2020-05-22T08:32:59-05:00 2019-09-30 061009205 BLUM SHAPIRO & COMPANY PC ONE INTERNATIONAL PLACE 16TH FLOOR BOSTON MA 02110 990 2018-10-01 060293500 CHURCH HOME OF HARTFORD INC CHUR 8602860243 200 SEABURY DRIVE BLOOMFIELD CT 06002 CRAIG SCOTT TREASURER 8602860243 2020-05-19 1 LAURA J KENNEY P00202198 6177170831 2020-05-19 64.251.63.131 2020-05-19 19:54:38 ED P 9F3B9057DC4C1AB93FF6CCB85D8B21EC61D194BB F655607A01BC9414CB150F5C2D5B642F4B7C09E6 2018 2020-09-22 18:59:49Z SEABURY RETIREMENT COMMUNITY CRAIG SCOTT 200 SEABURY DRIVE BLOOMFIELD CT 06002 35729553 0 X WWW.SEABURYLIFE.ORG X 1876 CT TO PROVIDE HOUSING AND SUPPLEMENTAL SERVICES TO THE ELDERLY. 15 15 481 15 0 0 1220582 193628 30719795 34663731 1204919 737068 289645 119268 33434941 35713695 0 0 0 0 17285410 17064789 0 0 0 20465703 24111114 37751113 41175903 -4316172 -5462208 155052179 145158508 154804351 151349706 247828 -6191198 TO PROVIDE HOUSING AND SUPPLEMENTAL SERVICES TO THE ELDERLY. 0 0 37682429 34663731 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. 37682429 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 1 122 0 1 481 1 0 0 0 0 0 0 0 0 0 0 0 0 X 15 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 THOMAS E ANDERSEN DIRECTOR 0.60 0.00 X 0 0 0 BRADFORD BABBITT DIRECTOR 0.60 0.00 X 0 0 0 LINDA BERRY DIRECTOR 0.60 0.00 X 0 0 0 REV ROWENA KEMP BISHOP'S REPRESENTATIVE 0.60 0.00 X X 0 0 0 MARNIE W MUELLER DIRECTOR 0.60 0.00 X 0 0 0 MONIQUE R POLIDORO DIRECTOR 0.60 0.00 X 0 0 0 REV ERL G PURNELL DIRECTOR/SECRETARY 0.60 0.30 X X 0 0 0 CRAIG SCOTT DIRECTOR 0.60 0.00 X 0 0 0 RONALD THERIAULT DIRECTOR 0.60 0.00 X 0 0 0 JOHN R WADSWORTH DIRECTOR 0.60 0.00 X 0 0 0 RICHARD WOODRING DIRECTOR 0.60 0.00 X 0 0 0 DR JONATHAN A DIXON DIRECTOR/VICE CHAIR 0.60 0.00 X X 0 0 0 RIGHT REV IAN T DOUGLAS DIRECTOR/EX OFFICIO 0.60 0.00 X X 0 0 0 GALE A MATTISON DIRECTOR/CHAIR 0.60 0.60 X X 0 0 0 WILLIAM J THOMPSON DIRECTOR/TREASURER 0.60 0.00 X X 0 0 0 RICHARD HEATH PRESIDENT/CEO (UNTIL 6/19) 40.00 0.60 X 385775 0 47358 RENEE BERNASCONI VP MKTG/PRES & CEO (AS OF 6/1/19) 40.00 0.60 X 257172 0 30077 RUSLAN KUZMENKO CFO AND VP OF FINANCE 40.00 0.00 X 148490 0 24503 GRAHAM FONG UNTIL 71219 VP ENGINEERING/TECHNOLOGY 40.00 0.00 X 158779 0 24392 BRIAN NYBERG UNTIL 41219 VP OF HEALTH SERVICES 40.00 0.00 X 138742 0 18319 PEGEEN SULLIVAN UNTIL 51719 VP OF COMMUNITY LIFE 40.00 0.00 X 136648 0 20464 GWYNNE DEVEAU VP OF HUMAN RESOURCES 40.00 0.00 X 117006 0 6570 TATIANA KOZAK REGISTERED NURSE 62.00 0.00 X 115042 0 6003 MARINA SOLOVEYCHIK REGISTERED NURSE 52.00 0.00 X 110633 0 6003 MARJORIE SULLIVAN UNTIL 52018 FORMER VP HEALTH SERVICES 0.00 0.00 X 168270 0 3866 1736557 0 187555 12 1 1 0 KBE BUILDING CORP 76 BATTERSON PARK ROAD FARMINGTON CT 06032 CONSTRUCTION 10389067 SODEXO INC & AFFILIATES PO BOX 360170 PITTSBURGH PA 15251 FOOD SERVICES 1388943 HEALTH PRO THERAPY SERVICES 536 OLD HOWELL ROAD GREENVILLE SC 29615 REHAB SERVICES 987717 INFINITY GROUP 68 EAST DUDLEY TOWN ROAD BLOOMFIELD CT 06002 CONSTRUCTION 857112 SFCS INC 305 SOUTH JEFFERSON STREET ROANOKE VA 24011 CONSTRUCTION/ARCHITECTURE 358585 9 193628 193628 RESIDENT SERVICE REV. 623000 16033933 16033933 HEALTH CENTER REV. 623000 8977900 8977900 AMORT. OF DEFERRED REVENUE 900099 3306870 3306870 ASSISTED LIVING SERVICES 623000 3292138 3292138 SEABURY AT HOME SERVICE REVENUE 621610 1550903 1550903 1501987 1501987 34663731 747209 747209 58092 0 58092 58092 58092 5717 15858 0 -15858 5717 -10141 -10141 OTHER INCOME 900099 50448 50448 FINANCE CHARGES 900099 5478 5478 ADMISSIONS 900099 5250 5250 61176 35713695 34663731 0 856336 925702 925702 12623108 11754844 868264 428380 346801 81579 2120692 1997600 123092 966907 859243 107664 71667 71667 217101 84473 132628 98610 98610 63600 63600 470648 2096 468552 1275187 1226980 48207 113488 90522 22966 4146586 4063583 83003 7649646 7510947 138699 729706 706973 22733 CONTRACTED SERVICES 2947183 2821513 125670 FOOD 1670656 1656463 14193 REAL ESTATE TAXES 1359527 1335307 24220 REPAIRS 708926 691515 17411 2588583 2398302 190281 41175903 37682429 3493474 0 7684833 6745296 180 0 2318247 2405496 945259 943232 170924396 61158684 115684215 109765712 20608034 19350694 270123 345607 7541288 5602471 155052179 145158508 2937358 2349397 29996081 30795179 87320722 82626102 34550190 35579028 154804351 151349706 X -6116223 -12337298 714575 708919 5649476 5437181 247828 -6191198 155052179 145158508 X -5462208 288418 -1265236 X 0 1 X 1 0 X 230302 169427 121979 1220582 193628 1935918 23703497 26394587 26850386 30719795 34663731 142331996 23933799 26564014 26972365 31940377 34857359 144267914 0 0 0 144267914 298641 300728 393401 758402 805301 2556473 298641 300728 393401 758402 805301 2556473 106932 130565 348673 255143 61176 902489 24339372 26995307 27714439 32953922 35723836 147726876 0.97660 0.96860 0.01730 0.01520 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 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 679 1 100 580 0 13205816 500000 603378 42842 14266352 14986718 317294 732030 2830226 13205816 14497451 1537331 1048064 14986718 14785792 1470400 1758741 14497451 15739596 562875 -1050047 466632 14785792 0.93000 0.04000 0.03000 0 1 1 4429495 4429495 156089219 56985879 99103340 10123965 4006224 6117741 281717 166581 115136 109765712 ACCRUED BOND INTEREST 327896 ENTRANCE FEE DEPOSITS 184953 DEFERRED COMPENSATION 224434 CAPITAL LEASES 383817 ENTRANCE FEE REFUNDS PAYABLE 34457928 35579028 35784101 288418 -212295 76123 35707978 5717 5717 35713695 41170186 0 41170186 5717 5717 41175903 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 -212,295. PART XI, LINE 4B - OTHER ADJUSTMENTS: RECLASS OF ASSET DISPOSAL 5,717. PART XII, LINE 4B - OTHER ADJUSTMENTS: RECLASS OF ASSET DISPOSAL 5,717. X X X X 1 0 0 0 0 0 0 1 0 RICHARD HEATH PRESIDENT/CEO (UNTIL 6/19) 309617 0 76158 0 0 0 18500 0 28858 0 433133 0 0 0 RENEE BERNASCONI VP MKTG/PRES & CEO (AS OF 6/1/19) 228664 0 28508 0 0 0 18500 0 11577 0 287249 0 0 0 RUSLAN KUZMENKO CFO AND VP OF FINANCE 134990 0 13500 0 0 0 0 0 24503 0 172993 0 0 0 GRAHAM FONG UNTIL 71219 VP ENGINEERING/TECHNOLOGY 142879 0 15900 0 0 0 0 0 24392 0 183171 0 0 0 BRIAN NYBERG UNTIL 41219 VP OF HEALTH SERVICES 126242 0 12500 0 0 0 0 0 18319 0 157061 0 0 0 PEGEEN SULLIVAN UNTIL 51719 VP OF COMMUNITY LIFE 121788 0 14860 0 0 0 0 0 20464 0 157112 0 0 0 MARJORIE SULLIVAN UNTIL 52018 FORMER VP HEALTH SERVICES 71466 0 0 0 96804 0 0 0 3866 0 172136 0 0 0 PART I, LINE 4A MARJORIE SULLIVAN SEPARATED FROM SERVICE IN MAY 2018 AND WILL RECEIVE 12 MONTHS OF SEVERANCE PAY. DURING TAX YEAR 2018 SHE RECEIVED $$96,804. PART I, LINE 7 THE BONUSES PAID TO THE NEW CEO/PRESIDENT ARE FIXED/CONTRACTUAL AND THE BONUSES PAID TO THE OTHERS ARE DISCRETIONARY AND BASED ON PERFORMANCE. 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 4765619 35270619 2621533 705412 16542642 15398751 2281 2016 1 0 1 1 B 24389570 76904570 2598449 1538091 72540333 227697 0 0 0 0 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 0 0 1 1 0 0 0 1 A 1 B 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: PUBLIC FINANCE AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 04/08/2015 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 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 IT IS FILED 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. IN ADDITION, THE ORGANIZATION HAS HIRED A CONSULTANT FOR A REVIEW OF MARKET COMPENSATION. THE COMPENSATION COMMITTEE'S DELIBERATIONS AND DECISIONS REGARDING CEO COMPENSATION ARE DOCUMENTED. THE CEO 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 -212,295. PRIOR PERIOD ADJUSTMENT - DEFERRED MARKETING COSTS WRITE OFF PER ASU 2014-0 -1,052,941. 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 TO PROVIDE SUPPORT TO 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 10 SEABURY INC 1 SEABURY AT POWDER FOREST LLC 200 SEABURY DRIVE BLOOMFIELD CT 06002 474481221 REAL ESTATE CT N/A 0 0 1 1 0 0 0 0 0 1 0 1 0 1 1 0 1 0 0 SEABURY AT HOME INCORPORATED L 1550903 FMV SEABURY CHARITABLE FOUNDATION INC C 193628 AMOUNT GIFTED SEABURY CHARITABLE FOUNDATION INC L 177222 FMV SEABURY AT HOME INCORPORATED D 385246 FMV