2020-07-15T14:00:50-05:00 2019-08-31 910189318 MOSS ADAMS LLP 10960 WILSHIRE BLVD SUITE 1100 LOS ANGELES CA 90024 990 2018-09-01 953510024 LOS ANGELES JEWISH HOME FOR THE AGING LOSA 8187743372 7150 TAMPA AVE RESEDA CA 913353700 GILAD GOLDENBERG CFO 8187743372 2020-07-10 1 LAUREN A HAVERLOCK P00545829 3104770450 2020-07-10 68.5.96.36 2020-07-10 15:58:06 PD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 A684B3357E27637731C2152B3B8EE3B07A471F14 2018 2021-01-29 14:40:06Z GILAD GOLDENBERG 7150 TAMPA AVE RESEDA CA 913353700 37349536 0 X WWW.JHA.ORG X 1912 CA NURSING, RESIDENTIAL AND CLINICAL CARE FOR THE ELDERLY. 19 19 309 28 0 -154 47936489 17710255 13942212 16075053 370507 -226436 -276542 2478866 61972666 36037738 0 0 0 0 16701031 17901010 0 0 3203649 29957077 33985713 46658108 51886723 15314558 -15848985 278376025 269579259 273491228 285442629 4884797 -15863370 EXCELLENCE IN SENIOR CARE REFLECTIVE OF JEWISH VALUES. 0 0 26059477 2914218 FUNDING ORGANIZATION AND MANAGEMENT SERVICES FOR RELATED ORGANIZATIONS: EISENBERG VILLAGE OF THE LOS ANGELES JEWISH HOME FOR THE AGING, GRANCELL VILLAGE OF THE LOS ANGELES JEWISH HOME FOR THE AGING, JHA GERIATRIC SERVICES, ANNENBERG SCHOOL OF NURSING AND BRANDMAN CENTERS FOR SENIOR CARE, INC. 17556995 13160835 DEVELOPMENT AND OPERATIONS OF AN INDEPENDENT LIVING FACILITY THAT PROVIDES MEMORY CARE SERVICES. 43616472 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 1 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 292 0 1 309 1 0 0 0 0 0 0 0 0 0 0 0 0 X 19 19 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X GILAD GOLDENBERG 8187743000 7150 TAMPA AVENUE RESEDA CA 91335 R BENDER DIRECTOR 2.00 0.00 X 0 0 0 A BERMAN CHAIR 2.00 0.00 X X 0 0 0 J BRANDMAN DIRECTOR 2.00 4.00 X 0 0 0 J EISENBERG-KEEFER DIRECTOR 2.00 0.00 X 0 0 0 E FRIEDMAN DIRECTOR 2.00 0.00 X 0 0 0 J GLASSMAN VICE CHAIR, PAST CHAIR 2.00 0.00 X X 0 0 0 S GOOD DIRECTOR, PAST CHAIR 2.00 0.00 X 0 0 0 L GRANOW VICE CHAIR 2.00 0.00 X X 0 0 0 I HALPERN DIRECTOR 2.00 4.00 X 0 0 0 J HELD VICE CHAIR 2.00 0.00 X X 0 0 0 M HESLOV DIRECTOR, PAST CHAIR 2.00 0.00 X 0 0 0 R HIRSCH DIRECTOR, PAST CHAIR 2.00 2.00 X 0 0 0 S REISSMAN DIRECTOR 2.00 4.00 X 0 0 0 A PRICE DIRECTOR 2.00 0.00 X 0 0 0 D ROSETT SECRETARY, VICE-CHAIR 2.00 4.00 X X 0 0 0 P RUBIN DIRECTOR 2.00 0.00 X 0 0 0 DR E SCHNEIDER DIRECTOR 2.00 4.00 X 0 0 0 J SEIDEL DIRECTOR 2.00 0.00 X 0 0 0 D SWARTZ IMM PAST CHAIR 2.00 0.00 X 0 0 0 M FORREST CEO-PRESIDENT 30.00 10.00 X 739205 0 13481 I SILBERMAN CFO (THROUGH 2/1/2019) 30.00 10.00 X 330992 0 25389 G GOLDENBERG CFO (START 6/10/2019) 30.00 10.00 X 0 0 0 S CUNNINGHAM CFO (2/3/19 THROUGH 7/9/19) 30.00 10.00 X 39962 0 0 L STEPANIANS COO 36.00 4.00 X 352386 0 9169 N MARCO CMO 38.00 2.00 X 406417 0 22215 A POSSICK CHIEF STRATEGY OFFICER 40.00 0.00 X 318220 0 15686 A ALDERMAN VICE PRESIDENT HR 38.00 2.00 X 155180 0 10350 T CARLSON COMPLIANCE OFFICER 40.00 0.00 X 189750 0 5840 S KLAPPHOLZ FOUNDATION SENIOR VP 40.00 0.00 X 214992 0 16284 J ERBE DIRECTOR INFO SYSTEMS 40.00 0.00 X 236243 0 18214 H SABET SENIOR MGR INFO SYSTEMS 40.00 0.00 X 222763 0 10565 C SLAVIN VP FUND DEVELOPMENT 40.00 0.00 X 191767 0 15838 L PLACHTA DIRECTOR OF DEVELOPMENT 40.00 0.00 X 184424 0 17926 B POLISHUK DIRECTOR OF COMMUNITY RELATIONS 40.00 0.00 X 169356 0 14135 3751657 0 195092 27 0 1 0 UNIVERSAL PROTECTION SERVICE LP PO BOX 101034 PASADENA CA 91189 SECURITY SERVICES 411837 KAN-DI -KI LLC (DIAGNOSTIC LABORATORIES 6400 PINE PLANO TX 75024 LABORATORY SERVICES 293937 MOSS ADAMS LLP PO BOX 748369 LOS ANGELES CA 90074 AUDIT, TAX 197940 SNELL & WILMER LLP ONE ARIZONA CENTER PHOENIX AZ 85004 LEGAL SERVICES 174951 LITTLER MENDELSON PC PO BOX 207137 DALLAS TX 75320 LEGAL SERVICES 155483 12 1281713 16428542 17710255 CCRC REVENUE 900099 13160835 13160835 SERVICE TO BCSC 900099 2107990 2107990 RENT FROM BCSC 900099 488529 488529 SERVICE TO HOSPICE 900099 222588 222588 SERVICE TO HHLTH & CARE T 900099 95111 95111 16075053 731148 731148 4000 961584 -957584 -957584 -957584 492627 1281713 350214 142413 142413 OTHER REVENUE 900099 2336453 2336453 2336453 36037738 16075053 0 2252430 4022362 2827740 892970 301652 10924280 7440015 2349479 1134786 241346 176374 26789 38183 1702732 1254748 252368 195616 1010290 668569 248047 93674 507772 411168 82537 14067 401316 347256 54060 1010566 597064 398041 15461 766521 426511 340010 339266 217829 54457 66980 1723769 1379015 344754 828474 802304 26170 76879 26830 40245 9804 503654 21186 5296 477172 5385604 5385604 5165425 5165425 974081 779265 194816 FUNDING TO RELATED ORGS 10230270 10230270 DIETARY AND FOOD SUPPLI 1426123 1426123 DUES, LICENSES 366883 345464 18344 3075 RECRUITMENT COSTS 311054 311054 3968056 3376658 78229 513169 51886723 43616472 5066602 3203649 30316377 12599741 2814072 22483659 38580072 35800932 28176 51795 4252318 958857 191554503 25938890 169511154 165615613 12349295 13148081 20524561 18920581 278376025 269579259 13393179 16974886 142300348 147492160 115929535 111745131 0 6000000 1868166 3230452 273491228 285442629 X -52766410 -76587710 46189551 48005498 11461656 12718842 4884797 -15863370 278376025 269579259 -15848985 74195 -4973377 0 X 0 1 X 1 0 X 21996052 12343472 19967337 47936489 17710255 119953605 21996052 12343472 19967337 47936489 17710255 119953605 43632912 76320693 150225 95885 295681 379531 731148 1652470 149230 229939 68718 60841 2336453 2845181 124451256 64075655 0.61330 0.61700 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: SETTLEMENT OTHER INCOME - 2014 AMOUNT: $ 149,230. 2015 AMOUNT: $ 229,939. 2016 AMOUNT: $ 68,718. 2017 AMOUNT: $ 60,841. 2018 AMOUNT: $ 2,336,453. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 57651177 6240194 35939 3202970 60724340 37437877 24492812 33963 4313475 57651177 37106068 3894535 16793 3579519 37437877 39870912 1251419 6243 4022506 37106068 34999704 12955007 9610 8093409 39870912 0.00000 0.21000 0.79000 0 0 21480859 21480859 152605519 12894048 139711471 16147266 12753755 3393511 1320859 291087 1029772 165615613 FUNDS HELD BY TRUSTEE UNDER DEBT AGREEMENT 11798928 DEBT ISSUANCE COSTS, NET OF ACCUMULATED AMORTIZATION 5450969 CHARITABLE REMAINDER TRUST RECEIVABLES 447900 ARTWORK 121042 GOODWILL 200000 DUE FROM RELATED PARTIES 872565 DEPOSITS 29177 18920581 ANNUITY OBLIGATIONS 1648651 OTHER 1408940 OBLIGATION TO PROVIDE FUTURE SNF 102294 OTHER PAYABLES 70567 3230452 X PART V, LINE 4: ENDOWMENT FUNDS ARE USED TO SUPPORT OPERATIONS. PART X, LINE 2: WITH THE EXCEPTION OF THE IPA, THE HOME IS EXEMPT FROM TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND SECTION 23701D OF THE CALIFORNIA REVENUE AND TAXATION CODE AND IS GENERALLY NOT SUBJECT TO FEDERAL OR STATE INCOME TAXES. HOWEVER, THE HOME IS SUBJECT TO INCOME TAXES ON ANY NET INCOME THAT IS DERIVED FROM A TRADE OR BUSINESS, REGULARLY CARRIED ON, AND NOT IN FURTHERANCE OF THE PURPOSES FOR WHICH IT WAS GRANTED EXEMPTION. NO INCOME TAX PROVISION HAS BEEN RECORDED AS THE NET INCOME, IF ANY, FROM ANY UNRELATED TRADE OR BUSINESS, IN THE OPINION OF MANAGEMENT, IS NOT MATERIAL TO THE CONSOLIDATED FINANCIAL STATEMENTS TAKEN AS A WHOLE. THE HOME RECOGNIZES THE TAX BENEFIT FROM UNCERTAIN TAX POSITIONS ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITIONS WILL BE SUSTAINED ON EXAMINATION BY THE TAX AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE TAX BENEFIT IS MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50% LIKELIHOOD OF BEING REALIZED UPON ULTIMATE SETTLEMENT. THERE WERE NO UNCERTAIN TAX POSITIONS AS OF AUGUST 31, 2019 OR 2018. MIDDLE EAST AND NORTH AFRICA - ALGERIA, BAHRAIN, DJIBOUTI, EGYPT, 0 0 INVESTMENTS 2006000 0 0 0 0 0 0 2006000 0 2006000 0 0 0 0 0 0 GUARDIANS GALA 665273 598746 66527 16284 TREE OF LIFE 213017 191716 21301 78855 7 896050 491251 404799 255075 1774340 1281713 492627 350214 350214 142413 X X X X X 0 0 0 0 0 0 0 1 0 M FORREST CEO-PRESIDENT 589205 0 150000 0 0 0 8850 0 4631 0 752686 0 0 0 I SILBERMAN CFO (THROUGH 2/1/2019) 295992 0 35000 0 0 0 7605 0 17784 0 356381 0 0 0 L STEPANIANS COO 322386 0 30000 0 0 0 7780 0 1389 0 361555 0 0 0 N MARCO CMO 371417 0 35000 0 0 0 8996 0 13219 0 428632 0 0 0 A POSSICK CHIEF STRATEGY OFFICER 298220 0 20000 0 0 0 6325 0 9361 0 333906 0 0 0 A ALDERMAN VICE PRESIDENT HR 145180 0 10000 0 0 0 4708 0 5642 0 165530 0 0 0 T CARLSON COMPLIANCE OFFICER 179750 0 10000 0 0 0 0 0 5840 0 195590 0 0 0 S KLAPPHOLZ FOUNDATION SENIOR VP 214992 0 0 0 0 0 0 0 16284 0 231276 0 0 0 J ERBE DIRECTOR INFO SYSTEMS 236243 0 0 0 0 0 6384 0 11830 0 254457 0 0 0 H SABET SENIOR MGR INFO SYSTEMS 222763 0 0 0 0 0 5877 0 4688 0 233328 0 0 0 C SLAVIN VP FUND DEVELOPMENT 191767 0 0 0 0 0 6618 0 9220 0 207605 0 0 0 L PLACHTA DIRECTOR OF DEVELOPMENT 184424 0 0 0 0 0 5920 0 12006 0 202350 0 0 0 B POLISHUK DIRECTOR OF COMMUNITY RELATIONS 169356 0 0 0 0 0 5840 0 8295 0 183491 0 0 0 PART I, LINE 7 ALL BONUSES ARE DISCRETIONARY EXCEPT FOR THE CEO-PRESIDENT'S WHICH IS FIXED FOR THE FIRST THREE YEARS OF HER 5 YEAR CONTRACT AND THEN BECOMES DISCRETIONARY FOR THE LAST TWO YEARS. THIS IS THE THIRD YEAR OF HER CONTRACT THEREFORE, IT IS FIXED FOR THE 2018 TAX YEAR. A CA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY 680164610 000000000 2013-12-20 71155000 REFUND OUTSTANDING DEBT ISSUED 12/1/2003 0 0 0 B CA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY 680164610 13081AAN2 2014-08-27 150100266 SEE PART VI 0 0 0 C CA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY 680164610 000000000 2019-08-08 16594304 REFUND OUTSTANDING DEBT ISSUED 2/4/2008 FOR 108-BED CONTINUING CARE FACILITY 0 0 0 A 13010000 71155000 7702011 1302898 2270808 62473253 2008 1 0 1 1 B 110470000 150100267 5489389 2321805 5418729 121026624 2017 0 0 1 1 C 16594304 648900 331886 450589 15162929 1 0 1 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 A 0 0 0 1 0 0 0 0 0 B 0 0 0 1 0 0 0 0 0 C 0 1 0 0 0 0 0 0 0 A 0 B 0 C 0 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: CA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 09/26/2019 ISSUER NAME: CA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 08/27/2019 SCHEDULE K, PART I, ROW B, COLUMN (F) - DESCRIPTION OF PURPOSE: CONSTRUCTION OF A 175-BED CONTINUING CARE RETIREMENT FACILITY AND 24 ASSISTED LIVING AND MEMORY CARE UNITS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WILL BE REVIEWED BY THE VOTING MEMBERS OF THE BOARD OF DIRECTORS PRIOR TO SUBMISSION. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST FORM SPECIFIES ACTIONS THAT WOULD BE CONSIDERED CONFLICTS OF INTEREST AND EXPLAINS THE ORGANIZATION'S PROCEDURES TO REPORT ANY SUSPECTED CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 POLICY FOR DETERMINATION OF EXECUTIVE COMPENSATION, OFFICERS AND TOP MANAGEMENT INCLUDES REVIEWING COMPARABILITY DATA FROM NUMEROUS SALARY AND COMPENSATION SURVEYS AND THE FORM 990 DATA OF SIMILAR ORGANIZATIONS. THE COMPENSATION FOR TOP MANAGEMENT IS DETERMINED BY THE EXECUTIVE REVIEW COMMITTEE AND APPROVED BY THE FULL EXECUTIVE COMMITTEE OF THE BOARD. COMPENSATION IS REVIEWED FOR OFFICERS AND TOP MANAGEMENT ON AN ANNUAL BASIS. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. JHA WEST 16 LLC 7150 TAMPA AVENUE RESEDA CA 91335 263639876 CONTINUING CARE RETIREMENT COMMUNITY CA 13385016 188476881 LOS ANGELES JEWISH HOME FOR THE AGING JHA GERIATRIC SERVICES INC 7150 TAMPA AVE RESEDA CA 91335 954407317 CLINICAL AND HOSPICE SERVICES FOR THE ELDERLY CA 501(C)(3) 10 LOS ANGELES JEWISH HOME FOR THE AGING 1 EISENBERG VILLAGE OF THE LOS ANGELES JEWISH HOME FOR THE AGING 7150 TAMPA AVE RESEDA CA 91335 951691015 RESIDENTIAL CARE AND SKILLED NURSING FACILITY CA 501(C)(3) 10 LOS ANGELES JEWISH HOME FOR THE AGING 1 ANNENBERG SCHOOL OF NURSING 7150 TAMPA AVE RESEDA CA 91335 208449705 VOCATIONAL NURSE EDUCATION CA 501(C)(3) 2 LOS ANGELES JEWISH HOME FOR THE AGING 1 GRANCELL VILLAGE OF THE LOS ANGELES JEWISH HOME FOR THE AGING 7150 TAMPA AVE RESEDA CA 91335 951831045 RESIDENTIAL CARE AND SKILLED NURSING FACILITY CA 501(C)(3) 10 LOS ANGELES JEWISH HOME FOR THE AGING 1 BRANDMAN CENTERS FOR SENIOR CARE INC 7150 TAMPA AVE RESEDA CA 91335 264023159 PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY CA 501(C)(3) 10 LOS ANGELES JEWISH HOME FOR THE AGING 1 JEWISH HOME FOUNDATION 7150 TAMPA AVE RESEDA CA 91335 800927200 FUNDRAISING CA 501(C)(3) LINE 12A, I LOS ANGELES JEWISH HOME FOR THE AGING 1 BRANDMAN RESEARCH INSTITUTE 7150 TAMPA AVE RESEDA CA 91335 954414031 GERONTOLOGICAL RESEARCH CA 501(C)(3) LINE 12A, I LOS ANGELES JEWISH HOME FOR THE AGING 1 LOS ANGELES JEWISH HOME IPA 7150 TAMPA AVE RESEDA CA 91335 811160437 INDEPENDENT PRACTICE ASSOCIATION CA N/A C 0 1 0 0 1 1 0 0 0 0 1 0 1 1 1 1 1 1 1 1 EISENBERG VILLAGE OF THE LOS ANGELES JEWISH HOME FOR THE AGING Q 4638613 FMV GRANCELL VILLAGE OF THE LOS ANGELES JEWISH HOME FOR THE AGING Q 8423683 FMV ANNENBERG SCHOOL OF NURSING Q 173356 FMV JHA GERIATRIC SERVICES Q 3138612 FMV BRANDMAN CENTERS FOR SENIOR CARE INC A 488529 FMV