2026-08-17T14:04:56-05:00 2025-09-30 331374517 PKF O'CONNOR DAVIES ADVISORY LLC 20 COMMERCE DRIVE SUITE 301 CRANFORD NJ 070163618 990 2024-10-01 030371612 KEYSTONE INDEMNITY COMPANY LTD KEYS 8028601958 159 BANK STREET 4TH FLOOR BURLINGTON VT 05401 DAVID LAWLOR CFO 8028601958 2026-08-12 1 1 GARRETT M HIGGINS P00543209 9082726200 2026-08-11 2024 2025-03-06 01:10:19Z JON-PAUL VENOIT 159 BANK STREET 4TH FLOOR BURLINGTON VT 05401 9214261 0 X N/A X 2001 CT PROVIDE PROFESSIONAL MEDICAL LIABILITY INSURANCE AND GENERAL LIABILITY INSURANCE FOR MASONICARE CORPORATION AND ITS AFFILIATES. 5 5 0 5 0 0 0 0 509000 481000 680603 1333153 0 0 1189603 1814153 0 0 0 0 0 0 0 0 0 291644 6309918 291644 6309918 897959 -4495765 18850867 13834363 3334494 3661625 15516373 10172738 PROVIDE PROFESSIONAL MEDICAL LIABILITY INSURANCE AND GENERAL LIABILITY INSURANCE FOR MASONICARE CORPORATION AND ITS AFFILIATES. 0 0 207910 0 481000 MASONICARE IS THE LEADING PROVIDER OF HEALTHCARE AND RETIREMENT LIVING FOR SENIORS IN THE STATE OF CONNECTICUT. THROUGH ITS AFFILIATES, MASONICARE PROVIDES CONTINUING CARE RETIREMENT COMMUNITY LIVING, INDEPENDENT LIVING, ASSISTED LIVING, SKILLED NURSING CARE (LONG TERM INCLUDING MEMORY CARE AND SHORTTERM REHABILITATION), ACUTE CARE (PSYCHIATRIC AND HOSPICE), HOME HEALTH AND HOSPICE SERVICES AND ATHOME SERVICES (LIVEIN, PATIENT CARE ATTENDANTS AND HOMEMAKER). KEYSTONE INDEMNITY COMPANY PROVIDES PROFESSIONAL AND GENERAL LIABILITY INSURANCE COVERAGES TO MEMBERS OF THE MASONICARE FAMILY. 207910 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 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 0 0 0 1 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 5 5 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 0 X DAVID LAWLOR 8028601958 159 BANK STREET 4TH FLOOR BURLINGTON VT 05401 ROBERT F POLITO JR CHAIRMAN 1.00 0.00 X X 0 0 0 CHRISTOPHER J EARLE VICE CHAIR 1.00 8.00 X X 0 0 0 ROBERT J FURCE SECRETARY 1.00 8.00 X X 0 0 0 NEWTON BUCKNER TREASURER 1.00 8.00 X X 0 0 0 JAY S NICKSE DIRECTOR 1.00 8.00 X 0 0 0 JON-PAUL VENOIT PRESIDENT & CEO, ASSISTANT SECRETARY 1.00 48.00 X 0 769803 86091 DAVID LAWLOR CFO ASSISTANT TREASURER (EFFECTIVE 01/01/2025) 1.00 48.00 X 0 796666 32904 STEVEN D BEAULIEU CFO ASSISTANT TREASURER (THRU 12/31/24) 1.00 48.00 X 0 195468 65651 0 1761937 184646 0 0 1 0 LAW OFFICE OF JONATHAN E SPODNICK 672 WHITES PLAINS ROAD TRUMBULL CT 06611 LEGAL SERVICES 293501 1 NET EARNED PREMIUM 522220 481000 481000 481000 845010 845010 7888251 7400108 488143 488143 488143 1814153 481000 0 1333153 6067 6067 31170 31170 64771 64771 155469 155469 1441 1441 50625 50625 DIVIEND PREMIUMS 6000000 6000000 TAXES AND RENEWALS 375 375 6309918 207910 6102008 0 28281 7250 1035689 958818 98178 120373 12537151 7546354 5151568 5201568 18850867 13834363 44584 39269 3289910 3622356 3334494 3661625 X 250000 250000 2971423 2971423 12294950 6951315 15516373 10172738 18850867 13834363 X -4495765 -238870 -609000 X 0 1 X 1 0 X X 7 MASONICARE AT ASHLAR VILLAGE INC 061050830 9 1 0 0 MASONICARE HOME HEALTH AND HOSPICE INC 061101924 9 1 0 0 MASONIC CHARITY FOUNDATION OF CONNECTICUT 061435920 7 0 0 0 MASONICARE HEALTH CENTER 060655131 3 1 0 0 MASONICARE AT HOME INC 202377783 9 0 0 0 MASONICARE HOME HEALTH AND HOSPICE INC 260758992 9 0 0 0 MASONICARE AT CHESTER VILLAGE 822936624 9 0 0 0 7 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 X 1 1 PART IV, SECTION A, LINE 1: THE SUPPORTED ORGANIZATIONS ARE DESIGNATED BY PURPOSE AS WELL AS A HISTORIC AND CONTINUING RELATIONSHIP. ALL OF THE SUPPORTED ORGANIZATIONS SHARE A COMMON PURPOSE OF ENHANCING THE QUALITY OF LIFE OF SENIORS THROUGH EXCEPTIONAL CARE. THE SUPPORTED ORGANIZATIONS ARE ALL PART OF THE MASONICARE SENIOR CARE SYSTEM SINCE THEIR INCEPTION. PART IV, SECTION A, LINE 2: SUPPORTED ORGANIZATION, MASONICARE CORPORATION HAS IRS DETERMINATION OF STATUS UNDER 509(A)(3), HOWEVER IT IS AN ORGANIZATION DESCRIBED IN 509(A)(2) IN THAT IT MEETS THE 33 1/3 SUPPORT TEST REQUIRED OF 509(A)(2) ORGANIZATIONS. PART IV, SECTION D, LINE 3: THE ORGANIZATION'S SUPPORTED ORGANIZATIONS HAD A SIGNIFICANT VOICE IN THE ORGANIZATION'S INVESTMENT POLICIES AND IN DIRECTING THE USE OF THE ORGANIZATION'S INCOME OR ASSETS AT ALL TIMES DURING THE FISCAL YEAR, DUE TO COMMON MANAGEMENT. THE TOP MANAGEMENT OFFICIAL AND TOP FINANCIAL OFFICIAL ARE THE SAME INDIVIDUALS, ACROSS THE ORGANIZATION AND ALL SUPPORTED ORGANIZATIONS, AND A MAJORITY OF THE DIRECTORS OF THE ORGANIZATION ALSO SERVE AS DIRECTOR OF THE SUPPORTED ORGANIZATIONS. PART IV, SECTION E, LINE 2A: SUBSTANTIALLY ALL OF THE ORGANIZATION'S ACTIVITIES DURING THE TAX YEAR DIRECTLY FURTHERED THE EXEMPT PURPOSES OF THE SUPPORTED ORGANIZATIONS. IN PROVIDING RISK MANAGEMENT AND REDUCING THE COSTS OF RISK MANAGEMENT OF THOSE ORGANIZATIONS, THE SUPPORTED ORGANIZATIONS WERE ENABLED TO DIRECTLY FURTHER THEIR EXEMPT PURPOSE. PART IV, SECTION E, LINE 2B: THE SUPPORTED ORGANIZATIONS WOULD HAVE ENGAGED IN THE ACTIVITIES OF RISK MANAGEMENT AND RISK MANAGEMENT FINANCING BUT FOR THE ORGANIZATION'S INVOLVEMENT AS A NECESSARY ACTIVITY OF MANAGEMENT OF THOSE ORGANIZATIONS. PART I, LINE 12G, COLUMN IV: THE ORGANIZATION WAS FORMED FOR THE PURPOSE OF WRITING INSURANCE AND REINSURANCE AS A CAPTIVE INSURANCE COMPANY. MASONICARE CORPORATION IS THE SOLE MEMBER OF KEYSTONE. AS A RESULT KEYSTONE IS INDIRECTLY RELATED TO THE OTHER AFFILIATES, AS MASONICARE CORPORATION IS THE SOLE MEMBER OF THOSE AS WELL. 92195566 98236 -2222350 178808 24225 89868419 87901791 134344 4318924 152304 7189 92195566 86314927 63401 1772860 242823 6574 87901791 88482467 2551822 -4512040 196479 10843 86314927 84884852 457427 3659627 192064 327375 88482467 0.00000 0.94530 0.05470 0 1 1 0 REINSURANCE RECOVERABLE 745000 NOTES RECEIVABLE FROM PARENT 4456568 5201568 LOSS RESERVES 3622356 3622356 X 1510512 -238870 -238870 1749382 64771 64771 1814153 854147 895421 895421 -41274 64771 6286421 6351192 6309918 PART V, LINE 4: THE ENDOWMENT FUNDS ARE USED TO SUPPORT THE PHILANTHROPIC MISSION AND ACTIVITIES OF MASONICARE CORPORATION AND ITS AFFILIATES. PART X, LINE 2: THE COMPANY ACCOUNTS FOR UNCERTAIN TAX POSITIONS IN ACCORDANCE WITH FASB ASC 740 INCOME TAXES, WHICH PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN, OR EXPECTED TO BE TAKEN, ON A TAX RETURN. FASB ASC 740 ADDRESSES THE DETERMINATION OF WHETHER TAX BENEFITS CLAIMED OR EXPECTED TO BE CLAIMED ON A TAX RETURN SHOULD BE RECORDED IN THE FINANCIAL STATEMENTS. FASB ASC 740 PERMITS THE RECOGNITION OF TAX POSITIONS THAT MEET A "MORE LIKELY THAN NOT" THRESHOLD, BASED ON THE TECHNICAL MERITS OF THE POSITION. PART XII, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN RESERVES 895,421. PART XII, LINE 4B - OTHER ADJUSTMENTS: LOSS BENEFIT ADJUSTMENT 286,421. DIVIDEND PREMIUMS REPORTED ON PART IX 6,000,000. 0 0 0 0 0 0 0 0 0 JON-PAUL VENOIT PRESIDENT & CEO, ASSISTANT SECRETARY 0 682194 0 40000 0 47609 0 43404 0 42687 0 855894 0 0 DAVID LAWLOR CFO ASSISTANT TREASURER (EFFECTIVE 01/01/2025) 0 796666 0 0 0 0 0 31800 0 1104 0 829570 0 0 STEVEN D BEAULIEU CFO ASSISTANT TREASURER (THRU 12/31/24) 0 160033 0 13571 0 21864 0 29291 0 36360 0 261119 0 0 FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS A SOLE MEMBER (MASONICARE CORPORATION). FORM 990, PART VI, SECTION A, LINE 7A SECTION A. IN THE COURSE OF CARRYING OUT THE PURPOSES OF KEYSTONE, THE BOARD OF DIRECTORS OF KEYSTONE SHALL REFER CERTAIN RESERVED POWERS TO ITS SHAREHOLDER. THE BOARD OF DIRECTORS SHALL RESPECT THESE CONTROLS IN A FASHION THAT RESPECTS THE CORPORATE INTEGRITY OF KEYSTONE WHILE PROMOTING THE PURPOSES OF ITS SHAREHOLDER, AS STATED IN ITS CERTIFICATE OF INCORPORATION. SECTION B. THE POWERS RESERVED FOR THE SHAREHOLDER SHALL INCLUDE: 1. THE PRIOR APPROVAL OF ALL AMENDMENTS TO KEYSTONE'S CERTIFICATE OF INCORPORATION AND BYLAWS 2. THE PRIOR APPROVAL OF KEYSTONE'S MISSION STATEMENT AND AMENDMENTS THERETO 3. THE APPOINTMENT OF ALL KEYSTONE'S DIRECTORS AND THE RIGHT TO REMOVE SUCH DIRECTORS, PROVIDED THAT THE AUTHORITY TO APPOINT OR REMOVE ANY CROSS DIRECTOR SHALL BE RESERVED TO THE CHAIRMAN OF THE BOARD OF TRUSTEES OF THE SHAREHOLDER 4. THE APPOINTMENT OF KEYSTONE'S BOARD CHAIRMAN BY THE CHAIRMAN OF THE BOARD OF TRUSTEES OF THE SHAREHOLDER 5. THE PRIOR APPROVAL OF ANY MERGER, CONSOLIDATION, DISSOLUTION, ACQUISITION OF CONTROLLING INTERESTS IN ANOTHER ENTITY, CORPORATE AFFILIATION AND/OR CHANGE OF SPONSORSHIP OF OR INVOLVING KEYSTONE 6. THE PRIOR APPROVAL OF ANY SALE, DONATION OR TRANSFER OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF KEYSTONE 7. THE PRIOR APPROVAL OF THE CREATION OF ANY TAXABLE OR TAXEXEMPT SUBSIDIARY ORGANIZATION BY KEYSTONE 8. THE PRIOR APPROVAL OF ALL LONG RANGE PLANS OF KEYSTONE 9. THE PRIOR APPROVAL OF ANY CERTIFICATE OF NEED REQUESTS AND/OR APPLICATIONS BY KEYSTONE 10. THE PRIOR APPROVAL OF KEYSTONE S ANNUAL BUDGET, AND THE PRIOR APPROVAL OF ALL NONBUDGETED EXPENDITURES CUMULATING IN EXCESS OF THREE PERCENT (3%) OF KEYSTONE S APPROVED ANNUAL BUDGET 11. THE RETENTION OF A CERTIFIED PUBLIC ACCOUNTANT TO PERFORM ANNUAL AUDITS OF THE FINANCIAL RECORDS OF KEYSTONE 12. THE PRIOR APPROVAL OF THE WRITTEN INVESTMENT POLICY AND INVESTMENT MANAGERS OF ALL SIGNIFICANT INVESTMENTS OF KEYSTONE 13. THE PRIOR APPROVAL OF ALL WRITTEN POLICIES AND PROCEDURES OF KEYSTONE WHICH ARE RELEVANT TO THE MISSION, VISION AND VALUES OF THE SHAREHOLDER AND/OR KEYSTONE AND 14. SUCH OTHER POWERS AS MAY BE SET FORTH IN THESE BYLAWS. SECTION C. THE SHAREHOLDER'S RESERVED RIGHT TO GIVE PRIOR APPROVAL IS IN ADDITION TO AND NOT IN LIEU OF THE RIGHT OF THE BOARD OF DIRECTORS TO REVIEW AND APPROVE THE ACTIONS IN QUESTION. SECTION D. THE SHAREHOLDER MAY EXERCISE ITS RESERVE POWERS HEREUNDER BY EXECUTING AND DELIVERING TO THE CHAIRMAN OR SECRETARY OF KEYSTONE A WRITTEN INSTRUMENT OR INSTRUMENTS, SIGNED BY AN AUTHORIZED OFFICER OF THE SHAREHOLDER, SETTING FORTH THE ACTION TAKEN AND THE APPLICABLE CORPORATE AUTHORIZATIONS OR DIRECTIONS FROM THE SHAREHOLDER. THE ACTION OF THE SHAREHOLDER SHALL BE DEEMED TO HAVE BEEN TAKEN ON THE DATES THAT THE WRITTEN INSTRUMENTS ARE SO DELIVERED UNLESS THE INSTRUMENTS PROVIDE OTHERWISE. THE ACTIONS SHALL BE FILED IN THE CORPORATE RECORDS OF KEYSTONE. FORM 990, PART VI, SECTION A, LINE 7B ALL DECISIONS OF THE GOVERNING BODY OF THE ORGANIZATION ARE SUBJECT TO APPROVAL BY THE SOLE MEMBER (MASONICARE CORPORATION). FORM 990, PART VI, SECTION A, LINE 8B KEYSTONE INDEMNITY COMPANY, LTD. DOES NOT HAVE ANY COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY DURING THE TAX YEAR. FORM 990, PART VI, SECTION B, LINE 11B THE FINANCIAL MANAGEMENT OF THE PARENT ORGANIZATION, MASONICARE CORPORATION REVIEWS THE FORM 990 TAX RETURN FOR COMPLETENESS AND ACCURACY. IT IS THEN REVIEWED BY MASONICARE CORPORATION'S CHIEF EXECUTIVE OFFICER AND CHAIRMAN OF THE BOARD. THE TAX RETURN IS BROUGHT FOR DISCUSSION BEFORE THE ORGANIZATION'S BOARD. AFTER RESPONDING TO COMMENTS/QUESTIONS, CHANGES ARE MADE AS APPROPRIATE AND THE RETURN IS FINALIZED AND FILED. FORM 990, PART VI, SECTION B, LINE 12C MASONICARE CORPORATION (THE PARENT) REQUIRES ALL VOTING BOARD MEMBERS TO DISCLOSE CONFLICTS OF INTEREST. THE ENTIRE PROCESS IS COORDINATED BY THE MASONICARE CORPORATION'S CORPORATE COMPLIANCE OFFICER. ALL RESPONDENTS ARE ADVISED OF THEIR CONTINUING DUTY TO DISCLOSE ANY POSSIBLE CONFLICT OF INTEREST THAT MAY ARISE DURING THE COURSE OF THEIR SERVICE. SUMMARIES OF THE CONFLICT OF INTEREST DISCLOSURES ARE SHARED AMONG ALL BOARD MEMBERS OF MASONICARE CORPORATION. ANY OFFICER OR BOARD MEMBER SHALL NOT MAKE OR SECOND MOTIONS OR VOTE (OTHER THAN ABSTAIN) ON MATTERS IF A CONFLICT OF INTEREST EXISTS, WHETHER OR NOT THE OFFICER OR BOARD MEMBER HAD AN OPPORTUNITY TO MAKE A WRITTEN DISCLOSURE THROUGH THE FORMALIZED PROCESS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES FORM 990, ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN RESERVES -895,421. LOSS BENEFIT ADJUSTMENT 286,421. MASONICARE INC PO BOX 70 WALLINGFORD CT 06492 061435919 PARENT HOLDING AND SUPPORT ORGANIZATION CT 501(C)(3) LINE 12C, III-FI N/A 0 MASONICARE AT ASHLAR VILLAGE INC PO BOX 70 WALLINGFORD CT 06492 061050830 RETIREMENT AND ASSISTED LIVING COMMUNITY CT 501(C)(3) LINE 10 MASONICARE CORPORATION 0 MASONICARE HOME HEALTH & HOSPICE INC PO BOX 70 WALLINGFORD CT 06492 061101924 PROVIDE HOME HEALTH/HOSPICE SERVICES CT 501(C)(3) LINE 10 MASONICARE CORPORATION 0 MASONICARE HEALTH CENTER PO BOX 70 WALLINGFORD CT 06492 060655131 PROVIDE MEDICAL SERVICES TO THE ELDERLY CT 501(C)(3) LINE 10 MASONICARE CORPORATION 0 MASONIC CHARITY FOUNDATION OF CONNECTICUT PO BOX 70 WALLINGFORD CT 06492 061435920 PROVIDE PLANNED GIVING AND DEVELOPMENT CT 501(C)(3) LINE 7 MASONICARE CORPORATION 0 MASONICARE AT HOME INC PO BOX 70 WALLINGFORD CT 06492 202377783 PROVIDE HOME SERVICES TO THE ELDERLY CT 501(C)(3) LINE 10 MASONICARE CORPORATION 0 MASONICARE AT MYSTIC INC PO BOX 70 WALLINGFORD CT 06492 464656008 MANAGE SENIOR LIVING FACILITY CT 501(C)(3) LINE 12A, I MASONICARE AT ASHLAR VILLAGE 0 MASONICARE AT CHESTER VILLAGE PO BOX 70 WALLINGFORD CT 06492 822936624 CONTINUING CARE AND RETIREMENT COMMUNITY CT 501(C)(3) LINE 10 MASONICARE CORPORATION 0 MASONICARE AT ROCKY HILL PO BOX 70 WALLINGFORD CT 06492 611055020 PROVIDE SENIOR HEALTH AND RESIDENTIAL LIVING OPTIONS CT 501(C)(3) LINE 7 MASONICARE CORPORATION 0 GENM SENIOR CARE CONSULTING GROUP LLC 22 MASONIC AVENUE WALLINGFORD CT 06492 871834093 CONSULTING CT MASONICARE CORPORATION C 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 1 1 1 0 0