS THE HEALING MINISTRY OF JESUS CHRIST BY EXTENDING PROFESSIONAL AND COMPASSIONATE CARE TO SENIORS IN NEED THROUGH THE OPERATION OF A 208-BED SKILLED NURSING FACILITY. THE FACILITY'S CLINICIANS ARE PROFESSIONALS WHO ARE DEDICATED TO THE WELL-BEING AND HEALTH OF THEIR RESIDENTS. 24687897 1 1 0 0 0 0 0 0 1 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1 0 0 0 1 34 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 17 16 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 MA X CORRINNE SCHINDLER 5185377500 646 WOODS ROAD GERMANTOWN NY 12526 X STEVEN LAROCHELLE CHAIR 1.00 5.00 X X 0 0 0 CAROL HOWARD VICE CHAIRPERSON 1.00 6.00 X X 0 0 0 JERRY FRECHETTE TREASURER 1.00 3.00 X X 0 0 0 SR JEANNE ARCHAMBAULT SCO CLERK 1.00 3.00 X X 0 0 0 THOMAS J BROWN DIRECTOR 1.00 3.00 X 0 0 0 JOSEPH CLERMONT ESQ DIRECTOR 1.00 3.00 X 0 0 0 MARK S COCHRAN DIRECTOR 1.00 3.00 X 0 0 0 SR PETER LILLIAN DI MARIA O CARM DIRECTOR 1.00 3.00 X 0 0 0 REVERAND PETER G GORI OSA JCD DIRECTOR 1.00 3.00 X 0 0 0 MOTHER MARY ROSE HEERY OCARM DIRECTOR 1.00 11.00 X 0 0 0 AMY J HOEY DIRECTOR 1.00 3.00 X 0 0 0 SR PAULINE LEBLANC SCO DIRECTOR 1.00 3.00 X 0 0 0 JAMES LINNEHAN JR ESQ DIRECTOR 1.00 3.00 X 0 0 0 SR PRESCILLE MALO SCO DIRECTOR 1.00 3.00 X 0 0 0 WILLIAM F MARTIN JR ESQ DIRECTOR 1.00 3.00 X 0 0 0 JUDITH RAMIREZ DIRECTOR 1.00 3.00 X 0 0 0 SR MARK LOUIS RANDALL OCARM DIRECTOR 1.00 12.00 X 0 0 0 PATRICIA GATHERS PRESIDENT/ CEO CARMELITE 1.00 39.00 X 0 712713 48935 NAOMI PRENDERGAST FORMER ADMINISTRATOR 1.00 39.00 X 0 161116 2380 MICHAEL FERRICK CEO 1.00 39.00 X 0 232120 0 0 1105949 51315 0 0 1 0 FIRESIDE STAFFING INC 17 GAUDET LANE PELHAM NH 03076 NURSING CONTRACT LABOR 2104908 INTELYCARE INC 1250 HANCOCK STREET SUITE 501N QUINCY MA 02169 NURSING CONTRACT LABOR 484880 TRELYNE HOMECARE AND STAFFING LLC 70 PELCZAR ROAD DRACUT MA 01826 NURSING CONTRACT LABOR 439245 AMERICAN HEALTHCARE STAFFING 84 HIGHLAND AVENUE SUITE 312 SALEM MA 01970 NURSING CONTRACT LABOR 350611 HEART TO HEART HOMECARE ASSOCIATES INC 5 ROBINHOOD RD TYNGSBORO MA 01879 NURSING CONTRACT LABOR 244894 11 119808 119808 PATIENT REVENUE 623990 24412523 24412523 24412523 273070 273070 1325268 1241024 84244 84244 84244 OTHER OPERATING INCOME 623990 212460 212460 212460 25102105 24624983 0 357314 X 12940930 12644829 296101 118811 89020 29791 1365999 1365999 1358647 1235896 118477 4274 193968 193968 86992 86992 88733 88733 4783185 4432446 350739 184987 72808 112179 105971 1764 104207 504127 504127 592779 592779 5223 899 4324 571467 514320 57147 864894 778405 86489 655477 589929 65548 SUPPLIES 888961 888961 BED TAX/ASSESSMENT 506623 506623 FOOD 303422 303422 REPAIRS AND MAINTENANCE 115617 92177 23440 598272 577620 20652 26835085 24687897 2142914 4274 1280444 465036 2116739 1920891 1969432 2389724 107429 128097 32595291 21851930 10918017 10743361 2772465 3368016 451107 2551820 19615633 21566945 2507827 3020861 10124237 10133592 70448 70449 52689 3025534 12755201 16250436 X 6860432 5316509 6860432 5316509 19615633 21566945 X -1732980 225685 -36628 X 1 X 1 X 1 1 1 X 67731 1419773 4127436 1724656 119808 7459404 22308697 21040579 23236112 23867420 24624983 115077791 22376428 22460352 27363548 25592076 24744791 122537195 0 0 0 122537195 80317 81663 66660 88026 273070 589736 80317 81663 66660 88026 273070 589736 22456745 22542015 27430208 25680102 25017861 123126931 0.99520 0.99680 0.00480 0.00320 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 820995 820995 26417187 17267459 9149728 4600199 4256054 344145 756910 328417 428493 10743361 ASSETS LIMITED AS TO USE 70949 DUE FROM RELATED PARTIES 2468961 ACCOUNTS RECEIVABLE, NON-RESIDENTS 11910 2551820 DUE TO RELATED PARTIES 2988906 OTHER LIABILITIES 36628 3025534 X PART X, LINE 2: D'YOUVILLE SENIOR CARE, INC. IS A NONPROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC) AND IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE IRC. THE ORGANIZATION FOLLOWS THE PROVISIONS OF THE INCOME TAX ACCOUNTING STANDARDS REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. IT IS THE ORGANIZATION'S POLICY TO ACCOUNT FOR ANY INTEREST OR PENALTIES ASSESSED RELATING TO UNCERTAIN TAX POSITIONS, IF ANY, AS ADMINISTRATIVE EXPENSES. THE ORGANIZATION DID NOT INCUR ANY INTEREST OR PENALTIES FOR THE YEARS ENDED DECEMBER 31, 2023 AND 2022. THE APPLICATION OF THESE PROVISIONS HAS NO IMPACT ON THE ORGANIZATION'S FINANCIAL STATEMENTS. THE ORGANIZATION'S TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL AND STATE AUTHORITIES. 0 0 0 0 0 0 0 0 0 PATRICIA GATHERS PRESIDENT/ CEO CARMELITE 0 602910 0 109803 0 0 0 22500 0 26435 0 761648 0 0 MICHAEL FERRICK CEO 0 210719 0 21401 0 0 0 0 0 0 0 232120 0 0 NAOMI PRENDERGAST FORMER ADMINISTRATOR 0 157343 0 77 0 3696 0 0 0 2380 0 163496 0 0 PART I, LINE 3 THE ORGANIZATION'S COMPENSATION IS ESTABLISHED BY D'YOUVILLE LIFE AND WELLNESS COMMUNITY, INC. A RELATED PARTY. COMPENSATION IS DETERMINED BY THE FOLLOWING: 1. COMPENSATION COMMITTEE 2. FORM 990 OF OTHER ORGANIZATIONS 3. COMPENSATION SURVEY/STUDY 4. APPROVAL BY THE BOARD OF DIRECTORS/COMPENSATION COMMITTEE A MASSACHUSETTS DEVELOPMENT FINANCE AGENCY 043431814 2022-12-14 24660380 DEBT REFINANCING AND CONSTRUCTION 0 0 0 A 2142641 24660380 22639233 521147 1500000 1 0 0 1 A 0 0 0 0 0 0 0 A 0 0 0 0 1 0 0 0 0 A 0 SCHEDULE K SUPPLENTAL INFORMATION THE BOND ISSUANCE OF $20,500,000 WAS PARTIALLY USED FOR THE PAYOFF OF AN EXISTING DEBT OF $11,000,000 AND $1,500,000 OF CONSTRUCTION FOR D'YOUVILLE SENIOR CARE, INC., IN ADDITION THE REMAINING $8,000,000 WAS USED FOR CONSTRUCTION OF A RELATED ORGANIZATION, D'YOUVILLE TRANSITIONAL CARE, INC. FORM K, PART II, LINE 3: THE GROSS PROCEEDS FROM THE BOND ISSUANCE TOTAL $20,500,000, THE PROCEEDS USED BY D'YOUVILLE SENIOR CARE, INC. TOTAL $12,500,000. THE REMAINING PROCEEDS OF $8,000,000 HAVE BEEN USED BY A RELATED TAX EXEMPT PARTY CONSISTENT WITH THE TERMS OF THE BOND ISSUANCE. STEVEN LAROCHELLE DIRECTOR 562316 DEBT SERVICE INTEREST - EBTC - DSC & DTC 0 FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION'S MANAGEMENT DUTIES ARE PERFORMED BY A RELATED ORGANIZATION, D'YOUVILLE LEADERSHIP SOLUTIONS, INC. D'YOUVILLE LEADERSHIP SOLUTIONS, INC. PROVIDES MANAGEMENT AND ADMINISTRATIVE SUPPORT SERVICES AS FOLLOWS: MANAGEMENT OVERSIGHT, ALL BUSINESS OFFICE FUNCTIONS, HUMAN RESOURCES, MARKETING, INFORMATION TECHNOLOGY, ADMISSIONS, AND MAINTENANCE. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE CORPORATION IS D'YOUVILLE LIFE AND WELLNESS COMMUNITY, INC., ("DLWC") A MASSACHUSETTS NONPROFIT CORPORATION RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. FORM 990, PART VI, SECTION A, LINE 7A TWO OF THE CORPORATION'S DIRECTORS MUST BE MEMBERS OF THE GENERAL COUNCIL OF THE CARMELITE SISTERS OF THE AGED AND INFIRM, INC. (THE "CARMELITE SISTERS"), AND ARE SELECTED BY THE CARMELITE SISTERS. THE CORPORATION'S SOLE MEMBER, DLWC, ELECTS THE CORPORATION'S REMAINING DIRECTORS AND ITS PRESIDENT, WHO SERVES EX-OFFICIO AS A DIRECTOR. FORM 990, PART VI, SECTION A, LINE 7B AS SOLE MEMBER OF THE CORPORATION, DLWC HAS ALL POWERS RESERVED TO IT BY STATE LAW. IN ADDITION, DLWC HOLDS THE FOLLOWING RESERVED POWERS: (A) TO APPROVE ANY CHANGE TO THE PHILOSOPHY AND MISSION OF THE CORPORATION OR ANY SUBSIDIARY OF THE CORPORATION, AND TO MONITOR COMPLIANCE WITH SAME; (B) TO AMEND THE ARTICLES OF ORGANIZATION AND BYLAWS OF THE CORPORATION, AND TO APPROVE THE ADOPTION OR AMENDMENT OF THE CHARTER AND THE BYLAWS (OR OTHER GOVERNING INSTRUMENTS) OF ANY SUBSIDIARY OF THE CORPORATION; (C) TO ELECT THE DIRECTORS OF THE CORPORATION (OTHER THAN THE DIRECTORS APPOINTED BY THE CARMELITE SISTERS OF THE AGED AND INFIRM, INC.) AND TO REMOVE THEM WITH OR WITHOUT CAUSE; (D) TO APPOINT AND REMOVE THE PRESIDENT OF THE CORPORATION IN CONSULTATION WITH THE BOARD OF DIRECTORS; (E) TO RATIFY THE BOARD OF DIRECTORS' ELECTION OF THE CHAIRPERSON OF THE BOARD OF DIRECTORS; (F) TO APPROVE ALL PLANS OF MERGER, CONSOLIDATION, REORGANIZATION OR DISSOLUTION OF THE CORPORATION OR ANY SUBSIDIARY OF THE CORPORATION, OR THE SALE, LEASE, ASSIGNMENT OR TRANSFER OF SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION OR ANY SUBSIDIARY OF THE CORPORATION, OR THE PURCHASE OR ACQUISITION BY THE CORPORATION OR AN SUBSIDIARY OF THE CORPORATION OF AN INTEREST IN ANY CORPORATION, PARTNERSHIP, JOINT VENTURE OR OTHER ENTITY, WHETHER NEWLY CREATED OR PREVIOUSLY EXISTING, WHICH INTEREST, IN THE CASE OF A FOR PROFIT ENTITY, REPRESENTS TWENTY-FIVE PERCENT OR MORE OF THE VOTING POWER THEREOF OR EQUITY INTEREST THEREIN, OR, IN THE CASE OF A NON-PROFIT ENTITY, REPRESENTS TWENTY-FIVE PERCENT OR MORE OF THE VOTING POWER THEREOF OR MEMBERSHIP INTEREST THEREIN; (G) TO APPROVE THE ACQUISITION, SALE, TRANSFER OR ENCUMBRANCE OF ANY REAL ESTATE, OR THE CONSTRUCTION OR DESTRUCTION OF ANY IMPROVEMENTS THEREON, BY THE CORPORATION OR ANY SUBSIDIARY OF THE CORPORATION VALUED IN EXCESS OF AN AMOUNT SET BY THE MEMBER FROM TIME TO TIME; (H) TO APPROVE ALL DEBT OF THE CORPORATION OR ANY SUBSIDIARY OF THE CORPORATION FOR BORROWED MONEY IN EXCESS OF AN AMOUNT SET BY THE MEMBER FROM TIME TO TIME BEFORE SUCH DEBT IS INCURRED, AND TO APPROVE ALL CHANGES TO THE TERMS OF ANY SUCH DEBT; (I) TO APPROVE THE SALE, ASSIGNMENT OR TRANSFER BY THE CORPORATION OR ANY SUBSIDIARY OF THE CORPORATION OF ANY EQUITY INTEREST OR MEMBERSHIP INTEREST IN ANY SUBSIDIARY OF THE CORPORATION, TO APPROVE ANY RECLASSIFICATION OR OTHER CHANGE OF ANY CAPITAL STOCK OR OTHER EQUITY SECURITY OF ANY SUBSIDIARY OF THE CORPORATION, OR ANY RECAPITALIZATION OF ANY SUBSIDIARY OF THE CORPORATION; AND TO APPROVE THE ISSUANCE OF, OR THE CREATION OF ANY OBLIGATION TO ISSUE, ANY EQUITY SECURITY OF ANY SUBSIDIARY OF THE CORPORATION, OR ANY INCREASE OR DECREASE IN THE TOTAL NUMBER OF SHARES OF AUTHORIZED CAPITAL STOCK OR OTHER EQUITY SECURITY OF ANY SUBSIDIARY OF THE CORPORATION; (J) TO APPROVE ALL LONG-RANGE STRATEGIC PLANS OF THE CORPORATION AND ANY SUBSIDIARY OF THE CORPORATION BEFORE THEIR IMPLEMENTATION; (K) TO APPROVE ALL CAPITAL AND OPERATING BUDGETS OF THE CORPORATION AND ANY SUBSIDIARY OF THE CORPORATION AND NON-BUDGETED EXPENDITURES BY THE CORPORATION OR ANY SUBSIDIARY OF THE CORPORATION IN EXCESS OF AN AMOUNT SET BY THE MEMBER FROM TIME TO TIME; (L) TO APPOINT THE CORPORATION'S AUDITORS AND THE AUDITORS OF ANY SUBSIDIARY OF THE CORPORATION; (M) TO APPROVE THE ENGAGEMENT OF LEGAL COUNSEL FOR THE CORPORATION AND ANY SUBSIDIARY OF THE CORPORATION; (N) TO APPROVE THE ENGAGEMENT OF MONEY MANAGERS FOR THE CORPORATION AND ANY SUBSIDIARY OF THE CORPORATION; (O) TO APPROVE THE LENDING OF FUNDS OR THE MAKING OR RECEIPT OF GIFTS OR DONATIONS BY THE CORPORATION OR ANY SUBSIDIARY OF THE CORPORATION IN EXCESS OF AN AMOUNT SET BY THE MEMBER FROM TIME TO TIME; (P) TO APPROVE CONTRACTS BY THE CORPORATION OR ANY SUBSIDIARY OF THE CORPORATION WHICH ARE IN EXCESS OF AN AMOUNT SET BY THE MEMBER FROM TIME TO TIME; (Q) TO APPROVE ANY CHANGE IN LICENSURE, LEVEL OF CARE, BED CAPACITY AND TYPE OF SERVICE OF THE CORPORATION OR ANY SUBSIDIARY OF THE CORPORATION IN CONFORMANCE WITH THE MISSION AND PHILOSOPHY OF THE CORPORATION OR SUCH SUBSIDIARY OF THE CORPORATION AND THE ETHICAL AND RELIGIOUS DIRECTIVES FOR CATHOLIC HEALTH CARE FACILITIES; AND (R) TO (I) REQUIRE THE PARTICIPATION OF THE CORPORATION AND ANY SUBSIDIARY OF THE CORPORATION IN AN OBLIGATED GROUP INCLUDING AUTHORIZATION AND THE EXECUTION OF A MASTER TRUST INDENTURE PROVIDING FOR THE CROSS-COLLATERALIZATION OF THE ASSETS OF THE CORPORATION OR ANY SUBSIDIARY OF THE CORPORATION THAT BECOMES A MEMBER OF THE OBLIGATED GROUP TO SECURE FINANCING FOR THE PROJECTS AND BUDGETS OF THE MEMBERS OF THE OBLIGATED GROUP, (II) REQUIRE THE EXECUTION BY THE CORPORATION AND ANY SUBSIDIARY OF THE CORPORATION THAT BECOMES A MEMBER OF THE OBLIGATED GROUP OF A SUPPLEMENTAL MASTER TRUST INDENTURE AND MASTER NOTE AS A MEMBER OF AN OBLIGATED GROUP, AND A MASTER TRUST INDENTURE MORTGAGE AS A MEMBER OF THE OBLIGATED GROUP GRANTING A MORTGAGE ON THE CORPORATION'S REAL PROPERTY TO SECURE THE ENTIRE MASTER TRUST INDENTURE DEBT, (III) REQUIRE AND SECURE THE OPINION OF COUNSEL FOR THE CORPORATION AND ANY SUBSIDIARY OF THE CORPORATION THAT BECOMES A MEMBER OF THE OBLIGATED GROUP THAT THE MASTER TRUST INDENTURE, SUPPLEMENTAL TRUST INDENTURE, MASTER NOTE AND MORTGAGE, AS DEEMED APPLICABLE ARE VALID, BINDING AND ENFORCEABLE OBLIGATIONS OF THE CORPORATION, (IV) SELECT THE MASTER TRUSTEE FOR AN OBLIGATED GROUP, (V) REQUIRE THE PLEDGE OF COLLATERAL OF THE CORPORATION AND ANY SUBSIDIARY OF THE CORPORATION THAT BECOMES A MEMBER OF THE OBLIGATED GROUP, INCLUDING THE ENTRY INTO ANY DOCUMENTATION RELATING TO PLEDGE OF SUCH COLLATERAL, (VI) TAKE ANY ACTION NECESSARY IN CONNECTION WITH THE INCURRENCE OF DEBT BY THE CORPORATION AND ANY SUBSIDIARY OF THE CORPORATION THAT BECOMES A MEMBER OF THE OBLIGATED GROUP IN CONNECTION WITH THE OBLIGATED GROUP OR THE SECURING OF ANY SUCH DEBT OF THE CORPORATION AND ANY SUBSIDIARY OF THE CORPORATION THAT BECOMES A MEMBER OF THE OBLIGATED GROUP; AND (VII) HAVE ANY AUTHORIZED OFFICER OF THE MEMBER EXECUTE ANY OF THE DOCUMENTS DESCRIBED OR RELATED TO THE POWERS SET FORTH IN THIS SUBSECTION (R). THE CARMELITE SISTERS IS THE "SPONSOR" OF THE CORPORATION'S SOLE MEMBER, DLWC. THE CARMELITE SYSTEM, INC. (THE "CARMELITE SYSTEM"), IS THE SOLE MEMBER OF DLWC. DLWC'S RESERVED POWERS AND RIGHTS WITH RESPECT TO THE CORPORATION ARE SUBJECT TO THE POWERS AND RIGHTS OF THE CARMELITE SISTERS AND THE CARMELITE SYSTEM WITH RESPECT TO DLWC. FORM 990, PART VI, SECTION B, LINE 11B THE FINANCE COMMITTEE REPORTS TO THE BOARD OF DIRECTORS REGARDING THE REVIEW OF THE FORM 990. A COMPLETE COPY OF THE FORM 990 IS PROVIDED TO THE BOARD PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C EACH EMPLOYEE IS GIVEN THE CONFLICT OF INTEREST POLICY AT ORIENTATION AND IS REQUIRED TO REVIEW THIS POLICY ON AN ON-GOING BASIS. DIRECTORS ARE GIVEN THE POLICY AT ORIENTATION AND REVIEW CHANGES AS THEY OCCUR. THE POLICY COVERS ALL EMPLOYEES AND BOARD MEMBERS AND POTENTIAL CONFLICTS ARE REVIEWED BY MANAGEMENT ON AN ON-GOING BASIS TO ASSURE COMPLIANCE. IDENTIFIED ISSUES ARE DISCUSSED AT THE BOARD LEVEL AND AN APPROPRIATE COURSE OF ACTION IS TAKEN BASED ON THE VIOLATION. TO PREVENT TRADE CONFLICT, ALL MATERIAL EXPENDITURES NEED A MINIMUM OF THREE BIDS FROM CONTRACTORS. FORM 990, PART VI, SECTION B, LINE 15A THE DLWC COMPENSATION COMMITTEE CONSULTS WITH RAY ANSTISS, JR, CPA, PRINCIPAL OF ANSTISS AND COMPANY, PC, FOR INDUSTRY INFORMATION RELATING TO THE COMPENSATION OF THE DLWC PRESIDENT/CEO AND CFO POSITIONS. RAY ANSTISS ALSO MAINTAINS RECORDS OF THE COMPENSATION COMMITTEE DECISIONS FOR FUTURE REFERENCE FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART VII: D'YOUVILLE SENIOR CARE, INC. EMPLOYEES ARE PAID BY A RELATED ENTITY, D'YOUVILLE LEADERSHIP SOLUTIONS, INC. (EIN 27-4675543). THE SALARIES AND RELATED EXPENSES FOR THESE EMPLOYEES ARE ALLOCATED BACK TO D'YOUVILLE SENIOR CARE, INC. FORM 990, PART IX, LINE 11G PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 4,432,446. MANAGEMENT AND GENERAL EXPENSES 350,739. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,783,185. FORM 990, PART XI, LINE 9: CHANGE IN FAIR VALUE OF INTEREST RATE SWAP -36,628. D'YOUVILLE ELDERLY HOUSING CORPORATION 975 VARNUM AVENUE LOWELL MA 01854 043536564 LOW-INCOME SENIOR HOUSING MA 501(C)(3) LINE 10 PLANNING OFFICE FOR URBAN AFFAIRS INC 0 D'YOUVILLE LEADERSHIP SOLUTIONS INC 981 VARNUM AVENUE LOWELL MA 01854 274675543 MANAGEMENT COMPANY MA 501(C)(3) LINE 12B, II CARMELITE SISTERS FOR THE AGED AND INFIRM INC 0 D'YOUVILLE LIFE & WELLNESS COMMUNITY INC 981 VARNUM AVENUE LOWELL MA 01854 274675379 SUPPORT SERVICES MA 501(C)(3) LINE 12B, II CARMELITE SISTERS FOR THE AGED AND INFIRM INC 0 D'YOUVILLE SENIOR CARE FOUNDATION INC 981 VARNUM AVENUE LOWELL MA 01854 912055004 FUNDRAISING MA 501(C)(3) LINE 7 CARMELITE SISTERS FOR THE AGED AND INFIRM INC 0 D'YOUVILLE SENIOR LIVING INC 979 VARNUM AVENUE LOWELL MA 01854 200837361 LOW-INCOME SENIOR HOUSING MA 501(C)(3) LINE 10 D'YOUVILLE SENIOR CARE INC 1 D'YOUVILLE TRANSITIONAL CARE INC 1071 VARNUM AVENUE LOWELL MA 01854 271680453 SHORT-TERM REHAB MA 501(C)(3) LINE 10 CARMELITE SISTERS FOR THE AGED AND INFIRM INC 0 SISTERS OF CHARITY OF OTTAWA 245 UNIVERSITY AVENUE LOWELL MA 01854 042127030 SCHOOL - GRADES K-8 MA 501(C)(3) LINE 1 N/A 0 CARMELITE SISTERS FOR THE AGED AND INFIRM INC 600 WOODS ROAD GERMANTOWN NY 12526 141369151 LONG TERM HEALTHCARE MINISTRY NY 501(C)(3) LINE 10 N/A 0 CARMEL MANOR INC 100 CARMEL MANOR ROAD FT THOMAS KY 41075 610523290 SKILLED NURSING FACILITY KY 501(C)(3) LINE 10 CARMELITE SISTERS FOR THE AGED AND INFIRM INC 0 CARMEL TERRACE INC 933 CENTRAL STREET FRAMINGHAM MA 01701 043210051 ASSISTED LIVING FACILITY MA 501(C)(3) LINE 10 CARMELITE SISTERS FOR THE AGED AND INFIRM INC 0 KAHL HOME FOR THE AGED AND INFIRM 6701 JERSEY RIDGE ROAD DAVENPORT IA 52807 420760833 SKILLED NURSING FACILITY IA 501(C)(3) LINE 10 CARMELITE SISTERS FOR THE AGED AND INFIRM INC 0 LOURDES FOUNDATION INC 315 SOUTH FLAGLER DRIVE WEST PALM BEACH FL 33401 592632080 FUNDRAISING FL 501(C)(3) LINE 12A, I CARMELITE SISTERS FOR THE AGED AND INFIRM INC 0 LOURDES-NOREEN MCKEEN RESIDENCE FOR GERIATRIC CARE INC 315 SOUTH FLAGLER DRIVE WEST PALM BEACH FL 33401 590879342 SKILLED, ASSISTED AND INDEPENDENT LIVING FACILITY FL 501(C)(3) LINE 10 CARMELITE SISTERS FOR THE AGED AND INFIRM INC 0 MARIAN MANOR FOR THE AGED AND INFIRM INC 130 DORCHESTER STREET BOSTON MA 02127 042173054 SKILLED NURSING FACILITY MA 501(C)(3) LINE 10 CARMELITE SISTERS FOR THE AGED AND INFIRM INC 0 MOTHER ANGELINE MCCRORY MANOR INC 5199 EAST BROAD STREET COLUMBUS OH 43213 912134683 SKILLED NURSING FACILITY OH 501(C)(3) LINE 10 CARMELITE SISTERS FOR THE AGED AND INFIRM INC 0 MOUNT CARMEL CARE CENTER INC 320 PITTSFIELD ROAD LENOX MA 01240 383902709 SKILLED NURSING FACILITY MA 501(C)(3) LINE 10 CARMELITE SISTERS FOR THE AGED AND INFIRM INC 0 OZANAM HALL OF QUEENS NURSING HOME INC 42-41 201ST STREET BAYSIDE NY 11361 112167809 SKILLED NURSING FACILITY NY 501(C)(3) LINE 10 CARMELITE SISTERS FOR THE AGED AND INFIRM INC 0 ST MARGARET HALL INC 1960 MADISON ROAD CINCINNATI OH 45206 310655031 SKILLED AND ASSISTED LIVING FACILITY OH 501(C)(3) LINE 10 CARMELITE SISTERS FOR THE AGED AND INFIRM INC 0 ST PATRICK'S HOME FOR THE AGED AND INFIRM INC 66 VAN CORTLAND PARK SOUTH BRONX NY 10463 131740033 SKILLED NURSING FACILITY NY 501(C)(3) LINE 10 CARMELITE SISTERS FOR THE AGED AND INFIRM INC 0 ST PATRICK'S MANOR INC 863 CENTRAL STREET FRAMINGHAM MA 01701 042157057 SKILLED NURSING FACILITY MA 501(C)(3) LINE 10 CARMELITE SISTERS FOR THE AGED AND INFIRM INC 0 ST PATRICK'S RESIDENCE 1400 BROOKDALE ROAD NAPERVILLE IL 60563 362527011 SKILLED NURSING FACILITY IL 501(C)(3) LINE 10 CARMELITE SISTERS FOR THE AGED AND INFIRM INC 0 THE CARMELITE SYSTEM INC 646 WOODS ROAD GERMANTOWN NY 12526 141810368 MANAGEMENT NY 501(C)(3) LINE 10 CARMELITE SISTERS FOR THE AGED AND INFIRM INC 0 VILLAS AT ST THERESE INC 5253 EAST BROAD STREET COLUMBUS OH 43213 472021696 INDEPENDENT LIVING & ASSISTED LIVING FACILITY OH 501(C)(3) LINE 10 CARMELITE SISTERS FOR THE AGED AND INFIRM INC 0 TCIG INC 159 BANK STREET FOURTH FLOOR BURLINGTON VT 05401 872580182 INSURANCE COMPANY VT 501(C)(3) LINE 10 CARMELITE SISTERS FOR THE AGED AND INFIRM INC 0 MARIAN WOODS INC 152 RIDGE RD HARTSDALE NY 10530 061512701 RELIGIOUS ORGANIZATION NY 501(C)(3) LINE 10 CARMELITE SISTERS FOR THE AGED AND INFIRM INC 0 0 0 1 1 1 0 0 0 1 0 1 0 1 1 1 1 1 0 0 SCHEDULE R, PART II: D'YOUVILLE SENIOR CARE FOUNDATION, INC. IS RECOGNIZED AS EXEMPT AS BEING A SUBORDINATE UNDER A GROUP EXEMPTION, AND ORIGINALLY QUALIFIED AS A PUBLIC CHARITY BY REASON OF BEING A SUPPORTING ORGANIZATION. D'YOUVILLE SENIOR CARE FOUNDATION, INC. BELIEVES THAT IT HAS QUALIFIED AS A PUBLICLY SUPPORTED ORGANIZATION UNDER SECTIONS 509(A)(1) AND 170(B)(1)(A)(VI) SINCE ITS FORMATION, AND INTENDS TO CORRECT INTERNAL REVENUE SERVICE RECORDS, INCLUDING BY THE FILING OF A FORM 8940 REQUESTING RECLASSIFICATION ACCORDINGLY.