2022-05-16T14:48:54-05:00 2021-06-30 910189318 MOSS ADAMS LLP 101 SECOND STREET SUITE 900 SAN FRANCISCO CA 94105 990 2020-07-01 940545320 HEBREW HOME FOR AGED DISABLED HEBR 4153342500 302 SILVER AVENUE SAN FRANCISCO CA 941121510 MARY CONNICK INTERIM CEO 4153342500 2022-05-13 1 MARY CONNICK 999009999 MICHAEL LUMSDEN P01262236 4159561500 2022-05-13 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z SAN FRANCISCO CAMPUS FOR JEWISH LIVING MARY CONNICK 302 SILVER AVENUE SAN FRANCISCO CA 941121510 101749782 0 X WWW.SFCJL.ORG X 1871 CA WE ARE A LICENSED NURSING HOME AND LICENSED RESIDENTIAL CARE FOR THE ELDERLY FACILITY THAT PROVIDES TO SENIORS LIFE ENRICHING SERVICES THAT PROMOTE INDIVIDUAL DIGNITY, ENCOURAGE INDEPENDENCE, AND REFLECT THE SOCIAL, CULTURAL, AND SPIRITUAL VALUES OF THE JEWISH TRADITION. 13 13 832 112 0 0 3637780 24534334 73258556 76455771 86687 139552 1295543 469222 78278566 101598879 0 200000 0 0 47793695 51331088 0 0 564787 31863149 53950938 79656844 105482026 -1378278 -3883147 304306014 286369109 134201478 116180525 170104536 170188584 X ENRICHING THE QUALITY OF LIFE OF OLDER ADULTS. 0 0 94500255 200000 76455771 SEE SCHEDULE O 94500255 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 96 0 1 832 1 0 0 0 0 0 0 0 0 0 1 0 0 0 X 13 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 1 0 CA X MARY CONNICK 4155622650 302 SILVER AVENUE SAN FRANCISCO CA 94112 X DANIEL RUTH PRESIDENT AND CEO 24.00 4.00 X 0 911285 134078 VICTOR MEINKE FORMER CFO 0.00 0.00 X 0 480005 56099 MICHAEL SKAFF CHIEF OPERATING OFFICER 25.00 5.00 X 0 385823 10660 SHERIE KOSHOVER CHIEF ADVANCEMENT OFFICER 16.00 2.00 X 0 300330 37801 MARY CONNICK CFO & TREASURER 25.00 5.00 X 0 277191 6278 STEPHEN T HALL ACUTE PSYCHIATRIC UNIT MEDICAL DIR 40.00 0.00 X 219749 0 28139 PEGGY CMIEL DIRECTOR OF NURSING & CLINICAL OPS 40.00 0.00 X 204423 0 26671 MARK FRIEDLANDER ED, NURSING HOME ADMIN THRU 3/2021 40.00 0.00 X 198260 0 16125 MARILYN MINERALES LICENSED VOCATIONAL NURSE 40.00 0.00 X 179111 0 33190 MARIO LEMAY DIRECTOR OF ORG EFFECTIVENESS 40.00 0.00 X 179582 0 15038 MATTHEW POWONDRA RCFE ADMINISTRATOR 40.00 0.00 X 155948 0 29339 JAN REICHER DIR, DEPT OF SPIRITUAL & JEWISH LIFE 40.00 0.00 X 176699 0 5681 MARILOU ESPANOL REGISTERED PSYCH NURSE 40.00 0.00 X 160374 0 14381 ROBERT H SARISON DIRECTOR OF CAMPUS PROGRAMS 40.00 0.00 X 166776 0 5346 DAVID LOWI CHAIR 4.00 0.00 X X 0 0 0 HOWARD F FINE VICE CHAIR 1.00 0.00 X X 0 0 0 BRIAN PERLMAN VICE CHAIR THRU 1/2021 1.00 0.00 X X 0 0 0 SOPHIE SHARP VICE CHAIR EFFECTIVE 1/2021 1.00 0.00 X X 0 0 0 STEVEN FAYNE TREASURER 1.00 0.00 X X 0 0 0 ALEX MANN SECRETARY 1.00 0.00 X X 0 0 0 JAMES A DAVIS MD TRUSTEE 1.00 0.00 X 0 0 0 JESSICA EISLER TRUSTEE 1.00 0.00 X 0 0 0 MATTHEW D GERSHUNY TRUSTEE 1.00 0.00 X 0 0 0 DAVID GOLDIN TRUSTEE 1.00 0.00 X 0 0 0 ADRIENNE GREENE MD TRUSTEE 1.00 0.00 X 0 0 0 LAURA KLAPPER TRUSTEE 1.00 0.00 X 0 0 0 DANIELLE NEMZER TRUSTEE THRU 6/2021 1.00 0.00 X 0 0 0 JUDITH PLAYER TRUSTEE EFFECTIVE 1/2021 1.00 0.00 X 0 0 0 LYNN SEDWAY TRUSTEE 1.00 0.00 X 0 0 0 HOWARD ZACK TRUSTEE THRU 6/2021 1.00 0.00 X 0 0 0 1640922 2354634 418826 65 1 1 0 CAHILL CONTRACTORS 425 CALIFORNIA STREET SUITE 2200 SAN FRANCISCO CA 94104 CONSTRUCTION SERVICES 43597486 JEWISH SENIOR LIVING GROUP 302 SILVER AVENUE SAN FRANCISCO CA 94112 MANAGEMENT/ADMINISTRATIVE SERVICES 7607000 ACCLAIM PROFESSIONAL HEALTHCARE LLC 4340 REDWOOD HIGHWAY SAN RAFAEL CA 94903 GERIATRIC CARE MANAGEMENT SERVICES 951593 URATA & SONS CONCRETE INC 3430 LUYUNG DRIVE RANCHO CORDOVA CA 95742 CONSTRUCTION SERVICES 683368 SERVING SENIORS CARE 355 GELLERT BLVD DALY CITY CA 94015 SENIOR CARE SERVICES 675499 34 2347613 22186721 9465 24534334 NET PATIENT SERV. REV. 623000 76174691 76174691 RENTAL INCOME - JSLG 900099 168000 168000 OTHER OPERATING REV. 623000 113080 113080 76455771 121552 121552 18000 0 18000 18000 18000 105131 150903 -45772 -45772 REIMBURSEMENTS 900099 480009 480009 CAFETERIA 722514 25331 25331 PARKING REVENUE 812930 9654 9654 514994 101598879 76455771 0 608774 X 200000 200000 973215 973215 68796 68796 37995837 37252420 382238 361179 929620 911591 9270 8759 8520583 8356215 84512 79856 2843037 2795460 23539 24038 697468 671682 25786 101024 101024 18362852 9873110 8473692 16050 228829 14808 178102 35919 2597278 2383008 200175 14095 826156 290656 535500 2842094 2612807 229287 13249 13249 8836 6961 1580 295 3575805 3575805 13367289 13367289 1735878 1735878 MEDICAL SUPPLIES 3769408 3769408 BLDG DEMO/ABATEMENT 2666259 2666259 FOOD 2286600 2286600 LICENSES AND TAXES 333841 333841 538072 341197 172279 24596 105482026 94500255 10416984 564787 17368 25948 23712129 4571688 6329 7597 9757880 12977759 800000 800000 182208 203964 1745289 667894 290804745 67769042 220781688 223035703 47303123 44078556 304306014 286369109 23423544 13790724 30000 0 1203923 56375 98018397 88064401 4841765 4474520 6683849 9794505 134201478 116180525 X 92390056 145732361 77714480 24456223 170104536 170188584 304306014 286369109 X -3883147 3967195 X 0 1 X 1 0 X 13461638 13765691 18225340 3637780 24534334 73624783 13461638 13765691 18225340 3637780 24534334 73624783 22470054 51154729 2638 2041 2064 86687 121552 214982 712059 296606 598972 1347957 514991 3470585 77310350 354314585 0.66170 0.67430 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER REVENUE - 2016 AMOUNT: $ 712,059. 2017 AMOUNT: $ 296,606. 2018 AMOUNT: $ 598,972. 2019 AMOUNT: $ 1,347,957. 2020 AMOUNT: $ 514,991. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 8198 8198 0 PART II-B, LINE 1: THE ORGANIZATION PAYS DUES TO: (I) THE CALIFORNIA HOSPITAL ASSOCIATION/HOSPITAL COUNCIL NORTHERN AND CENTRAL CALIFORNIA; (II) LEADING AGE CALIFORNIA; AND (III) LEADING AGE NATIONAL. A PORTION OF THOSE DUES ($8,198) HAVE BEEN INDICATED AS UTILIZED FOR LOBBYING ACTIVITIES RELATED TO THE PROMOTION OF SENIOR CARE INITIATIVES. 15617661 2917785 18535446 14761999 855662 15617661 13365303 1396696 14761999 12664908 739632 39237 13365303 10534341 1000000 1130567 12664908 0.00000 0.45996 0.54004 1 0 90849 90849 268495526 43287272 225208254 18297486 22136888 -3839402 3920884 2344882 1576002 223035703 BENEFICIAL INTEREST IN JHSLF 23944963 SPLIT INTEREST AGREEMENTS 2872194 OTHER ASSETS 35184 INTEREST IN NET ASSETS OF JHSLF 5127617 DUE FROM AFFILIATED ORGANIZATIONS 2510707 UNSPENT BOND PROCEEDS HELD BY TRUSTEE 7077934 WORKERS COMP DEPOSITS 2265007 OTHER RECEIVABLES 241535 CASH HELD FOR RESIDENTS 3415 44078556 DEPOSITS 195922 DUE TO AFFILIATED ORGANIZATIONS 211083 AFFILIATED ORGANIZATION LOANS PAYABLE 9387500 9794505 X 105698977 3967195 3967195 101731782 -132903 -132903 101598879 105614929 132903 132903 105482026 0 105482026 PART V, LINE 4: THE ORGANIZATION'S ENDOWMENT ASSETS CONSISTS OF FUNDS ESTABLISHED TO GENERATE OPERATING SUPPORT TO THE ORGANIZATION AND CAPITAL CAMPAIGN FUNDS WHICH THE BOARD OF TRUSTEES MAY USE TO REPAY THE PRINCIPAL PORTION OF THE CONSTRUCTION DEBT AND INCLUDES ACCUMULATED EARNINGS THEREON THAT HAVE NOT YET BEEN EXPENDED. PART X, LINE 2: THE ORGANIZATION FOLLOWS THE U.S. GAAP ACCOUNTING STANDARD REGARDING ACCOUNTING FOR UNCERTAIN TAX POSITIONS. THIS ACCOUNTING STANDARD PROVIDES DETAILED GUIDANCE FOR FINANCIAL STATEMENT RECOGNITION, MEASUREMENT, AND DISCLOSURE OF UNCERTAIN TAX POSITIONS RECOGNIZED IN THE ORGANIZATION'S FINANCIAL STATEMENTS. THE STANDARD REQUIRES AN ENTITY TO RECOGNIZE THE FINANCIAL STATEMENT IMPACT OF A TAX POSITION WHEN IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL NOT BE SUSTAINED UPON EXAMINATION. THE ORGANIZATION HAS REVIEWED ITS TAX POSITIONS FOR ALL OPEN YEARS AND BELIEVES THAT IT HAS APPROPRIATE SUPPORT FOR THE TAX POSITIONS TAKEN. THEREFORE, NO LIABILITY HAS BEEN RECORDED. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN VALUE OF SPLIT INTEREST AGREEMENTS 249,665. CHANGE IN BENEFICIAL INTEREST IN JHSLF 3,247,390. CHANGE IN OTHER INTEREST IN JHSLF 470,140. PART XI, LINE 4B - OTHER ADJUSTMENTS: COST OF GOODS SOLD -150,903. GAIN ON SALE OF ASSETS 18,000. PART XII, LINE 2D - OTHER ADJUSTMENTS: COST OF GOODS SOLD 150,903. GAIN ON SALE OF ASSETS -18,000. 1 1 X 1 X 1 X 1 0 1 1 25065 25065 0.00020 64459650 47626869 16832781 0.15960 64484715 47626869 16857846 0.15980 108997 108997 0.00100 108997 108997 0.00100 64593712 47626869 16966843 0.16080 1 954109 18572 13378942 13033595 345347 X 1 1 1 1 JEWISH HOME & REHAB CENTER 302 SILVER AVENUE SAN FRANCISCO CA 94112 WWW.SFCJL.ORG 106380842 X ACUTE PSYCHIATRIC HOSPITAL HEBREW HOME FOR AGED DISABLED 1 0 0 1 X X X X X X X X X 18 1 1 1 1 X HTTPS://SFCJL.ORG/ABOUT-COMMUNITY-BENEFIT.HTM X 1 19 1 HTTPS://SFCJL.ORG/ABOUT-COMMUNITY-BENEFIT.HTM 0 1 X 100.000000000000 350.000000000000 X X X X X 1 1 X X X 1 X HTTPS://SFCJL.ORG/ABOUT-CHARITABLE.HTM X HTTPS://SFCJL.ORG/ABOUT-CHARITABLE.HTM X HTTPS://SFCJL.ORG/ABOUT-CHARITABLE.HTM X X X X X 1 X 0 X X X 1 X 0 0 HEBREW HOME FOR AGED DISABLED PART V, SECTION B, LINE 5: THE CITY AND COUNTY OF SAN FRANCISCO'S CHNA IS CONDUCTED BY THE HEALTH DEPARTMENT AND OVERSEEN BY THE SAN FRANCISCO HEALTH IMPROVEMENT PARTNERSHIP (SFHIP), A MULTISECTOR COLLABORATION THAT INCLUDES SAN FRANCISCO'S HOSPITALS. THIS CHNA SERVES AS THE COMMON BASIS FOR ALL SAN FRANCISCO'S HOSPITAL CHNAS, INCLUDING OURS. WE HAVE SUPPLEMENTED THE SFHIP CHNA WITH OUR OWN ASSESSMENT OF NEEDS, DUE TO THE FACT THAT WE SERVE A HIGHLY SPECIALIZED POPULATION AND MANY OF OUR PATIENTS LIVE OUTSIDE OF SAN FRANCISCO.TO SUPPLEMENT THE SFHIP CHNA, SFCJL IMPLEMENTED THE FOLLOWING METHODS IN JUNE 2019:(I) REVIEW OF THE LITERATURE PERTAINING TO OLDER ADULTS WITH PSYCHIATRIC DISORDERS. SEVERAL PUBLISHED BOOK AND JOURNAL ARTICLES, AS WELL AS NEWS ARTICLES, SERVED AS SOURCES FOR IDENTIFYING POPULATION NEEDS.(II) KEY INFORMANT INTERVIEWS WITH EXPERTS. IT WAS NOT FEASIBLE FOR US TO GATHER DIRECT INPUT FROM PATIENTS DUE TO THE CHALLENGES INHERENT IN CONDUCTING INTERVIEWS OR FOCUS GROUPS WITH PATIENTS WITH ACUTE MENTAL HEALTH DISORDERS, INCLUDING PATIENT ABILITY TO PROVIDE INFORMED CONSENT AND BE SUFFICIENTLY STABLE, BOTH MEDICALLY AND PSYCHIATRICALLY, TO PARTICIPATE. IN LIEU OF PATIENT INPUT, WE CONDUCTED NINE KEY INFORMANT INTERVIEWS WITH PEOPLE WHO REPRESENT THE BROAD INTERESTS OF OUR POPULATION: FOUR GERIATRIC PSYCHIATRISTS; TWO GERIATRIC PSYCHIATRY HOSPITAL PROGRAM DIRECTORS/ADMINISTRATORS; ONE NURSE MANAGER; ONE RECREATION THERAPIST; AND ONE SOCIAL SERVICES DIRECTOR. SIX OF THE KEY INFORMANTS WERE EXPERTS FROM SFCJL, THREE WERE FROM OTHER INSTITUTIONS WITH REPUTABLE GERIATRIC PSYCHIATRY PROGRAMS, AND ONE WAS AN INDEPENDENT PSYCHIATRY CONSULTANT. COLLECTIVELY, THE INTERVIEW PARTICIPANTS HAVE EXTENSIVE EXPERIENCE AND A LONG HISTORY OF SERVING OLDER ADULTS WITH MENTAL HEALTH DISORDERS ACROSS THE SOCIOECONOMIC SPECTRUM, INCLUDING PEOPLE OF ALL GENDERS AND FROM ALL RACIAL/ETHNIC BACKGROUNDS. DATA FROM THESE INTERVIEWS WAS ANALYZED USING BASIC THEMATIC ANALYSIS TECHNIQUES. HEBREW HOME FOR AGED DISABLED PART V, SECTION B, LINE 6A: SFCJL CONDUCTED ITS MOST RECENT CHNA IN CONJUNCTION WITH SAN FRANCISCO HEALTH PLAN (SFHIP), A MULTISECTOR COLLABORATION THAT INCLUDES THE FOLLOWING SAN FRANCISCO HOSPITALS (OTHER THAN SAN FRANCISCO CAMPUS FOR JEWISH LIVING): CHINESE HOSPITAL; DIGNITY HEALTH--SAINT FRANCIS MEMORIAL HOSPITAL; DIGNITY HEALTH--ST. MARY'S MEDICAL CENTER; KAISER PERMANENTE; SUTTER HEALTH; AND UCSF HEALTH. HEBREW HOME FOR AGED DISABLED PART V, SECTION B, LINE 6B: OTHER NON-HOSPITAL FACILITIES WHO COLLABORATED WITH SFHIP IN DEVELOPING THE MOST RECENT CHNA INCLUDE THE SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH, THE CLINICAL AND TRANSLATIONAL SCIENCE INSTITUTE'S COMMUNITY ENGAGEMENT AND HEALTH POLICY PROGRAM AT UCSF, THE SAN FRANCISCO UNIFIED SCHOOL DISTRICT, THE OFFICE OF THE MAYOR, HUMAN SERVICES NETWORK, CHICANO/LATINO/INDIGENA HEALTH EQUITY COALITION, THE AFRICAN AMERICAN COMMUNITY HEALTH COUNCIL, THE COMMUNITY CLINIC CONSORTIUM, THE HOSPITAL COUNCIL OF NORTHERN CALIFORNIA, AND FAITH-BASED AND OTHER PHILANTHROPIC PARTNERS. HEBREW HOME FOR AGED DISABLED PART V, SECTION B, LINE 11: THE ORGANIZATION'S 2019 COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED THE FOLLOWING FIVE PRIORITY HEALTH NEEDS: (I) ACCESS TO COORDINATED, CULTURALLY AND LINGUISTICALLY APPROPRIATE CARE AND SERVICES; (II) FOOD SECURITY, HEALTHY EATING AND ACTIVE LIVING; (III) HOUSING SECURITY AND AN END TO HOMELESSNESS; (IV) SAFETY FROM VIOLENCE AND TRAUMA; (V) SOCIAL, EMOTIONAL, AND BEHAVIORAL HEALTH.TO ADDRESS THE HEALTH NEEDS OF "ACCESS TO COORDINATED, CULTURALLY AND LINGUISTICALLY APPROPRIATE CARE AND SERVICES", THE ORGANIZATION HAS IMPLEMENTED A GOAL TO SHARE KNOWLEDGE AND PROVIDE TRAINING IN SUPPORT OF INCREASING PSYCHIATRIC RESOURCES FOR OLDER ADULTS AND DISPEL THE SOCIETAL STIGMA ASSOCIATED WITH PSYCHIATRIC NEED. TO MEET THIS GOAL, THE ORGANIZATION PLANS ON: (I) TRAINING FOUR GERIATRIC PSYCHIATRY STUDENTS BY JUNE 30, 2022; (II) DEVELOP AND IMPLEMENT A NURSE INTERNSHIP PROGRAM AND TRAIN FOUR NURSES; (III) ENGAGE WITH FIVE COMMUNITY ORGANIZATIONS TO PROVIDE TEN COMMUNITY OUTREACH ACTIVITIES; AND (IV) BY JUNE 30, 2022, EXPAND CURRENT TRAINING OPTIONS FROM ONE SOCIAL WORKER AND ONE RECREATIONAL THERAPIST TO TWO SOCIAL WORKERS, TWO RECREATIONAL THERAPISTS, AND TWO OCCUPATIONAL THERAPISTS.IT SHOULD BE NOTED THAT NO ONE ORGANIZATION CAN ADDRESS ALL THE HEALTH NEEDS IDENTIFIED IN ITS COMMUNITY. JEWISH HOME & REHAB CENTER AT THE SAN FRANCISCO CAMPUS FOR JEWISH LIVING IS COMMITTED TO SERVING THE COMMUNITY BY ADHERING TO ITS MISSION, AND USING ITS SKILLS, EXPERTISE AND RESOURCES TO PROVIDE A RANGE OF COMMUNITY BENEFIT PROGRAMS TO ADDRESS ACCESS TO CARE AND SERVICES. DUE TO LIMITED RESOURCES AND/OR EXPERTISE, THIS IMPLEMENTATION STRATEGY DOES NOT INCLUDE SPECIFIC PLANS TO ADDRESS OTHER PRIORITIZED HEALTH NEEDS INCLUDING: FOOD SECURITY, HEALTHY EATING AND ACTIVE LIVING; HOUSING SECURITY AND AN END TO HOMELESSNESS; SAFETY FROM VIOLENCE AND TRAUMA; SOCIAL, EMOTIONAL AND BEHAVIORAL HEALTH. HEBREW HOME FOR AGED DISABLED PART V, SECTION B, LINE 13B: MEDICAID/MEDICARE, STATE REGULATION 1 1 - HEBREW HOME FOR AGED DISABLED 302 SILVER AVENUE SAN FRANCISCO CA 94112 SKILLED NURSING FACILITY AND REHABILITATION CENTER PART I, LINE 7: A COST TO CHARGE RATIO, AS DETERMINED BY WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS, WAS USED TO CALCULATE THE AMOUNTS REPORTED ON LINE 7A AND 7B. THE COSTING METHODOLOGY USED ON LINE 7H WAS CALCULATED BASED ON ACTUAL COSTS FROM THE ORGANIZATION'S GENERAL LEDGER.THE INFORMATION PRESENT ON SCHEDULE H, PART I, LINE 7 DOES ENCOMPASS MANY OTHER "NON-HOSPITAL" ACTIVITIES OF THE ORGANIZATION, SUCH AS ITS SKILLED-NURSING FACILITY. PART I, LN 7 COL(F): BAD DEBT EXPENSE IS REPORTED AS A NET ADJUSTMENT TO PATIENT CHARGES AND THEREFORE, IS NOT INCLUDED AS A PART OF TOTAL EXPENSES FROM FORM 990, PART IX, LINE 25, COLUMN A. PART III, LINE 2: UNCOLLECTED RESIDENT ACCOUNTS ARE ANALYZED BASED ON STANDARD PROCEDURES FOR ALL RESIDENT ACCOUNTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE ORGANIZATION ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY).FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE ORGANIZATION RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES, IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.FOR UNINSURED PATIENTS THAT DO NOT QUALIFY FOR CHARITY CARE, THE ORGANIZATION RECOGNIZES REVENUE ON THE BASIS OF ITS STANDARD RATES FOR SERVICES PROVIDED. BASED ON HISTORICAL EXPERIENCE, A SIGNIFICANT PORTION OF THE ORGANIZATION'S UNINSURED PATIENTS WILL BE UNABLE OR UNWILLING TO PAY FOR THE SERVICES PROVIDED. THUS, THE ORGANIZATION RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS RELATED TO UNINSURED PATIENTS IN THE PERIOD THE SERVICES ARE PROVIDED. PART III, LINE 3: COST-TO-CHARGE RATIO METHOD PART III, LINE 4: THE FOOTNOTE IN THE AUDITED FINANCIAL STATEMENTS THAT ADDRESSES "PATIENT ACCOUNTS RECEIVABLE, NET", WHICH INCLUDES A DISCUSSION OF "ALLOWANCE FOR DOUBTFUL ACCOUNTS" CAN BE FOUND ON PAGE 11 OF THE AUDITED FINANCIAL STATEMENTS; IN ADDITION, NOTE 14 - NET PATIENT SERVICE REVENUE" ON PAGES 27-28 ADDRESSES BAD DEBT EXPENSE. PART III, LINE 8: MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST-TO-CHARGE RATIO. THE AMOUNTS REPORTED IN LINES 5, 6, AND 7 COME FROM THE ORGANIZATION'S FILED MEDICARE COST REPORT. THE TOTAL REVENUE EQUATES TO MEDICARE PAYMENTS, AND THE MEDICARE ALLOWABLE COSTS ARE DETERMINED ON THE MEDICARE COST REPORT THAT UTILIZED COST TO CHARGE RATIOS APPLIED TO COVERED MEDICARE REVENUES. PART III, LINE 9B: PATIENTS WHO ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE MAY REQUEST AND NEGOTIATE THE TERMS OF AN EXTENDED PAYMENT PLAN. IF THE PATIENT AND SFCJL AGREE ON A PAYMENT PLAN, THE PATIENT MUST MAKE REGULAR, TIMELY PAYMENTS. A PATIENT WHO DOES NOT COMPLY WILL BE SENT TO COLLECTIONS, MAY HAVE ADVERSE INFORMATION REPORTED TO A CREDIT AGENCY, AND MAY BE SUBJECT TO A PROPERTY LIEN, EXCLUDING THE PATIENT'S PRIMARY RESIDENCE. HOWEVER, ASSET INFORMATION OBTAINED IN THE CHARITY CARE ELIGIBILITY DETERMINATION PROCESS ARE NOT USED FOR COLLECTION ACTIVITIES. PART VI, LINE 2: THE SFHIP CHNA REPORT DESCRIBES THE PROCESS USED TO PRIORITIZE HEALTH NEEDS. IN SUMMARY: IN OCTOBER 2018, THE SFHIP STEERING COMMITTEE PARTICIPATED IN A STRUCTURED, FACILITATED PROCESS TO IDENTIFY AND PRIORITIZE THE NEEDS BASED ON A REVIEW OF THE CHNA DATA. PRIOR TO THE MEETING, SFHIP IDENTIFIED THE FOLLOWING TWO CRITERIA TO SCREEN AND PRIORITIZE THE HEALTH NEEDS: (I) THE HEALTH NEED IS CONFIRMED BY MORE THAN ONE INDICATOR AND/OR DATA SOURCE, AND (II) THE HEALTH NEED PERFORMS POORLY AGAINST A DEFINED BENCHMARK. THE MEETING WAS FACILITATED USING THE TECHNOLOGY OF PARTICIPATION, A METHOD CREATED BY THE INSTITUTE FOR CULTURAL AFFAIRS THAT INCORPORATES "AN INTEGRATED SET OF FACILITATION METHODS, TOOLS AND APPROACHES THAT FOSTER AUTHENTIC PARTICIPATION AND MEANINGFUL COLLABORATION." THE PROCESS BEGAN WITH SMALL GROUP DISCUSSIONS OF THE DATA, FOLLOWED BY RE-CONVENING AS A LARGE GROUP TO LIST ALL THE NEEDS IDENTIFIED IN THE SMALL GROUPS, CLUSTER SIMILAR NEEDS TOGETHER, AND NAME EACH CLUSTER. THE RESULT WAS CONSENSUS AROUND FIVE PRIORITY HEALTH NEEDS: 1) ACCESS TO COORDINATED, CULTURALLY AND LINGUISTICALLY APPROPRIATE CARE AND SERVICES; 2) FOOD SECURITY, HEALTHY EATING, AND ACTIVE LIVING; 3) HOUSING SECURITY AND AN END TO HOMELESSNESS; 4) SAFETY FROM VIOLENCE AND TRAUMA; AND 5) SOCIAL, EMOTIONAL, AND BEHAVIORAL HEALTH. A WORKING GROUP OF SFCJL STAFF, INCLUDING AGPH CLINICAL AND ADMINISTRATIVE STAFF, WAS CONVENED IN JUNE 2019 TO CONDUCT OUR SUPPLEMENTAL NEEDS ASSESSMENT, WHICH FOCUSED ON IDENTIFYING THE SPECIFIC NEEDS OF OUR POPULATION WITHIN EACH OF THESE FIVE PRIORITY HEALTH NEEDS. PART VI, LINE 3: A RESIDENT SERVICES COORDINATOR STAFF MEMBER IS AVAILABLE TO ASSIST RESIDENTS AND/OR THEIR FAMILY MEMBERS OR LEGAL REPRESENTATIVES THROUGH THE PROCESS OF DETERMINING THEIR ELIGIBILITY FOR ALL GOVERNMENT PROGRAMS AND ASSIST THEM IN THE APPLICATION PROCESS.WRITTEN NOTICE OF THE ORGANIZATION'S CHARITY CARE AND DISCOUNT PAYMENT POLICY FOR FINANCIALLY QUALIFIED PATIENTS IS CLEARLY AND CONSPICUOUSLY POSTED AND VISIBLE TO THE PUBLIC IN THE ADMISSIONS OFFICE AND THE BILLING DEPARTMENT. THE NOTICE INCLUDES INFORMATION ABOUT ELIGIBILITY, AND CONTACT INFORMATION FOR THE ORGANIZATION'S PATIENT FINANCIAL SERVICES STAFF, FROM WHOM PATIENTS AND OTHER INTERESTED PERSONS CAN OBTAIN FURTHER INFORMATION ABOUT THIS POLICY.LASTLY, ALL PRIVATE INVOICES THAT ARE MAILED MONTHLY TO PATIENTS INCLUDE THE FOLLOWING STATEMENT: "IF YOU ARE NOT ABLE TO PAY THE BALANCE IN FULL, PLEASE CONTACT THE PATIENT FINANCIAL SERVICES OFFICE FOR PAYMENT OPTIONS."WRITTEN NOTICE, INCLUDING THE ABOVE INFORMATION, IS GIVEN TO EACH PATIENT AS A PART OF THEIR ADMISSION PACKET. PART VI, LINE 4: IN ADDITION TO SERVING AS A SKILLED NURSING FACILITY, THE ORGANIZATION IS ALSO A LICENSED 13-BED GERO-PSYCHIATRIC INPATIENT UNIT DEVOTED TO PROVIDING BEHAVIORAL HEALTH SERVICES EXCLUSIVELY DESIGNED FOR OLDER ADULTS SUFFERING FROM ACUTE PSYCHIATRIC DISORDERS. ACCORDING TO A RECENTLY PUBLISHED ARTICLE IN US NEWS AND WORLD REPORT, "ONE IN FOUR ADULTS AGES 65 AND OLDER EXPERIENCES A MENTAL HEALTH PROBLEM SUCH AS DEPRESSION, ANXIETY, SCHIZOPHRENIA OR DEMENTIA, ACCORDING TO THE AMERICAN PSYCHOLOGICAL ASSOCIATION. AND PEOPLE 85 AND OLDER HAVE THE HIGHEST SUICIDE RATE OF ANY AGE GROUP ACCORDING TO THE NATIONAL COUNCIL ON AGING." IT IS ESTIMATED THAT 5.6 - 8.0 MILLION U.S ADULTS OVER AGE 65 EXPERIENCED A MENTAL HEALTH DISORDER (INCLUDING SUBSTANCE USE DISORDERS) IN 2010, AND THIS NUMBER IS EXPECTED TO GROW BY 80% BY 2030. A 2015 STUDY USING A NATIONALLY REPRESENTATIVE SAMPLE OF ADULTS AGES 55 AND OLDER FOUND THAT IN THE PRIOR YEAR, 6.77% EXPERIENCED A MOOD DISORDER, 11.39% AN ANXIETY DISORDER, AND 3.75% A SUBSTANCE USE DISORDER. IN ADDITION,14.53% EXPERIENCED A PERSONALITY DISORDER IN THEIR LIFETIME. INSUFFICIENT DATA EXISTS TO DEVELOP A SCIENTIFICALLY SOUND ESTIMATE OF THE SIZE OF OUR TARGET COMMUNITY IN CALIFORNIA. BASED ON NATIONAL DATA, HOWEVER, IT IS SAFE TO SAY THAT THERE ARE AT LEAST 1 MILLION OLDER ADULTS IN OUR STATE WITH MENTAL HEALTH DISORDERS, ALTHOUGH ONLY A SMALL SUBSET OF THOSE WILL EXPERIENCE SYMPTOMS ACUTE ENOUGH TO REQUIRE HOSPITALIZATION.OUR PROGRAM PROVIDES TREATMENT AND FACILITATES RECOVERY FOR ADULTS AGED 55 AND OLDER RESIDING IN CALIFORNIA WITH ACUTE PSYCHIATRIC NEEDS, INCLUDING ANXIETY, DEPRESSION, MOOD OR BEHAVIORAL DISTURBANCES, IMPAIRMENT IN LEVEL OF FUNCTIONING, THOUGHT OR OTHER EMOTIONAL DISTURBANCES, SUICIDALITY, ASSAULTIVE BEHAVIORS DUE TO A PSYCHIATRIC DISORDER, OR WHO ARE A THREAT TO OTHERS. IN 2018, 83% OF OUR PATIENTS WERE ADMITTED AS 5150 OR 5250 (DANGER TO SELF OR OTHERS, OR GRAVE DISABILITY), 15% WERE VOLUNTARY ADMISSIONS, AND 2% WERE UNDER CONSERVATORSHIP. OUR GOAL IS TO STABILIZE PATIENTS AND PROVIDE THEM WITH THE TOOLS AND RESOURCES TO BE ABLE TO RETURN TO COMMUNITY-BASED LIVING.AS WE ARE ONE OF THE ONLY FACILITIES OF ITS KIND IN THE REGION, OUR PATIENTS COME FROM ALL OVER NORTHERN AND CENTRAL CALIFORNIA. IN 2018, WE ADMITTED 170 PATIENTS FROM 18 COUNTIES. WE ACCEPT ELIGIBLE PATIENTS OF ALL RACIAL/ETHNIC IDENTITIES AND GENDERS. THE MOST COMMON PSYCHIATRIC DIAGNOSES OF OUR PATIENTS ARE MAJOR DEPRESSIVE DISORDER (63% IN 2018), ANXIETY (25%), AND BIPOLAR DISORDER (20%). OTHER DISORDERS INCLUDE SCHIZOPHRENIA, SCHIZOAFFECTIVE DISORDER, PSYCHOSIS, SUICIDAL IDEATION, SUICIDE ATTEMPT, PANIC DISORDER, POSTTRAUMATIC STRESS DISORDER (PTSD), AND OBSESSIVE COMPULSIVE DISORDER (OCD). IN ADDITION TO HAVING PSYCHIATRIC NEEDS, OUR PATIENTS ARE ALSO COPING WITH THE TRADITIONAL DISEASES OF AGING, INCLUDING HYPERTENSION (44% IN 2018), CARDIOVASCULAR DISEASE (27%), DEMENTIA AND RELATED ILLNESS (25%), TYPE 2 DIABETES (19%), ATHEROSCLEROSIS (16%), COPD (14%), AND OSTEOARTHRITIS (8%). PART VI, LINE 5: A COMMITMENT TO EXCELLENCE IN SERVICE TO OTHERS AND PROVIDING EXCEPTIONAL CARE TO FRAIL VULNERABLE SENIORS, INCLUDING CHARITABLE SUPPORT, IS SFCJL'S FOUNDING FOCUS AND REMAINS KEY TO ITS MISSION--TO ENHANCE AND ENRICH OLDER ADULTS' QUALITY OF LIFE. AS SUCH, SFCJL DEDICATES SUBSTANTIAL RESOURCES TO SERVICES, TRAINING, RESEARCH, AND OTHER ACTIVITIES THAT BENEFIT THE LARGER COMMUNITY OF OLDER ADULTS IN THE BAY AREA. MANY OF THESE RESOURCES HELP TO ADDRESS SOME OF THE NEEDS IDENTIFIED IN ITS MOST RECENTLY COMPLETED CHNA. WE BROADENED THE CONTINUUM OF LIVING OPTIONS, OFFERING INDEPENDENT LIVING, ASSISTED LIVING, AND MEMORY CARE AND SUPPORT FOR THE SURGING POPULATION OF SENIORS, AS WELL AS DEVELOPING SENIOR-ORIENTED SERVICES THAT WILL ADDRESS THIS COHORT'S CHANGING AND UNMET NEEDS. THIS EXPANSION IS DESIGNED TO BENEFIT THE ENTIRE BAY AREA COMMUNITY. OUR EXTENSIVE AND CLOSE PARTNERSHIPS WITH NUMEROUS ORGANIZATIONS HAVE ALLOWED US TO HELP SHAPE AND EXPAND THE RESOURCES AND SERVICE NETWORKS THAT ARE SO CRITICAL FOR THE HEALTH AND WELL-BEING OF SENIORS. IN ADDITION, SINCE 2012, SFCJL HAS SERVED AS A TRAINING SITE FOR FUTURE GERIATRIC PSYCHIATRISTS AND PROVIDES CLINICAL TRAINING AND INTERNSHIP OPPORTUNITIES TO MITIGATE THE CURRENT AND FUTURE PROVIDER SHORTAGES.THE ORGANIZATION IS FORTUNATE TO BE CO-LOCATED WITH NUMEROUS CLINICAL AND SUPPORT SERVICES ON OUR NINE ACRE CAMPUS. PATIENTS HAVE ACCESS TO PAIN MANAGEMENT SERVICES, CARE PLANNING, DENTAL CARE, PHARMACY, AUDIOLOGY, PHYSICAL REHABILITATION, OCCUPATIONAL THERAPY, NUTRITION COUNSELING (ALL SFCJL PATIENTS SEE A DIETICIAN WITHIN 72 HOURS OF ADMISSION), AND A HOST OF SOCIAL, SPIRITUAL, AND ENRICHMENT OPPORTUNITIES. ALL THESE SERVICES HELP TO SOCIALIZE PATIENTS AND REDUCE THEIR SENSE OF ISOLATION. WE ALSO OFFER INDIVIDUALIZED PATIENT EDUCATION AND SKILLS-BASED GROUPS TO STRENGTHEN PATIENTS' COPING SKILLS IN PREPARATION FOR SUCCESSFUL POST-DISCHARGE COMMUNITY LIVING. PART VI, LINE 7, REPORTS FILED WITH STATES CA 1 UNIVERSITY OF CALIFORNIA SAN FRANCISCO FOUNDATION 2001 THE EMBARCADERO 3RD FLOOR SAN FRANCISCO CA 94133 942829914 501(C)(3) 200000 GERIATRIC FELLOWSHIP PROGRAM 1 0 PART I, LINE 2: THE ORGANIZATION REQUIRES GRANTEES TO PROVIDE PERIODIC REPORTS INCLUDING BUDGETS, FINANCIAL REPORTS, AND AUDITED FINANCIAL STATEMENTS TO MONITOR THE USE OF THE FUNDS FOR THE INTENDED PURPOSE. FOR RESTRICTED GRANTS, THE ORGANIZATION ENSURES THAT THE PERFORMANCE OF THE RESTRICTION IS MET. ADDITIONALLY, PROPER USE OF GRANT FUNDS IS MONITORED VIA WITNESSING THE WORK THE OF THE PROGRAM FOR WHICH THE ORGANIZATION HELPED FUND. 0 1 0 0 0 0 0 0 0 DANIEL RUTH PRESIDENT AND CEO 0 775564 0 0 0 135721 0 108550 0 25528 0 1045363 0 87268 VICTOR MEINKE FORMER CFO 0 111702 0 0 0 368303 0 52138 0 3961 0 536104 0 284783 MICHAEL SKAFF CHIEF OPERATING OFFICER 0 368441 0 50 0 17332 0 8550 0 2110 0 396483 0 0 SHERIE KOSHOVER CHIEF ADVANCEMENT OFFICER 0 218435 0 50 0 81845 0 36886 0 915 0 338131 0 63400 MARY CONNICK CFO & TREASURER 0 277141 0 50 0 0 0 5625 0 653 0 283469 0 0 STEPHEN T HALL ACUTE PSYCHIATRIC UNIT MEDICAL DIR 219699 0 50 0 0 0 0 0 28139 0 247888 0 0 0 PEGGY CMIEL DIRECTOR OF NURSING & CLINICAL OPS 204373 0 50 0 0 0 6179 0 20492 0 231094 0 0 0 MARK FRIEDLANDER ED, NURSING HOME ADMIN THRU 3/2021 189015 0 50 0 9195 0 6014 0 10111 0 214385 0 0 0 MARILYN MINERALES LICENSED VOCATIONAL NURSE 176811 0 2300 0 0 0 0 0 33190 0 212301 0 0 0 MARIO LEMAY DIRECTOR OF ORG EFFECTIVENESS 179532 0 50 0 0 0 5449 0 9589 0 194620 0 0 0 MATTHEW POWONDRA RCFE ADMINISTRATOR 155898 0 50 0 0 0 1200 0 28139 0 185287 0 0 0 JAN REICHER DIR, DEPT OF SPIRITUAL & JEWISH LIFE 176574 0 50 0 75 0 5314 0 367 0 182380 0 0 0 MARILOU ESPANOL REGISTERED PSYCH NURSE 159874 0 50 0 450 0 4815 0 9566 0 174755 0 0 0 ROBERT H SARISON DIRECTOR OF CAMPUS PROGRAMS 166726 0 50 0 0 0 4979 0 367 0 172122 0 0 0 PART I, LINE 3 THE ORGANIZATION RELIED ON A RELATED ORGANIZATION TO ESTABLISH THE COMPENSATION AND BENEFITS OF THE TOP MANAGEMENT OFFICIAL, WHICH UTILIZED THE FOLLOWING METHODS: INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINE 4B DURING THE 2020 CALENDAR YEAR, A RELATED ORGANIZATION CONTRIBUTED THE FOLLOWING AMOUNTS TO THE FOLLOWING INDIVIDUALS' SUPPLEMENTAL 457(F) RETIREMENT PLAN, WHICH HAS BEEN REPORTED AS "DEFERRED COMPENSATION" ON SCHEDULE J, PART II, COLUMN (C): DANIEL RUTH - $100,000 VICTOR MEINKE - $50,000 SHERIE KOSHOVER - $30,029 ADDITIONALLY, DUE TO VESTING OF THE 457(F) RETIREMENT PLAN, THE FOLLOWING INDIVIDUALS RECOGNIZED THE FOLLOWING AMOUNTS AS TAXABLE COMPENSATION, WHICH HAS BEEN REPORTED WITHIN "OTHER REPORTABLE COMPENSATION" IN SCHEDULE J, PART II, COLUMN (B)(III) AND SCHEDULE J, PART II, COLUMN (F): DANIEL RUTH - $87,268 VICTOR MEINKE - $284,783 SHERIE KOSHOVER - $63,400 A CALIFORNIA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY 680164610 13080SPQ1 2016-11-29 142815660 CONSTRUCTION OF TWO NEW RESIDENTIAL CARE FACILITY BUILDINGS 0 0 0 A 33415000 142815660 3157814 1960461 7211174 12549544 117150631 786036 2020 0 0 1 1 A 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 1 0 0 0 1 A 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: CALIFORNIA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 12/06/2019 DANIEL RUTH PRESIDENT & CEO COMPENSATION PACKAGE X 800000 800000 0 1 1 800000 KYLE RUTH-ISLAS SON OF PRES. & CEO 68796 COMPENSATION 0 FORM 990, PART III, LINE 4A: THE ORGANIZATION PROVIDES LONG-TERM CARE, SHORT-TERM REHABILITATION, AND ACUTE PSYCH CARE SERVICES. IT PROVIDES PROFESSIONAL AND COMPREHENSIVE PROGRAMS THAT INCLUDES PERSONAL HEALTH CARE TO RESIDENTS IN ITS 374 BED FACILITY. IN THE CURRENT FISCAL YEAR, THE ORGANIZATION SERVED AN AVERAGE OF 315 RESIDENTS A DAY. THERE WERE 59 NEW ADMISSIONS FOR LONG-TERM CARE, 908 SHORT-TERM CARE PATIENTS, AND 209 PATIENTS THAT REQUIRED ACUTE PSYCH HOSPITALIZATION. THE ORGANIZATION ALSO PROVIDES ASSISTED LIVING AND MEMORY CARE IN A NEWLY CONSTRUCTED FACILITY WITH 190 UNITS. THIS FACILITY OPENED DURING THE CURRENT FISCAL YEAR AND SERVED AN AVERAGE OF 57 RESIDENTS DURING THE YEAR. THE ORGANIZATION AND ITS PROGRAMS ARE HOUSED IN 5 BUILDINGS ON A 9-ACRE CAMPUS. FORM 990, PART VI, SECTION B, LINE 11B A COMPLETE COPY OF THE FORM 990 IS PROVIDED TO ALL MEMBERS OF THE BOARD OF TRUSTEES PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. MANAGEMENT OF THE ORGANIZATION ALSO REVIEWS THE COMPLETED FORM 990 AND FOLLOWS UP WITH THE TAX RETURN PREPARATION FIRM TO ANSWER ANY QUESTIONS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REGULARLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. EACH PERSON WHO IS DEEMED TO HAVE SUBSTANTIAL INFLUENCE OVER THE ORGANIZATION (INCLUDING TRUSTEES, OFFICERS, AND KEY EMPLOYEES) SIGNS AN ANNUAL DISCLOSURE STATEMENT WHICH AFFIRMS THAT THE PERSON HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY, HAS READ AND UNDERSTOOD THE POLICY, AND HAS AGREED TO COMPLY WITH THE POLICY, AND DISCLOSES ANY DIRECT OR INDIRECT AFFILIATIONS. ALL ANNUAL DISCLOSURE STATEMENTS ARE SUBMITTED TO THE SECRETARY. EACH EMPLOYEE DISCLOSES TO THE CHIEF EXECUTIVE OFFICER ALL MATERIAL FACTS REGARDING THE AFFILIATION OF SUCH EMPLOYEE WITH ANY PERSON WITH WHOM THE ORGANIZATION IS CONSIDERING ENTERING A TRANSACTION; THE CHIEF EXECUTIVE OFFICER THEN DETERMINES WHETHER A CONFLICT OF INTEREST EXISTS FOR THESE EMPLOYEES. THE CHIEF EXECUTIVE OFFICER AND ANY OTHER PERSON WITH SUBSTANTIAL INFLUENCE OVER THE ORGANIZATION SHALL DISCLOSE TO THE BOARD ALL MATERIAL FACTS REGARDING HIS OR HER AFFILIATION WITH ANY PERSON WITH WHOM THE JEWISH HOME IS CONSIDERING ENTERING A TRANSACTION; THE BOARD THEN DETERMINES IF A CONFLICT OF INTEREST EXISTS FOR THE CHIEF EXECUTIVE OFFICER OR PERSON WITH SUBSTANTIAL INFLUENCE OVER THE ORGANIZATION. IF A BOARD MEMBER IS THE INDIVIDUAL WITH WHICH A CONFLICT OF INTEREST IS BEING DETERMINED, THE BOARD MEMBER IS NOT ALLOWED TO VOTE ON THE MATTER. FORM 990, PART VI, SECTION B, LINE 15B THE CHIEF EXECUTIVE OFFICER IS COMPENSATED BY JEWISH SENIOR LIVING GROUP, A RELATED ORGANIZATION. AS SUCH, PART VI, SECTION B, LINE 15A HAS BEEN MARKED "NO", AS MANDATED BY THE FORM 990 INSTRUCTIONS. PLEASE REFERENCE THE DISCLOSURE IN SCHEDULE J, PART III INCLUDED IN THIS FORM 990 OR PART VI, SECTION B, LINE 15A IN JEWISH SENIOR LIVING GROUP'S FORM 990 FOR A DISCUSSION ON HOW JEWISH SENIOR LIVING GROUP DETERMINES COMPENSATION FOR THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER. THE CHIEF EXECUTIVE OFFICER REVIEWS AND APPROVES THE ANNUAL COMPENSATION FOR THE OTHER EXECUTIVE TEAM MEMBERS BASED ON VARIOUS FACTORS, INCLUDING DATA COLLECTED FROM AN INDEPENDENT COMPENSATION CONSULTANT (DEPENDING ON POSITION) WHO UTILIZES COMPENSATION DATA OBTAINED FROM SURVEYS, ANNUAL COMPENSATION SURVEYS, PERFORMANCE APPRAISALS, AND OTHER NON-PROFIT RESOURCES FOR SIMILAR ORGANIZATIONS. THE BOARD OF TRUSTEES APPROVES THE ANNUAL BUDGET THAT INCLUDES COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST. FORM 990, PART VII, SECTION A, COLUMN (B): AVERAGE HOURS PER WEEK REPORTED IN FORM 990, PART VII, SECTION A, COLUMN (B) FOR DANIEL RUTH, MICHAEL SKAFF, SHERIE KOSHOVER, AND MARY CONNICK APPEAR LOW AS THESE INDIVIDUALS DEVOTE A PORTION OF THEIR WORKING TIME TO AFFILIATED ORGANIZATIONS WHICH DO NOT MEET THE DEFINITION OF A RELATED ORGANIZATION, PER THE FORM 990 INSTRUCTIONS. FORM 990, PART IX, LINE 11G OTHER CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 9,567,885. MANAGEMENT AND GENERAL EXPENSES 8,247,542. FUNDRAISING EXPENSES 15,593. TOTAL EXPENSES 17,831,020. OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 305,225. MANAGEMENT AND GENERAL EXPENSES 226,150. FUNDRAISING EXPENSES 457. TOTAL EXPENSES 531,832. FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF SPLIT INTEREST AGREEMENTS 249,665. CHANGE IN BENEFICIAL INTEREST IN JHSLF 3,247,390. CHANGE IN OTHER INTEREST IN JHSLF 470,140. JEWISH SENIOR LIVING GROUP 302 SILVER AVENUE SAN FRANCISCO CA 94112 800291740 SEE PART VII CA 501(C)(3) LINE 12A, I N/A 0 BAY AREA JEWISH SENIOR LIFE 302 SILVER AVENUE SAN FRANCISCO CA 94112 455092344 SEE PART VII CA 501(C)(3) LINE 12A, I JEWISH SENIOR LIVING GROUP 0 CHARITABLE REMAINDER TRUSTS (3) CHARITABLE GIVING CA SFCJL 1 0 0 0 1 1 0 0 0 0 1 0 0 1 1 1 0 1 0 0 PART II, COLUMN (B) JEWISH SENIOR LIVING GROUP PRIMARY ACTIVITY: TO PROMOTE THE PROVISION OF JEWISH LIVING SERVICES, FACILITIES AND AGING SERVICES IN NORTHERN CALIFORNIA BY PROVIDING SERVICES DESIGNED TO ASSIST THE SUPPORTED CHARITIES IN THEIR OWN OPERATIONS AND ASSIST WITH DEVELOPING NEW SERVICES AND FACILITIES IN THE AFFILIATED NETWORK. PART II, COLUMN (B) BAY AREA JEWISH SENIOR LIFE PRIMARY ACTIVITY: TO ASSIST THE SUPPORTED CHARITIES IN THEIR OWN OPERATIONS AND ASSIST WITH DEVELOPING NEW SERVICES AND FACILITIES IN THE AFFILIATED NETWORK.