SCHEDULE O
(Form 990 or 990-EZ)

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.
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OMB No. 1545-0047
2020
Open to Public
Inspection
Name of the organization
Masonicare at Chester Village Inc
 
Employer identification number

82-2936624
Return Reference Explanation
Form 990, Part VI, Line 15a compensation of top management official Form 990, Part VI, Line 15a checked "no" in accordance with the IRS instructions since the filing organization does not compensate the top management official.
Form 990, Part VI, Line 15b Compensation of the Organization's officers or key employees The CEO recommends any salary adjustments of the executive leadership, using the results of the valuation study and his assessment of individual performance or other pertinent information. The proposed executive salary changes are provided to the Compensation Committee. The process was completed in May 2021 for the following positions: Chief Financial Officer, Chief Information Officer, Chief Human Resources Officer, Vice President of Mission Effectiveness, Vice President of Strategy & Business Development., Executive Director of Masonicare at Mystic, Executive Director of Masonicare at Chester Village, Executive Director of Masonic Charity Foundation, Executive Director of Masonicare at Home, Health and Hospice, Director of Masonicare at Home, LTC Administrator of Masonicare Health Center.
Form 990, Part VI, Line 6 Classes of members or stockholders The organization has a sole corporate member, Masonicare Corporation, with the right to appoint members of the governing body and to participate in the organization's governance.
Form 990, Part VI, Line 7a Members or stockholders electing members of governing body Masonicare Corporation, as sole corporate member, annually appoints the members of the governing body.
Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders Pursuant to the Certificate of Incorporation of the organization, Masonicare Corporation, as the sole corporate member, has certain reserved powers to take or approve certain actions of the governing body. These powers include the prior approval of amendments to the organization's certificate of incorporation and bylaws, approval of long range plans, budgets and material changes in budgets, mission statements and policies (including investment policies) as well as sales or transfer of assets, mergers and/or dissolutions and Certificate of Need applications. The sole corporate member's powers also include the appointment and removal of directors, the organization's Board Chair and independent audit firm.
Form 990, Part VI, Line 8b Documentation of meetings held by committees of governing body Masonicare at Chester Village does not have any committees with authority to act on behalf of the governing body during the tax year.
Form 990, Part VI, Line 11b Review of form 990 by governing body Masonicare management and our external accountants review the tax return for completeness and accuracy. It is reviewed by the chief executive officer and chairman of the board. The tax return is also placed on a secured website that can be accessed by all board members for their review. At a full board meeting a discussion is held regarding comments/questions from board members. The tax return is then finalized and filed.
Form 990, Part VI, Line 12c Conflict of interest policy Annually, officers, directors and senior employees are required to complete a conflict of interest disclosure questionnaire. The Corporate Compliance Officer annotates the results to determine if, and to what extent, a conflict of interest exists. The results of the officer and Board Member disclosures are first reviewed by the Board Chairman and then reported at the board meetings. 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. Senior employee disclosures are reported to the President and Chief Executive Officer. The entire process is coordinated by the 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.
Form 990, Part VI, Line 19 Required documents available to the public The Organization provides required documents upon request.
Form 990, Part VII, Section A, Line 1a Trustees Hours related for volunteer trustees (column B) are the estimated hours per week that the volunteer trustees contribute to this and all other related exempt organizations, not necessarily equally but in the proportion required for which they receive no compensation. Related organizations include, Masonicare Corporation, Masonic Charity Foundation of CT, Masonicare Health Center, Inc., Masonicare at Ashlar Village Inc., Masonicare Home Health and Hospice Inc., Masonicare at Home, Masonicare at Mystic Inc. and Keystone Indemnity Company LTD.
Form 990, Part VIII, Line 11d Other Miscellaneous Revenue - Total Revenue: 52760, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 52760;
Form 990, Part IX, Line 11g Other Fees PURCHASE SERVICES - Total Expense: 1077309, Program Service Expense: 534568, Management and General Expenses: 542741, Fundraising Expenses: ; SHARED SERVICES - Total Expense: 281409, Program Service Expense: , Management and General Expenses: 281409, Fundraising Expenses: ;
Form 990, Part XI, Line 9 Other changes in net assets or fund balances CHANGE IN VALUE OF INTEREST RATE SWAP AGREEMENT - 197106; CAPITAL CONTRIBUTED TO RELATED ORGANIZATIONS - 1654378;
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2020


Additional Data


Software ID: 20011424
Software Version: 2020v4.0