2023-05-01T14:24:09-05:00 2021-12-31 390859910 BAKER TILLY US LLP 1570 FRUITVILLE PIKE SUITE 400 LANCASTER PA 17601 990 2021-01-01 223146725 FELLOWSHIP VILLAGE INC FELL 9085803805 8000 FELLOWSHIP VILLAGE ROAD BASKING RIDGE NJ 07920 MARK F MAZZELLA CFO 9085803805 2023-05-01 1 MARK MAZZELLA 999009999 KERRI N BOGDA CPA P00760402 7177404863 2023-05-01 X 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z X BRIAN G LAWRENCE 8000 FELLOWSHIP VILLAGE ROAD BASKING RIDGE NJ 07920 57948492 0 X WWW.FELLOWSHIPSENIORLIVING.ORG X 1992 NJ TO SERVE SENIORS OF VARIED BACKGROUNDS THROUGH OUR CHRIST-CENTERED COMMUNITY. 10 10 490 250 6291 0 1468289 4198762 42204704 43823043 1502142 2383027 2163414 1337540 47338549 51742372 13565 159682 0 0 24276918 23467473 1140 0 0 22944966 23008007 47236589 46635162 101960 5107210 187391253 199925318 142786488 145857748 44604765 54067570 X TO SERVE SENIORS OF VARIED BACKGROUNDS THROUGH OUR CHRIST-CENTERED COMMUNITY, BRINGING THEM TOGETHER IN MUTUAL RESPECT AND UNITY. WE PROVIDE SENIORS IN NEED WITH THE HIGHEST QUALITY OF SERVICES THAT FOSTER LONG-TERM HEALTH, PERSONAL INDEPENDENCE, SPIRITUAL GROWTH, AND FELLOWSHIP. OUR FOUNDATION IS THE WORD OF GOD, BOTH THE OLD AND NEW TESTAMENTS, WHICH GOVERNS OUR FAITH AND LIFE. 0 0 36689158 159682 43823043 FELLOWSHIP SENIOR LIVING, INC, OPERATING OUT OF BASKING RIDGE, NEW JERSEY, IS A NOT-FOR-PROFIT FAITH BASED PROVIDER OF SENIOR LIVING COMMUNITIES, SERVICES AND PROGRAMS AND EMBODIES A CULTURE OF HOSPITALITY AND EXCELLENCE. WE SERVE SENIORS OF ALL BELIEFS AND BACKGROUNDS WHO WISH TO ENJOY INDEPENDENCE, FELLOWSHIP, COMPASSIONATE CARE AND ACCESS TO A WIDE RANGE OF SERVICES INCLUDING LIFE PLAN COMMUNITY (CONTINUING CARE RETIREMENT COMMUNITY/CCRC), INDEPENDENT LIVING, ASSISTED LIVING, MEMORY CARE, SKILLED NURSING, REHABILITATION, THERAPY AT HOME, FITNESS TRAINING, HOME CARE, CONCIERGE SERVICES, HOSPICE, ON-SITE MEDICAL CENTER, CARE MANAGEMENT AND LONG TERM CARE PLANS.FELLOWSHIP SENIOR LIVING SERVES OVER 400 RESIDENTS AND ON ITS CAMPUS HAS 257 APARTMENTS, VILLAS, COTTAGES, AND FREESTANDING HOMES THAT COMPRISE THE INDEPENDENT LIVING SECTION OF THE COMMUNITY. FELLOWSHIP SENIOR LIVING OFFERS A FULL CONTINUUM OF SERVICES FROM INDEPENDENT LIVING TO RESPITE CARE. FELLOWSHIP HAS 81 ASSISTED LIVING ROOMS WHICH ALSO HAVE A SPECIALIZED MEMORY CARE PROGRAM AND 54 SKILLED NURSING BEDS. RESIDENTS ARE SUPPORTED BY THE REHABILITATION AND WELLNESS CENTER AND MEDICAL CENTER OF THE COMMUNITY. FELLOWSHIP SENIOR LIVING ALSO OFFERS HOME COMMUNITY BASED SERVICES THAT ARE DESIGNED TO DELIVER SERVICES TO SENIORS INSIDE THEIR OWN HOME. FELLOWSHIP SENIOR LIVING OFFERS MORE THAN 30 RESIDENT AND MEMBER DRIVEN CLUBS, ACTIVITIES, AND COMMITTEES FOR THOSE WANTING A MORE ACTIVE LIFESTYLE. 36689158 1 1 0 1 0 0 0 0 1 0 1 0 0 0 1 1 0 1 0 0 1 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 119 0 490 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 1 0 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 0 NJ CA X MARK F MAZZELLA CFO 9085803845 8000 FELLOWSHIP ROAD BASKING RIDGE NJ 07920 STANLEY MORIN CPA CHAIRMAN 2.00 X X 0 0 0 TED HARVEY DIRECTOR (UNTIL MAY '21) 1.00 X 0 0 0 RICK MORLEY DIRECTOR 1.00 X 0 0 0 JEFFREY ZENNA VICE CHAIRMAN 1.00 X X 0 0 0 CHARLES MILLER DIRECTOR (UNTIL MAY '21) 1.00 X 0 0 0 JOHN WOODS DIRECTOR (UNTIL MAY '21) 1.00 X 0 0 0 JAMES P HUETHER DIRECTOR 1.00 X 0 0 0 SUZANNE SHUGG DIRECTOR 1.00 X 0 0 0 JUDY PASNICK DIRECTOR 1.00 X 0 0 0 RALPH ACQUAVIVA DIRECTOR 1.00 X 0 0 0 RULENE DIFRANCESCO DIRECTOR 1.00 X 0 0 0 WILLIAM DOBSON DIRECTOR 1.00 X 0 0 0 RONALD WHALIN DIRECTOR 1.00 X 0 0 0 BRIAN G LAWRENCE PRESIDENT & CEO 40.00 X 725254 0 80273 MARK F MAZZELLA CHIEF FINANCIAL OFFICER 40.00 X 246120 0 35340 JACK ELLIAS VP HEALTH SERVICES 40.00 X 224481 0 29804 ELIZABETH FANDEL SVP HCBS 40.00 X 213691 0 16407 LAURA SHARP DIRECTOR OF CLINICAL OPERATIONS 40.00 X 170505 0 11501 JUDY AMIR CLIENT SERVICES MANAGER 40.00 X 149319 0 18145 NICHOLAS BOTTARO VP OF SALES & MARKETING 40.00 X 142612 0 12200 RAYCHELL MIDDLEBROOKS REGISTERED NURSE 40.00 X 178366 0 0 DR ARUTHER SHEPPELL MEDICAL DIRECTOR 40.00 X 285870 0 20995 VERA ADDY REGISTERED NURSE 40.00 X 152257 0 5329 2488475 0 229994 28 0 1 0 MORRISON SENIOR DINING PO BOX 102289 ATLANTA GA 30268 DINING MGMT FEES 5820689 FLICK CW PO BOX 102289 ATLANTA GA 30268 PLANT OPERATIONS & HOUSEKEEPING MGMT 2676375 MONK'S FRANCHISING LLC 1095 MT KEMBLE AVE MORRISTOWN NJ 07960 CONSTRUCTION 1877467 MONK'S KITCHEN & BATH DESIGN STUDIO 1095 MT KEMBLE AVE MORRISTOWN NJ 07960 CONSTRUCTION 1530177 NJSB CONSTRUCTION LLC 12 WILLIAM LANE OCEAN TOWNSHIP NJ 07712 CONSTRUCTION 1105111 14 4147700 51062 4198762 RESIDENT SERVICES 623000 24221719 24221719 HOME/ COMMUNITY SVCS 623000 7816494 7816494 NON RESIDENT PATIENT SERVICES 623000 5980621 5980621 THERAPY 623000 2489147 2489147 MEDICARE PAYMENTS 623000 2057724 2057724 1257338 1257338 43823043 1760017 6291 1753726 5062 5062 103168 28216 74952 74952 74952 6795852 6073300 104604 722552 -104604 617948 617948 CABLE 623000 430315 430315 DEFERRED CONTRACT REVENUE 900099 117839 117839 CAFETERIA 623000 114107 114107 600327 600327 1262588 51742372 43823043 6291 3714276 159682 159682 987072 769709 217363 18480761 15271964 3208797 507062 419021 88041 1514421 1246699 267722 1978157 1542538 435619 1753877 1367657 386220 268687 30170 238517 255059 255059 1061 1061 6470 6470 156977 85562 71415 991053 658641 332412 1308601 1018657 289944 200980 200980 2525209 2424201 101008 72769 27594 45175 2346417 1759813 586604 5734342 4321918 1412424 738005 708485 29520 FOOD SERVICES 5590271 4359240 1231031 REPAIRS & MAINTENANCE 602426 480658 121768 BAD DEBTS 390281 390281 LICENSES & FEES 65522 36949 28573 46635162 36689158 9946004 0 2004300 2639789 526566 1015629 3556649 3925949 20104 20104 1737157 880495 213677883 86764145 114196210 126913738 57893778 54574156 4771919 6564792 2595178 3292295 50055 50055 39337 48316 187391253 199925318 5877921 5050655 4147700 31716 17778850 17341689 85294564 84469558 293532 190053 10026162 9385507 864856 744480 18502903 28644090 142786488 145857748 X 42009587 50775275 2595178 3292295 44604765 54067570 187391253 199925318 X 5107210 3658478 697117 X 0 1 X 1 1 1 X 237440 408980 493010 1468289 4198762 6806481 38412044 40437564 40595102 42204704 43823043 205472457 2111011 2152508 1984091 1837352 1079217 9164179 40760495 42999052 43072203 45510345 49101022 221443117 5000 5000 5000 15000 760193 304952 1904745 2095506 5065396 765193 309952 5000 1904745 2095506 5080396 216362721 1796256 1462913 1304897 1486964 1868247 7919277 1796256 1462913 1304897 1486964 1868247 7919277 257663 241156 183371 682190 42556751 44461965 44634763 47238465 51152640 230044584 0.94050 0.94890 0.03440 0.03400 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: GROSS FUNDRAISING RECEIPTS - 2019 AMOUNT: $ 17,690. GAMING RECEIPTS - 2019 AMOUNT: $ 3,090. 2020 AMOUNT: $ 3,532. SOLAR REC INCOME - 2019 AMOUNT: $ 119,043. 2020 AMOUNT: $ 119,785. 2021 AMOUNT: $ 65,532. DEFERRED CONTRACT REVENUE - 2019 AMOUNT: $ 117,840. 2020 AMOUNT: $ 117,839. 2021 AMOUNT: $ 117,839. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1061 1061 0 PART II-B, LINE 1: FELLOWSHIP SENIOR LIVING (FSL) IS A MEMBER OF NATIONAL LEADINGAGE AND LEADINGAGE NEW JERSEY. FSL PAID COMBINED DUES OF $25,393 TO LEADINGAGE AND LEADINGAGE NJ. THE PORTION OF DUES ALLOCATED TO LOBBYING IS $1,061. 0 1 X 1587195 141089 2380224 4108508 2098375 410583 362838 1284601 1587195 1960594 432377 -193385 101211 2098375 1637500 279293 158570 114769 1960594 0.00000 0.00000 0.00000 1 6838577 6838577 152679782 69437321 83242461 28520196 17326824 11193372 25639328 25639328 126913738 REFUNDABLE ADVANCE FEES 28644090 28644090 X 55973099 3658478 544033 4202511 51770588 -28216 -28216 51742372 46510294 28216 28216 46482078 153084 153084 46635162 PART IV, LINE 2B: ESCROW IS USED TO HOLD 10% OF LIFECARE ENTRANCE FEE CONTRACT AMOUNTS. THESE AMOUNTS ARE APPLIED TO ENTRANCE FEES THAT ARE DUE WHEN RESIDENTS MOVE INTO FELLOWSHIP VILLAGE. PART V, LINE 4: THE AMOUNTS REPORTED ABOVE ARE ASSETS WITH DONOR RESTRICTIONS. THE ORGANIZATION MAINTAINS FOUR FUNDS FOR THE FOLLOWING USES: CAPITAL FUND, PROMISE FUND, LIFE ENRICHMENT FUND, TEAM MEMBER FUND AND THE HEALTH AND MEDICAL FUND. THE ENDOWMENT IS TRANSFERRED TO AND REPORTED ON THE FELLOWSHIP FOUNDATION, INC., A RELATED ORGANIZATION IN 2020. PART X, LINE 2: FSL ACCOUNTS FOR UNCERTAINTY IN INCOME TAXES USING A RECOGNITION THRESHOLD OF MORE LIKELY THAN NOT TO BE SUSTAINED UPON EXAMINATION BY THE APPROPRIATE TAXING AUTHORITY. MEASUREMENT OF THE TAX UNCERTAINTY OCCURS IF THE RECOGNITION THRESHOLD IS MET. PART XI, LINE 2D - OTHER ADJUSTMENTS: CONTRIBUTION TO RELATED ENTITY -146,614. CHANGE IN INTEREST OF NET ASSETS OF FOUNDATION 697,117. INVESTMENT FEES -6,470. PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES -28,216. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 28,216. PART XII, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT FEES 6,470. CONTRIBUTION TO RELATED ENTITY 146,614. CENTRAL AMERICA AND THE CARIBBEAN 0 0 INVESTMENTS 2044824 0 0 0 0 0 0 2044824 0 2044824 0 0 1 0 1 0 PART II, LINE 1 ACCOUNTING METHOD: THE ORGANIZATION HAS OFFSHORE INVESTMENTS BUT ITS OWNERSHIP DOES NOT MEET THE REQUIREMENTS FOR REPORTING THEIR INTERESTS ON FORMS 5471 AND 8865. PART III ACCOUNTING METHOD: 1 FELLOWSHIP FOUNDATION 8000 FELLOWSHIP VILLAGE ROAD BASKING RIDGE NJ 07920 842975643 501(C)(3) 146614 0 GENERAL OPERATIONS 1 PART I, LINE 2: THE FILING ORGANIZATION GRANTED FUNDS TO ITS AFFILIATE, FELLOWSHIP FOUNDATION. ALL ACCOUNTNG FOR THE AFFILIATES IS CENTRALIZED AND NO ADDITIONAL MONITORING IS NECESSARY. X X X X X 0 0 0 0 0 0 0 1 0 BRIAN G LAWRENCE PRESIDENT & CEO 552629 0 90000 0 82625 0 60150 0 20123 0 805527 0 0 0 DR ARUTHER SHEPPELL MEDICAL DIRECTOR 285870 0 0 0 0 0 2159 0 18836 0 306865 0 0 0 MARK F MAZZELLA CHIEF FINANCIAL OFFICER 224453 0 21667 0 0 0 8729 0 26611 0 281460 0 0 0 JACK ELLIAS VP HEALTH SERVICES 211731 0 12750 0 0 0 8122 0 21682 0 254285 0 0 0 ELIZABETH FANDEL SVP HCBS 196908 0 16783 0 0 0 7558 0 8849 0 230098 0 0 0 LAURA SHARP DIRECTOR OF CLINICAL OPERATIONS 164505 0 6000 0 0 0 6190 0 5311 0 182006 0 0 0 RAYCHELL MIDDLEBROOKS REGISTERED NURSE 177766 0 600 0 0 0 0 0 0 0 178366 0 0 0 JUDY AMIR CLIENT SERVICES MANAGER 149319 0 0 0 0 0 5538 0 12607 0 167464 0 0 0 VERA ADDY REGISTERED NURSE 151657 0 600 0 0 0 5329 0 0 0 157586 0 0 0 NICHOLAS BOTTARO VP OF SALES & MARKETING 134912 0 7700 0 0 0 5034 0 7166 0 154812 0 0 0 PART I, LINE 7 BONUSES ARE NON-FIXED PAYMENTS WHICH ARE BASED UPON PERFORMANCE AND ATTAINING GOALS SET DURING THE YEAR. THE PRESIDENT & CEO'S BONUS IS DETERMINED THROUGH THE COMPENSATION COMMITTEE OF THE BOARD. THE ORGANIZATION ALSO UTILIZES AN HR CONSULTING COMPANY TO ARRIVE AT A COMPENSATION LEVELS THAT INCORPORATE FOR PROFIT AND NON PROFIT SALARY RANGES FOR SIMILAR POSITIONS FOR BOTH THE PRESIDENT & CEO AND ALL SENIOR MANAGEMENT. ALL SENIOR MANAGEMENT SALARIES ARE WITHIN SUCH RANGES, AND IN ADDITION ALL SENIOR MANAGEMENT IS REVIEWED ANNUALLY FOR BOTH MERIT AND BONUS BY THE PRESIDENT & CEO. A PUBLIC FINANCE AUTHORITY 273866124 74443UCD3 2019-12-19 80055000 SEE SUPPLEMENTAL INFORMATION 0 0 0 A 85618896 1486117 15951186 57924940 3848814 2022 1 0 0 1 A 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 0 A 0 1 0 0 0 0 0 0 0 A 0 SCHEDULE K, PART I, COLUMN F: PROCEEDS OF THE 2019 BOND A INCLUDE A) CURRENT REFUNDING OF ALL OF THE OUTSTANDING SERIES 2013 A BONDS IN THE AMOUNT OF $32,027,666 AND 2013 SERIES B BONDS IN THE AMOUNT OF $33,513,092; (B) FINANCING FOR PHASE III OF THE HEALTH CENTER EXPANSION AND RENOVATION PROJECT; (C) PAY ASSOCIATED COSTS WITH THE ISSUANCE OF THE SERIES 2019 BONDS INCLUDING THE TERMINATION OF RELATED RATE SWAP AGREEMENT; AND (D) RECOVER A PORTION OF EQUITY CONTRIBUTIONS AS SPECIFIED UNDER THE 2013 SERIES A AGREEMENT FOR PHASES I AND II. SCHEDULE K, PART III, LINE 9, PART IV, LINE 7, PART V: THE ORGANIZATION IS A PRUDENT AND CONSCIENTIOUS TAXPAYER THAT UNDERSTANDS ITS OBLIGATIONS REGARDING MONITORING THE USES AND INVESTMENT OF BOND ISSUANCE PROCEEDS. THE ORGANIZATION FOLLOWS THE SAFE HARBOR REGULATIONS REGARDING BOND ISSUES AND IS IN THE PROCESS OF ESTABLISHING WRITTEN POLICIES TO FORMALIZE POST-BOND ISSUANCE PROCEDURES. THE USE OF PROCEEDS FROM THE BOND ISSUE IS MONITORED BY THE TRUSTEE TO ENSURE THE BOND PROCEEDS ARE UTILIZED FOR THE AGREED-ON PURPOSES. FORM 990, PART VI, SECTION A, LINE 4 THE BYLAWS OF THE ORGANIZATION WERE CHANGED IN SEPTEMBER 2021 TO REFLECT THE INCORPORATION OF A NEW ENTITY, FSL, INC. (EIN 61-2015757), WHICH AS FORMED TO BE THE PARENT AND SOLE MEMBER OF THE FILING ORGANIZATION. THE NAME OF THE FILING ORGANIZATION WAS ALSO CHANGED TO FELLOWSHIP VILLAGE, INC. FORM 990, PART VI, SECTION A, LINE 6 IN SEPTEMBER 2021, THE ORGANIZATION FORMED FSL, INC. (EIN 61-2015757) WHICH WAS DESIGNATED THE PARENT OF THE ORGANIZATION AND ITS SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A FSL, INC. HAS THE RIGHT TO ELECT THE BOARD MEMBERS OF ITS SUBSIDIDARIES. FORM 990, PART VI, SECTION A, LINE 7B FSL, INC., THE SOLE MEMBER AND PARENT OF THE FILING ORGANIZATION, HAS RESERVED RIGHTS OVER MAJOR DECISIONS OF THE FILING ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION DOES CONTEMPORANEOUSLY DOCUMENT THE MEETINGS OF THE ORGANIZATION'S COMMITTEES, BUT THE COMMITTEES DO NOT HAVE AUTHORITY TO ACT ON BEHALF OF THE ORGANIZATION, AND THEREFORE QUESTION 8B HAS BEEN ANSWERED "NO". FORM 990, PART VI, SECTION B, LINE 11B THE CFO REVIEWS THE DRAFT AND THEN PROVIDES THE DRAFT OF THE RETURN TO ALL BOARD MEMBERS. COMMENTS ARE ACCEPTED DURING THIS REVIEW PROCESS. ONCE BOARD MEMBERS HAVE BEEN GIVEN ACCESS TO THE FORM 990, THE RETURN IS FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C ALL EMPLOYEES ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE AT THE BEGINNING OF THEIR EMPLOYMENT. BOARD DIRECTORS SUBMIT A CONFLICT OF INTEREST FORM ANNUALLY. THE CFO AND CEO OF FELLOWSHIP SENIOR LIVING, INC. REVIEW TRANSACTIONS PERFORMED BY THE BOARD, OFFICERS, AND KEY EMPLOYEES FOR CONFLICTS OF INTEREST ON AN ONGOING BASIS. IF THERE IS A CONFLICT AT THE BOARD LEVEL, THAT INDVIDUAL WOULD ABSTAIN FROM VOTING. FAMILY AND BUSINESS RELATIONSHIPS ARE EXPRESSLY MENTIONED IN THE POLICY. THE HUMAN RESOURCES DEPARTMENT REVIEWS AND RETAINS THE FORMS AND NOTIFIES SENIOR MANAGMENT OR THE BOARD IF ANY CONFLICTS EXIST. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION COMMITTEE REVIEWS COMPENSATION FOR THE CEO BY COMPARING TO OTHER CEOS IN THE CCRC AND HEALTHCARE INDUSTRY THAT ARE IN THE LOCAL REGION. THE COMPENSATION COMMITTEE RECOMMENDS TO THE WHOLE BOARD THE CEO SALARY INCREASES FOR FULL BOARD APPROVAL. THE CEO AND HUMAN RESOURCES REVIEW COMPENSATION FOR THE OTHER OFFICERS AND KEY EMPLOYEES. THE ORGANIZATION USES COMPARATIVE DATA FOR THE INDUSTRY AND REGION FROM AN OUTSIDE PROFESSIONAL SOURCE FOR DETERMINING COMPENSATION TO ENSURE COMPENSATION IS IN LINE WITH FAIR MARKET VALUE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES THE REQUESTED INFORMATION AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST OF NET ASSETS OF FOUNDATION 697,117. FELLOWSHIP FOUNDATION INC 8000 FELLOWSHIP VILLAGE ROAD BASKING RIDGE NJ 07920 842975643 FUNDRAISING NJ 501(C)(3) LINE 7 N/A 0 FSL INC 8000 FELLOWSHIP VILLAGE ROAD BASKING RIDGE NJ 07920 612015757 PARENT COMPANY NJ 501(C)(3) LINE 7 N/A 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0