2020-02-04T21:13:26-06:00 2019-09-30 061009205 BLUM SHAPIRO & COMPANY PC ONE INTERNATIONAL PLACE 16TH FLOOR BOSTON MA 02110 990 2018-10-01 060763898 CHURCH HOMES INC CONGREGATIONAL CHUR 8605279126 217 AVERY HEIGHTS HARTFORD CT 061064200 RAYMOND A GASPERINI VICE PRESIDENT/CFO 8605279126 2020-01-31 1 LAURA J KENNEY P00202198 6177170831 2020-01-31 64.251.63.131 2020-01-31 10:49:43 ES P B49528270D5C596423F272EFB472E66EFBF6AFC8 C2A8F68C24BA4106533A6CD8C72FD917E7C6626D 2018 2020-09-23 17:36:50Z RAYMOND A GASPERINI 217 AVERY HEIGHTS HARTFORD CT 06106 44339444 0 X WWW.CHURCHHOMES.ORG X 1957 CT TO PROVIDE, ON A NOT-FOR-PROFIT BASIS AND WITHOUT DISCRIMINATION, A FULL RANGE OF RESIDENTIAL LIVING AND HEALTH CARE SERVICES FOR OLDER ADULTS. 12 11 571 200 0 0 424308 959532 40561009 42153043 1152676 586105 546732 601024 42684725 44299704 25035 40936 0 0 23728419 24090824 0 0 55435 17704167 18663584 41457621 42795344 1227104 1504360 57765674 58402377 16730367 15887917 41035307 42514460 X TO PROVIDE, ON A NOT-FOR-PROFIT BASIS AND WITHOUT DISCRIMINATION, A FULL RANGE OF RESIDENTIAL LIVING AND HEALTH CARE SERVICES FOR OLDER ADULTS BY PROMOTING AND IMPLEMENTING SYSTEMS THAT MAINTAIN AND SUPPORT EVERY INDIVIDUAL'S OPTIMAL INDEPENDENCE AND LIFE WISHES IN A SAFE, DIGNIFIED ATMOSPHERE CONDUCIVE TO QUALITY RETIREMENT, BY ASSURING KNOWLEDGEABLE AND CONSISTENT LEADERSHIP IN RETIREMENT LIVING, LONG-TERM CARE, HOME CARE AND SUPPORT SERVICES AND BY DEVELOPING INNOVATIVE PROGRAMS AND SERVICES WHICH RESPOND TO THE CHANGING NEEDS OF ITS RESIDENTS AND CLIENTS AND THE SOCIETY IT SERVES. 0 0 39295306 40936 42619597 CHURCH HOMES, INC. CONGREGATIONAL IS A NOT-FOR-PROFIT CORPORATION, WHICH OWNS AND OPERATES RETIREMENT AND HEALTH CARE FACILITIES IN HARTFORD, CT (AVERY HEIGHTS) AND SALISBURY, CT (NOBLE HORIZONS). AVERY HEIGHTS CONSISTS OF 130 SKILLED NURSING BEDS, 69 INTERMEDIATE CARE BEDS, 58 INDEPENDENT LIVING COTTAGES, 127 INDEPENDENT LIVING AND ASSISTED LIVING APARTMENTS, PLUS 20 MEMORY CARE UNITS. IN ADDITION, AVERY HEIGHTS OPERATES A HOME HEALTH AGENCY. NOBLE HORIZONS CONSISTS OF 61 SKILLED NURSING BEDS, 30 INTERMEDIATE CARE BEDS, 50 INDEPENDENT LIVING COTTAGES, AND 19 ACCOMMODATIONS IN A HOME FOR THE AGED. 39295306 1 1 0 0 0 0 0 0 1 1 1 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 1 0 0 0 1 149 0 1 571 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 12 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 1 1 0 CT X RAYMOND A GASPERINI 8605279126 217 AVERY HEIGHTS HARTFORD CT 061064200 DAVID E CANUEL CHAIRMAN 1.00 0.00 X X 0 0 0 HENRY B MCNULTY VICE CHAIRMAN 1.00 0.00 X X 0 0 0 GERARD J BALDWIN DIRECTOR 1.00 0.00 X 0 0 0 PATRICK S GILLIGAN DIRECTOR 1.00 0.00 X 0 0 0 MARGARET A GOLAS DIRECTOR 1.00 0.00 X 0 0 0 PETER L HOLLAND DIRECTOR 1.00 0.00 X 0 0 0 THOMAS P KELLEY DIRECTOR 1.00 0.00 X 0 0 0 MERCEDESE E LARGE DIRECTOR 1.00 0.00 X 0 0 0 PETER B MATTHEWS DIRECTOR 1.00 0.00 X 0 0 0 CYNTHIA W SHAHEN DIRECTOR 1.00 0.00 X 0 0 0 PATRICK Y YUNG DIRECTOR 1.00 0.00 X 0 0 0 PATRICK GILLAND PRESIDENT/CEO 40.00 1.50 X X 280616 0 51305 RAYMOND GASPERINI VICE PRESIDENT/CFO 40.00 0.00 X 181347 0 35511 WILLIAM THOMPSON VICE PRESIDENT 40.00 0.00 X 189145 0 41482 WILLIAM POND VICE PRESIDENT 40.00 0.00 X 115467 0 1151 DOREEN BALDONI SECRETARY 20.00 0.00 X 23121 0 0 ANNA LUKAS NURSE MANAGER 40.00 0.00 X 139327 0 0 MICHELLE PASCETTA DIR BUDGETING / REIMBURSEMENT 40.00 0.00 X 114568 0 0 BONITA GANIM DIRECTOR - NURSING SERVICE 40.00 0.00 X 112423 0 0 RUTH DONAHUE CONTROLLER 40.00 1.00 X 101573 1750 0 1257587 1750 129449 8 0 1 0 HEALTHCARE SERVICES GROUP INC 3220 TILLMAN DR STE 300 BENSALEM PA 19020 HOUSEKEEPING/LAUNDRY/DIETARY SERVICES 2842990 SYMBRIA REHAB 28100 TORCH PARKWAY SUITE 600 WARRENVILLE IL 60555 REHAB THERAPY 1622654 EAGLE RIVET ROOF SERVICE CORP 15 BRITTON DR BLOOMFIELD CT 06002 ROOFING SERVICES 791703 SULLIVAN BROTHERS REMODELING 1 WOLCOTT RD WOLCOTT CT 06716 COTTAGE REMODELING 399975 H&H LINEN SERVICES 60 BELAMOSE AVE UNIT A10 ROCKY HILL CT 06067 LINEN SERVICE 184688 12 64315 895217 188463 959532 RESIDENT SERVICES 623000 42014455 42014455 OTHER SERVICES 623000 138588 138588 42153043 292894 292894 123585 0 123585 123585 123585 304096 0 10885 304096 -10885 293211 -10885 304096 28855 64315 28855 0 OTHER INCOME 900099 467734 467734 FEES INCOME 900099 9705 9705 477439 44299704 42619597 0 720575 X 40936 40936 943590 378525 565065 17313725 15676740 1622350 14635 1211542 1068701 141872 969 3256878 2917200 336970 2708 1365089 1204145 159852 1092 1868 1868 36007 36007 83370 83370 6997917 6904427 93479 11 125985 124090 1798 97 284328 166221 112628 5479 189496 76781 105595 7120 2021874 1985733 36141 11403 8201 3202 1065 859 206 342951 342951 2730104 2730104 437260 437260 PROVIDER TAX 1734824 1734824 FOOD 762532 762532 SUPPLIES 726221 704087 22134 BAD DEBTS 562000 562000 1614379 1468989 122066 23324 42795344 39295306 3444603 55435 3701914 5100723 293173 597137 3490360 3439580 179483 199194 254242 288778 88955027 62842061 27290643 26112966 21466751 22149357 1002919 0 86189 514642 57765674 58402377 3267566 3336527 13051668 12157831 122501 130957 2630 0 286002 262602 16730367 15887917 X 30212271 31582175 8170771 8280020 2652265 2652265 41035307 42514460 57765674 58402377 1504360 -25207 0 X 0 1 X 1 0 X 402859 2430717 1153420 424308 959532 5370836 39859295 38368672 39149234 41000239 42619597 200997037 40262154 40799389 40302654 41424547 43579129 206367873 18000 4100 22100 0 18000 4100 22100 206345773 189677 143712 332856 475822 416479 1558546 189677 143712 332856 475822 416479 1558546 17400 5400 5400 28200 40469231 40948501 40640910 41900369 43995608 207954619 0.99230 0.99170 0.00750 0.00790 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 11208936 89575 251596 526786 11023321 10993200 85828 728206 598298 11208936 10369650 65976 1193533 635960 10993200 9692954 87798 960411 371513 10369650 10152116 131662 -262110 328714 9692954 0.54990 0.24060 0.20950 0 0 3365284 3365284 53771283 37883876 15887407 27506164 21667649 5838515 4312296 3290536 1021760 26112966 ANNUITIES PAYABLE 14953 RESIDENT DEPOSITS 139974 DUE TO THIRD PARTY REIMBURSEMENT AG 9427 MISCELLANEOUS 98248 262602 43703347 -25207 -25207 43728554 571150 571150 44299704 42224194 0 42224194 571150 571150 42795344 PART IV, LINE 2B: THE FUNDS IN THE CUSTODIAL ACCOUNTS BELONG TO THE RESIDENTS, WHO AGREE TO LET CHURCH HOMES (AVERY HEIGHTS AND NOBLE HORIZONS) MANAGE THE FUNDS. THE RESIDENTS MAY MAKE WITHDRAWALS OR PAY BILLS FROM THESE FUNDS UPON REQUEST. PART V, LINE 4: THE INTENDED USE OF THE ENDOWMENT FUNDS IS TO GENERATE INVESTMENT INCOME UTILIZED TO SUPPORT OPERATIONS. PART XI, LINE 4B - OTHER ADJUSTMENTS: DIRECT RESIDENT SUPPORT 9,150. BAD DEBTS 562,000. PART XII, LINE 4B - OTHER ADJUSTMENTS: DIRECT RESIDENT SUPPORT 9,150. BAD DEBTS 562,000. GOLF OUTING 74170 52587 21583 5076 15993 514 FESTIVAL OF TREES 19000 11728 7272 7272 93170 64315 28855 5076 15993 7272 514 28855 0 1 SCHOLARSHIPS 17 40936 PART I, LINE 2: SCHOLARSHIP ASSISTANCE IS OFFERED TO EMPLOYEES OR THEIR CHILDREN WHO WISH TO PURSUE PROFESSIONAL AND VOCATIONAL COURSES OF STUDY THAT ARE RELATED TO THE EMPLOYEE'S POTENTIAL FOR PROMOTION OR MINIMUM JOB REQUIREMENTS. ALL COURSES MUST BE OFFERED THROUGH AN ACCREDITED INSTITUTION OF HIGHER LEARNING OR BE APPROVED FOR CONTINUING EDUCATION UNITS. TO QUALIFY, THE EMPLOYEE MUST BE EMPLOYED 32 HOURS OR MORE AND HAVE COMPLETED ONE YEAR OF CONTINUOUS EMPLOYMENT. THE EMPLOYEE MUST HAVE A GOOD WORK ATTENDANCE RECORD. THE EMPLOYEE OR THEIR CHILD MUST MEET THE REQUIREMENTS OF THE INSTITUTION OR AGENCY OFFERING THE COURSE. THE SCHOLARSHIP ASSISTANCE IS AVAILABLE IF THE APPLICANT IS NOT ELIGIBLE FOR ASSISTANCE FROM OTHER SOURCES OF REIMBURSEMENT. X X 0 0 0 0 0 0 0 1 0 PATRICK GILLAND PRESIDENT/CEO 258016 0 22600 0 0 0 32678 0 18627 0 331921 0 0 0 RAYMOND GASPERINI VICE PRESIDENT/CFO 178347 0 3000 0 0 0 20715 0 14796 0 216858 0 0 0 WILLIAM THOMPSON VICE PRESIDENT 182145 0 7000 0 0 0 21687 0 19795 0 230627 0 0 0 PART I, LINE 7 BONUSES ARE AWARDED BASED ON THE ACHIEVEMENT OF SPECIFIC PERFORMANCE GOALS. A STATE OF CONNECTICT HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 060806186 2015-11-18 15282000 REFUND PRIOR ISSUE 0 0 0 A 3016666 15282000 134222 15147778 2015 1 0 1 1 A 0 0 0 0 0.01720 0.01720 0 0 0 A 0 1 0 0 0 0 0 0 0 A 0 PART II, LINE 11, OTHER SPENT PROCEEDS: OTHER SPENT PROCEEDS OF $15,147,778 WERE USED TO REFUND A PRIOR ISSUE. SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 110326 MAINTENANCE 0 X 2 188463 MARKET VALUE 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED WITH THE BOARD OF DIRECTORS AT REGULARLY SCHEDULED BOARD OF DIRECTORS MEETINGS. FORM 990, PART VI, SECTION B, LINE 12C THE PRESIDENT OF CHURCH HOMES, INC. REVIEWS THE RESPONSES TO THE ANNUAL CONFLICT OF INTEREST QUESTIONNAIRE WITH THE COMMITTEE ON DIRECTORS. WHERE AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST EXISTS, THE COMMITTEE ON DIRECTORS IS AUTHORIZED TO TAKE APPROPRIATE CORRECTIVE ACTION. FORM 990, PART VI, SECTION B, LINE 15 THE PERSONNEL COMMITTEE OF THE BOARD OF CHURCH HOMES, INC., REVIEWS AND APPROVES OFFICER COMPENSATION ANNUALLY. THE COMMITTEE USES COMPARABILITY DATA FOR ITS REVIEW. THE DELIBERATION AND DECISION REGARDING THE COMPENSATION IS DOCUMENTED. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G MEDICAL THERAPY: PROGRAM SERVICE EXPENSES 1,946,818. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,946,818. DIETARY SERVICES: PROGRAM SERVICE EXPENSES 1,919,512. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,919,512. HOUSEKEEPING: PROGRAM SERVICE EXPENSES 884,125. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 884,125. TEMPORARY NURSING: PROGRAM SERVICE EXPENSES 554,887. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 554,887. SECURITY: PROGRAM SERVICE EXPENSES 140,013. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 140,013. LAUNDRY: PROGRAM SERVICE EXPENSES 478,240. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 478,240. MAINTENANCE & REPAIRS: PROGRAM SERVICE EXPENSES 498,306. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 498,306. OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 482,526. MANAGEMENT AND GENERAL EXPENSES 93,479. FUNDRAISING EXPENSES 11. TOTAL EXPENSES 576,016. CONNECTICUT ALLIANCE FOR LONG TERM CARE 217 AVERY HEIGHTS HARTFORD CT 06106 061465316 ADMINISTER PROVIDER BASED NETWORK TO PROVIDE COST-EFFECTIVE HEALTH CARE CT 501(C)(3) LINE 12A, I N/A 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0