efile Public Visual Render
ObjectId: 202013219349308096 - Submission: 2020-11-16
TIN: 04-3274643
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
Attach to Form 990.
Go to
www.irs.gov/Form990
for instructions and the latest information.
OMB No. 1545-0047
20
19
Open to Public Inspection
Name of the organization
CHELSEA JEWISH NORTH SHORE ASSISTED
LIVING INC
Employer identification number
04-3274643
Part I
Identification of Disregarded Entities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) of disregarded entity
(b)
Primary activity
(c)
Legal domicile (state
or foreign country)
(d)
Total income
(e)
End-of-year assets
(f)
Direct controlling
entity
Part II
Identification of Related Tax-Exempt Organizations.
Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.
(a)
Name, address, and EIN of related organization
(b)
Primary activity
(c)
Legal domicile (state
or foreign country)
(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))
(f)
Direct controlling
entity
(g)
Section 512(b)(13) controlled entity?
Yes
No
(1)
CHELSEA JEWISH LIFECARE INC
165 CAPTAINS ROW
CHELSEA
,
MA
02150
51-0141617
MANAGEMENT
MA
501(C)(3)
LINE 7
N/A
No
(2)
CHELSEA JEWISH COMMUNITY INC
165 CAPTAINS ROW
CHELSEA
,
MA
02150
27-1756594
MANAGEMENT, HOMECARE, PERSONAL CARE, HOSPICE, THERAPY
MA
501(C)(3)
LINE 10
CHELSEA JEWISH LIFECARE INC
No
(3)
CHELSEA JEWISH CHARITABLE FOUNDATION INC
240 LYNNFIELD STREET
PEABODY
,
MA
01960
26-1244471
FUNDRAISING & SUPPORT
MA
501(C)(3)
LINE 12B, II
CHELSEA JEWISH LIFECARE INC
No
(4)
CHELSEA JEWISH GREEN HOUSE INC
165 CAPTAINS ROW
CHELSEA
,
MA
02150
04-3326727
ASSISTED LIVING & NURSING HOME
MA
501(C)(3)
LINE 10
CHELSEA JEWISH LIFECARE INC
No
(5)
CHELSEA JEWISH NORTH SHORE FOUNDATION INC
240 LYNNFIELD STREET
PEABODY
,
MA
01960
22-3102199
FUNDRAISING & SUPPORT
MA
501(C)(3)
LINE 7
CHELSEA JEWISH LIFECARE INC
No
(6)
CHELSEA JEWISH NURSING HOME INC
17 LAFAYETTE AVENUE
CHELSEA
,
MA
02150
04-2200583
NURSING HOME
MA
501(C)(3)
LINE 10
CHELSEA JEWISH LIFECARE INC
No
(7)
JEWISH REHABILITATION CENTER FOR AGED OF THE NORTH SHORE INC
240 LYNNFIELD STREET
PEABODY
,
MA
01960
04-2106768
SKILLED NURSING & ADH
MA
501(C)(3)
LINE 10
CHELSEA JEWISH LIFECARE INC
No
(8)
ADMIRAL'S HILL ASSISTED LIVING CORP II
165 CAPTAINS ROW
CHELSEA
,
MA
02150
04-3538833
ASSISTED LIVING
MA
501(C)(3)
LINE 10
CHELSEA JEWISH LIFECARE INC
No
(9)
JGS LIFECARE CORPORATION
770 CONVERSE STREET
LONGMEADOW
,
MA
01106
04-2129128
GERIATRIC/NURSIGN PROVIDER
MA
501(C)(3)
LINE 7
CHELSEA JEWISH LIFECARE INC
No
(10)
JGS ADMINISTRATIVE SERVICES
770 CONVERSE STREET
LONGMEADOW
,
MA
01106
04-3295014
ADMIN SUPPORT TO JEWISH GERIATRIC SERVICES
MA
501(C)(3)
LINE 10
JGS LIFECARE CORPORATION
No
(11)
JEWSIH NURSING HOME OF WESTERN MA INC
770 CONVERSE STREET
LONGMEADOW
,
MA
01106
04-3138403
SKILLED NURSING FACILITY
MA
501(C)(3)
LINE 10
JGS LIFECARE CORPORATION
No
(12)
JGS HOUSING SERVICES INC
770 CONVERSE STREET
LONGMEADOW
,
MA
01106
04-3321157
ASSISTED LIVING
MA
501(C)(3)
LINE 10
JGS LIFECARE CORPORATION
No
(13)
SPECTRUM HOME HEALTH & HOSPICE
770 CONVERSE STREET
LONGMEADOW
,
MA
01106
04-3237982
HOME HEALTH & HOSPICE CARE
MA
501(C)(3)
LINE 10
JGS LIFECARE CORPORATION
No
(14)
SPECTRUM HOME CARE INC
770 CONVERSE STREET
LONGMEADOW
,
MA
01106
04-3399549
NON-CERTIFIED HOME HEALTH AGENCY
MA
501(C)(3)
LINE 10
JGS LIFECARE CORPORATION
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2019
Page 2
Schedule R (Form 990) 2019
Page
2
Part III
Identification of Related Organizations Taxable as a Partnership.
Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or foreign
country)
(d)
Direct controlling
entity
(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Disproprtionate allocations?
(i)
Code V-UBI
amount in box 20 of
Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership
Yes
No
Yes
No
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust.
Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or foreign
country)
(d)
Direct controlling
entity
(e)
Type of entity
(C corp, S corp,
or trust)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Percentage
ownership
(i)
Section 512(b)(13) controlled entity?
Yes
No
(1)
WINTHROP APARTMENTS LLC
165 CAPTAINS ROW
CHELSEA
,
MA
02150
46-3739775
REAL ESTATE
MA
N/A
No
Schedule R (Form 990) 2019
Page 3
Schedule R (Form 990) 2019
Page
3
Part V
Transactions With Related Organizations.
Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note.
Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1
During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a
Receipt of
(i)
interest,
(ii)
annuities,
(iii)
royalties, or
(iv)
rent from a controlled entity
.....................
1a
No
b
Gift, grant, or capital contribution to related organization(s)
............................
1b
No
c
Gift, grant, or capital contribution from related organization(s)
............................
1c
No
d
Loans or loan guarantees to or for related organization(s)
............................
1d
Yes
e
Loans or loan guarantees by related organization(s)
............................
1e
Yes
f
Dividends from related organization(s)
............................
1f
No
g
Sale of assets to related organization(s)
............................
1g
No
h
Purchase of assets from related organization(s)
............................
1h
No
i
Exchange of assets with related organization(s)
............................
1i
No
j
Lease of facilities, equipment, or other assets to related organization(s)
.......................
1j
No
k
Lease of facilities, equipment, or other assets from related organization(s)
......................
1k
No
l
Performance of services or membership or fundraising solicitations for related organization(s)
.....................
1l
No
m
Performance of services or membership or fundraising solicitations by related organization(s)
.................
1m
Yes
n
Sharing of facilities, equipment, mailing lists, or other assets with related organization(s)
...................
1n
Yes
o
Sharing of paid employees with related organization(s)
............................
1o
Yes
p
Reimbursement paid to related organization(s) for expenses
............................
1p
No
q
Reimbursement paid by related organization(s) for expenses
............................
1q
No
r
Other transfer of cash or property to related organization(s)
............................
1r
Yes
s
Other transfer of cash or property from related organization(s)
............................
1s
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization
(b)
Transaction
type (a-s)
(c)
Amount involved
(d)
Method of determining amount involved
Schedule R (Form 990) 2019
Page 4
Schedule R (Form 990) 2019
Page
4
Part VI
Unrelated Organizations Taxable as a Partnership.
Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity
(b)
Primary activity
(c)
Legal domicile
(state or foreign
country)
(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)
(e)
Are all partners
section
501(c)(3)
organizations?
(f)
Share of total income
(g)
Share of
end-of-year
assets
(h)
Disproprtionate allocations?
(i)
Code V-UBI
amount in box 20
of Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership
Yes
No
Yes
No
Yes
No
Schedule R (Form 990) 2019
Page 5
Schedule R (Form 990) 2019
Page
5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R. (see instructions).
Return Reference
Explanation
Schedule R (Form 990) 2019
Additional Data
Software ID:
Software Version: