2021-05-04T13:33:59-05:00 2020-09-30 910189318 MOSS ADAMS LLP 10960 WILSHIRE BLVD SUITE 1100 LOS ANGELES CA 90024 990 2019-10-01 952047121 CONGREGATIONAL HOMES INC CONG 9096245061 900 E HARRISON AVE POMONA CA 91767 MAUREEN BEITH PRESIDENT/CEO 9096245061 2021-05-03 1 LAUREN A HAVERLOCK P00545829 3104770450 2021-05-03 2019 2022-09-23 18:48:47Z MT SAN ANTONIO GARDENS MAUREEN BEITH 900 E HARRISON AVE POMONA CA 91767 48181141 0 X WWW.MSAGARDENS.ORG X 1957 CA THE MISSION OF CONGREGATIONAL HOMES, INC. IS TO HELP ENSURE A HIGH QUALITY OF LIFE FOR OLDER ADULTS BY PROVIDING COMPREHENSIVE AND SECURE SERVICES THAT PROMOTE WELLNESS, INDEPENDENCE, PARTICIPATION AND DIGNITY. 29 28 461 100 0 0 850296 1716813 28002482 28036186 1176116 1168119 182582 240967 30211476 31162085 387691 388266 0 0 16673760 17560894 0 0 0 13052106 13786946 30113557 31736106 97919 -574021 118054112 121754742 77304544 79568271 40749568 42186471 X THE MISSION OF CONGREGATIONAL HOMES, INC IS TO HELP ENSURE A HIGH QUALITY OF LIFE FOR OLDER ADULTS BY PROVIDING COMPREHENSIVE AND SECURE SERVICES THAT PROMOTE WELLNESS, INDEPENDENCE, PARTICIPATION AND DIGNITY.MT. SAN ANTONIO GARDENS, FONDLY KNOWN AS "THE GARDENS", IS A NATIONALLY RECOGNIZED LIFE CARE COMMUNITY IN SOUTHERN CALIFORNIA THAT OFFERS THE IDEAL BASE FROM WHICH TO LAUNCH NEW ADVENTURES AND ENJOY THE RICHNESS OF LIFE OWING MUCH OF ITS APPEAL TO THE DIVERSITY AND HARMONY OF ITS RESIDENTS WHO SHARE AN INTEREST IN PURSUING AN ENGAGED, VIBRANT LIFESTYLE. 0 0 17448434 388266 23956990 RESIDENTIAL SERVICES - MSAG PROVIDES INDEPENDENT AND ASSISTED LIVING SENIOR SERVICES TO RESIDENTS FOR A STATED MONTHLY FEE. MSAG RECOGNIZES REVENUE FOR SENIOR LIVING SERVICES UNDER THE RESIDENTIAL SERVICES AGREEMENT FOR INDEPENDENT LIVING AND ASSISTED LIVING IN ACCORDANCE WITH THE PROVISION OF ASC 840. TOTAL RESIDENT DAYS THIS YEAR AMOUNTED TO 137,467 DAYS IN INDEPENDENT LIVING AND 24,066 DAYS IN ASSISTED LIVING. WE AVERAGED 376 INDEPENDENT LIVING RESIDENTS AND 66 ASSISTED LIVING RESIDENTS PER DAY. THE MSAG CAMPUS COVERS OVER 30 ACRES AND ALL BUILDINGS (83) ARE MAINTAINED TO FIT THE SPECIAL NEEDS OF THE SENIOR POPULATION THAT LIVE HERE. MSAG WAS BUILT IN 1959-1961 WITH MANY RENOVATIONS OVER THE YEARS TO KEEP A MODERN, YET SAFE AND COMFORTABLE, FEEL FOR SENIOR LIVING.THE NEWEST, COMPLETED RENOVATION WAS IN ASSISTED LIVING FOR MEMORY CARE RESIDENTS, WHICH OPENED IN MAY 2016. MSAG BEGAN THE CONSTRUCTION OF A NEW WELLNESS CENTER IN JANUARY 2021. MSAG'S CLINIC AND HOME HEALTH DEPARTMENTS TRANSPORT RESIDENTS TO THEIR DOCTOR APPOINTMENTS AND PROVIDE HEALTH AND ASSISTANCE IN EACH OF OUR SENIOR'S HOMES. 9453941 0 4079196 MSAG PROVIDES SKILLED NURSING CARE REPORTED AS PATIENT SERVICE REVENUE. THESE AMOUNTS ARE DUE FROM PATIENTS, THIRD-PARTY PAYERS, AND OTHERS, NET OF CONTRACTUAL ALLOWANCES FOR MEDICARE, AND OTHER PROGRAMS. MSAG PROVIDED MEDICAL CARE AND OUTPATIENT SERVICES TO OUR AGED POPULATION AND 15 SENIORS IN THE COMMUNITY. TOTAL PATIENT DAYS THIS YEAR AMOUNTED TO 22,109 INCLUDING 5,464 DAYS FOR COMMUNITY PATIENTS. 21,358 OF THE TOTAL DAYS WERE FOR CUSTODIAL CARE WHICH IS NOT REIMBURSED BY MEDICARE OR HEALTH INSURANCE COMPANIES. WE AVERAGED 60 SENIOR PATIENTS IN OUR SKILLED NURSING FACILITY PER DAY. SKILLED NURSING IS COMPRISED OF TWO LOCATIONS ON CAMPUS, THE NEWEST OF WHICH ARE THE EVERGREEN VILLAS WHICH OPENED DURING FISCAL YEAR 2014. 26902375 1 1 0 0 0 0 0 1 0 1 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 67 0 1 461 1 0 0 0 0 0 0 0 0 0 0 0 0 X 29 28 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X PATRICIA L WILLIAMS 9096245061 900 E HARRISON AVE POMONA CA 91767 MAUREEN BEITH PRESIDENT & CEO 40.00 X 228572 0 26807 PATRICIA WILLIAMS CFO 40.00 X 167544 0 24915 LISA ATILANO VP HEALTH CARE SERVICES 40.00 X 145951 0 8686 NORMA DERAS COMPENSATION & BENEFITS AD 40.00 X 107215 0 12917 LINNETTE GUIDERA HUMAN RESOURCES 40.00 X 100351 0 16000 JUSTINE KIM DIRECTOR OF NURSING 40.00 X 114564 0 3955 WILLIAM LEVITT DIRECTOR OF FACILITIES & GROUNDS 40.00 X 104923 0 12531 AMY FABELA IT MANAGER & RESIDENT BENEFITS 40.00 X 103840 0 10384 TIM DAUWALDER DO DIRECTOR 1.00 X 10350 0 0 LOUISE TAYLOR BOARD CHAIRPERSON 3.00 X X 0 0 0 ROBIN ASPINALL 1ST VICE CHAIRPERSON 2.00 X X 0 0 0 JANE GOODFELLOW SECRETARY 2.00 X X 0 0 0 HENRY FORD MEMBER AT LARGE 1.00 X X 0 0 0 TOMAS SANDOVAL MEMBER AT LARGE 1.00 X X 0 0 0 DENNIS SMITH MEMBER AT LARGE 1.00 X X 0 0 0 ARLENE ANDREW DIRECTOR 1.00 X 0 0 0 TOM BEAL DIRECTOR 1.00 X 0 0 0 JO ANN CALMELAT DIRECTOR 1.00 X 0 0 0 CHARLES CARPENTER DIRECTOR 1.00 X 0 0 0 BETSY CRIGHTON DIRECTOR 1.00 X 0 0 0 MICHAEL DAVIS DIRECTOR 2.00 X 0 0 0 NEIL GERARD DIRECTOR 1.00 X 0 0 0 BECCA KURTZ DIRECTOR 1.00 X 0 0 0 JIM LIKENS DIRECTOR 1.00 X 0 0 0 CARLENE MILLER DIRECTOR 2.00 X 0 0 0 SHERI NAGEL DIRECTOR 2.00 X 0 0 0 LESLIE NEGRITTO DIRECTOR 1.00 X 0 0 0 JAY O'NEAL DIRECTOR 1.00 X 0 0 0 BOB ROGERS DIRECTOR 1.00 X 0 0 0 JIM SPERA DIRECTOR 2.00 X 0 0 0 JEFF STARK DIRECTOR 1.00 X 0 0 0 CINDY SULLIVAN DIRECTOR 1.00 X 0 0 0 JIM TRANQUADA DIRECTOR 2.00 X 0 0 0 KIMBERLEY VALENTINE DIRECTOR 2.00 X 0 0 0 WILLIAM WELLS DIRECTOR 1.00 X 0 0 0 PETER YAO DIRECTOR 1.00 X 0 0 0 CONRAD MAAS DIRECTOR 1.00 X 0 0 0 JOAN ANDERSON DYM DIRECTOR (THRU 12/19) 1.00 X 0 0 0 JIM LEHMAN DIRECTOR (THRU 12/19) 1.00 X 0 0 0 OTTO SOLORZANO DIRECTOR (THRU 12/19) 1.00 X 0 0 0 ROYCE STUTZMAN DIRECTOR (THRU 12/19) 1.00 X 0 0 0 JOE UNIS MD DIRECTOR (THRU 12/19) 1.00 X 0 0 0 BILL WELLS DIRECTOR (THRU 12/19) 1.00 X 0 0 0 NORMA WILSON DIRECTOR (THRU 12/19) 1.00 X 0 0 0 1083310 0 116195 9 0 1 0 DRISKO STUDIO ARCHITECTS INC 1130 SOUTH FLOWER ST SUITE 213 LOS ANGELES CA 90015 ARCHITECT 373792 JACKMAN TILE 14994 FIR STREET HESPERIA CA 92345 CONSTRUCTION 310220 IMAGE DESIGN CONSTRUCTION 1753 N 2ND AVE UPLAND CA 91784 CONSTRUCTION 253475 ISN GLOBAL ENTERPRISES INC PO BOX 1391 CLAREMONT CA 917111391 COMPUTER SERVICES 226063 REDLINE AIR INC 5728 WACO STREET CHINO CA 91710 HVAC 135820 10 709527 1007286 158663 1716813 CARE AND SERVICE FEES 623000 20582056 20582056 AMORT OF ADVANCE FEES 623000 4755776 4755776 NON RESIDENT HLTH SRVCS/ASSISTED 623000 2080055 2080055 OTHER SRVCS-RESIDENT/NON-RESIDENT 623000 385409 385409 HMO/MEDICARE INSURANCE 623000 232890 232890 28036186 953203 953203 31410 0 31410 31410 31410 17222472 11500 17016756 2300 205716 9200 214916 214916 FOOD SERVICES 623000 163890 163890 OTHER INCOME 623000 45667 45667 209557 31162085 28036186 0 1409086 X 388266 388266 622848 175331 447517 13235697 11466337 1769360 625626 509167 116459 2048485 1839797 208688 1028238 874229 154009 285126 285126 88719 88719 122970 122970 3615193 2997091 618102 212990 16334 196656 1075597 669596 406001 120203 115664 4539 3025095 2992254 32841 54148 43078 11070 21225 17526 3699 3967057 3891783 75274 177717 175758 1959 MED SUPPLIES/EQUIPMENT 566726 494116 72610 OTHER EXPENSES 230392 97075 133317 OTHER EMPLOYEE EXPENSES 143298 58483 84815 PHARMACEUTICALS 80490 80490 31736106 26902375 4833731 0 5514827 1405253 2571692 1359431 1701640 1003845 74863 306524 395317 470350 108972180 58829378 50604875 50142802 39508507 53220919 17682391 13845618 118054112 121754742 2030672 2596570 37426352 36750622 36283918 35985142 1563602 4235937 77304544 79568271 X 28051333 28665972 12698235 13520499 40749568 42186471 118054112 121754742 X -574021 2021270 -10346 X 0 1 X 1 0 X 831136 572889 912691 850296 1716813 4883825 23326905 26645037 27702946 28002482 28036186 133713556 2918554 170337 179783 183108 163890 3615672 27076595 27388263 28795420 29035886 29916889 142213053 320417 244608 372763 321020 259272 1518080 0 320417 244608 372763 321020 259272 1518080 140694973 875858 952489 1010774 1148794 984613 4972528 875858 952489 1010774 1148794 984613 4972528 -74036 45667 -28369 27952453 28340752 29806194 30110644 30947169 147157212 0.95610 0.95530 0.03380 0.03450 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2018 AMOUNT: $ -74,036. 2019 AMOUNT: $ 45,667. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 68583 0 0 X ENJOYMENT OF RESIDENTS 0 17726508 59589 1813990 657350 801 18941936 17640548 58457 717582 689499 580 17726508 16814780 312150 1125259 611061 580 17640548 15470485 443654 1573617 672596 380 16814780 14562377 49119 1523872 664503 380 15470485 0.49200 0.37040 0.13760 0 0 2195371 2195371 83544587 45598611 37945976 6160799 3490623 2670176 17071423 9740144 7331279 50142802 DUE FROM RESTRICTED FUNDS 176 ASSETS LIMITED TO USE 13845442 13845618 REFUNDABLE DEPOSITS 154883 SPLIT-INTEREST AGREEMENTS 433494 ASSET RETIREMENT OBLIGATION 121804 WORKERS' COMPENSATION LIABILITY 469239 PAYROLL PROTECTION PROGRAM LOAN 3056517 4235937 X 32661773 2021270 -398612 1622658 31039115 122970 122970 31162085 31224870 0 31224870 122970 388266 511236 31736106 PART III, LINE 4: FROM TIME TO TIME, MSAG RECEIVES DONATED WORKS OF ART WHICH ARE DISPLAYED AT THE FACILITY TO ENHANCE THE EXPERIENCE OF OUR RESIDENTS AND FAMILIES DURING THEIR VISIT. PART V, LINE 4: TO GENERATE INCOME TO OFFSET OPERATING EXPENSES AND PROVIDE A SAVINGS ACCOUNT WITH A LONG-TERM INVESTMENT STRATEGY. PART X, LINE 2: MSAG HAS EVALUATED ITS TAX POSITIONS AND THE CERTAINTY AS TO WHETHER THOSE POSITIONS WILL BE SUSTAINED IN THE EVENT OF AN AUDIT BY TAXING AUTHORITIES AT THE FEDERAL AND STATE LEVELS. THE PRIMARY TAX POSITIONS EVALUATED ARE RELATED TO MSAG'S CONTINUED QUALIFICATION AS A TAX-EXEMPT ORGANIZATION AND WHETHER THERE IS UNRELATED BUSINESS INCOME ACTIVITIES CONDUCTED THAT WOULD BE TAXABLE. MANAGEMENT HAS DETERMINED THAT ALL INCOME TAX POSITIONS ARE MORE LIKELY THAN NOT (>50%) OF BEING SUSTAINED UPON POTENTIAL AUDIT OR EXAMINATION; THEREFORE, NO DISCLOSURES OF UNCERTAIN INCOME TAX POSITIONS ARE REQUIRED. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN ACTUARIAL VALUE OF SPLIT-INTERST AGREEMENTS -10,346. RECLASSIFICATION OF RESIDENT ASSISTANCE FROM REVENUE TO EXPENSES -388,266. PART XII, LINE 4B - OTHER ADJUSTMENTS: RECLASSIFICATION OF RESIDENT ASSISTANCE FROM REVENUE TO EXPENSES 388,266. 1 CARE AND SERVICE FEE ASSISTANCE FROM HOMESHIP FUND 15 388266 PART I, LINE 2: IF A RESIDENT IS UNABLE TO AFFORD HIS/HER MONTHLY CARE FEES, HE/SHE MAY REQUEST FINANCIAL ASSISTANCE FROM MT. SAN ANTONIO GARDENS. THE RESIDENT COMPLETES AN APPLICATION FOR ASSISTANCE AND MEETS WITH THE CFO TO REVIEW HIS/HER FINANCIAL RESOURCES. THE CFO AND CEO REVIEW AND APPROVE ANY APPLICATIONS FOR ASSISTANCE. THE FUNDS ARE CREDITED TO THE RESIDENT'S INTERNAL ACCOUNTS TO REDUCE THE COST FOR THEIR MONTHLY CARE AND SERVICES. MT. SAN ANTONIO GARDENS GRANTED FUNDS TO COMMUNITY SENIOR SERVICES TO ASSIST WITH EXPENSES FOR SENIOR SERVICES. MT. SAN ANTONIO GARDENS MEETS WITH COMMUNITY SENIOR SERVICES TO DISCUSS THE USE OF THE FUNDS FOR SERVICES TO SENIORS. A MUTUAL AGREEMENT AMOUNT THE TWO ORGANIZATIONS IS THAT THE FUNDS ARE USED TO SERVE SENIORS. X X X X 0 0 0 0 0 0 0 0 0 MAUREEN BEITH PRESIDENT & CEO 228572 0 0 0 0 0 23057 0 3750 0 255379 0 0 0 PATRICIA WILLIAMS CFO 167544 0 0 0 0 0 17545 0 7370 0 192459 0 0 0 LISA ATILANO VP HEALTH CARE SERVICES 145951 0 0 0 0 0 8686 0 0 0 154637 0 0 0 A CALIFORNIA MUNICIPAL FINANCE AUTHORITY 201563466 13049RBG0 2019-07-10 36283918 SEE PART VI 0 0 0 A 36283918 19183240 273769 725678 2281687 16375000 19183240 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 1 0 0 1 0 0 0 1 A 1 SCHEDULE K, ROW A, PART I, COLUMN (F): THE PROCEEDS OF THE BONDS WERE USED TO REFINANCE ALL OF THE OUTSTANDING SERIES 2010 BONDS, REIMBURSE MSAG FOR THE PAYMENT OF PRIOR EXPENDITURES FOR PLANNING THE WELNESS/INDEPENDENT LIVING EXPANSION PROJECT, FINANCE CONSTRUCTION, IMPROVEMENT, RENOVATION, AND EQUIPPING OF THE CAMPUS, PAY A PORTION OF THE INTEREST ON THE 2019 BONDS DURING THE CONSTRUCTION OF DESCRIBED PROJECTS, AND PAY CERTAIN COSTS OF ISSUANCE OF THE BONDS. X 1 1995 FMV X BLDG IMPRMTS 28 156668 FAIR MARKET VALUE 0 0 1 0 PART I, COLUMN (B): THE AMOUNT REPORTED IN PART I COLUMN (B) REPRESENTS THE NUMBER OF DONORS. FORM 990, PART VI, SECTION A, LINE 6 CONGREGATIONAL HOMES, INC. HAS ONE CLASS OF MEMBERS. THE CORPORATION CONSISTS OF AT LEAST 59 CORPORATE MEMBERS. THE CORPORATE MEMBERS CONSIST OF ELECTED MEMBERS OF THE BOARD OF DIRECTORS AND ELECTED MEMBERS AT LARGE. FORM 990, PART VI, SECTION A, LINE 7A CONGREGATIONAL HOMES, INC. HAS AT LEAST 59 CORPORATE MEMBERS WHO ELECT AND APPOINT THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS CONSIST OF NO LESS THAN 25 DIRECTORS AND NO MORE THAN 35 DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B GOVERNANCE DECISIONS ARE APPROVED BY CORPORATE MEMBERS OF WHICH CONSIST OF ELECTED MEMBERS OF THE BOARD OF DIRECTORS AND MEMBERS AT LARGE. THE BOARD OF DIRECTORS NOMINATING COMMITTEE DEVELOPS A SLATE OF NOMINEES FOR INCOMING MEMBERS OF THE CORPORATION, INCOMING DIRECTORS, OFFICERS OF THE CORPORATION, AND PERSONS TO FILL VACANCIES OCCURRING IN THE CORPORATION AND BOARD OF DIRECTORS EXCEPT UNDER CERTAIN CIRCUMSTANCES (E.G. DEATH, RESIGNATION, REMOVAL OF DIRECTOR, OR WHEN NUMBER OF DIRECTORS APPROVED IS INCREASED). NOMINEES ARE PRESENTED TO AND ELECTED BY MEMBERS OF THE CORPORATION. MEMBERS OF THE CORPORATION ALSO HAVE THE ABILITY TO CALL FOR THE REMOVAL OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B THE TAX RETURNS ARE FIRST SUBMITTED TO THE AUDIT COMMITTEE WHEN A DRAFT IS AVAILABLE, BUT PRIOR TO ITS IRS DUE DATE OR EXTENDED DUE DATE. QUESTIONS ARE DIRECTED TO THE CFO OR CEO. ONCE ACCEPTED BY THE AUDIT COMMITTEE, THE FORM 990 WILL BE PROVIDED TO ALL BOARD MEMBERS FOR THEIR REVIEW AND APPROVAL. FORM 990, PART VI, SECTION B, LINE 12C THE CEO'S SECRETARY DISTRIBUTES THE FORMS AT THE START OF EACH CALENDAR YEAR. SHE IS RESPONSIBLE FOR ENSURING THAT ALL ARE RETURNED. THE COMPLETED FORMS ARE THEN REVIEWED BY THE CHAIRMAN AND SECRETARY OF THE BOARD OF DIRECTORS. IT IS THE RESPONSIBILITY OF EACH DIRECTOR TO IDENTIFY WHEN POTENTIAL CONFLICTS OF INTEREST MAY OCCUR DURING BOARD PROCEEDINGS. THE CHAIRMAN AND THE SECRETARY MAY FIND IT NECESSARY TO REMIND INDIVIDUAL MEMBERS OF POTENTIAL CONFLICTS, AS NECESSARY. IN THE EVENT A POTENTIAL CONFLICT ARISES THE CHAIRMAN DECIDES IF THE INDIVIDUAL MEMBER SHOULD RECUSE HIM OR HERSELF FROM THE DISCUSSION AND/OR VOTE. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMMITTEE SERVES AS THE MANAGEMENT COMPENSATION COMMITTEE. SALARY ADJUSTMENTS ARE BASED ON GENERAL SALARY ADJUSTMENTS FOR ALL EMPLOYEES, POSITION IN THE MARKET, INDIVIDUAL PERFORMANCE AND VALUE TO THE ORGANIZATION. COMPETITIVE SALARY REVIEWS ARE CONDUCTED ON A PERIODIC BASIS USING AN INDEPENDENT COMPENSATION CONSULTANT AND FORM 990 OF OTHER ORGANIZATIONS. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE KEPT IN THE ADMINISTRATION OFFICE IN A BINDER - FOR PUBLIC REVIEW - THAT CONTAINS IRS TAX EXEMPTION LETTER, ARTICLES OF INCORPORATION, BYLAWS, CONFLICT OF INTEREST POLICY, CODE OF ETHICAL CONDUCT, AND THREE YEARS OF 990'S AND AUDITED FINANCIAL STATEMENTS. FORM 990, PART IX, LINE 11G OTHER FEES FOR SERVICES (NON-EMPLOYEES): PROGRAM SERVICE EXPENSES 2,997,091. MANAGEMENT AND GENERAL EXPENSES 618,102. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,615,193. FORM 990, PART XI, LINE 9: CHANGES IN ACTUARIAL VALUE OF SPLIT-INTEREST AGREEMENTS -10,346.