2021-02-12T08:14:59-06:00 2020-09-30 410746749 CLIFTONLARSONALLEN LLP TWO INTERNATIONAL PLACE 22ND FLOOR BOSTON MA 02110 990 2019-10-01 060293500 CHURCH HOME OF HARTFORD INC CHUR 8602860243 200 SEABURY DRIVE BLOOMFIELD CT 06002 CRAIG SCOTT TREASURER 8602860243 2021-02-11 1 LAURA J KENNEY P00202198 6177170831 2021-02-11 2019 2022-09-23 18:48:47Z SEABURY CRAIG SCOTT 200 SEABURY DRIVE BLOOMFIELD CT 06002 39593377 0 X WWW.SEABURYLIFE.ORG X 1876 CT TO PROVIDE HOUSING AND SUPPLEMENTAL SERVICES TO THE ELDERLY. 16 15 494 15 0 0 193628 141855 34663731 35707943 737068 1549234 119268 702438 35713695 38101470 0 0 0 0 17064789 17914142 0 0 0 24111114 22060010 41175903 39974152 -5462208 -1872682 145158508 142696505 151349706 150930119 -6191198 -8233614 TO PROVIDE HOUSING AND SUPPLEMENTAL SERVICES TO THE ELDERLY. 0 0 36918015 35707943 CHURCH HOME OF HARTFORD, INC. OPERATES A HEALTH CARE AND INDEPENDENT LIVING, ASSISTED LIVING, AND MEMORY CARE COMMUNITY FOR THE ELDERLY. CHURCH HOME IS AFFILIATED WITH THE EPISCOPAL DIOCESE OF CONNECTICUT AND ALSO OPERATES A HOME FOR RETIRED CLERGY. CHURCH HOME ALSO OPERATES ITS OWN HOME HEALTH AGENCY. 36918015 1 1 0 0 0 0 0 0 1 1 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 86 0 1 494 1 0 0 0 0 0 0 0 0 0 0 0 0 X 16 15 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 X DAVID GREENBLATT CONTROLLER 8602860243 200 SEABURY DRIVE BLOOMFIELD CT 06002 RENEE BERNASCONI PRESIDENT AND CEO 40.00 0.60 X 306087 0 31129 RICHARD HEATH PRESIDENT AND FORMER CEO 0.00 0.00 X 194515 0 33323 RUSLAN KUZMENKO VP OF FINANCE AND CFO 40.00 0.00 X 153874 0 32830 MICHAEL OAKES VP OF ENGINEERING AND SECURITY 40.00 0.00 X 129181 0 26334 TATIANA KOZAK REGISTERED NURSE 40.00 0.00 X 125961 0 8855 GWYNNE DEVEAU VP OF HUMAN RESOURCES 40.00 0.00 X 121740 0 6022 MARINA SOLOVEYCHIK REGISTERED NURSE 40.00 0.00 X 113048 0 24344 JOAN PINNEY PHYSICAL THERAPIST 40.00 0.00 X 111307 0 26937 AUDREY BROWN REGISTERED NURSE 40.00 0.00 X 111035 0 15216 LORI MAGLIERI SUPERVISOR ALSA 40.00 0.00 X 110127 0 24011 CHRISTINE DUPONT VP OF MARKETING 40.00 0.00 X 103099 0 0 HEATHER STANTON VP OF RESIDENT AND MEMBER SERVICES 40.00 0.00 X 93848 0 27645 JACOB BOMPASTORE VP OF HEALTH SERVICES 40.00 0.00 X 88263 0 25499 BRIAN NYBERG VP OF HEALTH SERVICES (FORMER) 40.00 0.00 X 52816 0 0 JONATHAN A DIXON CHAIR 0.30 0.30 X X 0 0 0 REV ERL G PURNELL VICE CHAIR 0.30 0.30 X X 0 0 0 CRAIG SCOTT TREASURER 0.30 0.00 X X 0 0 0 JOHN R WADSWORTH SECRETARY 0.30 0.00 X X 0 0 0 THOMAS E ANDERSEN DIRECTOR 0.30 0.00 X 0 0 0 BRADFORD S BABBITT DIRECTOR 0.30 0.00 X 0 0 0 CYNTHIA BECKER DIRECTOR 0.30 0.00 X 0 0 0 LINDA BERRY DIRECTOR 0.30 0.00 X 0 0 0 REV IAN T DOUGLAS DIRECTOR 0.30 0.00 X 0 0 0 REV ANNE FRALEY DIRECTOR 0.30 0.00 X 0 0 0 ROBERT HEWEY DIRECTOR 0.30 0.00 X 0 0 0 ROSS MEZZANOTTE DIRECTOR 0.30 0.00 X 0 0 0 MARNIE W MUELLER DIRECTOR 0.30 0.00 X 0 0 0 MONIQUE R POLIDORO ESQ DIRECTOR 0.30 0.30 X 0 0 0 MICHAEL SHERRILL DIRECTOR 0.30 X 0 0 0 RONALD THERIAULT DIRECTOR 0.30 X 0 0 0 1814901 0 282145 14 1 1 0 SODEXO INC & AFFILIATES PO BOX 360170 PITTSBURGH PA 15251 FOOD SERVICES 1804845 INFINITY GROUP 20 CHURCH STREET HARTFORD CT 06103 CONSTRUCTION 1375276 HEALTH PRO THERAPY SERVICES 536 OLD HOWELL ROAD GREENVILLE SC 29615 REHAB SERVICES 1250601 KBE BUILDING CONSTRUCTION 76 BATTERSON PARK RD FARMINGTON CT 06032 CONSTRUCTION 412368 TEMP SOURCE PO BOX 75343 CHICAGO IL 60675 TEMPORARY LABOR 261428 9 111485 30370 141855 RESIDENT SERVICE REV. 623000 17185395 17185395 HEALTH CENTER REV. 623000 8893529 8893529 AMORT. OF DEFERRED REVENUE 900099 3880061 3880061 ASSISTED LIVING SERVICES 623000 3284622 3284622 SEABURY AT HOME SERVICE REVENUE 621610 1488181 1488181 976155 976155 35707943 933679 933679 92010 0 92010 92010 92010 2107462 1488318 3589 619144 -3589 615555 615555 OTHER INCOME 900099 607363 607363 ADMISSIONS 900099 1950 1950 FINANCE CHARGES 900099 1115 1115 610428 38101470 35707943 0 2251672 1950555 1088415 862140 12420984 11568934 852050 394769 358661 36108 2146491 2012523 133968 1001343 900128 101215 126353 126353 86604 86604 66160 66160 89497 89497 246128 1772 244356 273480 205852 67628 1271212 1249900 21312 23176 13784 9392 4133885 4058627 75258 7666195 7525479 140716 640673 617857 22816 CONTRACTED SERVICES 2373467 2204841 168626 REAL ESTATE TAXES 1571091 1543127 27964 FOOD 1204626 1191274 13352 REPAIRS 509156 500019 9137 1778307 1660972 117335 39974152 36918015 3056137 0 6745296 9638949 202124 2405496 2027265 18500 943232 871781 172909440 68813243 109765712 104096197 19350694 19766475 345607 385295 5602471 5689919 145158508 142696505 2349397 2192810 30795179 28929960 82626102 81631483 35579028 38175866 151349706 150930119 X -12337298 -14702772 6146100 6469158 -6191198 -8233614 145158508 142696505 X -1872682 -357936 188202 X 0 1 X 1 0 X 169427 121979 1220582 193628 141855 1847471 26394587 26850386 30719795 34663731 35707943 154336442 26564014 26972365 31940377 34857359 35849798 156183913 0 0 0 156183913 300728 393401 758402 805301 1025689 3283521 300728 393401 758402 805301 1025689 3283521 130565 348673 255143 61176 610428 1405985 26995307 27714439 32953922 35723836 37485915 160873419 0.97080 0.97660 0.02040 0.01730 X SCHEDULE A, PART III, LINE 12, EXPLANATION FOR OTHER INCOME: OTHER INCOME: 2014: $106,932 2015: $130,565 2016: $348,673 2017: $255,143 2018: $61,176 2019: $610,428 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 580 391 369 602 0 14266352 1000000 842563 50205 16058710 13205816 500000 603378 42842 14266352 14986718 317294 732000 2830226 13205816 14497451 1537331 1048064 14986718 14785792 1470400 1758741 14497451 0.96000 0.04000 0 1 1 4429495 4429495 157583539 63874052 93709487 10273163 4754417 5518746 623243 184774 438469 104096197 ACCRUED BOND INTEREST 268992 ENTRANCE FEE DEPOSITS 157197 DEFERRED COMPENSATION 277339 CAPITAL LEASES 276091 ENTRANCE FEE REFUNDS PAYABLE 33917126 PPP LOAN PAYABLE 3279121 38175866 37865576 -357936 188201 -169735 38035311 66160 66160 38101471 39907992 0 39907992 66160 66160 39974152 PART IV, LINE 1B: CHURCH HOME OF HARTFORD, INC. SERVED AS A CUSTODIAN FOR RESIDENTS' FUNDS WHICH ARE NOT INCLUDED IN THE ORGANIZATION'S BALANCE SHEET. PART V, LINE 4: THE ENDOWMENT FUNDS ARE USED TO SUPPORT THE MISSION OF CHURCH HOME OF HARTFORD, INCORPORATED, WHICH IS TO PROVIDE HOUSING AND HEALTH CARE SERVICES TO THE ELDERLY. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN INTEREST IN PERPETUAL TRUST 188,201. X X X X 0 0 0 0 0 0 0 1 1 1 RENEE BERNASCONI PRESIDENT AND CEO 241147 0 38262 0 26678 0 31129 0 0 0 337216 0 0 0 RICHARD HEATH PRESIDENT AND FORMER CEO 128568 0 58833 0 7114 0 19000 0 14323 0 227838 0 0 0 RUSLAN KUZMENKO VP OF FINANCE AND CFO 139969 0 13905 0 0 0 7607 0 25223 0 186704 0 0 0 MICHAEL OAKES VP OF ENGINEERING AND SECURITY 129181 0 0 0 0 0 3456 0 22878 0 155515 0 0 0 PART I, LINE 7 THE BONUSES PAID TO THE CEO/PRESIDENT ARE FIXED/CONTRACTUAL AND THE BONUSES PAID TO THE OTHERS ARE DISCRETIONARY AND BASED ON PERFORMANCE. PART I, LINE 8 THE CEO/PRESIDENT IS IN HER INITIAL CONTRACT PERIOD EFFECTIVE JUNE 1, 2019 THROUGH SEPTEMBER 30, 2022. A PUBLIC FINANCE AUTHORITY 273866124 74442PAV7 2015-04-08 35270619 REFINANCE SERIES 2010 BONDS 0 0 0 B CONNECTICUT HEALTH & EDUCATIONAL FACILITIES AUTHORITY 060806186 20774YJ40 2016-04-21 76904570 HEALTHCARE FACILITY EXPANSION ISSUE 0 0 0 A 5775619 35270619 2511602 705412 16542642 15510963 2016 1 0 1 1 B 24389570 76904570 2569307 1538091 72540333 256839 2018 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 1 0 0 0 1 B 0 1 0 0 1 0 0 0 1 A 1 B 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: PUBLIC FINANCE AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 04/08/2020 SCHEDULE K, PART II, LINE 11: (A) ISSUER NAME: PUBLIC FINANCE AUTHORITY THE AMOUNT OF $14,251,527 WAS USED TO REFUND A PRIOR ISSUE. FORM 990, PART VI, SECTION A, LINE 6 SEABURY, INC. IS THE SOLE MEMBER OF CHURCH HOME OF HARTFORD, INC. AND THE BOARD OF SEABURY, INC. ELECTS THE BOARD OF CHURCH AND HOME OF HARTFORD, INC. FORM 990, PART VI, SECTION A, LINE 7A SEABURY, INC. IS THE SOLE MEMBER OF CHURCH HOME OF HARTFORD, INC. AND THE BOARD OF SEABURY, INC. ELECTS THE BOARD OF CHURCH HOME OF HARTFORD, INC. FORM 990, PART VI, SECTION A, LINE 7B MEMBERS APPROVE CHANGES TO THE ARTICLES OF INCORPORATION, CHANGES TO THE BY-LAWS, AND THE APPOINTMENT OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED BY THE FINANCE COMMITTEE AFTER FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY BY REVIEWING THE POLICY AT BOARD ORIENTATION AND AT BOARD MEETINGS THROUGHOUT THE YEAR. FORM 990, PART VI, SECTION B, LINE 15A COMPENSATION IS DETERMINED USING A REVIEW OF LIKE ORGANIZATIONS, FORM 990 REPORT FOR TOP PAID EMPLOYEES, AND USE OF ASSOCIATION COMPENSATION SURVEYS. THE COMPENSATION COMMITTEE'S DELIBERATIONS AND DECISIONS REGARDING CEO COMPENSATION ARE DOCUMENTED. THIS PROCESS WAS LAST UNDERTAKEN IN ADVANCE OF HER CONTRACT EFFECTIVE JUNE 1, 2019. THE CEO/PRESIDENT (ALONG WITH HUMAN RESOURCES) DETERMINES THE COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES USING COMPARABLE DATA. FORM 990, PART VI, SECTION C, LINE 19 COPIES OF THE DOCUMENTS ARE RETAINED IN SEABURY'S LIBRARY, ARE GIVEN TO OUR PROSPECTS AND ARE AVAILABLE UPON REQUEST. OUR ANNUAL REPORT IS ON OUR WEBSITE. FORM 990, PART XI, LINE 9: CHANGE IN PERPETUAL TRUSTS 188,202. SEABURY INC 200 SEABURY DRIVE BLOOMFIELD CT 06002 842187536 TO PROVIDE SUPPORT TO THE SUPPORTED ORGANIZATIONS CT 501(C)(3) LINE 12A, I 0 SEABURY CHARITABLE FOUNDATION INC 200 SEABURY DRIVE BLOOMFIELD CT 06002 061458630 SUPPORT CHURCH HOME OF HARTFORD, INCORPORATED CT 501(C)(3) LINE 12A, I SEABURY INC 1 SEABURY AT HOME INCORPORATED 200 SEABURY DRIVE BLOOMFIELD CT 06002 205096169 TO PROVIDE HOME HEALTH SERVICES TO THE ELDERLY CT 501(C)(3) LINE 1 SEABURY INC 1 SEABURY AT POWDER FOREST LLC 200 SEABURY DRIVE BLOOMFIELD CT 06002 474481221 REAL ESTATE CT N/A 0 0 1 1 1 0 0 0 0 1 0 1 1 0 0 0 1 0 0 SEABURY AT HOME INCORPORATED L 1682447 FMV SEABURY CHARITABLE FOUNDATION INC C 111485 AMOUNT GIFTED SEABURY CHARITABLE FOUNDATION INC L 59452 FMV SEABURY AT HOME INCORPORATED D 244362 FMV SEABURY AT HOME INCORPORATED J 47489 FMV