2023-02-27T16:53:12-06:00 2022-06-30 440160260 FORVIS LLP 1410 SPRING HILL ROAD SUITE 500 TYSONS VA 221023056 990 2021-07-01 541004092 COMMUNITY RESIDENCES INC COMM 7038422300 14160 NEWBROOK DRIVE 1ST FLOOR CHANTILLY VA 20151 TERENCE HURLEY EXECUTIVE VP - CFO & CAO 7038422321 2023-02-16 1 TERENCE HURLEY 999009999 AMY BIBBY P00445891 7039700400 2023-02-16 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z CRI ARTHUR GINSBERG 14160 NEWBROOK DRIVE 1ST FLOOR CHANTILLY VA 20151 35349534 0 X WWW.MYCRI.ORG X 1975 VA CRI IS DEDICATED TO PROVIDING PERSONALIZED RESOURCES TO YOUTH AND ADULTS WITH MENTAL HEALTH NEEDS AND DEVELOPMENTAL DISABILITIES. 14 13 631 487 0 0 5209388 502070 32258478 34833019 -1120 5412 10341 9033 37477087 35349534 0 1408 0 0 26867125 26571189 0 0 176007 6946219 9257234 33813344 35829831 3663743 -480297 11226952 8965819 7981126 5874827 3245826 3090992 X CRI IS DEDICATED TO PROVIDING PERSONALIZED RESOURCES TO YOUTH AND ADULTS WITH MENTAL HEALTH NEEDS AND DEVELOPMENTAL DISABILITIES. 0 0 30816731 1408 34847457 SEE SCHEDULE OCOMMUNITY RESIDENCES OFFERS A WIDE VARIETY OF SERVICES AND ACTIVITIES TO INDIVIDUALS WITH INTELLECTUAL DISABILITIES. THESE INDIVIDUALS ARE SUPPORTED IN COMMUNITY RESIDENCES' NEIGHBORHOOD HOMES. EVERY HOME IS LOCATED WITHIN REASONABLE ACCESS TO SHOPPING, RECREATIONAL, SOCIAL, CULTURAL AND RELIGIOUS ACTIVITIES; HEALTH CARE FACILITIES, TRANSPORTATION AND VOCATIONAL OPPORTUNITIES ARE ALSO AVAILABLE. ALL SERVICES ARE FLEXIBLE AND RESPONSIVE TO THE PERSON SUPPORTED AND THESE INDIVIDUALS ARE FULLY INTEGRATED INTO COMMUNITY LIFE. EACH PERSON'S SERVICE PLAN IS DIFFERENT. SERVICES AND ACTIVITIES MAY INCLUDE LIFE SKILLS, EDUCATION AND COACHING, SUPPORT WITH DAILY LIVING SKILLS, MEDICAL/CLINICAL COORDINATION AND OVERSIGHT. PSYCHO EDUCATIONAL COUNSELING, POSITIVE BEHAVIORAL AND CRISIS SUPPORT, RECREATION AND LEISURE ACTIVITIES, TRANSPORTATION AND RESOURCE AND BENEFITS COORDINATION ARE SERVICES THAT ARE ALSO AVAILABLE.COMMUNITY RESIDENCES PROVIDES SERVICES FOR INDIVIDUALS WITH MENTAL HEALTH DIAGNOSES WHO RESIDE IN A COMMUNITY RESIDENCES HOME, AND ALSO SERVES INDIVIDUALS WHO LIVE IN THE COMMUNITY. ALL COMMUNITY RESIDENCES HOMES ARE LOCATED IN NEIGHBORHOODS THAT ARE CLOSE TO SHOPPING, PUBLIC TRANSPORTATION, AND SOCIAL, RECREATIONAL AND CULTURAL ACTIVITIES. COMMUNITY SERVICES ARE DESIGNED TO PROMOTE COMMUNITY TENURE, TO PREVENT HOMELESSNESS, HOSPITALIZATION, INCARCERATION THROUGH LEARNING SKILLS, AND TO DEVELOP NATURAL SUPPORTS. THESE SERVICES REFLECT THE BELIEF THAT INDIVIDUALS CAN GROW, CHANGE AND RECOVER FROM THE SYMPTOMS OF MENTAL ILLNESS AND CAN LIVE MORE INDEPENDENTLY IN THE COMMUNITY OF THEIR CHOOSING. 30816731 1 1 0 0 0 0 0 0 1 0 1 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 13 0 1 631 1 0 0 0 0 0 0 0 0 0 0 0 0 X 14 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MD VA X THE ORGANIZATION 7038422300 14160 NEWBROOK DRIVE 1ST FLOOR CHANTILLY VA 20151 PERI-ANNE CHOBOT CHAIR 0.10 0.10 X X 0 0 0 MICHAEL NATHAN VICE CHAIR 0.10 0.10 X X 0 0 0 STEVEN DUNN SECRETARY 0.10 0.10 X X 0 0 0 NEWMAN C AINSLEY TREASURER 0.10 X X 0 0 0 ANDREW SCHNEIDER BOARD MEMBER 0.10 0.20 X 0 0 0 RICHARD BREWSTER BOARD MEMBER 0.10 X 0 0 0 MATT BARTLEY BOARD MEMBER 0.10 X 0 0 0 ARTHUR GINSBERG PRESIDENT/CEO 40.00 0.40 X X 325809 0 24428 CHIRSTINE B PLUMMER BOARD MEMBER 0.10 0.10 X 0 0 0 MICHAEL FITZGERALD BOARD MEMBER 0.10 0.10 X 0 0 0 TAMIKA HAWKINS ESQ BOARD MEMBER 0.10 X 0 0 0 MELANDEE JONES BOARD MEMBER 0.10 X 0 0 0 JOHN SLYE JR BOARD MEMBER 0.10 X 0 0 0 JINHEE KIM BOARD MEMBER 0.10 X 0 0 0 TERENCE HURLEY EXECUTIVE VP - CFO & CAO 40.00 0.10 X 249898 0 20202 RONALD GEORGE HR DIRECTOR & VP OF BUSINESS DEVELOPMENT 40.00 X 165936 0 23863 DEANNE MULLINS SR DIR OF CLINICAL SERVICE 40.00 X 130486 0 23621 LARRY SCURLOCK CHIEF INFORMATION OFFICER 40.00 X 132903 0 17627 JULIE ALLEN SR DIR OF CLINICAL SERVICE 40.00 X 133686 0 20467 BEATRICE CLAIBORNE DIRECTOR OF NURSING 40.00 X 131943 0 18553 1270661 0 148761 14 0 1 0 SERVICE SOURCE 10467 WHITE GRANITE DR OAKTON VA 22124 DAY SUPPORT 1244762 ISG TRANSPORTATION 7653 FRAMINGHAM CT GAINESVILLE VA 20155 TRANSPORTATION 820200 BIO-MEDIC HEALTH SERVICES 1099 COLONIAL FORT DR MONTVALE VA 24122 MEDICAL SUPPLIES 295716 DELTA-T GROUP PO BOX 884 BRYN MAWR PA 19010 TEMPORARY STAFFING 265366 NGUYEN MEDICAL PRACTICE 7202 POPLAR ST SUITE E ANNANDALE VA 22003 MEDICAL DIRECTOR 185500 5 7000 323386 171684 502070 MEDICAID FUNDS 623000 29651708 29651708 COUNTY FUNDS 623990 3651413 3651413 CONSUMER FEES AND RENT 623000 1361879 1361879 PROGRAM MANAGEMENT 623990 114946 114946 HUD TENANT ASSISTANCE 623990 53073 53073 34833019 7 7 5405 0 5405 5405 5405 MISCELLANEOUS INCOME 900099 9033 9033 9033 35349534 34847457 0 7 1408 1408 661838 55683 606155 21326885 18756634 2424782 145469 156001 133618 21350 1033 2708748 2341500 349122 18126 1717717 1471254 235084 11379 71528 54186 17342 161867 116140 45727 2407349 2201554 205795 2268 431 1837 165935 98584 67351 460922 254572 206350 2271674 1940083 331591 934095 908156 25939 15515 7222 8293 9431 9431 228891 171036 57855 81913 4967 76946 CONSUMER SUPPLIES 1151483 1143400 8083 DMAS ASSESSMENT 1146656 1146656 EMPLOYEE RECRUITMENT 147707 216 147491 35829831 30816731 4837093 176007 6462844 1905722 2595706 1872436 42593 20751 85074 102561 4087997 3620810 686753 467187 1353982 4597162 11226952 8965819 3888359 3913205 565975 570665 224649 127238 3302143 1263719 7981126 5874827 X 3232326 3077492 13500 13500 3245826 3090992 11226952 8965819 X -480297 325463 X X 0 1 X 1 1 1 X 485243 394468 233320 5209388 502070 6824489 485243 394468 233320 5209388 502070 6824489 112117 6712372 1 7 8 388 7927 91440 10341 9033 119129 6943626 171396253 0.96670 0.94970 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2017 AMOUNT: $ 388. 2018 AMOUNT: $ 7,927. 2019 AMOUNT: $ 91,440. 2020 AMOUNT: $ 10,341. 2021 AMOUNT: $ 9,033. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 111519 111519 171848 171848 0 113644 96163 17481 3690986 3352799 338187 467187 DEPOSITS HELD IN TRUST 621539 RESIDUAL RECEIPTS 6 REPLACEMENT RESERVES & OTHER RESTRICTED DEPOSITS 17480 SECURITY DEPOSITS 19127 DUE FROM AFFILIATES 1772503 DUE FROM DEPARTMENT OF MEDICAL ASSISTANCE 2166507 4597162 TENANT SECURITY DEPOSITS 3783 DUE TO DEPARTMENT OF MEDICAL ASSISTANCE SERVICES 347675 DUE TO AFFILIATES 197799 OTHER CURRENT LIABILITIES 211462 CONTINGENCY RESERVE 503000 1263719 X 35349534 0 35349534 0 35349534 35829831 0 35829831 0 35829831 PART IV, LINE 2B: THE ORGANIZATION ACTS AS A REPRESENTATIVE PAYEE/TRUSTEE ON BEHALF OF THE CONSUMER PERSONAL FUNDS. WITHDRAWALS FROM THE FUNDS ARE USED STRICTLY TO COVER THE PATIENT PAY OBLIGATIONS AND CONSUMERS AUTHORIZED SPENDING AS DETERMINED/APPROVED BY THE VIRGINIA DEPARTMENT OF SOCIAL SERVICES. THE BALANCE OF DEPOSITS HELD IN TRUST AS OF JUNE 30, 2022 AND 2021 WAS $621,539 AND $557,473, RESPECTIVELY. PART X, LINE 2: THE ORGANIZATION IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE; ACCORDINGLY, THE ACCOMPANYING FINANCIAL STATEMENTS DO NOT REFLECT A PROVISION OR LIABILITY FOR FEDERAL AND STATE INCOME TAXES. THE ORGANIZATION HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF JUNE 30, 2022 AND 2021. X X X 0 0 0 0 0 0 0 0 0 ARTHUR GINSBERG PRESIDENT/CEO 325809 0 0 0 0 0 0 0 24428 0 350237 0 0 0 TERENCE HURLEY EXECUTIVE VP - CFO & CAO 248698 0 1200 0 0 0 0 0 20202 0 270100 0 0 0 RONALD GEORGE HR DIRECTOR & VP OF BUSINESS DEVELOP 164736 0 1200 0 0 0 0 0 23863 0 189799 0 0 0 JULIE ALLEN SR DIR OF CLINICAL SERVICE 131886 0 1800 0 0 0 2723 0 17744 0 154153 0 0 0 DEANNE MULLINS SR DIR OF CLINICAL SERVICE 128686 0 1800 0 0 0 0 0 23621 0 154107 0 0 0 LARRY SCURLOCK CHIEF INFORMATION OFFICER 131703 0 1200 0 0 0 0 0 17627 0 150530 0 0 0 BEATRICE CLAIBORNE DIRECTOR OF NURSING 130143 0 1800 0 0 0 0 0 18553 0 150496 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY THE AGENCY'S AUDITORS AFTER MANAGEMENT'S INPUT AND CRITICAL REVIEW. IT IS THEN DISTRIBUTED AND REVIEWED WITH THE FINANCE COMMITTEE OF THE CRI BOARD FOR ITS APPROVAL. IN ADDITION, THE FINANCE COMMITTEE THEN REPORTS TO THE CRI BOARD PRIOR TO FILING ON ITS REVIEW PROCESS AND ANY SIGNIFICANT ISSUES DISCUSSED WITH THE AUDITORS FOR ITS APPROVAL. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REVIEWS ITS POLICIES WITH ALL THE NEW BOARD MEMBERS AND EMPLOYEES DURING AN ORIENTATION. IN ADDITION, ALL EXPENDITURES REQUIRE TWO EMPLOYEES' SIGNATURES FOR DISBURSEMENTS. THE ORGANIZATION ALSO HAS A WHISTLEBLOWER POLICY AND A DIRECTOR ACCOUNTABLE FOR INDEPENDENT INVESTIGATIONS OF ANY ALLEGED MISCONDUCT. FORM 990, PART VI, SECTION B, LINE 15 THE CEO COMPENSATION IS ULTIMATELY DETERMINED BY CRI'S BOARD OF DIRECTORS. THE GOVERNANCE COMMITTEE OF THE CRI BOARD OF DIRECTORS ANNUALLY COMPLETES A THOROUGH AND ROBUST REVIEW OF THE CEO'S PERFORMANCE. IF THE COMMITTEE DETERMINES AN INCREASE IN COMPENSATION IS WARRANTED, THE COMMITTEE WILL FORWARD THAT RECOMMENDATION TO THE CRI BOARD FOR THEIR REVIEW AND APPROVAL. FORM 990, PART VI, SECTION C, LINE 19 ALL GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND/OR FINANCIAL STATEMENTS ARE PROVIDED AS REQUIRED BY LAW. IN ADDITION, THE AGENCY PROVIDES AN ANNUAL REPORT TO THE COMMUNITY THAT DOCUMENTS ITS ACCOMPLISHMENTS AND FINANCIAL STATUS. THE AGENCY ALSO SUBMITS REPORTS TO VARIOUS STATE LICENSING AGENCIES AS PART OF ITS MISSION. FORM 990, PART XI, LINE 9: FORGIVENESS OF RELATED PARTY OTHER LIABILITIES 325,463. FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES THE RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT AUDITOR. THERE WERE NO CHANGES IN THE PROCESSES FROM THE PRIOR YEAR. COMMUNITY HAVENS INC 14610 NEWBROOK DRIVE CHANTILLY VA 201512297 542006078 SERVES PEOPLE WITH MENTAL ILLNESSES AND INTELLECTUAL DISABILITIES VA 501(C)(3) LINE 11 COMMUNITY RESIDENCES INC 1 COMMUNITY RESIDENCES FOUNDATION INC 14610 NEWBROOK DRIVE CHANTILLY VA 201512297 541753414 SERVES PROGRAMS OF CRI THROUGH FINANCIAL ASSISTANCE VA 501(C)(3) LINE 7 COMMUNITY RESIDENCES INC 1 COMMUNITY RESIDENCES OF ARLINGTON INC 14610 NEWBROOK DRIVE CHANTILLY VA 201512297 521303297 SERVES PEOPLE WITH MENTAL ILLNESSES AND INTELLECTUAL DISABILITIES VA 501(C)(4) COMMUNITY RESIDENCES INC 1 RESIDENTIAL YOUTH SERVICES INC 14610 NEWBROOK DRIVE CHANTILLY VA 201512297 540857751 SERVES THE NEEDS OF ABUSED, NEGLECTED, AT RISK & YOUNG ADULTS VA 501(C)(3) LINE 11 COMMUNITY RESIDENCES INC 1 0 0 1 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1