SCHEDULE O
(Form 990)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2021
Open to Public
Inspection
Name of the organization
SHAWL II SENIOR HOUSING OF MONTAGUE
 
Employer identification number

38-2931825
Return Reference Explanation
FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION SIGNED A MANAGEMENT AGREEMENT WITH SAMARITAS TO PROVIDE SERVICES, OVERSIGHT, AND STAFFING FOR THE FACILITY.
FORM 990, PART VI, SECTION A, LINE 7A SAMARITAS, A RELATED ORGANIZATION, ELECTS THE MAJORITY OF THE ORGANIZATION'S BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION B, LINE 11B ONCE THE FORM 990 IS COMPLETE, BEFORE SUBMISSION TO THE IRS, THE FORM 990 WILL BE PROVIDED TO THE BOARD OF DIRECTORS FOR THEIR REVIEW.
FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE WRITTEN CONFLICT OF INTEREST POLICY BY MONITORING CONTRACTS, INVOICES, AND PERSONNEL AND ALSO BY ATTENDING BOARD MEETINGS.
FORM 990, PART VI, SECTION C, LINE 19 GENERALLY, THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990) 2021


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