2021-03-23T09:03:43-05:00 2020-06-30 390859910 BAKER TILLY US LLP 1570 FRUITVILLE PIKE SUITE 400 LANCASTER PA 17601 990 2019-07-01 221717575 HEATH VILLAGE INC HEAT 9088524801 430 SCHOOLEYS MOUNTAIN ROAD HACKETTSTOWN NJ 078404099 PATRICK E BRADY CEO 9088524801 2021-03-17 1 KERRI N BOGDA CPA P00760402 7177404863 2019 2022-09-23 18:48:47Z PATRICK E BRADY 430 SCHOOLEYS MOUNTAIN ROAD HACKETTSTOWN NJ 078404099 29532270 0 X WWW.HEATHVILLAGE.COM X 1962 NJ RETIREMENT COMMUNITY OFFERING INDEPENDENT LIVING, ASSISTED LIVING, AND SKILLED NURSING CARE. 11 10 424 111 31566 0 224696 1108277 26195715 25515503 544187 458654 177477 183509 27142075 27265943 12959 12557 0 0 15423757 15697001 0 0 11132 9778326 10346334 25215042 26055892 1927033 1210051 73657057 102838038 26935362 59594637 46721695 43243401 X HEATH VILLAGE WAS FORMED FOR THE PURPOSE OF PLANNING, BUILDING AND OPERATING A RETIREMENT COMMUNITY. HEATH VILLAGE IS A MULTI-DENOMINATIONAL CHRISTIAN COMMUNITY FOR ALL PEOPLE, REGARDLESS OF RACE, CREED OR ETHNIC ORIGIN. HEATH VILLAGE BELIEVES IT IS IMPORTANT THAT RETIRED PERSONS HAVE A LIVING ENVIRONMENT THAT FOSTERS A MEANINGFUL LIFE WITH SECURITY, DIGNITY, FELLOWSHIP AND PERSONAL AND SPIRITUAL WELL-BEING. TO ACHIEVE THESE OBJECTIVES AND PURPOSE, HEATH VILLAGE PROVIDES RETIRED PERSONS WITH APPROPRIATE LIVING ACCOMMODATIONS, AS WELL AS SOCIAL, RECREATIONAL, EDUCATIONAL, RELIGIOUS AND OTHER PROGRAMS AND SERVICES THAT PROMOTE INDIVIDUAL INDEPENDENCE IN LIVING WITH THE AVAILABILITY OF SUPPORTIVE SERVICES WHEN NEEDED. HEATH VILLAGE ENCOURAGES INTERACTION BETWEEN HEATH VILLAGE EMPLOYEES, ITS RESIDENTS AND THE COMMUNITY AT LARGE. 0 0 21418156 12557 25515503 HEATH VILLAGE IS A FULL SERVICE RETIREMENT COMMUNITY WHICH ALSO INCLUDES A COMPREHENSIVE HEALTH CARE FACILITY. THERE ARE NO LIFE CARE FEES AND OPTIONAL ENTRANCE FEES, MAKING IT AN AFFORDABLE CHOICE FOR TODAY'S RETIREE WHO WANTS TO REMAIN ACTIVE, INVOLVED AND INDEPENDENT. THE 100+ ACRE COMMUNITY OFFERS A VARIETY OF LIVING ACCOMMODATIONS INCLUDING: 153 INDEPENDENT APARTMENTS RANGING IN SIZE FROM STUDIO TO TWO-BEDROOMS; 10 COTTAGE STYLE APARTMENTS WHICH INCLUDE TWO BEDROOMS, A SINGLE CAR GARAGE, UTILITY ROOM, TWO BATHS, AN EAT-IN KITCHEN AND A THREE-SEASON PORCH; 36 HOTEL-STYLE APARTMENTS WHICH INCLUDE HOUSEKEEPING SERVICES AND THREE MEALS PER DAY; 40 RESIDENTIAL HEALTHCARE BEDS AND 99 SKILLED NURSING BEDS, BOTH LICENSED BY THE NEW JERSEY STATE DEPARTMENT OF HEALTH. FOR THE FISCAL YEAR ENDED JUNE 30, 2020, THE INDEPENDENT APARTMENTS SERVED 253 RESIDENTS, THE RESIDENTIAL HEALTH CARE UNIT SERVED 54 RESIDENTS, AND THE SKILLED NURSING UNIT SERVED 430 SHORT-TERM AND LONG-TERM PATIENTS. THE FACILITY PROVIDED $632,459 IN BENEVOLENT CARE ACROSS ALL LEVELS OF CARE. ALL RESIDENTS AND PATIENTS OF THE COMMUNITY ENJOY AROUND THE CLOCK SECURITY, A WIRELESS EMERGENCY/NURSE CALL ALERT SYSTEM, WIFI, MAINTENANCE SERVICES, TRANSPORTATION SERVICES, PASTORAL SERVICES, AND SOCIAL ACTIVITIES BOTH ON CAMPUS AND OFF CAMPUS IN ADDITION TO A SWIMMING POOL AND JACUZZI, COMMUNITY GARDEN, SHUFFLE BOARD COURT, BOCCE COURT, NATURE/WALKING TRAIL, LIBRARY, FITNESS CENTER, BANK, COMPUTER CENTER, GIFT SHOP, BEAUTY SALON, CRAFT SHOP, CHAPEL, ART STUDIO, AND NUMEROUS OTHER AMENITIES. WHILE THE RESIDENTIAL HEALTHCARE AND SKILLED NURSING UNITS HAVE THEIR OWN DINING ROOM FACILITIES, ALL RESIDENTS AND GUESTS OF THE COMMUNITY HAVE THE OPTION OF DINING IN THE MAIN DINING ROOM FOR A RESTAURANT STYLE DINING OPTION, THE GRILL ROOM FOR A FINE DINING EXPERIENCE, THE PUB, OR IN THE CAFE FOR A LESS FORMAL SETTING. RESIDENTS ALSO ENJOY VARIOUS SPECIAL DINING EVENTS IN THE MAIN DINING FACILITIES THROUGHOUT THE YEAR INCLUDING BIRTHDAY NIGHT, HOLIDAY DINNERS, A RESIDENT ANNIVERSARY CELEBRATION, AND A NEWCOMER'S RECEPTION. DURING THE FISCAL YEAR ENDING JUNE 30, 2020 THE DINING SERVICES DEPARTMENT TEAMED UP WITH A LOCAL FARM TO INTRODUCE A FARM TO TABLE PROGRAM, WHICH IMPLEMENTS SEASONAL FRESH FRUITS AND VEGETABLES INTO THE MENUS. BY USING A LOCAL FARM, THE PRODUCE IS ALLOWED TO RIPEN MUCH LONGER THAN PRODUCE PURCHASED FROM OTHER VENDORS, WHICH PROVIDES FOR BETTER QUALITY AND PEAK FRESHNESS.RESIDENTS OF THE COMMUNITY CONTINUE TO PARTICIPATE IN OVER 40 RESIDENT GROUPS AND ORGANIZATIONS, INCLUDING THE BOCCE BALL LEAGUE, PICKLEBALL, BRIDGE PLAYERS, MAHJONG, AND BOOK DISCUSSION GROUP, TO NAME A FEW. VOLUNTEERS WHO RESIDE ON-CAMPUS CONTINUED THE EFFORTS OF THE FACILITY'S THRIFT STORE KNOWN AS THE FRIENDSHIP STORE, WHICH GENERATED PROCEEDS OF $8,797 TO SUPPORT THE BENEVOLENT CARE FUND. AN ADDITIONAL $1,510 NET PROCEEDS WERE GENERATED FROM THE VILLAGE GIFT SHOP. OTHER RESIDENT VOLUNTEERS ALSO RAISED $1,863 FOR THE FUND BY HOLDING BAKE SALES, A FARMER'S MARKET AND A HOLIDAY BAZAAR.RESIDENTS CONTINUE TO ENJOY PARTIES AT THE POOL ALONG WITH WATER AEROBICS IN THE SUMMER SEASON. OTHER ON-CAMPUS EVENTS INCLUDED OUTSIDE CONCERTS, LECTURES, AND COCKTAIL PARTIES. THE ANNUAL FAMILY DAY EVENT WAS WELL ATTENDED BY RESIDENTS, PATIENTS, EMPLOYEES, AND FAMILY MEMBERS. THE RESIDENTS ALSO ATTENDED VARIOUS OFF-CAMPUS TRIPS DURING THE FISCAL YEAR, PRIOR TO THE PANDEMIC, INCLUDING NUMEROUS TRIPS TO LOCAL RESTAURANTS, HUNTERDON HILLS PLAYHOUSE, NEW JERSEY SYMPHONY ORCHESTRA, CENTENARY STAGE PRODUCTIONS, PAPER MILL PLAYHOUSE, AND THE VERY POPULAR ANNUAL MYSTERY TRIP. REGULAR ACTIVITIES CONTINUED UNTIL MID-MARCH WHEN THE PANDEMIC FORCED ALL PROGRAMS TO BE CANCELLED, INCLUDING THE ANNUAL OVER-NIGHT TRIP PLANNED FOR JUNE. WITH ALL THE RESTRICTIONS IN PLACE, THE ACTIVITIES DEPARTMENT PROVIDED VARIOUS WAYS TO KEEP THE INDEPENDENT RESIDENTS ACTIVE AND ENTERTAINED SUCH AS PROVIDING INTERESTING WEBSITES TO EXPLORE MUSEUMS, VARIOUS DESTINATIONS, LISTEN TO MUSIC AND LEARN NEW EXERCISES. THEY ALSO PROVIDED WEEKLY TRIVIA, PUZZLES, BOOKS, CARDS, GAMES AND COLORING PAGES TO ALL WHO WERE INTERESTED. RESIDENTS WERE ENCOURAGED TO MAKE CARDS TO SEND TO FAMILY MEMBERS. THE COMMUNITY GARDEN WAS ALSO AVAILABLE FOR RESIDENTS GET SOME FRESH AIR WHILE PLANTING AND HARVESTING VARIOUS VEGETABLES AND FLOWERS DURING THE SPRING. IN OBSERVANCE OF ARBOR DAY, THE FACILITY PROVIDED A MAP OF THE CAMPUS IDENTIFYING THE LOCATION OF ALL 41 ARBOR DAY TREES PLANTED ON THE PROPERTY OVER THE YEARS, AND RESIDENTS WERE ENCOURAGED TO TAKE A WALK OUTDOORS IN ORDER TO LOCATE EACH TREE. LIMITED GROUP ACTIVITIES RESUMED IN MID-JUNE SUCH AS THE ART GROUP, WOODWORKING GROUP, FITNESS CLASSES, AND CHAPEL SERVICES. ALL PROPER PROTOCOLS WERE FOLLOWED TO ENSURE SAFETY SUCH AS SOCIAL DISTANCING AND FACIAL MASKS. DURING THE PANDEMIC, THE FACILITY ASSISTED INDEPENDENT RESIDENTS BY PROVIDING PICK-UP AND DELIVERY SERVICE FOR PRESCRIPTIONS, AND GROCERY SHOPPING WITH DELIVERY DIRECTLY TO THEIR APARTMENTS. THE DINING DEPARTMENT ALSO PROVIDED FREE DELIVERY OF MEALS UPON REQUEST. THIS ALLOWED RESIDENTS TO FOLLOW THE GOVERNOR'S STAY-AT-HOME ORDER AND REMAIN SAFELY QUARANTINED IN THEIR APARTMENTS. REGULAR UPDATES WERE DISTRIBUTED BY THE FACILITY TO RESIDENTS THROUGHOUT THE PANDEMIC, AND SPECIAL TREATS ACCOMPANIED THE NOTICES. THE SKILLED NURSING UNIT BOASTS A SUB-ACUTE CARE AND REHABILITATION FACILITY WHICH PROVIDES FIRST-RATE IN-PATIENT CARE FOR ADULT PATIENTS FIFTY-FIVE AND OLDER WHO ARE RECOVERING FROM AN ACUTE ILLNESS OR INJURY. THE FACILITY PROVIDES THE FOLLOWING COMPREHENSIVE SERVICES: MEDICAL AND SURGICAL RECOVERY, CARDIAC CARE, WOUND CARE, PHYSICAL AND OCCUPATIONAL THERAPY, SPEECH THERAPY, IV THERAPY, VESTIBULAR THERAPY, ASSISTIVE DEVICE TRAINING, MEDICATION MANAGEMENT AND HOSPICE CARE. THEY SPECIALIZE IN BALANCE, GAIT ASSESSMENT, FALL PREVENTION AND IMPROVING OVERALL MOBILITY. INDEPENDENT RESIDENTS OF THE COMMUNITY ALSO BENEFIT FROM THE OUT-PATIENT THERAPY SERVICES PROVIDED BY THIS FACILITY. DURING THE FISCAL YEAR ENDING JUNE 30, 2020, THE REHAB FACILITY SERVED 25 OUT-PATIENTS. RESIDENTS WHO LIVE INDEPENDENTLY OUTSIDE OF THE NURSING FACILITY ALSO BENEFIT FROM HOME HEALTH SERVICES AND OUT-PATIENT NURSING CARE MADE AVAILABLE THROUGH THE SKILLED NURSING UNIT.THE SKILLED NURSING FACILITY HAS A SOCIAL SERVICES DEPARTMENT WHICH IS DEDICATED TO THE PSYCHOSOCIAL WELL-BEING OF ALL PATIENTS AND RESIDENTS WITHIN THE COMMUNITY. THIS DEPARTMENT SERVES AS AN INTERDEPARTMENTAL LIAISON FOR THE PATIENTS AND FAMILY MEMBERS TO MAKE SURE ALL THEIR NEEDS ARE MET MEDICALLY, PHYSICALLY, AND EMOTIONALLY. THIS DEPARTMENT CONTINUES TO EDUCATE PATIENTS AND RESIDENTS ABOUT THE POLST (PRACTITIONER ORDERS FOR LIFE-SUSTAINING TREATMENT) AND ASSIST THEM WITH PREPARING THE POLST FORM. THIS ALLOWS THE INDIVIDUAL TO BE THEIR OWN MEDICAL ADVOCATE, IDENTIFIES MEDICAL TREATMENTS THAT THEY APPROVE OR DISAPPROVE OF IF THEY ARE UNABLE TO SPEAK FOR THEMSELVES, AND REDUCES THE BURDEN ON FAMILY AND CAREGIVERS. IN ADDITION, THE SOCIAL SERVICE DEPARTMENT IS AVAILABLE TO ASSIST PATIENTS WITH COMPLETING LIVING WILLS AND DESIGNATING A MEDICAL POWER OF ATTORNEY. THE DEPARTMENT ALSO CONTINUED TO WORK ON REDUCING THE SIGNS AND SYMPTOMS OF DEPRESSION IN BOTH LONG-TERM CARE AND SUB-ACUTE PATIENTS, BY WORKING TOGETHER WITH PSYCHIATRISTS, THERAPISTS, AND THE INTERDISCIPLINARY TEAM. DUE TO THIS TEAM EFFORT, RATES OF DEPRESSION HAVE DECREASED. THE SOCIAL SERVICE DEPARTMENT SCHEDULES AND FACILITATES ALL THE INTERDISCIPLINARY TEAM MEETINGS WHICH ARE HELD TWICE A WEEK WITH THE RESIDENTS AND THEIR FAMILY MEMBERS. THESE MEETINGS ARE DESIGNED TO UPDATE THE RESIDENTS AND FAMILY MEMBERS ON MEDICAL ISSUES, THEIR REHAB PROGRESS, ETC. THE SOCIAL WORKER ASSISTS WITH DISCHARGE PLANNING FOR THOSE PATIENTS THAT ARE RECEIVING SUBACUTE REHAB AND ASSISTS WITH SETTING UP SERVICES IN THE COMMUNITY FOR THE PATIENTS TO ENABLE THEM TO RESUME THEIR LIVES AFTER REHAB (I.E., PRIVATE DUTY HOME HEALTH AIDE, NURSING, PT, OT, MEALS ON WHEELS, ETC.), OR IF THE PATIENT IS NOT ABLE TO RETURN HOME, THEY ASSIST WITH FACILITY PLACEMENT. THE SOCIAL SERVICE DEPARTMENT ALSO ASSISTS RESIDENTS WITH THE MEDICAID APPLICATION AND ASSESSMENT, AND COMPLETES BIOPSYCHOSOCIAL ASSESSMENTS FOR MEDICARE. DURING THE FISCAL YEAR, THE SOCIAL SERVICE DEPARTMENT COMPLETED THE 2020 CENSUS FOR ALL RESIDENTS IN THE SKILLED NURSING AND RESIDENTIAL HEALTHCARE UNITS. 21418156 1 1 0 1 0 0 0 0 1 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 1 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 1 360 0 424 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 X 11 10 1 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 0 1 0 0 NJ X ANTHONY PUCCIO 9086845018 422 SCHOOLEYS MOUNTAIN ROAD HACKETTSTOWN NJ 078404099 PATRICK E BRADY CEO/EXECUTIVE DIRECTOR 40.00 0.50 X X 638297 0 43817 MARY ELLEN BOVE CHIEF OPERATING OFFICER 40.00 0.50 X 358385 0 106701 ANTHONY PUCCIO CHIEF FINANCIAL OFFICER 40.00 0.50 X 195384 0 21544 VIVIAN BLANDURA DIRECTOR OF NURSING 40.00 0.00 X 131882 0 24765 JANICE CIPRIANI DIRECTOR OF MARKETING 40.00 0.00 X 117731 0 17214 JONATHAN MANUEL DIRECTOR OF REHAB 40.00 0.00 X 105974 0 23513 THOMAS NORMA RN 40.00 0.00 X 106309 0 16456 LEAH GRAUSO OCCUPATIONAL THERAPIST 40.00 0.00 X 107999 0 5437 CAROL MCKINNEY CHAIR 0.30 0.30 X X 0 0 0 L ALLISON GARDE VICE CHAIR 0.30 0.30 X X 0 0 0 HAROLD S LAPPIN SECRETARY/TREASURER 0.30 0.30 X X 0 0 0 SANDERS DAVIS TRUSTEE (THROUGH 11/18/19) 0.30 0.30 X 0 0 0 ROBERT GALLAGHER TRUSTEE 0.30 0.30 X 0 0 0 MARY ALICE HORN TRUSTEE 0.30 0.30 X 0 0 0 HERBERT KORTE TRUSTEE 0.30 0.30 X 0 0 0 FRANK REITZ TRUSTEE-RESIDENT REPRESENTATIVE 0.30 0.00 X 0 0 0 ARTHUR SHENINGER TRUSTEE 0.30 0.00 X 0 0 0 TIMOTHY STEWART TRUSTEE 0.30 0.30 X 0 0 0 PETER R VAN BRUNT TRUSTEE 0.30 0.30 X 0 0 0 1761961 0 259447 8 0 1 0 LECESSE CONSTRUCTION SERVICES LLC 15 CIRCLE STREET ROCHESTER NY 14607 CONSTRUCTION 23677360 CHRIS BRANDS CONSTRUCTION CO 710 LAUREL HILL ROAD BANGOR PA 18013 CARPENTRY 816782 EXIGENT TECHNOLOGIES LLC 55 MADISON AVENUE SUITE 400 MORRISTOWN NJ 07960 INFORMATION TECHNOLOGY 577898 SODEXO INC AND AFFILIATES PO BOX 360170 PITTSBURGH PA 15251 FOOD SERVICE 431725 KDA ARCHITECTS ONE ECHELON PLAZA 227 LAUREL RD S VOORHEES NJ 08043 ARCHITECTURE 365083 13 72815 821414 214048 3105 1108277 NET RESIDENT SERVICE REV 623000 25515503 25515503 25515503 504971 504971 2199202 2245519 -46317 -46317 -46317 7795 72815 11172 -3377 -3377 80 0 80 80 11345 9636 1709 1709 NON-RESIDENT REVENUE 721000 45047 32566 12481 MEALS 722210 41298 41298 INSURANCE RECOVERY 900099 40863 40863 57889 -1000 58889 185097 27265943 25515503 31566 610597 12557 12557 1354266 1354266 10923431 9901597 1016119 5715 392462 354359 37817 286 2171104 1846536 323597 971 855738 704729 150551 458 172296 160296 12000 25985 25985 79982 79982 721 721 65610 65610 827849 671641 156208 52897 52897 187240 86943 96595 3702 308905 14833 294072 1571829 1571829 18855 15054 3801 51415 43089 8326 3202854 3202854 417175 11292 405883 FOOD 904377 890078 14299 SUPPLIES & MINOR EQUIPM 789809 789809 PHARMACY & OTHER ANCILI 636628 636628 BAD DEBT EXPENSE 344802 344802 687105 504032 183073 26055892 21418156 4626604 11132 46287 12925 3672711 10700133 1569023 1306338 117994 220527 106819 338577 118684919 47181943 49404330 71502976 17658806 17669092 24157 295419 289150 785668 774163 73657057 102838038 8191866 5952677 3377158 3403911 10714338 38049497 780111 774163 2655100 3871889 8759289 26935362 59594637 X 43464057 40420761 3257638 2822640 46721695 43243401 73657057 102838038 X 1210051 195585 -4883930 X 0 1 X 1 0 X 354265 169820 974536 224696 1108277 2831594 28850998 25336457 25804985 26196536 25517212 131706188 29205263 25506277 26779521 26421232 26625489 134537782 0 0 0 134537782 440907 415093 348742 436913 504971 2146626 440907 415093 348742 436913 504971 2146626 0 0 0 0 0 127426 142762 171344 130029 153531 725092 29773596 26064132 27299607 26988174 27283991 137409500 0.97910 0.97690 0.01560 0.01610 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MEALS - 2015 AMOUNT: $ 61,606. 2016 AMOUNT: $ 55,090. 2017 AMOUNT: $ 55,566. 2018 AMOUNT: $ 54,305. 2019 AMOUNT: $ 41,298. LATE FEE INCOME - 2015 AMOUNT: $ 20,551. 2016 AMOUNT: $ 34,675. 2017 AMOUNT: $ 10,417. 2018 AMOUNT: $ 7,544. 2019 AMOUNT: $ 10,425. GUEST ROOMS - 2015 AMOUNT: $ 21,700. 2016 AMOUNT: $ 23,830. 2017 AMOUNT: $ 24,840. 2018 AMOUNT: $ 28,505. 2019 AMOUNT: $ 20,260. FIREWOOD SALES - 2017 AMOUNT: $ 3,819. 2019 AMOUNT: $ 9,365. RESIDENT MAINTENANCE SERVICES - 2017 AMOUNT: $ 9,152. 2019 AMOUNT: $ 7,931. GIFT SHOP - 2015 AMOUNT: $ 3,441. 2018 AMOUNT: $ 8,311. THRIFT STORE REVENUE - 2015 AMOUNT: $ 9,785. 2016 AMOUNT: $ 9,341. 2017 AMOUNT: $ 7,853. 2019 AMOUNT: $ 8,797. MISCELLANEOUS INCOME - 2015 AMOUNT: $ 11,093. 2016 AMOUNT: $ 21,377. 2017 AMOUNT: $ 49,578. 2018 AMOUNT: $ 18,933. 2019 AMOUNT: $ 161. PARTNERSHIP GAIN/LOSS - 2015 AMOUNT: $ -750. 2016 AMOUNT: $ -1,551. 2017 AMOUNT: $ -1,881. NON-RESIDENT REVENUE - 2017 AMOUNT: $ 12,000. 2018 AMOUNT: $ 12,431. 2019 AMOUNT: $ 12,481. INSURANCE RECOVERY - 2019 AMOUNT: $ 40,863. RELATED NONRESIDENT REVENUE - 2019 AMOUNT: $ 1,950. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 721 721 0 PART II-B, LINE 1: HEATH VILLAGE PAID MEMBERSHIP DUES TO LEADING AGE OF NJ OF $11,731, OF WHICH AN ESTIMATED 4.1% OR $481 WENT TOWARDS LOBBYING ACTIVITY. HEATH VILLAGE PAID MEMBERSHIP DUES TO LEADING AGE NATIONAL OF $8,000, OF WHICH AN ESTIMATED 3% OR $240 WENT TOWARDS LOBBYING ACTIVITY. 0 1 X 4592220 4592220 57163286 37627361 19535925 9950718 7387402 2563316 46978695 2167180 44811515 71502976 ANNUITIES PAYABLE 338857 DERIVATIVE FINANCIAL INSTRUMENT 8397421 DUE TO AFFILIATE 23011 8759289 22464201 195585 -4931717 -4736132 27200333 65610 65610 27265943 25942495 -47787 -47787 25990282 65610 65610 26055892 PART IV, LINE 2B: SECURITY DEPOSITS AND PNA (PERSONAL NEEDS ALLOWANCE) FUNDS HELD IN TRUST FOR PATIENTS AND RESIDENTS. FUNDS ARE SEGREGATED AND HELD IN AN INTEREST-BEARING BANK ACCOUNT. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN FAIR VALUE OF DERIVATIVE FINANCIAL INSTRUMENTS -4,883,930. CHANGE IN THE SEGREGATED GIFT ANNUITY RESERVE -57,423. GIFT SHOP EXP 9,636. PART XII, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN THE SEGREGATED GIFT ANNUITY RESERVE -57,423. GIFT SHOP EXPENSES 9,636. BENEFIT GALA 80215 72815 7400 107 4189 400 5260 80215 72815 7400 107 4189 400 5260 9956 -2556 0 CENTENARY STAGE COMPANY 400 JEFFERSON ST HACKETTSTOWN NJ 07840 221500484 501(C)(3) 12000 SPONSORSHIP FOR THE 2019-2020 SEASON. 1 0 PART I, LINE 2: HEATH VILLAGE MADE A DONATION TO SPONSOR AN UNRELATED TAX-EXEMPT ORGANIZATION AND RECEIVED AN ACKNOWLEDGMENT LETTER FROM THE DONEE ORGANIZATION. X X X 0 1 0 0 0 0 0 1 0 PATRICK E BRADY CEO/EXECUTIVE DIRECTOR 337580 0 300717 0 0 0 14000 0 29817 0 682114 0 0 0 MARY ELLEN BOVE CHIEF OPERATING OFFICER 258385 0 100000 0 0 0 89000 0 17701 0 465086 0 0 0 ANTHONY PUCCIO CHIEF FINANCIAL OFFICER 195384 0 0 0 0 0 9829 0 11715 0 216928 0 0 0 VIVIAN BLANDURA DIRECTOR OF NURSING 124382 0 7500 0 0 0 7064 0 17701 0 156647 0 0 0 PART I, LINE 4B THE COO HAS A DEFERRED COMPENSATION ARRANGEMENT. THE ORGANIZATION PAID THE COO $40,000 ON 4/9/20 FOR THE DEFERRED COMPENSATION THAT WAS AWARDED ON 3/25/17. THE COO WAS AWARDED $95,000 ON 3/25/20, WHICH WILL BE VESTED ON 3/25/23. THE TOTAL DEFERRED COMPENSATION BALANCE AT 6/30/20 WAS $220,000. PART I, LINE 7 THE CEO DETERMINES THE COO'S BONUS AT THE CEO'S DISCRETION. THE CEO'S BONUS IS DETERMINED IN ACCORDANCE WITH AN EMPLOYMENT AGREEMENT. THE BOARD HAS DISCRETION TO ADJUST THE CEO'S BONUS DUE TO EXTRAORDINARY CIRCUMSTANCES. A PUBLIC FINANCE AUTHORITY 273866124 2018-08-10 38500000 TO FINANCE THE CONSTRUCTION OF A SKILLED NURSING FACILITY. 0 0 0 A 38500000 36937668 1562332 2020 0 0 0 1 A 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 1 1 BRANCH BANKING AND TRUST COMPANY 15.000000000000 0 0 0 0 1 A 1 FORM 990, PART III, LINE 4A DURING THE COVID-19 PANDEMIC, THE SOCIAL SERVICE DEPARTMENT ASSISTED RESIDENTS AND THEIR FAMILY MEMBERS WITH STAYING CONNECTED DESPITE THE VISITATION RESTRICTIONS, BY WAY OF PHONE, VIDEO CHAT, WINDOW VISITS, OUTDOOR VISITS, AND INDOOR VISITS, WHEN PERMITTED. THE FACILITY PROVIDED IPADS AS A MEANS FOR RESIDENTS IN THE SKILLED NURSING AND RESIDENTIAL HEALTHCARE UNITS TO SAFELY VIDEO CHAT WITH FAMILY MEMBERS. THE SOCIAL SERVICES DEPARTMENT HANDLED THE SCHEDULING OF ALL VISITS AND BROUGHT THE RESIDENT TO THE VISIT OR SAT WITH THEM AS NEEDED DURING THE VIDEO CHAT TO ASSIST WITH THE ELECTRONICS. DUE TO COVID, MANY DOCTORS AND OTHER MEDICAL PROFESSIONALS WERE OPTING TO DO TELEMEDICINE WITH THE RESIDENTS, SO THE SOCIAL SERVICE DEPARTMENT SCHEDULED AND FACILITATED THOSE APPOINTMENTS AS WELL. THE SOCIAL SERVICE DEPARTMENT ALSO CONTINUED TO PROVIDE ONE-ON-ONE EMOTIONAL SUPPORT TO RESIDENTS, PATIENTS, FAMILY MEMBERS AND STAFF DURING THE PANDEMIC. THE HEALTH CARE CENTER STRIVES TO PROVIDE A HOME-LIKE ATMOSPHERE AND HAS EMBRACED A WONDERFUL ENRICHMENT PROGRAM THAT INCORPORATES BRINGING THE "OUT OF DOORS" INSIDE. A DEDICATED STAFF OF ACTIVITY PROFESSIONALS ENHANCES NURSING CARE WITH A PROGRAM DESIGNED TO PROMOTE INTEREST AND ENJOYMENT. DURING THE FISCAL YEAR ENDING JUNE 30, 2020, PRIOR TO THE PANDEMIC, THE FACILITY CONTINUED TO PROVIDE A VARIETY OF THERAPEUTIC ACTIVITIES INCLUDING VISITS FROM PET THERAPY DOGS, CERTIFIED MUSIC THERAPY, ART THERAPY AND TAI CHI. PATIENTS ALWAYS ENJOYED REGULAR VISITS FROM AND ACTIVITIES WITH THE FRIENDSHIP CENTER CHILDCARE CENTER STUDENTS, PRIOR TO THE PANDEMIC. PATIENTS ALSO HAD THE OPPORTUNITY TO TAKE TRIPS OUTSIDE OF THE FACILITY FOR ICE CREAM AND LUNCH AT LOCAL RESTAURANTS. A "MINI MALL" IS BROUGHT TO THE SKILLED NURSING UNIT SO THAT PATIENTS CAN SHOP ON PREMISE. STARTING IN MID-MARCH 2020, WHEN THE PANDEMIC IMPOSED RESTRICTIONS ON THE FACILITY, ACTIVITIES WERE MODIFIED FOR THE SAFETY OF ALL RESIDENTS AND STAFF IN ORDER TO ENSURE PROPER SOCIAL DISTANCING. ACTIVITIES WERE DONE ROOM TO ROOM IN WHICH STAFF DECORATED CARTS AND VISITED RESIDENTS INDIVIDUALLY TO HAVE TEA PARTIES OR BIRTHDAY PARTIES, AND BROUGHT THEM DESSERT CARTS, ACTIVITY FUN CARTS WITH CRAFTS, AND ART PROJECTS. THEY INTRODUCED "HALLWAY" BINGO AND TRIVIA, WHICH ALLOWED RESIDENTS TO REMAIN PROPERLY SOCIAL DISTANCED WHILE PARTICIPATING IN A GROUP ACTIVITY. WEEKLY OUTDOOR ENTERTAINMENT WAS ALSO PROVIDED IN THE GARDEN. RESIDENTS WERE BROUGHT OUT TO THE PATIO, 6 FEET APART, AND DOORS AND WINDOWS WERE OPENED FOR ROOM-BOUND RESIDENTS SO THAT THEY COULD ENJOY THE FRESH AIR AND LISTEN TO LIVE MUSIC. THIS LIVE ENTERTAINMENT INCLUDED HARP MUSIC, SINGERS, GUITAR PLAYERS, KEYBOARD AND DANCING. THESE WERE UPLIFTING PROGRAMS THAT ENTICED RESIDENTS TO CLAP AND MOVE THEIR FEET. THE RESIDENTS ENJOYED ALL THE MODIFIED PROGRAMS AND ACTIVITIES. HEATH VILLAGE ALSO SERVES THE LOCAL COMMUNITY BY HOSTING A MONTHLY PARKINSON'S SUPPORT GROUP AND SENIOR SEMINARS, ALL OF WHICH ARE FREE AND OPEN TO THE PUBLIC. THIS FISCAL YEAR THE SENIOR SEMINARS INCLUDED AN AGING SEMINAR, COMMUNITY GARDEN PARTY, NETWORKING EVENT, US CENSUS INFORMATION SESSION, HEART HEALTH SEMINAR AND MORE. FORM 990, PART VI, SECTION A, LINE 1 THE HEATH ALLIANCE FOR CARE, INC. EXECUTIVE COMMITTEE SHALL CONSIST OF SEVEN (7) MEMBERS, INCLUDING THE PRESIDENT, VICE-PRESIDENT, SECRETARY, TREASURER, ASSISTANT SECRETARY, ASSISTANT TREASURER, AND IMMEDIATE PAST PRESIDENT. FIVE (5) MEMBERS SHALL CONSTITUTE A QUORUM FOR THE TRANSACTION OF ALL BUSINESS. THE EXECUTIVE COMMITTEE SHALL MEET, AS NECESSARY, TO TRANSACT EMERGENCY BUSINESS BETWEEN BOARD MEETINGS. THE EXECUTIVE COMMITTEE MEETS AT THE CALL OF THE PRESIDENT OR UPON WRITTEN REQUEST OF ANY OTHER TWO MEMBERS THEREOF. THE EXECUTIVE COMMITTEE SHALL HAVE ALL POWERS AND DUTIES OF THE BOARD EXCEPT IT SHALL NOT HAVE THE POWER TO REMOVE OR ELECT A TRUSTEE OR THE CEO OR TO APPROVE OR DISAPPROVE THE OPERATING OR CAPITAL EXPENSE BUDGETS. HOWEVER, IN TIMES DEEMED BY THEM TO BE OF EMERGENCY, THE EXECUTIVE COMMITTEE MAY APPROVE EXPENDITURES NOT IN THE BUDGETS BUT NOT TO EXCEED SUCH AMOUNTS AS CURRENTLY ESTABLISHED BY THE BOARD. THE SECRETARY OF THE BOARD SHALL KEEP MINUTES OF ALL MEETINGS OF THE EXECUTIVE COMMITTEE AND SEND COPIES OF SAID MINUTES TO ALL BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 2 MARY ALICE HORN, TRUSTEE ON THE HEATH VILLAGE BOARD OF TRUSTEES, IS MARRIED TO NORRIS HORN, TRUSTEE ON THE HEATH ALLIANCE FOR CARE BOARD OF TRUSTEES. HEATH ALLIANCE FOR CARE IS THE NON-PROFIT PARENT CORP OF HEATH VILLAGE. THIS WAS IDENTIFIED ON THE CONFLICT OF INTEREST FORM COMPLETED BY MARY ALICE HORN ON 6/9/20. FORM 990, PART VI, SECTION A, LINE 4 THE BYLAWS WERE AMENDED IN DECEMBER 2019 AS FOLLOWS: THE "INC." WAS REMOVED FROM THE HEATH VILLAGE NAME. ARTICLE 1.1 WAS REVISED TO CLARIFY THAT HEATH VILLAGE IS A SUBSIDIARY OF HEATH ALLIANCE FOR CARE. THE PREVIOUS VERSION ONLY REFLECTED THAT HEATH ALLIANCE WAS THE SOLE MEMBER. ARTICLE 2.3 HEATH VILLAGE'S POWERS WERE EXPANDED TO INCLUDE THE POWER TO SELL, EXCHANGE, CONVEY MORTGAGE, LEASE, TRANSFER OR OTHERWISE DISPOSE OF REAL AND PERSONAL PROPERTY IN ORDER TO BE CONSISTENT WITH THE CERTIFICATE OF INCORPORATION. ARTICLE 2.4 REGARDING HEATH ALLIANCE'S POWERS WAS ADDED IN ORDER TO IDENTIFY THE POWERS OF THE SOLE MEMBER. THIS INCLUDES ALL THE RIGHTS OF VOTING MEMBERS AND CERTAIN MANAGEMENT POWERS OF HEATH VILLAGE'S BOARD OF TRUSTEES ADOPTION AND AMENDMENT OF HEATH VILLAGE'S CERTIFICATE OF INCORPORATION AND/OR BYLAWS, ELECTION OF HEATH VILLAGE'S TRUSTEES, APPROVAL OF REMOVAL OF HEATH VILLAGE'S TRUSTEES AND/OR OFFICERS, REMOVAL OF HEATH VILLAGE'S TRUSTEES AND/OR OFFICERS, APPROVAL AND MONITORING OF HEATH VILLAGE'S ANNUAL OPERATING AND CAPITAL BUDGETS, APPROVAL OF ANY EXPENDITURE OR INCURRENCE OF INDEBTEDNESS IN EXCESS OF $250,000 AND APPROVAL OF HEATH VILLAGE'S LONG RANGE PLANS. THE CORPORATE SEAL WAS ADDED AS ARTICLE 3.2. A PARAGRAPH WAS ADDED TO ARTICLE 4.6 TO INDICATE THAT HEATH ALLIANCE WILL SET THE DATE OF THE ANNUAL MEETING OF THE HEATH VILLAGE BOARD AND WILL PROVIDE NOTICE TO THE HEATH VILLAGE BOARD BY PROVIDING A DULY CERTIFIED COPY OF ITS RESOLUTION TO THAT EFFECT TO THE HEATH VILLAGE BOARD CHAIR OR VICE CHAIR. ARTICLE 5.1 WAS MODIFIED TO INDICATE THAT THE HEATH VILLAGE BOARD OF TRUSTEES SHALL APPOINT THE SECRETARY/TREASURER. THE PRIOR VERSION INDICATED THAT THE PRESIDENT OF THE BOARD OF HEATH ALLIANCE APPOINTED THIS POSITION. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF HEATH VILLAGE IS HEATH ALLIANCE FOR CARE, INC., A RELATED NOT-FOR-PROFIT ORGANIZATION THAT IS TAX-EXEMPT UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 186. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER OF HEATH VILLAGE IS HEATH ALLIANCE FOR CARE, INC. AS THE SOLE MEMBER OF HEATH VILLAGE, HEATH ALLIANCE FOR CARE, INC. HAS ALL THE RIGHTS OF VOTING MEMBERS. IN ADDITION, HEATH ALLIANCE HAS THE FOLLOWING MANAGEMENT POWERS: ELECTION OF THE CORPORATION'S TRUSTEES, APPROVAL OF REMOVAL OF THE CORPORATION'S TRUSTEES AND/OR OFFICERS BY THE CORPORATION'S BOARD OF TRUSTEES, AND REMOVAL OF THE CORPORATION'S TRUSTEES AND/OR OFFICERS WITH OR WITHOUT CAUSE. ALL OF THE TRUSTEES OF HEATH VILLAGE SHALL BE APPOINTED BY THE BOARD OF TRUSTEES OF HEATH ALLIANCE (THE NON-PROFIT PARENT CORPORATION). THE HEATH VILLAGE RESIDENT COUNCIL MAY NOMINATE ONE RESIDENT VOTING MEMBER TO THE BOARD OF TRUSTEES FOR A THREE YEAR TERM. A MAJORITY VOTE OF THE CURRENT TRUSTEES OF THE HEATH ALLIANCE SHALL BE REQUIRED FOR THE APPOINTMENT OF SAID RESIDENT MEMBER. THE PRESIDENT OF THE BOARD OF TRUSTEES OF HEATH ALLIANCE SHALL APPOINT BOTH THE CHAIRPERSON ("CHAIR") AND THE VICE-CHAIRPERSON ("VICE CHAIR") OF THE BOARD OF TRUSTEES OF HEATH VILLAGE FOR A ONE YEAR RENEWABLE TERM FROM AMONG THE TRUSTEES OF HEATH VILLAGE. BOTH POSITIONS SHALL BE INCLUDED IN ALL COUNTS OF TRUSTEES. VACANCIES IN THE BOARD OCCURRING BETWEEN TERMS SHALL BE FILLED FOR THE UNEXPIRED PORTION OF THE TERM BY A MAJORITY VOTE OF THE TRUSTEES OF THE HEATH ALLIANCE FOR CARE BOARD. FORM 990, PART VI, SECTION A, LINE 7B THE BOARD OF TRUSTEES OF HEATH ALLIANCE FOR CARE HAS AUTHORITY OVER THE HEATH VILLAGE BOARD OF TRUSTEES ON VARIOUS DUTIES AS IDENTIFIED IN THE HEATH VILLAGE BYLAWS AND ARTICLES OF INCORPORATION. HEATH ALLIANCE FOR CARE IS THE NON-PROFIT PARENT CORPORATION AND SOLE MEMBER OF HEATH VILLAGE. ALL MEMBERS OF THE BOARD OF TRUSTEES SHALL BE APPOINTED BY THE BOARD OF TRUSTEES OF HEATH ALLIANCE FOR CARE. THE PRESIDENT OF THE BOARD OF HEATH ALLIANCE SHALL APPOINT THE CHAIRPERSON AND VICE-CHAIRPERSON OF THE BOARD OF TRUSTEES OF HEATH VILLAGE. HEATH ALLIANCE SHALL EMPLOY AN EXECUTIVE DIRECTOR OF HEATH VILLAGE. THE EXECUTIVE DIRECTOR SHALL REPORT TO THE CHIEF EXECUTIVE OFFICER OF HEATH ALLIANCE. THE CHIEF EXECUTIVE OFFICER OF HEATH ALLIANCE SHALL BE A TRUSTEE OF HEATH VILLAGE. THE EXECUTIVE DIRECTOR SHALL HAVE FULL POWER AND AUTHORITY TO ADMINISTER THE DAILY OPERATIONS AND BUSINESS OF HEATH VILLAGE IN PERIODS BETWEEN THE REGULAR MEETINGS OF THE BOARD OF TRUSTEES. THE EXECUTIVE DIRECTOR SHALL APPOINT AND REMOVE, EMPLOY AND DISCHARGE AND RECOMMEND THE COMPENSATION OF THE EMPLOYEES OF HEATH VILLAGE, OTHER THAN THE EXECUTIVE DIRECTOR'S OWN. THE HEATH VILLAGE BOARD MAY, BEFORE THE BEGINNING OF EACH FISCAL YEAR RECOMMEND A CAPITAL BUDGET TO THE FINANCE AND CORPORATE DEVELOPMENT COMMITTEE OF HEATH ALLIANCE. SUCH BUDGET, WHEN ADOPTED BY THE BOARD OF TRUSTEES OF HEATH ALLIANCE UNTIL AND AS AMENDED, SHALL LIMIT HEATH VILLAGE'S POWERS OTHERWISE EXISTING TO DISBURSE FUNDS AND TO CONTRACT TO DISBURSE FUNDS. THE BOARD SHALL REVIEW, ON AN ANNUAL BASIS, ALL CONSULTING CONTRACTS OR AGREEMENTS PERTAINING TO THE AFFAIRS OF HEATH VILLAGE AND PRESENT ITS FINDINGS TO THE APPROPRIATE COMMITTEE OF HEATH ALLIANCE WITH RECOMMENDATIONS TO RENEW OR NOT TO RENEW EXISTING CONTRACTS OR AGREEMENTS. ANY NEW CONTRACT OR AGREEMENT ENTERED INTO BY HEATH VILLAGE SHALL BE PRESENTED TO THE PROPER COMMITTEE OF HEATH ALLIANCE FOR RECOMMENDATION FOR APPROVAL OR DISAPPROVAL. HOWEVER, SHOULD HEATH VILLAGE BOARD OF TRUSTEES CONSIDER THE LEGAL ASPECTS OF SUCH A NATURE IN A GIVEN SITUATION THAT INVOLVES MORE THAN ROUTINE MATTERS, THE MATTER SHALL BE REFERRED TO THE BOARD OF TRUSTEES OF HEATH ALLIANCE FOR FURTHER LEGAL ACTION TO BE TAKEN IN CONJUNCTION WITH LEGAL COUNSEL. THE RECOMMENDATION OF HEATH ALLIANCE SHALL BE PRESENTED TO THE BOARD OF TRUSTEES OF HEATH VILLAGE FOR DISCUSSION AND APPROVAL. IF, FOR ANY REASON, THE HEATH VILLAGE BOARD OF TRUSTEES DOES NOT ACT, ITS DUTIES MAY BE PERFORMED BY THE HEATH ALLIANCE BOARD OR BY AN APPROPRIATE COMMITTEE OF HEATH ALLIANCE, AS DETERMINED BY THE HEATH ALLIANCE BOARD. HEATH ALLIANCE HAS AUTHORITY TO APPROVE THE FOLLOWING WITH RESPECT TO RESIDENT SERVICES: POLICY DEVELOPMENT FOR PROGRAMS AND SERVICES, GUIDELINES FOR RECOGNIZING CONTRIBUTIONS OF HEATH VILLAGE, AND ANY MAJOR CHANGES AND/OR NEW POLICY RECOMMENDATIONS INCLUDING RECOMMENDATIONS OF BYLAW CHANGES. ALL AMENDMENTS TO THE HEATH VILLAGE BYLAWS AND/OR CERTIFICATE OF INCORPORATION ARE SUBJECT TO APPROVAL BY THE BOARD OF TRUSTEES OF HEATH ALLIANCE. HEATH ALLIANCE HAS THE AUTHORITY TO APPROVE THE FOLLOWING WITH RESPECT TO FACILITIES: CHANGES, ADDITIONS, ALTERNATIONS AND EXPENDITURES THAT SHOULD BE MADE TO MAINTAIN THE HEATH VILLAGE PROPERTY IN GOOD CONDITION, EXPANSION OF THE FACILITIES, AND THE FINAL FORMULATION OF MASTER PLAN FOR HEATH VILLAGE. AS SOLE MEMBER OF HEATH VILLAGE, HEATH ALLIANCE HAS ALL THE RIGHTS OF VOTING MEMBERS, AS PROVIDED IN THE NEW JERSEY NONPROFIT CORPORATION ACT. IN ADDITION, PURSUANT TO N.J.S.A. 15A:5-19(B) AND NOTWITHSTANDING ANY STATEMENT TO THE CONTRARY CONTAINED IN THE BYLAWS, THE FOLLOWING MANAGEMENT POWERS OF THE BOARD OF TRUSTEES SHALL BE EXERCISED BY HEATH ALLIANCE FOR CARE AS THE SOLE MEMBER OF THE CORPORATION, EXCEPT TO THE EXTENT SUCH MANAGEMENT POWERS ARE FROM TIME TO TIME DELEGATED BY THE MEMBER TO THE BOARD OF TRUSTEES OF HEATH VILLAGE: A. ADOPTION AND AMENDMENT OF THE CORPORATION'S CERTIFICATE OF INCORPORATION AND/OR BYLAWS; B. ELECTION OF THE CORPORATION'S TRUSTEES; APPROVAL OF REMOVAL OF THE CORPORATION'S TRUSTEES AND/OR OFFICERS BY THE CORPORATION'S BOARD OF TRUSTEES; AND REMOVAL OF THE CORPORATION'S TRUSTEES AND/OR OFFICER WITH OR WITHOUT CAUSE; C. APPROVAL AND MONITORING OF THE CORPORATION'S ANNUAL OPERATING AND CAPITAL BUDGETS; D. APPROVAL OF ANY EXPENDITURE OR INCURRENCE OF INDEBTEDNESS (NOT INCLUDED IN THE CORPORATION'S ANNUAL OPERATING OR CAPITAL BUDGETS) IN EXCESS OF $250,000 (INDIVIDUALLY OR IN THE AGGREGATE); AND E. APPROVAL OF THE CORPORATION'S LONG-RANGE PLANS. HEATH ALLIANCE SHALL DETERMINE THE DATE OF THE ANNUAL MEETING OF HEATH VILLAGE'S BOARD OF TRUSTEES. HEATH ALLIANCE FOR CARE, AS SOLE MEMBER, MUST ALSO APPROVE DISTRIBUTION OF ANY REMAINING ASSETS OF THE CORPORATION IN THE EVENT OF A LIQUIDATION, DISSOLUTION, TERMINATION OR WINDING UP OF HEATH VILLAGE. FORM 990, PART VI, SECTION B, LINE 11B THE SENIOR ACCOUNTANT, CFO, AND CEO REVIEW THE FORM PRIOR TO FILING. THE HEATH ALLIANCE FOR CARE FINANCE AND CORPORATE DEVELOPMENT COMMITTEE REVIEWS THE FORM AT A BOARD MEETING. THEN THE FINAL FORM IS DISTRIBUTED TO ALL MEMBERS OF THE HEATH VILLAGE BOARD PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C ALL BOARD MEMBERS AND OFFICERS ARE REQUIRED TO COMPLETE THE DISCLOSURE OF POSSIBLE CONFLICT OF INTEREST FORM ON AN ANNUAL BASIS. THE NOMINATING AND CORPORATE GOVERNANCE COMMITTEE IS RESPONSIBLE FOR DISTRIBUTING, COLLECTING AND REVIEWING ALL DISCLOSURE STATEMENTS ON AN ANNUAL BASIS. BOARD MEMBERS ARE REQUIRED TO REFRAIN FROM DISCUSSING, AS WELL AS VOTING ON, SUCH MATTERS IN WHICH A CONFLICT OF INTEREST EXISTS. IN SOME INSTANCES, THE INDIVIDUAL HAS BEEN RESPECTFULLY ASKED TO RESIGN FROM THEIR POSITION ON THE BOARD AS A RESULT OF A DISCLOSED CONFLICT. IN INSTANCES WHERE A CONFLICT OR POTENTIAL CONFLICT OF INTEREST EXISTS, THE BOARD OF TRUSTEES MUST DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED TRUSTEES PRESENT, THAT THE TRANSACTION OR ARRANGEMENT IS IN THE ORGANIZATION'S BEST INTEREST AND FOR ITS OWN BENEFIT, IS FAIR AND REASONABLE TO THE ORGANIZATION, AND THAT THE ORGANIZATION CANNOT OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT WITH REASONABLE EFFORTS. THE CEO ALSO REVIEWS THE COMPLETED FORMS AND RETAINS A FILE OF COMPLETED FORMS AFTER THE PROCESS OF COLLECTING AND REVIEWING THEM IS COMPLETED EACH YEAR. FORM 990, PART VI, SECTION B, LINE 15A THE CEO'S COMPENSATION IS DETERMINED AS FOLLOWS PER AN EXECUTED EMPLOYMENT AGREEMENT: "EMPLOYEE'S BASE SALARY IN EACH SUBSEQUENT YEAR OF THE PERIOD OF EMPLOYMENT SHALL BE REASONABLY ADJUSTED AND THE REASONABILITY OF SUCH ADJUSTMENT SHALL BE MADE WITH REFERENCE TO THE ANNUAL COMPENSATION SURVEYS PRODUCED BY THE AMERICAN ASSOCIATION OF HOMES AND SERVICES FOR THE AGING AND THE NEW JERSEY HOSPITAL ASSOCIATION FOR LIKE ORGANIZATIONS IN THE NORTHERN NEW JERSEY AREA, AND SUCH OTHER RELEVANT SALARY SURVEYS THAT MAY BE AVAILABLE FROM TIME TO TIME FROM OTHER INDEPENDENT INDUSTRY AND PROFESSIONAL ORGANIZATIONS. UPON CONSIDERATION OF RELEVANT SALARY DATA OF EMPLOYEES PERFORMING SERVICES COMMENSURATE WITH THOSE PERFORMED BY EMPLOYEE AND THE PERCENTAGE INCREASE GIVEN TO VILLAGE MANAGEMENT, THE PERSONNEL AND POLICY COMMITTEE, OR ANY SUCCESSOR COMMITTEE OF THE ALLIANCE BOARD, IN ITS SOLE DISCRETION, SUBJECT TO APPROVAL BY THE ALLIANCE BOARD, MAY ADJUST SUCH BASE SALARY INCREASES." IN ADDITION, HIS INCENTIVE BONUS IS ALSO COMPARED IN THE SAME MANNER. THE DIRECTOR OF HUMAN RESOURCES ALSO PROVIDES THE BOARD WITH INFORMATION FOR SIMILAR FACILITIES FROM GUIDESTAR. THIS WAS LAST PROVIDED TO THE BOARD ON 6/3/20 FOR THE CEO'S LAST ANNUAL REVIEW COMPLETED AT A BOARD MEETING ON 6/22/20. THIS COMPENSATION DETERMINATION PROCESS IS DOCUMENTED IN THE BOARD MINUTES. NO OTHER EMPLOYEE'S COMPENSATION IS DETERMINED IN THIS MANNER. THE COMPENSATION FOR THE COO AND CFO ARE BOTH DETERMINED BY THE CEO UPON HIRE. RAISES ARE AWARDED AT THE CEO'S DISCRETION UPON COMPLETION OF THEIR ANNUAL PERFORMANCE REVIEW. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN FAIR VALUE OF DERIVATIVE FINANCIAL INSTRUMENTS -4,883,930. HEATH ALLIANCE FOR CARE INC 422 SCHOOLEYS MOUNTAIN ROAD HACKETTSTOWN NJ 07840 223395211 SUPPORTING ORGANIZATION NJ 501(C)(3) LINE 12B, II N/A 0 THE HOUSE OF THE HOLY COMFORTER 33 MT PLEASANT AVE WEST ORANGE NJ 07052 221487578 RESIDENTIAL/ASSISTED LIVING HEALTH CARE FACILITY NJ 501(C)(3) LINE 10 HEATH ALLIANCE FOR CARE INC 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0