2021-06-21T18:05:56-05:00 2020-12-31 410746749 CLIFTONLARSONALLEN LLP 8390 EAST CRESCENT PARKWAY SUITE 300 GREENWOOD VILLAGE CO 80111 990 2020-01-01 742376546 SHALOM PARK SHAL 3036805000 14800 EAST BELLEVIEW DRIVE AURORA CO 800152258 MARC PENNER PRESIDENT/CEO 3036805000 2021-06-21 1 MARC PENNER 999009999 SARAH HINTZ P00492291 3037795710 2021-06-21 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z MARC PENNER 14800 EAST BELLEVIEW DRIVE AURORA CO 800152258 16998130 0 X WWW.SHALOMPARK.ORG X 1984 CO CREATING A JOYFUL COMMUNITY WHERE HONOR AND BELONGING FLOURISH. 18 17 427 28 0 0 780553 3357758 14245235 13450880 -10450 8490 133419 175252 15148757 16992380 672146 357478 0 0 8291295 9243245 0 0 150261 6817921 6913993 15781362 16514716 -632605 477664 10695212 10041097 2794956 1663177 7900256 8377920 X CREATING A JOYFUL COMMUNITY WHERE HONOR AND BELONGING FLOURISH. SHALOM PARK, AN EDEN ALTERNATIVE MILESTONE II ORGANIZATION, OPERATES A NURSING HOME FOR THE AGED. IT PROVIDES HEALTH CARE AND OTHER RELATED SERVICES TO RESIDENTS THROUGH THE OPERATION OF A MULTI-LEVEL SKILLED NURSING FACILITY. 0 0 14564405 357478 13450880 SHALOM PARK OPERATES A NURSING HOME. DURING 2020, THE ORGANIZATION PROVIDED CARE FOR 187 ELDERS. 14564405 1 1 0 0 0 0 0 0 1 1 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 54 0 1 427 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 18 17 1 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 0 0 CO X MARC PENNER 3036805000 14800 E BELLEVIEW DRIVE AURORA CO 800152258 MARC PENNER PRESIDENT/CEO 26.00 14.00 X X 319505 0 18809 RUTH MINNEMA DIRECTOR OF NURSING 40.00 0.00 X 159347 0 11732 MINDY MOSCOWITZ NURSING HOME ADMINISTRATOR 40.00 0.00 X 137474 0 12098 DENISE BILYEU DIRECTOR OF HUMAN RESOURCES 40.00 0.00 X 113659 0 11237 PREETY SHRESTHA CONTROLLER 36.00 4.00 X 105967 0 10899 NEIL OBERFELD CHAIR & DIRECTOR 10.00 1.00 X X 0 0 0 ELISA ROBYN VICE CHAIR & DIRECTOR 2.00 1.00 X X 0 0 0 ANDY HEINS PAST CHAIR 2.00 1.00 X X 0 0 0 JAN FISHER SECRETARY & DIRECTOR 2.00 1.00 X X 0 0 0 JARED SEIDENBERG TREASURER & DIRECTOR 2.00 1.00 X X 0 0 0 ROBIN CHOTIN DIRECTOR (THRU SEPTEMBER 2020) 1.00 0.00 X 0 0 0 LISA COOK DIRECTOR 1.00 1.00 X 0 0 0 LYNN GELLER DIRECTOR 1.00 0.00 X 0 0 0 SUSY GRAZI DIRECTOR 1.00 0.00 X 0 0 0 JULIE GUTMAN DIRECTOR 1.00 0.00 X 0 0 0 MARC LEVINE DIRECTOR 1.00 0.00 X 0 0 0 ANDY MILLER DIRECTOR (THRU JUNE 2020) 1.00 0.00 X 0 0 0 JAY MOSKOWITZ DIRECTOR 1.00 0.00 X 0 0 0 STUART PACK DIRECTOR 1.00 0.00 X 0 0 0 MELINDA QUIAT DIRECTOR 1.00 0.00 X 0 0 0 FRAN SIMON DIRECTOR 1.00 0.00 X 0 0 0 JJ SLATKIN DIRECTOR 1.00 0.00 X 0 0 0 ERIN YOURTZ DIRECTOR 1.00 0.00 X 0 0 0 SAM ZAITZ DIRECTOR 1.00 0.00 X 0 0 0 835952 0 64775 5 0 1 0 MORRISON MANAGEMENT SPECIALIST PO BOX 102289 ATLANTA GA 30368 DIETARY SERVICES 2113688 HAYNES MECHANICAL SYSTEMS 5700 S QUEBEC ST 210 GREENWOOD VILLAGE CO 80111 MECHANICAL MAINTENANCE 384334 PREMERE REHAB LLC 25117 SW PARKWAY SUITE D WILSONVILLE OR 97070 THERAPY SERVICES 374025 PLANTE & MORAN 8181 E TUFTS AVENUE SUITE 600 DENVER CO 80237 IT CONSULTING & SERVICES 196483 RIZE CONSTRUCTION 61 INVERNESS DRIVE EAST ENGLEWOOD CO 80112 MEANS OF EGRESS CONSTRUCTION 133104 5 50971 2322759 984028 3357758 RESIDENT FEES 623000 13346657 13346657 ANCILLARY SERVICES 623000 104223 104223 13450880 2 2 14238 5750 8488 8488 8488 MISCELLANEOUS INCOME 900099 175252 175252 175252 16992380 13450880 0 183742 X 357478 357478 626259 626259 7442345 7046454 297820 98071 531680 513839 11913 5928 642961 572398 63507 7056 35594 35594 28580 28580 2385017 2290279 94404 334 56685 25055 29093 2537 128102 102482 12810 12810 130083 50655 71485 7943 468181 380321 86504 1356 34387 15678 17122 1587 91662 73330 18332 1193219 976407 216812 359601 309916 46798 2887 PROGRAM SUPPLIES 1697438 1601110 87834 8494 REPAIRS AND MAINTENANCE 188505 156360 32145 OTHER EXPENSES 116939 92643 23038 1258 16514716 14564405 1800050 150261 729595 956254 24054 42202 10610 14468 937661 696660 258852 264367 25656586 17589440 8734440 8067146 10695212 10041097 1021058 880231 3100 72147 24054 42202 1746744 668597 2794956 1663177 X 7900256 8377920 7900256 8377920 10695212 10041097 477664 0 X X 0 1 X 1 0 X 9427314 780553 3357758 13565625 14158601 13162703 13433948 14245235 13450880 68451367 14158601 13162703 22861262 15025788 16808638 82016992 0 0 0 82016992 846 2 848 846 2 848 19298 10498 70452 202668 175252 478168 14177899 13173201 22932560 15228456 16983892 82496008 0.99420 0.99610 0.00000 0.00000 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER INCOME FUNDRAISING MISC REVENUE RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 3318718 380803 3699521 2951498 90000 277220 3318718 2898466 249998 -196966 2951498 2878912 318110 298556 2898466 2767682 125 156417 45312 2878912 0.00000 0.66520 0.33480 1 1 1 2561563 2561563 16920086 13936505 2983581 1730614 1663662 66952 4387001 1989273 2397728 57322 57322 8067146 X 16983890 -8490 -8490 16992380 0 16992380 16149250 -8488 -8488 16157738 356978 356978 16514716 PART IV, LINE 2B: SHALOM PARK HOLDS RESIDENT FUNDS IN TRUST FOR THEIR SECURITY. RESIDENTS MAY ACCESS THEIR FUNDS DURING NORMAL BUSINESS HOURS BY MAKING A REQUEST AT THE BUSINESS OFFICE. THE FUNDS ARE HELD IN A SEPARATE INTEREST-BEARING ACCOUNT. THE INTEREST IS CREDITED TO THE RESIDENTS' RESPECTIVE ACCOUNTS. PART V, LINE 4: BETH ISRAEL FOUNDATION FOR THE AGED, A RELATED ORGANIZATION, HOLDS ASSETS IN ENDOWMENT FUNDS. THE ENDOWMENTS CONSIST OF VARIOUS INDIVIDUAL FUNDS ESTABLISHED FOR A VARIETY OF PURPOSES. PART X, LINE 2: SHALOM PARK IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND A SIMILAR PROVISION FOR STATE LAW. HOWEVER, SHALOM PARK IS SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS. PART XI, LINE 2D - OTHER ADJUSTMENTS: GAIN ON DISPOSAL OF FIXED ASSETS -8,488. ROUNDING ADJUSTMENT -2. PART XII, LINE 2D - OTHER ADJUSTMENTS: GAIN ON DISPOSAL OF FIXED ASSETS -8,488. PART XII, LINE 4B - OTHER ADJUSTMENTS: TRANSFERS TO RELATED ORGANIZATIONS 356,978. 1 BETH ISRAEL FOUNDATION FOR THE AGED 14800 EAST BELLEVIEW DRIVE AURORA CO 80015 742195249 501(C)(3) 356978 N/A N/A GENERAL OPERATING SUPPORT 1 0 PART I, LINE 2: THE ONLY SIGNIFICANT GRANT WAS A TRANSFER TO A RELATED ORGANIZATION. PROPER USE OF THE FUNDS WAS ENSURED THROUGH COMMON BOARD MANAGEMENT OVERSIGHT BETWEEN THE TWO ORGANIZATIONS. X X X 0 0 0 0 0 0 0 0 0 MARC PENNER PRESIDENT/CEO 310205 0 9300 0 0 0 0 0 18809 0 338314 0 0 0 RUTH MINNEMA DIRECTOR OF NURSING 153847 0 5500 0 0 0 0 0 11732 0 171079 0 0 0 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE IS COMPOSED OF THE CURRENT OFFICERS, THE PAST CHAIR(S) AND SUCH OTHER MEMBERS AS ARE APPOINTED BY THE CHAIR. THE EXECUTIVE COMMITTEE MAY ACT ON BEHALF OF AND IN PLACE OF THE BOARD BETWEEN REGULAR MEETINGS OF THE BOARD WHEN REASONABLY NECESSARY TO FULFILL THE PURPOSES AND DUTIES OF THE BOARD, AS DETERMINED BY THE CHAIR, AND IS RESPONSIBLE FOR MAKING RECOMMENDATIONS TO THE BOARD OF TRUSTEES AND FOR SUCH OTHER POWERS AS THE BOARD FROM TIME TO TIME MAY PRESCRIBE. ACTIONS OF THE EXECUTIVE COMMITTEE MAY BE OVERRULED OR AMENDED BY LATER ACTION OF THE BOARD, BUT ANY ACTION PROPERLY TAKEN BY THE EXECUTIVE COMMITTEE SHALL BE BINDING UPON THE ORGANIZATION UNTIL SUCH LATER ACTION OF THE BOARD. FORM 990, PART VI, SECTION A, LINE 2 SAM ZAITZ AND LISA COOK HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 8B THE FINANCE COMMITTEE AND EXECUTIVE COMMITTEE DO NOT KEEP MINUTES OF THEIR MEETINGS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY THE INDEPENDENT CPA FIRM WITH INFORMATION PROVIDED BY MANAGEMENT . WHEN PREPARATION IS COMPLETED AND A DRAFT IS AVAILABLE THE CONTROLLER AND CEO REVIEWED THE FORM 990, AFTER WHICH THE FINANCE COMMITTEE REVIEWED AND APPROVED THE FORM 990. THE RETURN WAS THEN PROVIDED TO THE BOARD OF DIRECTORS FOR REVIEW PRIOR TO IT BEING FILED. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY THROUGH AN ANNUAL AFFIRMATION SIGNED BY EACH TRUSTEE. THE ORGANIZATION MONITORS COMPLIANCE WITH THE POLICY DURING THE YEAR BY INQUIRING AT ITS BOARD MEETINGS WHETHER ANY CONFLICTS OF INTEREST HAVE ARISEN SINCE THE ANNUAL AFFIRMATION WAS SIGNED. AN INDIVIDUAL WITH A CONFLICT MAY NOT VOTE ON ANY MATTER THAT MAY INVOLVE THE CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15A THE CHAIR OF THE BOARD OF DIRECTORS AND THE EXECUTIVE COMMITTEE ACTS AS THE COMPENSATION COMMITTEE FOR THE BOARD. THE COMPENSATION COMMITTEE CONSIDERS SEVERAL FACTORS, SUCH AS THE COMPLEXITY AND DIVERSITY OF RESPONSIBILITIES OF THE CEO'S POSITION (REGULATORY, FINANCIAL, OPERATIONS, QUALITY, COMMUNITY RELATIONS, FOUNDATION DEVELOPMENT, ETC.), SOCIAL SECURITY ADMINISTRATION COST OF LIVING ADJUSTMENT, THE ASSOCIATION OF JEWISH AGING SERVICE COMPENSATION SURVEY, AND THE CONTINUOUS EMPLOYMENT AGREEMENT BETWEEN THE ORGANIZATION AND THE CEO. BASED UPON THESE FACTORS, A MUTALLY AGREEABLE COMPENSATION AMOUNT IS DETERMINED BY THE COMPENSATION COMMITTEE AND THE CEO. THE ORGANIZATION MAINTAINS THE APPROPRIATE DOCUMENTATION OF THE PROCESS THROUGH WHICH THE COMPENSATION AMOUNT WAS SET. THIS COMPENSATION-SETTING PROCESS IS DONE ON AN ANNUAL BASIS. ON AN ANNUAL BASIS, 360 DEGREE FEEDBACK IS ALSO CONSIDERED IN COMPENSATION-SETTING PROCESS. THE ORGANIZATION DOES NOT HAVE ANY OTHER OFFICERS OR KEY EMPLOYEES; HOWEVER, IT DOES HAVE A PROCESS TO DETERMINE REASONABLE COMPENSATION FOR ITS EMPLOYEES THAT WAS COMPLETED IN 2020. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 2,290,279. MANAGEMENT AND GENERAL EXPENSES 94,404. FUNDRAISING EXPENSES 334. TOTAL EXPENSES 2,385,017. FORM 990 PART XII LINE 2C THE PROCESS FOR OVERSIGHT AND SELECTION OF AN INDEPENDENT ACCOUNT HAS NOT CHANGED FROM THE PRIOR YEAR. SHALOM CARES WELLNESS CENTER LLC 14800 E BELLEVIEW DRIVE AURORA CO 80015 452808418 FITNESS AND THERAPY CO 112640 5038128 BETH ISRAEL FOUNDATION FOR THE AGED BETH ISRAEL FOUNDATION FOR THE AGED 14800 E BELLEVIEW DRIVE AURORA CO 80015 742195249 FUNDRAISING TO SUPPORT SHALOM PARK CO 501(C)(3) LINE 7 SHALOM PARK 1 0 1 1 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 BETH ISRAEL FOUNDATION FOR THE AGED C 50971 CASH BETH ISRAEL FOUNDATION FOR THE AGED B 356978 CASH