2022-11-14T15:51:55-06:00 2021-12-31 450250958 EIDE BAILLY LLP 10681 FOOTHILL BLVD STE 300 RANCHO CUCAMONGA CA 917303831 990 2021-01-01 951652915 MONTE VISTA GROVE HOMES MONT 6267966135 2889 SAN PASQUAL STREET PASADENA CA 91107 DEBORAH A HERBERT CHIEF EXECUTIVE OFFICER 6267966135 2022-11-14 1 DEBORAH HERBERT 999009999 CATHERINE L GRAY CPA P01294460 9094664410 2022-11-09 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z DEBORAH A HERBERT 2889 SAN PASQUAL STREET PASADENA CA 91107 17483709 0 X WWW.MVGH.ORG X 1924 CA SENIOR COMMUNITY COMMITTEED TO BEST PRACTICES IN OUR CARE OF PEOPLE, FINANCES, TIME & ENVIRONMENT 19 18 120 30 0 0 1391247 4847702 7394673 6343196 495650 1322520 134630 205300 9416200 12718718 0 0 0 0 6677431 6350530 7250 0 169117 4177115 3964215 10861796 10314745 -1445596 2403973 29443161 29166964 6905738 3588162 22537423 25578802 X MONTE VISTA GROVE HOMES (MVGH) IS A HOLISTIC AND VIBRANT SENIOR COMMUNITY FILLED WITH CREATIVITY, LOVE AND COMPASSION. THE HISTORIC MISSION HAS BEEN TO BE A CHRIST-CENTERED COMMUNITY THAT MEETS THE NEEDS OF QUALIFIED RETIRED CHURCH WORKERS OF THE PRESBYTERIAN CHURCH (USA). CONSISTENT WITH CHANGING VOCATIONAL PATTERNS, MVGH NOW WELCOMES RESIDENTS FROM FIVE DENOMINATIONS WITH WHICH THE PRESBYTERIAN CHURCH (USA) IS IN FULL COMMUNION. IN ADDITION TO INDEPENDENT LIVING FOR THESE QUALIFIED CHURCH WORKERS, MVGH OFFERS FURTHER LEVELS OF CARE, REGARDLESS OF RELIGIOUS AFFILIATION. MVGH'S ASSISTED LIVING, MEMORY CARE, AND SKILLED NURSING ARE OPEN TO THE WIDER COMMUNITY. 0 1 4197843 2974023 OPERATION OF A 40 BED MEDICARE CERTIFIED SKILLED NURSING FACILITY THROUGH DECEMBER 29,2021. PROVIDE DIETARY ASSISTANCE, AND OTHER PROGRAM SERVICES. 2245841 1732001 PROVIDE UNLICENSED INDEPENDENT HOUSING IN 75 APARTMENTS ON CAMPUS. PROVIDE DIETARY ASSISTANCE, AND OTHER PROGRAM SERVICES. 1374307 980220 OPERATION OF 10 ROOM RESIDENTIAL CARE FACILITY FOR MEMORY CARE, PROVIDE DIETARY ASSISTANCE, AND OTHER PROGRAM SERVICES. 1050896 849418 OPERATION OF 16-APARTMENT RESIDENTIAL CARE FACILITY. PROVIDE DIETARY ASSISTANCE, AND OTHER PROGRAM SERVICES. 1050896 849418 8868887 1 1 0 0 0 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 1 61 0 1 120 1 0 0 0 0 0 0 0 0 0 0 0 0 X 19 18 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 CA X MONTE VISTA GROVE HOMES - KIM HOUSER CFO 6267966135 2889 SAN PASQUAL STREET PASADENA CA 91107 SANDRA MADER PRESIDENT 2.00 X X 0 0 0 JANET LOUIE VICE PRESIDENT 2.00 X X 0 0 0 AL BOEGH TREASURER 2.00 X X 0 0 0 REX MCDANIEL SECRETARY 2.00 X X 0 0 0 MYRON OAKES ASSISTANT TREASURER 2.00 X X 0 0 0 ARNOLFO BONG BRINGAS TRUSTEE 2.00 X 0 0 0 REV DR LYNN CHEYNEY TRUSTEE 2.00 X 0 0 0 HILARY DORSEY TRUSTEE 2.00 X 0 0 0 REV DR TOM EGGEBEEN TRUSTEE 2.00 X 0 0 0 REV MARK HONG TRUSTEE 2.00 X 0 0 0 REV DR MARILYN MANNING TRUSTEE 2.00 X 0 0 0 KEN RILEY TRUSTEE 2.00 X 0 0 0 ALICIA ROMO TRUSTEE 2.00 X 0 0 0 REV DON SMITH TRUSTEE 2.00 X 0 0 0 REV DR NORMAN THOMAS TRUSTEE 2.00 X 0 0 0 KATHLEEN TINGUS TRUSTEE 2.00 X 0 0 0 KAREN WALTER TRUSTEE 2.00 X 0 0 0 REV DR DAVID TOMLINSON PRESIDENT OF RESIDENT'S AS 2.00 X 0 0 0 DEBORAH HERBERT CHIEF EXECUTIVE OFFICER 40.00 X 170536 0 19132 KIM HOUSER CHIEF FINANCIAL OFFICER 40.00 X 159970 0 17330 EDEN CONORA DIRECTOR OF NURSING 40.00 X 142106 0 19025 472612 0 55487 3 0 1 0 SODEXO INC & AFFILIATES PO BOX 360170 PITTSBURG PA 152516170 FOOD SERVICE OPERATIONS: SERVICES, LABO 443135 JDE CONSTRUCTION INC 2850 WALNUT AVENUE SIGNAL HILL CA 90755 CONTRACTOR - INDEPENDENT LIVING REMODELS 406404 UNIDINE CORPORATION PO BOX 102289 ATLANTA GA 303682289 CONTRACTOR - INDEPENDENT LIVING REMODELS 361938 MAZUR CONSTRUCTION CO 1608 FAIR PARK AVENUE LOS ANGELES CA 90041 CONTRACTOR - INDEPENDENT LIVING REMODELS 207694 4 90761 982809 3774132 85367 4847702 SKILLED NURSING-HEALTH 623000 2413812 2413812 INDEPENDENT LIVING 623000 1221467 1221467 DIETARY REVENUES 623000 1061839 1061839 MEMORY CARE 623000 753509 753509 ASSISTED LIVING 623000 544313 544313 348256 348256 6343196 386256 386256 5668143 4723464 8415 944679 -8415 936264 936264 45946 90761 33112 12834 12834 COVID CREDITS 900099 192466 192466 192466 12718718 6535662 0 1335354 398217 167274 210033 20910 4772855 4345069 322219 105567 113311 86848 23767 2696 700327 632781 67157 389 365820 304129 55891 5800 46222 46222 68064 68064 70701 70701 926329 799642 122478 4209 5450 5450 69225 31286 29716 8223 323572 305421 17895 256 8428 5165 3036 227 14874 6807 7485 582 70337 70337 1045971 1023835 22088 48 234556 195962 38594 DIETARY FOOD SUPPLY 385938 376675 7333 1930 SUPPLIES AND EQUIPMENT 339940 303668 35166 1106 LICENSE AND PERMITS 172296 146133 15808 10355 SUNDRY 106615 62495 37301 6819 75697 75697 10314745 8868887 1276741 169117 759106 137887 92538 120309 132252 32912 889459 735216 2048000 2021049 57610 14292 248596 350237 33766690 23750724 10006498 10015966 13648452 13687990 1040411 1467520 520239 583586 29443161 29166964 796863 612227 1701577 1951087 3518736 0 888562 1024848 6905738 3588162 X 20020339 22911805 2517084 2666997 22537423 25578802 29443161 29166964 X 2403973 614676 22730 X 0 1 X 1 0 X 1993744 1137570 1387517 1391247 2350398 8260476 6202917 6891333 7301198 7394673 6343196 34133317 8196661 8028903 8688715 8785920 8693594 42393793 56820 45474 46966 76844 77540 303644 70466 16032 8690 243662 185947 524797 127286 61506 55656 320506 263487 828441 41565352 1594232 367908 442324 397791 386256 3188511 1594232 367908 442324 397791 386256 3188511 7836 7079 12834 27749 127551 192466 320017 9790893 8396811 9138875 9318341 9285150 45930070 0.90500 0.06940 X SCHEDULE A, PART VI, LIST OF UNUSUAL GRANTS: DESCRIPTION: BEQUEST DATE: 12/31/21 AMOUNT: 2497304. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3056917 35684 118046 71649 15984 3123014 3027420 22601 159715 137270 15549 3056917 2813137 11351 353661 135173 15556 3027420 3078718 11812 -133265 -129068 -15060 2813137 2810104 190203 154963 -58120 -18432 3078718 0.32010 0.67990 0.00000 0 0 97108 97108 29140763 20698143 8442620 3845182 3052581 792601 683637 683637 10015966 MONEY MARKET ACCOUNTS 1467520 F 1467520 LIABILITY FOR REFUNDABLE AND REPAYABLE ENTRANCE FEES 761112 DEPOSITS AND OTHER LIABILITIES 263736 1024848 X 13359055 614676 63250 677926 12681129 70701 -33112 37589 12718718 10317676 73632 73632 10244044 70701 70701 10314745 PART V, LINE 4: RICHMOND ENDOWMENT - ENDOWMENT FUNDS SUBJECT TO RESTRICTIONS REQUIRING THAT THE PRINCIPAL BE INVESTED IN PERPETUITY. INCOME FROM THE INVESTMENTS CAN BE UTILIZED AT THE DISCRETION OF THE BOARD OF TRUSTEES FOR THE HEALTH CENTER AND THE ORGANIZATION'S OPERATING EXPENSES AND IS RECORDED AS REVENUE WITHOUT DONOR RESTRICTIONS. QUALITY OF LIFE - ENDOWMENT FUNDS SUBJECT TO RESTRICTIONS REQUIRING THAT THE PRINCIPAL BE INVESTED IN PERPETUITY. INCOME IS TO BE USED TO PROVIDE HEALTH CARE SERVICES TO LOW INCOME RESIDENTS AND IS RECORDED AS REVENUE WITH DONOR RESTRICTIONS. RIDINGS FUND - ENDOWMENT FUNDS SUBJECT TO RESTRICTIONS REQUIRING THAT THE PRINCIPAL BE INVESTED IN PERPETUITY. INCOME FROM THE INVESTMENTS CAN BE UTILIZED AT THE DISCRETION OF THE BOARD OF TRUSTEES FOR THE HEALTH CENTER AND THE ORGANIZATION'S OPERATING EXPENSES AND IS RECORDED AS REVENUE WITHOUT DONOR RESTRICTIONS. PART X, LINE 2: MANAGEMENT BELIEVES THAT IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING ITS ANNUAL FILING REQUIREMENTS, AND AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. MVGH AND THE LLC WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSE IF SUCH INTEREST AND PENALTIES ARE INCURRED. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN VALUE - SPLIT INTEREST AGREEMENTS 3,900. CHANGE IN VALUE OF BENEFICIAL INTERESTS IN PERPETUAL TRUSTS 59,350. PART XI, LINE 4B - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSE INCLUDED WITH THE FUNCTIONAL EXPENSES -33,112. PART XII, LINE 2D - OTHER ADJUSTMENTS: LOSS ON UNCOLLECTIBLE PROGRAM REVENUE 40,520. SPECIAL EVENT EXPENSE INCLUDED WITH THE FUNCTIONAL EXPENSES 33,112. GALA 136707 90761 45946 355 20316 600 11841 136707 90761 45946 355 20316 600 11841 33112 12834 X 1 1 X X X 0 0 0 0 0 0 0 0 0 DEBORAH HERBERT CHIEF EXECUTIVE OFFICER 170536 0 0 0 0 0 6135 0 12997 0 189668 0 0 0 KIM HOUSER CHIEF FINANCIAL OFFICER 159970 0 0 0 0 0 5685 0 11645 0 177300 0 0 0 EDEN CONORA DIRECTOR OF NURSING 142106 0 0 0 0 0 5138 0 13887 0 161131 0 0 0 PART I, LINE 1A ALL REIMBURSEMENTS FOR SOCIAL CLUB DUES ARE SUBSTANTIATED AND APPROVED IN ACCORDANCE WITH ORGANIZATION POLICY. X BUILDING IMPROVEMENTS 2 85367 FMV - REPLACEMENT CO 0 1 0 PART I, COLUMN (B): THE NUMBER OF CONTRIBUTIONS REPRESENTS THE NUMBER OF CONTRIBUTORS MAKING CONTRIBUTIONS OF EACH TYPE. FORM 990, PART III, LINE 3 ON DECEMBER 29, 2021 MVGH SURRENDERED ITS SKILLED NURSING (SNF) LICENSE TO THE DEPARTMENT OF PUBLIC HEALTH. AS OF DECEMBER 30, 2021 THE RCFE (RESIDENTIAL CARE FACILITY FOR THE ELDERLY - ASSISTED LIVING) LICENSE WITH THE DEPARTMENT OF SOCIAL SERVICES WAS EXPANDED TO INCLUDE THE 40, FORMER SNF BEDS, FOR BEDRIDDEN/WHEELCHAIR BOUND RESIDENTS WHO NEED MORE ASSISTANCE WITH ACTIVITIES OF DAILY LIVING (ENHANCED ASSISTED LIVING). RESIDENTS WERE NOT RELOCATED DURING THE CHANGE IN LICENSURE. THEY REMAINED IN THE SAME ROOMS (BEDS) AS THEY WERE IN THE BUILDING WHICH WAS PREVIOUSLY REFERRED TO AS THE HEALTH CENTER (SNF) AND IS NOW THE STEWART COTTAGE ASSISTED LIVING (AL). REVENUE FOR DECEMBER 30 AND 31ST AL WAS SEPARATED. HOWEVER, AS THERE WERE ONLY TWO DAYS IN THE YEAR THAT WERE AL, EXPENSES WERE NOT SEPARATELY CLASSIFIED. FORM 990, PART VI, SECTION A, LINE 1A THE BOARD OF DIRECTORS DELEGATES THE POWER OF AUTHORITY TO THE EXECUTIVE COMMITTEE IN ACCORDANCE WITH THE BYLAWS. THE EXECUTIVE COMMITTEE THEN HAS THE AUTHORITY TO CARRY OUT GOVERNANCE AS OUTLINED IN THE BYLAWS. FORM 990, PART VI, SECTION B, LINE 11B THE MANAGEMENT COMMITTEE OF THE BOARD OF TRUSTEES AUTHORIZES THE CHIEF FINANCIAL OFFICER TO REVIEW THE FORM 990 IN DETAIL PRIOR TO FILING THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C A COMPREHENSIVE POLICY ON CONFLICTS OF INTEREST AND DISCLOSURE OF CERTAIN INTERESTS HAS BEEN ADOPTED AS A BOARD POLICY THAT IS REVIEWED ANNUALLY BY EACH MEMBER. FORM 990, PART VI, SECTION B, LINE 15 THE PERSONNEL COMMITTEE (WHICH IS A SUB-COMMITTEE OF THE MANAGEMENT COMMITEE) COLLABORATES WITH THE EXECUTIVE COMMITEE OF THE BOARD OF DIRECTORS TO OVERSEE THE ANNUAL PERFORMANCE EVALUATION/SALARY REVIEW OF THE CHIEF EXECUTIVE OFFICER. IN ADDITION, THE PERSONNEL COMMITEE PROVIDES COUNSEL AND SUPPORT TO THE CEO IN REGARDS TO MVGH SENIOR STAFF. THE CEO IS TO MAKE PROCEDURAL AND SALARY RECOMMENDATIONS TO THE MANAGEMENT COMMITTEE AS NECESSARY. PER THE MANAGEMENT COMMITTEE POLICIES AND PROCEDURES, THE MANAGEMENT COMMITEE APPROVES THE COMPENSATION PACKAGES FOR THE CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER. FORM 990, PART VI, SECTION C, LINE 19 AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN VALUE - SPLIT INTEREST AGREEMENTS 3,900. LOSS ON UNCOLLECTIBLE PROGRAM REVENUE -40,520. CHANGE IN VALUE OF BENEFICIAL INTERESTS IN PERPETUAL TRUSTS 59,350. THE GROVE CAMPUS LLC 2889 SAN PASQUAL STREET PASADENA CA 91107 462229596 OPERATION OF UNLICENSED SENIOR HOUSING (INDEPENDENT LIVING) CA 1280667 9451864 MONTE VISTA GROVE HOMES