2024.1 654 HOLDEN REHAB & SKILLED NURSING CTR 2024 General and Ownership Information 17 1 1 First Owner 505 Boylston Street, BOSTON, MA 02116 Direct 50.000 2 Second Owner 505 Boylston Street, BOSTON, MA 02116 Direct 50.000 3 Third Owner 5505 Boylston Street, BOSTON, MA 02116 Direct 50.000 4 Fourth Owner 505 Boylston Street, BOSTON, MA 02116 Direct 50.000 5 Fifth Owner 505 Boylston Street, BOSTON, MA 02116 Direct 50.000 6 Sixth Owner 505 Boylston Street, BOSTON, MA 02116 Direct 50.000 7 Seventh Owner 505 Boylston Street, BOSTON, MA 02116 Direct 50.000 8 Eighth Owner 505 Boylston Street, BOSTON, MA 02116 Direct 50.000 9 Ninth Owner 505 Boylston Street, BOSTON, MA 02116 Direct 50.000 10 Tenth Owner 5505 Boylston Street, BOSTON, MA 02116 Direct 50.000 1 HOLDEN REHAB & SKILLED NURSING CTR Yes 0215894 9874562123 HOLDEN REHAB & SKILLED NURSING CTR Direct 32 Mayo Dr, Holden, MA 01520 100.000 2 HOLDEN REHAB & SKILLED NURSING CTR Yes 0215894 9874562123 HOLDEN REHAB & SKILLED NURSING CTR Direct 32 Mayo Dr, Holden, MA 01520 100.000 3 HOLDEN REHAB & SKILLED NURSING CTR Yes 0215894 9874562123 HOLDEN REHAB & SKILLED NURSING CTR Direct 32 Mayo Dr, Holden, MA 01520 100.000 4 HOLDEN REHAB & SKILLED NURSING CTR Yes 0215894 9874562123 HOLDEN REHAB & SKILLED NURSING CTR Direct 32 Mayo Dr, Holden, MA 01520 100.000 5 HOLDEN REHAB & SKILLED NURSING CTR Yes 0215894 9874562123 HOLDEN REHAB & SKILLED NURSING CTR Direct 32 Mayo Dr, Holden, MA 01520 100.000 6 HOLDEN REHAB & SKILLED NURSING CTR Yes 0215894 9874562123 HOLDEN REHAB & SKILLED NURSING CTR Direct 32 Mayo Dr, Holden, MA 01520 100.000 7 HOLDEN REHAB & SKILLED NURSING CTR Yes 0215894 9874562123 HOLDEN REHAB & SKILLED NURSING CTR Direct 32 Mayo Dr, Holden, MA 01520 100.000 8 HOLDEN REHAB & SKILLED NURSING CTR Yes 0215894 9874562123 HOLDEN REHAB & SKILLED NURSING CTR Direct 32 Mayo Dr, Holden, MA 01520 100.000 9 HOLDEN REHAB & SKILLED NURSING CTR Yes 0215894 9874562123 HOLDEN REHAB & SKILLED NURSING CTR Direct 32 Mayo Dr, Holden, MA 01520 100.000 10 HOLDEN REHAB & SKILLED NURSING CTR Yes 0215894 9874562123 HOLDEN REHAB & SKILLED NURSING CTR Direct 32 Mayo Dr, Holden, MA 01520 100.000 11 HOLDEN REHAB & SKILLED NURSING CTR Yes 0215894 9874562123 HOLDEN REHAB & SKILLED NURSING CTR Direct 32 Mayo Dr, Holden, MA 01520 100.000 12 HOLDEN REHAB & SKILLED NURSING CTR Yes 0215894 9874562123 HOLDEN REHAB & SKILLED NURSING CTR Direct 32 Mayo Dr, Holden, MA 01520 100.000 13 HOLDEN REHAB & SKILLED NURSING CTR Yes 0215894 9874562123 HOLDEN REHAB & SKILLED NURSING CTR Direct 32 Mayo Dr, Holden, MA 01520 100.000 14 HOLDEN REHAB & SKILLED NURSING CTR Yes 0215894 9874562123 HOLDEN REHAB & SKILLED NURSING CTR Direct 32 Mayo Dr, Holden, MA 01520 100.000 15 HOLDEN REHAB & SKILLED NURSING CTR Yes 0215894 9874562123 HOLDEN REHAB & SKILLED NURSING CTR Direct 32 Mayo Dr, Holden, MA 01520 100.000 16 HOLDEN REHAB & SKILLED NURSING CTR Yes 0215894 9874562123 HOLDEN REHAB & SKILLED NURSING CTR Direct 32 Mayo Dr, Holden, MA 01520 100.000 17 HOLDEN REHAB & SKILLED NURSING CTR Yes 0215894 9874562123 HOLDEN REHAB & SKILLED NURSING CTR Direct 32 Mayo Dr, Holden, MA 01520 100.000 18 HOLDEN REHAB & SKILLED NURSING CTR Yes 0215894 9874562123 HOLDEN REHAB & SKILLED NURSING CTR Direct 32 Mayo Dr, Holden, MA 01520 100.000 19 HOLDEN REHAB & SKILLED NURSING CTR Yes 0215894 9874562123 HOLDEN REHAB & SKILLED NURSING CTR Direct 32 Mayo Dr, Holden, MA 01520 100.000 20 HOLDEN REHAB & SKILLED NURSING CTR Yes 0215894 9874562123 HOLDEN REHAB & SKILLED NURSING CTR Direct 32 Mayo Dr, Holden, MA 01520 100.000 1 HOLDEN REHAB 0123456 Direct Owner Partner Name Indirect Owner Partner Name HOLDEN REHAB & SKILLED NURSING CTR 2 HOLDEN REHAB 0123456 Direct Owner Partner Name Indirect Owner Partner Name HOLDEN REHAB & SKILLED NURSING CTR 3 HOLDEN REHAB 0123456 Direct Owner Partner Name Indirect Owner Partner Name HOLDEN REHAB & SKILLED NURSING CTR 4 HOLDEN REHAB 0123456 Direct Owner Partner Name Indirect Owner Partner Name HOLDEN REHAB & SKILLED NURSING CTR 5 HOLDEN REHAB 0123456 Direct Owner Partner Name Indirect Owner Partner Name HOLDEN REHAB & SKILLED NURSING CTR 6 HOLDEN REHAB 0123456 Direct Owner Partner Name Indirect Owner Partner Name HOLDEN REHAB & SKILLED NURSING CTR 7 HOLDEN REHAB 0123456 Direct Owner Partner Name Indirect Owner Partner Name HOLDEN REHAB & SKILLED NURSING CTR 8 HOLDEN REHAB 0123456 Direct Owner Partner Name Indirect Owner Partner Name HOLDEN REHAB & SKILLED NURSING CTR 9 HOLDEN REHAB 0123456 Direct Owner Partner Name Indirect Owner Partner Name HOLDEN REHAB & SKILLED NURSING CTR 10 HOLDEN REHAB 0123456 Direct Owner Partner Name Indirect Owner Partner Name HOLDEN REHAB & SKILLED NURSING CTR 11 HOLDEN REHAB 0123456 Direct Owner Partner Name Indirect Owner Partner Name HOLDEN REHAB & SKILLED NURSING CTR 12 HOLDEN REHAB 0123456 Direct Owner Partner Name Indirect Owner Partner Name HOLDEN REHAB & SKILLED NURSING CTR 13 HOLDEN REHAB 0123456 Direct Owner Partner Name Indirect Owner Partner Name HOLDEN REHAB & SKILLED NURSING CTR 14 HOLDEN REHAB 0123456 Direct Owner Partner Name Indirect Owner Partner Name HOLDEN REHAB & SKILLED NURSING CTR 15 HOLDEN REHAB 0123456 Direct Owner Partner Name Indirect Owner Partner Name HOLDEN REHAB & SKILLED NURSING CTR 1 Joe Johnson 2 HOLDEN REHAB & SKILLED NURSING CTR 3 Dr 4 32 Mayo Dr 5 Holden 6 MA 7 01520 8 (508) 829-4327 9 JJohnson@healthcare.com Revenue 1 1,911,688 714 2 335,517 500 3 0 0 4 2,733,043 442,577 5 1,097,158 0 6 1,829,521 3753 7 50,644 0 8 1,894,170 0 9 0 0 10 0 0 11 0 0 12 0 0 13 0 0 14 0 0 15 0 0 3 3,000 4 10,000 5 0 6 0 7 1,000,000 8 500,000 9 500,000 10 500,000 11 500,000 12 500,000 1 Other Endowment Non-Recoverable Revenue Description 100 2 Other Endowment Non-Recoverable Revenue Description 100 3 Other Endowment Non-Recoverable Revenue Description 100 4 Other Endowment Non-Recoverable Revenue Description 100 5 0 Expenses 1 160,812 160,812 0 2 160,812 160,812 0 3 16,849 160,812 0 4 0 160,812 0 5 160,812 6 160,812 7 160,812 160,812 0 8 160,812 160,812 0 9 160,812 160,812 0 10 0 160,812 0 11 160,812 12 160,812 160,812 0 13 160,812 160,812 0 14 160,812 160,812 0 15 0 160,812 0 16 160,812 17 160,812 160,812 0 18 160,812 160,812 0 19 160,812 160,812 0 20 0 160,812 0 21 160,812 22 0 23 160,812 160,812 0 1 154,735 154,735 0 2 154,735 154,735 0 3 154,735 154,735 0 4 0 154,735 0 5 0 6 239,966 7 154,735 154,735 0 8 11,608 154,735 0 9 25,142 154,735 0 10 0 154,735 0 11 31,696 154,735 0 12 177,943 154,735 0 13 57,373 154,735 0 14 0 154,735 0 15 6,259 154,735 0 16 0 154,735 0 17 28,429 154,735 0 18 0 154,735 0 19 60,918 154,735 0 20 108,510 154,735 0 21 0 154,735 0 22 0 0 24 0 25 0 26 0 1 92,408 92,408 0 2 4,470 92,408 0 3 9,682 92,408 0 4 0 92,408 0 5 121,932 92,408 0 6 5,899 92,408 0 7 12,775 92,408 0 8 168,151 92,408 0 9 50,814 92,408 0 10 355,940 92,408 0 11 15,524 92,408 0 12 0 13 84,703 92,408 0 14 4,098 92,408 0 15 8,875 92,408 0 16 0 92,408 0 17 0 18 438,371 92,408 0 19 21,206 92,408 0 20 45,929 92,408 0 21 329,177 92,408 0 22 11,374 92,408 0 23 37,007 92,408 0 24 0 92,408 0 25 0 92,408 0 26 0 92,408 0 27 92,408 92,408 0 28 92,408 92,408 0 29 384 92,408 0 30 0 92,408 0 31 0 92,408 0 32 0 92,408 0 33 0 92,408 0 34 0 92,408 0 35 0 36 15,807 92,408 0 37 765 92,408 0 38 1,656 92,408 0 39 51,111 92,408 0 40 328,026 92,408 0 41 13,852 92,408 0 42 30,002 92,408 0 43 0 92,408 0 44 0 92,408 0 45 0 92,408 0 46 0 92,408 0 47 0 92,408 0 48 88,932 92,408 0 49 4,488 92,408 0 50 9,721 92,408 0 51 11,095 92,408 0 52 0 92,408 0 53 0 92,408 0 54 0 92,408 0 55 0 92,408 0 56 0 92,408 0 57 0 92,408 0 58 0 92,408 0 59 0 92,408 0 60 186,529 61 28,566 62 1,097,448 63 0 64 153,420 92,408 0 65 7,422 92,408 0 66 16,075 92,408 0 67 8,628 92,408 0 68 6,842 92,408 0 69 0 92,408 70 3,856 92,408 0 71 0 92,408 0 72 0 92,408 0 73 0 92,408 0 74 0 92,408 0 75 0 92,408 0 76 0 92,408 0 77 0 92,408 0 78 174 92,408 0 79 0 92,408 0 80 1,055 92,408 0 81 0 92,408 0 82 32,058 92,408 0 83 0 92,408 0 84 0 92,408 0 85 5,828 92,408 0 86 0 92,408 0 87 618,330 88 0 92,408 0 89 350,629 92,408 0 90 0 91 0 92 9,671 92,408 0 2 21 21 0 3 0 4 0 21 0 5 0 6 8 21 0 7 0 8 88,640 21 0 9 0 10 0 21 0 11 0 12 9 21 0 13 0 14 0 18 60,343 1 John Doe Personal care, Dental services 10,000 0 100,000 random expenses Owner name 2 John Doe Personal care, Dental services 10,000 0 100,000 random expenses Owner name 3 John Doe Personal care, Dental services 10,000 0 100,000 random expenses Owner name 4 John Doe Personal care, Dental services 10,000 0 100,000 random expenses Owner name 5 John Doe Personal care, Dental services 10,000 0 100,000 random expenses Owner name 6 John Doe Personal care, Dental services 10,000 0 100,000 random expenses Owner name 7 John Doe Personal care, Dental services 10,000 0 100,000 random expenses Owner name 8 John Doe Personal care, Dental services 10,000 0 100,000 random expenses Owner name 9 John Doe Personal care, Dental services 10,000 0 100,000 random expenses Owner name 10 John Doe Personal care, Dental services 10,000 0 100,000 random expenses Owner name 11 John Doe Personal care, Dental services 10,000 0 100,000 random expenses Owner name 12 John Doe Personal care, Dental services 10,000 0 100,000 random expenses Owner name 13 John Doe Personal care, Dental services 10,000 0 100,000 random expenses Owner name 14 John Doe Personal care, Dental services 10,000 0 100,000 random expenses Owner name 15 John Doe Personal care, Dental services 10,000 0 100,000 random expenses Owner name Detail of Other A and G Expenses 2A 1 Miscellaneous 50 Detail of Non-Allowable A and G Expenses 2B 1 0 2 0 3 0 4 0 5 0 6 3898 7 0 8 1,824,392 9 0 10 0 11 3,137 12 0 13 0 14 113,871 15 870,660 16 0 Other Business Revenues and Expenses 1 No 2 No 3 No 4 No 5 No 6 No 7 No 8 No 9 No 10 No 11 No 12 No 13 Other Business Activities 1 0 2 0 3 0 4 0 5 0 6 0 7 0 8 0 1 0 2 0 3 0 4 0 5 0 6 438689 7 0 8 0 9 0 10 0 11 0 Statement of Operations and Reconciliation of Financial to Cost Reported Net Income 1 20192367 2 1176496 3 0 4 8387941 5 1278207 6 9626615 7 503821 8 113871 9 677715 10 9768 11 0 12 0 13 0 14 68592 15 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 18 19 20 3 Reconciling Item Description 100 4 5 6 2 0 3 Reconciling Item Description -11220 4 Reconciling Item Description 11220 5 6 Detail of Extraordinary Items 1C 1 Extra Item Description 10000 2 Extra Item Description 10000 3 Extra Item Description 10000 4 Extra Item Description 10000 5 Extra Item Description 10000 Detail of Changes in Accounting Principles 1D 1 Change Description 10000 2 Change Description 10000 3 Change Description 10000 4 Change Description 10000 5 Change Description 10000 Balance Sheet and Reconciliation of Owner's Equity 1 953,962 2 379,839 3 0 4 0 5 19,487 6 -19,295 7 0 8 131,947 9 0 10 0 11 0 12 0 13 0 14 0 15 11,015 16 0 1 137,338 2 84,234 3 532,847 4 327,236 5 0 6 0 1 0 2 0 4 29,457 5 348,347 6 -38,502 1 210,938 2 43,321 3 0 4 140,535 5 0 6 0 7 500,008 8 0 9 0 1 0 2 0 3 0 1 550 500 2 500 4 500 5 500 6 500 7 550 500 8 550 500 1 3 5 1 3 0 4 0 5 0 7 0 1 Facility maintenance Loan Sample Borrower Related Party Name Related Party address Related Party Relationship 100,000 2024 2.250 2 Facility maintenance Loan Sample Borrower Related Party Name Related Party address Related Party Relationship 100,000 2024 2.250 3 Facility maintenance Loan Sample Borrower Related Party Name Related Party address Related Party Relationship 100,000 2024 2.250 4 Facility maintenance Loan Sample Borrower Related Party Name Related Party address Related Party Relationship 100,000 2024 2.250 5 Facility maintenance Loan Sample Borrower Related Party Name Related Party address Related Party Relationship 100,000 2024 2.250 6 Facility maintenance Loan Sample Borrower Related Party Name Related Party address Related Party Relationship 100,000 2024 2.250 7 Facility maintenance Loan Sample Borrower Related Party Name Related Party address Related Party Relationship 100,000 2024 2.250 8 Facility maintenance Loan Sample Borrower Related Party Name Related Party address Related Party Relationship 100,000 2024 2.250 9 Facility maintenance Loan Sample Borrower Related Party Name Related Party address Related Party Relationship 100,000 2024 2.250 10 Facility maintenance Loan Sample Borrower Related Party Name Related Party address Related Party Relationship 100,000 2024 2.250 11 Facility maintenance Loan Sample Borrower Related Party Name Related Party address Related Party Relationship 100,000 2024 2.250 12 Facility maintenance Loan Sample Borrower Related Party Name Related Party address Related Party Relationship 100,000 2024 2.250 13 Facility maintenance Loan Sample Borrower Related Party Name Related Party address Related Party Relationship 100,000 2024 2.250 14 Facility maintenance Loan Sample Borrower Related Party Name Related Party address Related Party Relationship 100,000 2024 2.250 15 Facility maintenance Loan Sample Borrower Related Party Name Related Party address Related Party Relationship 100,000 2024 2.250 16 Facility maintenance Loan Sample Borrower Related Party Name Related Party address Related Party Relationship 100,000 2024 2.250 17 Facility maintenance Loan Sample Borrower Related Party Name Related Party address Related Party Relationship 100,000 2024 2.250 18 Facility maintenance Loan Sample Borrower Related Party Name Related Party address Related Party Relationship 100,000 2024 2.250 19 Facility maintenance Loan Sample Borrower Related Party Name Related Party address Related Party Relationship 100,000 2024 2.250 20 Facility maintenance Loan Sample Borrower Related Party Name Related Party address Related Party Relationship 100,000 2024 2.250 Detail of Other Current Assets 1A 1 Organization Expense 10 2 Purchased Goodwill 10 3 Leasehold Deposits 10 4 Utility Deposits 10 5 Cash Surrender Value of Officer Life Insurance 10 6 Some Extra 10 7 Some Extra 10 8 Some Extra 10 9 Some Extra 10 10 Some Extra 10 Detail of Other Deferred Charges and Non-Current Assets 3A 1 some other Expenses 10,000 2 some other Expenses 10,000 3 some other Expenses 10,000 4 some other Expenses 10,000 5 some other Expenses 10,000 6 some other Expenses 10,000 7 some other Expenses 10,000 8 some other Expenses 10,000 9 some other Expenses 10,000 10 some other Expenses 10,000 Detail of Other Current Liabilities 5A 1 Deferred Employee Retention Credit (ERC) Income 879,376 2 Unearned Revenue 5,905 3 extra 862,799 4 extra 862,799 5 extra 862,799 6 extra 862,799 7 extra 862,799 8 extra 862,799 9 extra 862,799 10 extra 862,799 Prior Period Adjustments 8D 1 Rounding 63 2 Rounding 63 3 Rounding 63 4 Rounding 63 5 Rounding 63 Detail of Fixed Assets and Depreciation 1 20 20 -10 2 20 20 -10 -5 -5 3 20 20 -10 -5 -5 4 20 20 -10 -5 -5 5 20 20 -10 -5 -5 6 0 0 0 0 0 1 1,112 100 100 -50 -50 2 0 0 0 0 0 3 100 100 100 -50 -50 5.00 40 -10 4 0 0 0 0 0 0 0 5 100 0 115 -10 0 0 -10 6 0 0 0 0 0 0 7 0 0 0 0 0 0 0 8 0 0 0 0 0 0 9 0 0 0 0 0 0 0 10 0 0 0 0 0 0 1 1994 2 2017-01-01 3 500500 4 No 5 No 6 123 7 123 8 123 9 0 10 1234.5 11 Yes 12 Yes 1 2024-10-05 sample text sample text 10,000 2 2024-10-05 sample text sample text 10,000 3 2024-10-05 sample text sample text 10,000 1 DON Project 1 2 DON 1 description 3 1995-01-01 4 10000 0 5 No 6 1998-01-01 7 0 0 8 10000 0 9 0 0 10 0 0 11 No 12 0 0 13 0 0 14 0 0 Statement of Cash Flows 1 75000 1 4500 2 4500 3 -500 1 4500 2 -500 1 4500 2 4500 3 -500 Licensure and Patient Statistics 1 500 0 0 500 500 500 500 500 0 0 0 0 0 0 2 0 0 0 0 0 0 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11 0 0 0 0 0 0 0 12 0 0 0 0 0 0 0 1 405 2 15 3 421 4 100 5 0 6 0 Detail of Facility Compensation and Purchased Nursing Services 1 100,000 37.5 100,000 37.5 100,000 37.5 2 100,000 37.59 75,000 40.5 65,000 40.0 3 110,000 100,000 55,00 4 150,00 25,00 75,00 1 45.55 40.50 25.30 20.55 60.50 2 0 0 0 0 0 3 0 0 0 0 0 1 1 125.5 250.5 2 0 0 0 3 0 0 0 4 0 0 0 5 0 0 0 6 0 0 0 7 0 0 0 8 0 0 0 9 0 0 0 10 0 0 0 11 0 0 0 12 0 0 0 13 0 0 0 14 0 0 0 15 0 0 0 16 0 0 0 17 0 0 0 18 0 0 19 0 0 20 0 0 21 0 0 0 22 0 0 0 1 Chukuemeka Josephine LPN 164,217 0 0 2 Snyder Cynthia DON 160,158 0 0 3 Wachira Joseph LPN 13,628 0 0 4 Oconnell Carolyn RN 135,265 0 0 5 Ofori Millicent Vent LPN Unit Manager 128,161 0 0 1 1 2 3 4 5 1 Driscoll Marc Manager 60 20,000 20,000 20,000 2 Driscoll Marc Manager 60 20,000 20,000 20,000 3 Driscoll Marc Manager 60 20,000 20,000 20,000 4 Driscoll Marc Manager 60 20,000 20,000 20,000 5 Driscoll Marc Manager 60 20,000 20,000 20,000 Notes Payable and Working Capital Debt 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 1 Lender Name Yes 123,456 123,456 2024-01-03 123,456 10 123,456 2 Lender Name Yes 123,456 123,456 2024-01-03 123,456 10 123,456 3 Lender Name Yes 123,456 123,456 2024-01-03 123,456 10 123,456 4 Lender Name Yes 123,456 123,456 2024-01-03 123,456 10 123,456 5 Lender Name Yes 123,456 123,456 2024-01-03 123,456 10 123,456 6 Lender Name Yes 123,456 123,456 2024-01-03 123,456 10 123,456 7 Lender Name Yes 123,456 123,456 2024-01-03 123,456 10 123,456