2023-08-11T15:04:01-05:00 2022-09-30 410746749 CLIFTONLARSONALLEN LLP TWO INTERNATIONAL PLACE 22ND FLOOR BOSTON MA 02110 990 2021-10-01 061073286 POMPERAUG WOODS INC POMP 2032626555 80 HERITAGE ROAD SOUTHBURY CT 06488 KEVIN MOSHIER EXECUTIVE DIRECTOR 2032626555 2023-08-11 1 KEVIN MOSHIER XXX-XX-XXXX LAURA J KENNEY P00202198 6177170831 2023-08-11 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z KEVIN MOSHIER 80 HERITAGE ROAD SOUTHBURY CT 06488 12311682 0 X WWW.POMPERAUGWOODS.COM X 1988 CT POMPERAUG WOODS IS A NONPROFIT LIFECARE CONTINUING CARE RETIREMENT COMMUNITY FOR INDIVIDUALS AGED 62 AND OVER CONSISTING OF 131 INDEPENDENT LIVING APARTMENTS, 16 MEMORY CARE BEDS, AND 37 SKILLED NURSING BEDS. SERVICES PROVIDED INCLUDE MEDICAL CARE, ASSISTANCE IN LIVING SERVICES, FOOD, LAUNDRY AND CLEANING. 10 10 221 28 0 0 376643 54104 10528026 12111711 -49370 -6132 46389 118911 10901688 12278594 0 0 0 0 6376117 7019061 0 0 0 5436032 6135923 11812149 13154984 -910461 -876390 21221148 19018725 33797012 32469557 -12575864 -13450832 TO PROVIDE CONTINUOUS CARE FOR RETIRED PEOPLE. 0 0 10220177 12213768 POMPERAUG WOODS IS A CONTINUING CARE RETIREMENT COMMUNITY CONSISTING OF 131 LIVING UNITS, 16 MEMORY CARE BEDS, AND 37 NURSING BEDS. SERVICES PROVIDED INCLUDED MEDICAL CARE, FOOD, CLEANING AND LAUNDRY. 10220177 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 0 1 0 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 0 0 0 0 1 68 0 1 221 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 10 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X LANA SMOLITSKY 2032626555 80 HERITAGE ROAD SOUTHBURY CT 06488 HELENA JEDLINSKY PRESIDENT 1.00 X X 0 0 0 JANET WALKER CO-VICE PRESIDENT 1.00 X X 0 0 0 JANE C CONNERY CO-VICE PRESIDENT 1.00 X X 0 0 0 JAMES R STRUB SECRETARY 1.00 X X 0 0 0 LISA WNUCK TREASURER 1.00 X X 0 0 0 EUGENE CORNELIUS DIRECTOR 1.00 X 0 0 0 CHRISTINE EDELSON DIRECTOR 1.00 X 0 0 0 DOUGLAS KENYON DIRECTOR 1.00 X 0 0 0 MARK LANCOR DIRECTOR (UNTIL 08/2022) 1.00 X 0 0 0 MATTHEW MIHALCIK DIRECTOR 1.00 X 0 0 0 GAIL E SEYMOUR DIRECTOR (UNTIL 04/2022) 1.00 X 0 0 0 ANTONIO VAS DIRECTOR 1.00 X 0 0 0 KEVIN MOSHIER EXECUTIVE DIRECTOR 40.00 X 219911 0 71774 LANA SMOLITSKY FINANCE DIRECTOR 40.00 X 126475 0 1335 CATHERINE PETERSON NURSING DIRECTOR 40.00 X 106929 0 19195 453315 0 92304 3 0 1 0 PANICCIA CONSTRUCTION CORP LLC 214 AMITY ROAD SUITE E WOODBRIDGE CT 06525 CONSTRUCTION 499324 LIFE CARE SERVICES 400 LOCUST STREET DES MOINES IA 50309 MANAGEMENT IT CONSULTANT 465794 THE NATURE'S EDGE LLCS 54 DORMAN ROAD OXFORD CT 06478 LANDSCAPING/SNOW REMOVAL 153416 ATTANE INC 8880 WARD PARKWAY SUITE 400 KANSAS CITY MO 64114 MARKETING SERVICES 151873 4 54104 54104 RESIDENT SERVICE REVENUE 623000 7834336 7834336 HEALTH CENTER FEES 623000 3226175 3226175 AMORTIZATION OF ENTRANCE FEES 623000 1051200 1051200 12111711 23056 23056 3900 33088 -29188 -29188 -29188 16854 0 16854 16854 MISC. REVENUE 623000 102057 102057 102057 12278594 12213768 0 10722 406113 406113 5429748 4716950 712798 54474 44345 10129 703824 655616 48208 424902 360909 63993 455342 12105 443237 12469 12469 45755 45755 105117 105117 466718 231275 235443 775859 775859 42693 42693 1452388 1445126 7262 227123 55831 171292 PROMOTIONAL SALES 659188 55518 603670 FOOD & SUPPLIES 644716 585299 59417 REAL ESTATE TAXES 463953 462926 1027 THERAPY 351569 351569 433033 319039 113994 13154984 10220177 2934807 0 186132 1203 4367585 3805111 1595712 587196 61110 79905 401203 378959 43165888 29112920 14498960 14052968 110446 113383 21221148 19018725 4276982 990231 5178967 5576879 1171438 1375800 23169625 24526647 33797012 32469557 X -12688481 -13570781 112617 119949 -12575864 -13450832 21221148 19018725 -876390 1422 0 X 0 1 X 1 0 X 11000 40160 1428223 376643 54104 1910130 12058264 12317725 11642579 10551985 12111711 58682264 12069264 12357885 13070802 10928628 12165815 60592394 0 245500 245500 245500 245500 60346894 15788 75969 25257 3340 23056 143410 15788 75969 25257 3340 23056 143410 14294 22430 16854 53578 102057 102057 12085052 12433854 13110353 10954398 12307782 60891439 0.99110 0.99740 0.00240 0.00200 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 272872 54104 1480 328456 165700 207074 97 100000 272872 383697 3448 749 222194 165700 448033 40160 5840 110336 383697 0.63000 0.37000 0 0 962264 962264 35519906 23779425 11740481 3653961 2919205 734756 3029757 2414290 615467 14052968 ENTRANCE FEE REFUNDS PAYABLE 24497110 CAPITAL LEASE 29537 24526647 12280016 1422 1422 12278594 0 12278594 13154984 0 13154984 0 13154984 PART V, LINE 4: BOARD DESIGNATED OR QUASI- ENDOWMENT IS UNRESTRICTED AND MAY BE DISBURSED TO PROVIDE SERVICES OR FACILITIES CONSISTENT WITH THE ORGANIZATION'S CHARITABLE PURPOSES AND MUST BE APPROVED BY THE BOARD OF DIRECTORS. TERM ENDOWMENT REPRESENTS CONTRIBUTIONS THAT ARE RESTRICTED BY THE DONOR EITHER AS TO PURPOSE OR AS TO TIME OF EXPENDITURE. 0 0 0 1 0 1 0 1 0 KEVIN MOSHIER EXECUTIVE DIRECTOR 183609 0 36302 0 0 0 44219 0 27555 0 291685 0 0 0 PART I, LINE 5 SOME BONUSES WERE CONTINGENT ON OCCUPANCY AND THEREFORE REVENUE. PART I, LINE 6 SOME BONUSES WERE CONTINGENT ON OCCUPANCY AND THEREFORE REVENUE. PART I, LINE 7 SOME OF THE EMPLOYEES OF THE ORGANIZATION RECEIVE DISCRETIONARY BONUSES BASED ON PERFORMANCE. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION UTILIZED LIFE CARE SERVICES, LLC TO SUPERVISE OPERATIONS OF THE FACILITY. THE EXECUTIVE DIRECTOR OF POMPERAUG WOODS, KEVIN MOSHIER IS AN EMPLOYEE OF LIFE CARE SERVICES, LLC. DURING CALENDAR YEAR 2021, KEVIN RECEIVED $219,911 OF REPORTABLE COMPENSATION, $44,219 OF DEFERRED COMPENSATION AND $27,555 OF NONTAXABLE BENEFITS FROM LIFE CARE SERVICES, LLC FOR PROVIDING MANAGEMENT SERVICES TO POMPERAUG WOODS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS REVIEWED BY JANET WALKER, VICE PRESIDENT OF THE BOARD, BEFORE FILING. THE ORGANIZATION WILL PROVIDE A COMPLETE COPY OF FORM 990 TO ALL VOTING MEMBERS PRIOR TO AND AFTER FILING FORM 990. FORM 990, PART VI, SECTION B, LINE 12C A CONFLICT OF INTEREST POLICY IS SIGNED OFF BY EACH BOARD MEMBER ANNUALLY. ANY CONFLICTS ARE REVIEWED BY THE EXECUTIVE COMMITTEE. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE DIRECTOR IS AN EMPLOYEE OF LIFE CARE SERVICES, LLC, (LCS) WHICH PROVIDES MANAGEMENT SERVICES TO POMPERAUG WOODS. THE COMPENSATION OF THE FINANCE DIRECTOR IS DETERMINED BY THE EXECUTIVE DIRECTOR USING COMPARABLE DATA, AND IS APPROVED BY THE PRESIDENT OF THE BOARD. LCS REVIEWS COMPENSATION ON A NATIONAL LEVEL USING A THIRD PARTY SURVEY. INCREASES ARE REVIEWED BY THE DIRECTOR OF OPERATIONS, LCS HR AND THE EXECUTIVE OFFICERS OF LCS FOR APPROVAL. POMPERAUG WOODS DOES A WAGE AND HOUR REVIEW ANNUALLY AND USES A THIRD PARTY WAGE AND HOUR SURVEY TO COMPARE WAGES. ALL INCREASES ARE REVIEWED BY THE EXECUTIVE DIRECTOR AND THE BOARD APPROVES WAGES AND ADJUSTMENTS ANNUALLY WITH THE ANNUAL BUDGET. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST.