2024-11-07T13:33:06-06:00 2023-12-31 410746749 CLIFTONLARSONALLEN LLP 4 BATTERYMARCH PARK SUITE 100 QUINCY MA 02169 990 2023-01-01 050258818 HATTIE IDE CHAFFEE NURSING HOME INC HATT 4014341520 200 WAMPANOAG TRAIL EAST PROVIDENCE RI 02915 BARRY B ZELTZER CEO 4014341520 2024-11-05 1 1 DANIELLE NIHILL P01350943 7819821001 2024-11-05 2023 2024-10-15 13:58:12Z DAVID MATERNE 200 WAMPANOAG TRAIL EAST PROVIDENCE RI 02915 10951841 0 X HATTIEIDECHAFFEE.ORG X 1948 RI PROVISION OF LONG TERM CARE FOR THE ELDERLY. 10 10 178 25 0 0 235825 154815 6741210 7703177 274540 327563 4909 26092 7256484 8211647 0 0 0 0 5210353 6538568 0 0 0 3177153 2994605 8387506 9533173 -1131022 -1321526 19376989 22731580 2827856 6866843 16549133 15864737 X IT'S THE MISSION OF HATTIE IDE CHAFFEE HOME TO ENSURE THE BEST QUALITY CARE. THIS COMES FROM HAVING THE FINEST IN STAFF. HATTIE IDE CHAFFEE'S HIGHLY TRAINED STAFF IS EQUIPPED TO RESPOND TO THE MOST COMPLEX MEDICAL PROBLEM. THE HOME'S FREQUENT REVIEWS CONTINUE TO MEET OR EXCEED THE HIGHEST STANDARDS SET BY THE STATE OF RHODE ISLAND. THE FACILITY HAS BEEN LICENSED BY THE STATE OF RHODE ISLAND, AND CERTIFIED BY THE STATE MEDICAID AND THE FEDERAL MEDICARE PROGRAMS. IN ADDITION, THE FACILITY ALSO OFFERS PHYSICAL, OCCUPATIONAL, SPEECH AND LANGUAGE THERAPY. THROUGH ITS NONPROFIT STATUS, VOLUNTEER BOARD OF DIRECTORS, PHYSICIAN INVOLVEMENT, AND GENEROUS BEQUESTS, THE ORGANIZATION CONTINUES TO THRIVE. TRUE TO ITS 70+ YEAR HISTORY, THE HOME OFFERS SKILLED AND RESPITE CARE FOR THOSE IN NEED. FOR FAMILIES WHO SEEK THE BEST FOR THEIR LOVED ONES, HATTIE IDE CHAFFEE OFFERS COMFORT, SATISFACTION, AND ASSURANCE THAT COME FROM THE ATTENTIVE AND PROFESSIONAL STAFF. 0 0 8383748 0 7733489 THE FACILITY IS MEDICARE AND MEDICAID CERTIFIED TO PROVIDE LONG-TERM NURSING CARE. HATTIE IDE CHAFFEE'S SERVICES ALSO INCLUDE PHYSICAL, OCCUPATIONAL, SPEECH AND LANGUAGE THERAPY. 8383748 1 1 0 0 0 0 0 0 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 10 0 1 178 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 RI X BARRY ZELTZER 4014341520 200 WAMPANOAG TRAIL EAST PROVIDENCE RI 02915 DAVID MATERNE PRESIDENT 1.00 X X 0 0 0 KAREN RICE VICE PRESIDENT 1.00 X X 0 0 0 TEDFORD B RADWAY SECRETARY 1.00 X X 0 0 0 AMY GULDHAUGE TREASURER 1.00 X X 0 0 0 JAY GREGORY DIRECTOR 1.00 X 0 0 0 KIMBERLY SERRA DIRECTOR 1.00 X 0 0 0 SHARLEEN BOWEN DIRECTOR 1.00 X 0 0 0 PETER MINIATI DIRECTOR 1.00 X 0 0 0 MICHAEL REUTER DIRECTOR 1.00 X 0 0 0 CHRISTINA SCOLA DIRECTOR 1.00 X 0 0 0 CASSANDRA THAYER DIRECTOR UNTIL 6/30/23 1.00 X 0 0 0 BARRY ZELTZER ADMINISTRATOR/CEO 40.00 X 197500 0 23626 RALPH SANTORO OFFICER / MEDICAL DIRECTOR 4.00 X 24000 0 0 MARLENE VERRIER DIRECTOR OF NURSING 40.00 X 130181 0 22356 MANGALA GUNARATNE NURSE 40.00 X 108640 0 8577 460321 0 54559 3 0 1 0 0 36059 118756 28000 154815 PATIENT SERVICE REVENUE 623000 7703177 7703177 7703177 219420 219420 2822065 2713922 108143 108143 108143 22052 36059 26272 -4220 -4220 MISCELLANEOUS 561300 30312 30312 30312 8211647 7733489 0 323343 197499 23109 174390 5301019 4897564 403455 140807 117018 23789 494658 494658 404585 372130 32455 17019 17019 54989 54989 115329 115329 53429 36657 16772 20871 20871 110466 33591 76875 94201 94201 319145 319145 1236 1236 101313 101313 385323 385323 102557 102557 PURCHASED SERVICES 501689 501689 FOOD & DRUG 398367 398367 HEALTHCARE PROVIDER TAX 366293 366293 SUPPLIES 266998 266998 85380 68649 16731 9533173 8383748 1149425 0 1508728 734856 4010 2769 657947 940271 8634 8634 30006 77007 18674105 5619555 8870124 13054550 8283380 7900448 14160 13045 19376989 22731580 2107273 1168396 720583 5698447 2827856 6866843 X 15859112 15184642 690021 680095 16549133 15864737 19376989 22731580 X -1321526 649205 -12075 X X 0 1 X 1 0 X 38891 840691 314754 210005 154815 1559156 6410101 6050808 6210241 6741210 7703177 33115537 38705 44360 0 0 83065 6487697 6935859 6524995 6951215 7857992 34757758 0 675547 675547 675547 675547 34082211 211846 193814 0 215913 219420 840993 211846 193814 215913 219420 840993 10045 9481 13286 3857 30312 66981 6709588 7139154 6538281 7170985 8107724 35665732 0.95560 0.97440 0.02360 0.02430 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME - 2019 AMOUNT: $ 10,045. 2020 AMOUNT: $ 9,481. 2021 AMOUNT: $ 13,286. 2022 AMOUNT: $ 3,857. 2023 AMOUNT: $ 30,312. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 225 6829 6908 146 0 8297540 860953 1245000 7913493 10546165 -1523625 725000 8297540 10864476 1618658 2000000 10546165 9830946 1033530 10864476 8008488 1822458 9830946 0.91410 0.00000 0.08590 0 0 41732 41732 16054097 4179304 11874793 1735218 1326041 409177 843058 114210 728848 13054550 X 8760887 649205 26272 675477 8085410 115329 10908 126237 8211647 9444116 26272 26272 9417844 115329 115329 9533173 PART IV, LINE 1B: THE ORGANIZATION HOLDS CERTAIN CASH ACCOUNTS FOR THE BENEFIT OF ITS RESIDENTS. PART V, LINE 4: DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: THE UNRESTRICTED ENDOWMENT FUNDS ARE SET ASIDE FOR THE SUPPORT OF THE GENERAL OPERATIONS OF HATTIE IDE CHAFFEE NURSING HOME'S FACILITY AND ITS VARIOUS PROGRAMS. TERMPORARILY RESTRICTED ENDOWMENT FUNDS ARE RESTRICTED FOR THE PURPOSES STIPULATED BY THE DONOR. PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE HOME AND RECOGNIZE A TAX LIABILITY IF THE HOME HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. THE HOME IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. THE HOME RECOGNIZES INTEREST AND PENALTIES, IF ANY, AS A COMPONENT OF OTHER INCOME (EXPENSE). PART XI, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EVENT EXPENSES 26,272. PART XI, LINE 4B - OTHER ADJUSTMENTS: FUNDRAISING 10,908. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EVENT EXPENSES 26,272. HIC 2023 GOLF TOURNAMENT 58111 36059 22052 1300 14595 7032 3345 58111 36059 22052 1300 14595 7032 3345 26272 -4220 X X 0 0 0 0 0 1 0 1 0 BARRY ZELTZER ADMINISTRATOR/CEO 190000 0 7500 0 0 0 292 0 23334 0 221126 0 0 0 MARLENE VERRIER DIRECTOR OF NURSING 129052 0 1129 0 0 0 5271 0 17085 0 152537 0 0 0 PART I, LINE 3 DISCUSSION AND APPROVAL BY BOARD MEMBERS. PART I, LINE 6 THE ADMINISTRATOR RECEIVES COMPENSATION IN THE FORM OF A BONUS WHICH IS CONTINGENT, IN PART, UPON THE LEVEL OF OPERATING INCOME EARNED BY THE FACILITY. PART I, LINE 7 THE ADMINISTRATOR IS AWARDED A BONUS BASED ON PERFORMANCE. X 2 6000 PER ARTIST X LANDSCAPING 1 22000 FMV 0 0 0 PART I, COLUMN (B): THE NUMBER PROVIDED IN COLUMN B REPRESENTS THE NUMBER OF ITEMS. FORM 990, PART VI, SECTION B, LINE 11B IT IS THE HATTIE IDE CHAFFEE NURSING HOME BOARD OF DIRECTORS' POLICY TO REVIEW THE IRS FORM 990 PRIOR TO FILING. THE CEO AND DOF ALONG WITH THE BOARD WILL REVIEW WITH THE AUDITORS. FORM 990, PART VI, SECTION B, LINE 12C AT THE FIRST BOARD MEETING OF EACH CALENDAR YEAR, THE CONFLICT OF INTEREST POLICY IS READ AND EACH BOARD MEMBER AND OFFICER IS ASKED TO SIGN THE CONFLICT OF INTEREST POLICY. THE TERMS OF THE POLICY REQUIRE THEM TO DISCLOSE ANY CONFLICTS. FORM 990, PART VI, SECTION B, LINE 15A THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS FUNCTIONS AS A COMPENSATION COMMITTEE IN DETERMINING SALARY AND BONUSES ANNUALLY FOR THE ADMINISTRATOR. THE COMMITTEE MEETS WITH THE ADMINISTRATOR TO REVIEW HER PERFORMANCE DURING THE PAST YEAR. IN MAKING ITS DECISION ON COMPENSATION, THE COMMITTEE TAKES INTO ACCOUNT THE COMPENSATION PAID TO SIMILAR ADMINISTRATORS AT COMPARABLE NON-PROFIT ORGANIZATIONS IN THE AREA. THE COMMITTEE CONSIDERS THE PERFORMANCE OF THE ORGANIZATION DURING THE REVIEW PERIOD AND CONSIDERS THE ADMINISTRATOR'S SUCCESS IN ACHIEVING ORGANIZATIONAL GOALS. THE ORGANIZATION HAS CONTEMPORANEOUS SUBSTANTIATION OF THE COMPENSATION DELIBERATION AND DECISION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: FUNDRAISING -12,075. PART XII LINE 2C THE AUDIT/FINANCE COMMITTEE OF THE BOARD OF DIRECTORS CONTINUES TO BE RESPONSIBLE FOR THE OVERSIGHT OF THE ANNUAL AUDIT.