2020-02-24T12:47:34-06:00 2019-06-30 390859910 BAKER TILLY VIRCHOW KRAUSE LLP 1570 FRUITVILLE PIKE SUITE 400 LANCASTER PA 17601 990 2018-07-01 221717575 HEATH VILLAGE INC HEAT 9088524801 430 SCHOOLEYS MOUNTAIN ROAD HACKETTSTOWN NJ 078404099 PATRICK E BRADY CEO 9088524801 2020-02-22 1 KERRI N BOGDA CPA P00760402 7177404863 148.75.192.64 2020-02-22 16:19:48 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 45D50D8E3994CEF8BF8842BFE43A81B55B26F885 2018 2020-09-23 17:36:50Z PATRICK E BRADY 430 SCHOOLEYS MOUNTAIN ROAD HACKETTSTOWN NJ 078404099 28989688 0 X WWW.HEATHVILLAGE.COM X 1962 NJ RETIREMENT COMMUNITY OFFERING INDEPENDENT LIVING, ASSISTED LIVING, AND SKILLED NURSING CARE. 12 11 432 67 42407 0 974536 224696 25803215 26195715 547448 544187 229901 177477 27555100 27142075 12947 12959 0 0 14669141 15423757 0 0 9659 9757270 9778326 24439358 25215042 3115742 1927033 56486540 73657057 8817590 26935362 47668950 46721695 X HEATH VILLAGE WAS FORMED FOR THE PURPOSE OF PLANNING, BUILDING AND OPERATING A RETIREMENT COMMUNITY. HEATH VILLAGE IS A MULTI-DENOMINATIONAL CHRISTIAN COMMUNITY FOR ALL PEOPLE, REGARDLESS OF RACE, CREED OR ETHNIC ORIGIN. HEATH VILLAGE BELIEVES IT IS IMPORTANT THAT RETIRED PERSONS HAVE A LIVING ENVIRONMENT THAT FOSTERS A MEANINGFUL LIFE WITH SECURITY, DIGNITY, FELLOWSHIP AND PERSONAL AND SPIRITUAL WELL-BEING. TO ACHIEVE THESE OBJECTIVES AND PURPOSE, HEATH VILLAGE PROVIDES RETIRED PERSONS WITH APPROPRIATE LIVING ACCOMMODATIONS, AS WELL AS SOCIAL, RECREATIONAL, EDUCATIONAL, RELIGIOUS AND OTHER PROGRAMS AND SERVICES THAT PROMOTE INDIVIDUAL INDEPENDENCE IN LIVING WITH THE AVAILABILITY OF SUPPORTIVE SERVICES WHEN NEEDED. HEATH VILLAGE ENCOURAGES INTERACTION BETWEEN HEATH VILLAGE EMPLOYEES, ITS RESIDENTS AND THE COMMUNITY AT LARGE. 0 0 21179549 12959 26195715 HEATH VILLAGE IS A FULL SERVICE RETIREMENT COMMUNITY WHICH ALSO INCLUDES A COMPREHENSIVE HEALTH CARE FACILITY. THERE ARE NO LIFE CARE FEES AND OPTIONAL ENTRANCE FEES, MAKING IT AN AFFORDABLE CHOICE FOR TODAY'S RETIREE WHO WANTS TO REMAIN ACTIVE, INVOLVED AND INDEPENDENT. THE 100+ ACRE COMMUNITY OFFERS A VARIETY OF LIVING ACCOMMODATIONS INCLUDING: 150 INDEPENDENT APARTMENTS RANGING IN SIZE FROM STUDIO TO TWO-BEDROOMS; 10 COTTAGE STYLE APARTMENTS WHICH INCLUDE TWO BEDROOMS, A SINGLE CAR GARAGE, UTILITY ROOM, TWO BATHS, AN EAT-IN KITCHEN AND A THREE-SEASON PORCH; 38 HOTEL-STYLE APARTMENTS WHICH INCLUDE HOUSEKEEPING SERVICES AND THREE MEALS PER DAY; 40 RESIDENTIAL HEALTHCARE BEDS AND 99 SKILLED NURSING BEDS, BOTH LICENSED BY THE NEW JERSEY STATE DEPARTMENT OF HEALTH. FOR THE FISCAL YEAR ENDED JUNE 30, 2019, THE INDEPENDENT APARTMENTS SERVED 260 RESIDENTS, THE RESIDENTIAL HEALTH CARE UNIT SERVED 51 RESIDENTS, AND THE SKILLED NURSING UNIT SERVED 482 SHORT-TERM AND LONG-TERM PATIENTS. THE FACILITY PROVIDED $712,756 IN BENEVOLENT CARE ACROSS ALL LEVELS OF CARE. ALL RESIDENTS AND PATIENTS OF THE COMMUNITY ENJOY AROUND THE CLOCK SECURITY, A WIRELESS EMERGENCY/NURSE CALL ALERT SYSTEM, WIFI, MAINTENANCE SERVICES, TRANSPORTATION SERVICES, PASTORAL SERVICES, AND SOCIAL ACTIVITIES BOTH ON CAMPUS AND OFF CAMPUS IN ADDITION TO A SWIMMING POOL AND JACUZZI, COMMUNITY GARDEN, SHUFFLE BOARD COURT, BOCCE COURT, NATURE/WALKING TRAIL, LIBRARY, FITNESS CENTER, BANK, COMPUTER CENTER, GIFT SHOP, BEAUTY SALON, CRAFT SHOP, CHAPEL, ART STUDIO, AND NUMEROUS OTHER AMENITIES. WHILE THE RESIDENTIAL HEALTHCARE AND SKILLED NURSING UNITS HAVE THEIR OWN DINING ROOM FACILITIES, ALL RESIDENTS AND GUESTS OF THE COMMUNITY HAVE THE OPTION OF DINING IN THE MAIN DINING ROOM FOR A RESTAURANT STYLE DINING OPTION, THE GRILL ROOM FOR A FINE DINING EXPERIENCE, THE PUB, OR IN THE CAFE FOR A LESS FORMAL SETTING. RESIDENTS ALSO ENJOY VARIOUS SPECIAL DINING EVENTS IN THE MAIN DINING FACILITIES THROUGHOUT THE YEAR INCLUDING BIRTHDAY NIGHT, HOLIDAY DINNERS, A RESIDENT ANNIVERSARY CELEBRATION, AND A NEWCOMER'S RECEPTION. RESIDENTS OF THE COMMUNITY CONTINUE TO PARTICIPATE IN OVER 40 RESIDENT GROUPS AND ORGANIZATIONS, INCLUDING THE BOCCE BALL LEAGUE, WII BOWLING LEAGUE, BRIDGE PLAYERS, MAHJONG, AND BOOK DISCUSSION GROUP, TO NAME A FEW. DURING THE FISCAL YEAR, A NEW CHOIR GROUP AND PICKLEBALL GROUP WERE ADDED. VOLUNTEERS WHO RESIDE ON-CAMPUS CONTINUED THE EFFORTS OF THE FACILITY'S THRIFT STORE KNOWN AS THE FRIENDSHIP STORE, WHICH GENERATED PROCEEDS OF $8,311 TO SUPPORT THE BENEVOLENT CARE FUND. OTHER RESIDENT VOLUNTEERS ALSO RAISED $7,679 FOR THE FUND BY HOLDING BAKE SALES, A FARMER'S MARKET, AND A SILENT AUCTION.RESIDENTS CONTINUE TO ENJOY PARTIES AT THE POOL ALONG WITH WATER AEROBICS IN THE SUMMER SEASON. OTHER ON-CAMPUS EVENTS INCLUDED OUTSIDE CONCERTS, LECTURES, AND COCKTAIL PARTIES. THE ANNUAL FAMILY DAY EVENT WAS WELL ATTENDED BY RESIDENTS, PATIENTS, EMPLOYEES, AND FAMILY MEMBERS. THE RESIDENTS ALSO ATTENDED VARIOUS OFF-CAMPUS TRIPS DURING THE FISCAL YEAR INCLUDING NUMEROUS TRIPS TO LOCAL RESTAURANTS, HUNTERDON HILLS PLAYHOUSE, NEW JERSEY SYMPHONY ORCHESTRA, CENTENARY STAGE PRODUCTIONS, PAPER MILL PLAYHOUSE, AND THE VERY POPULAR ANNUAL MYSTERY TRIP. TWENTY-FOUR RESIDENTS, STAFF AND COMMUNITY MEMBERS EVEN ATTENDED AN OVER-NIGHT TRIP TO THE FINGER LAKES WHICH INCLUDED STOPS AT THE CORNING GLASS MUSEUM AND FINGER LAKES CASINO, WINE TASTING AND DINNER AT THE BELHURST CASTLE, TOURS OF THE SONNENBURG GARDENS AND MANSION AND THE WILLARD MEMORIAL CHAPEL, AND A SIGHTSEEING CRUISE ON LAKE SKANEATELES. TWO HEATH VILLAGE RESIDENTS BEGAN OFFERING ENGLISH CONVERSATION CLASSES TO INTERESTED EMPLOYEES DURING FEBRUARY 2019. BOTH RESIDENTS ARE TRAINED ENGLISH TUTORS THROUGH LITERACYNJ. CLASSES ARE HELD TWO DAYS PER WEEK AFTER WORK. THE RESIDENT VOLUNTEERS ASSIST EMPLOYEES TO IMPROVE THEIR COMMAND OF THE ENGLISH LANGUAGE BY MEANS OF CONVERSATION, READING STORIES, AND PLAYING GAMES. EMPLOYEES PARTICIPATE FROM VARIOUS DEPARTMENTS AND REPRESENT MANY COUNTRIES INCLUDING MEXICO, COLOMBIA, GUATEMALA, ECUADOR, RUSSIA AND UKRAINE.THE SKILLED NURSING UNIT BOASTS A SUB-ACUTE CARE AND REHABILITATION FACILITY WHICH PROVIDES FIRST-RATE IN-PATIENT CARE FOR ADULT PATIENTS FIFTY-FIVE AND OLDER WHO ARE RECOVERING FROM AN ACUTE ILLNESS OR INJURY. THE FACILITY PROVIDES THE FOLLOWING COMPREHENSIVE SERVICES: MEDICAL AND SURGICAL RECOVERY, CARDIAC CARE, WOUND CARE, PHYSICAL AND OCCUPATIONAL THERAPY, SPEECH THERAPY, IV THERAPY AND HOSPICE CARE. INDEPENDENT RESIDENTS OF THE COMMUNITY ALSO BENEFIT FROM THE OUT-PATIENT THERAPY SERVICES PROVIDED BY THIS FACILITY. DURING THE FISCAL YEAR ENDING JUNE 30, 2019, THE REHAB FACILITY SERVED 27 OUT-PATIENTS. RESIDENTS WHO LIVE INDEPENDENTLY OUTSIDE OF THE NURSING FACILITY ALSO BENEFIT FROM HOME HEALTH SERVICES AND OUT-PATIENT NURSING CARE MADE AVAILABLE THROUGH THE SKILLED NURSING UNIT.THE SKILLED NURSING FACILITY ALSO HAS A SOCIAL SERVICES DEPARTMENT WHICH IS DEDICATED TO THE PSYCHOSOCIAL WELL-BEING OF ALL PATIENTS AND RESIDENTS WITHIN THE COMMUNITY. THIS DEPARTMENT SERVES AS AN INTERDEPARTMENTAL LIAISON FOR THE PATIENTS AND FAMILY MEMBERS TO MAKE SURE ALL OF THEIR NEEDS ARE MET MEDICALLY, PHYSICALLY AND EMOTIONALLY. THIS DEPARTMENT CONTINUES TO EDUCATE PATIENTS AND RESIDENTS ABOUT THE POLST (PRACTITIONER ORDERS FOR LIFE-SUSTAINING TREATMENT) AND ASSIST THEM WITH PREPARING THE POLST FORM. THIS ALLOWS THE INDIVIDUAL TO BE THEIR OWN MEDICAL ADVOCATE, IDENTIFIES MEDICAL TREATMENTS THAT THEY APPROVE OR DISAPPROVE OF IN THE EVENT THAT THEY ARE UNABLE TO SPEAK FOR THEMSELVES, AND REDUCES THE BURDEN ON FAMILY AND CAREGIVERS. IN ADDITION, THE SOCIAL SERVICE DEPARTMENT AVAILABLE TO ASSIST PATIENTS WITH COMPLETING LIVING WILLS AND DESIGNATING A MEDICAL POWER OF ATTORNEY. DURING THE FISCAL YEAR, THIS DEPARTMENT STARTED A NEW REMINISCE SUPPORT GROUP THAT IS HELD BIWEEKLY TO PROVIDE ONE-ON-ONE EMOTIONAL SUPPORT. THE DEPARTMENT ALSO CONTINUED TO WORK ON REDUCING THE SIGNS AND SYMPTOMS OF DEPRESSION IN BOTH LONG-TERM CARE AND SUB-ACUTE PATIENTS, BY WORKING TOGETHER WITH PSYCHIATRISTS, THERAPISTS, AND THE INTERDISCIPLINARY TEAM. DUE TO THIS TEAM EFFORT, RATES OF DEPRESSION HAVE DECREASED. THE HEALTH CARE CENTER STRIVES TO PROVIDE A HOME-LIKE ATMOSPHERE AND HAS EMBRACED A WONDERFUL ENRICHMENT PROGRAM THAT INCORPORATES BRINGING THE "OUT OF DOORS" INSIDE. A DEDICATED STAFF OF ACTIVITY PROFESSIONALS ENHANCES NURSING CARE WITH A PROGRAM DESIGNED TO PROMOTE INTEREST AND ENJOYMENT. DURING THE FISCAL YEAR ENDING JUNE 30, 2019, THE FACILITY CONTINUED TO PROVIDE A VARIETY OF THERAPEUTIC ACTIVITIES INCLUDING VISITS FROM PET THERAPY DOGS, CERTIFIED MUSIC THERAPY, ART THERAPY AND TAI CHI. PATIENTS ALWAYS ENJOY REGULAR VISITS FROM AND ACTIVITIES WITH THE FRIENDSHIP CENTER CHILDCARE CENTER STUDENTS. PATIENTS ALSO HAVE THE OPPORTUNITY TO TAKE TRIPS OUTSIDE OF THE FACILITY FOR ICE CREAM AND LUNCH AT LOCAL RESTAURANTS. A "MINI MALL" IS BROUGHT TO THE SKILLED NURSING UNIT SO THAT PATIENTS CAN SHOP ON PREMISE.HEATH VILLAGE ALSO SERVES THE LOCAL COMMUNITY BY HOSTING A MONTHLY PARKINSON'S SUPPORT GROUP AND SENIOR SEMINARS, ALL OF WHICH ARE FREE AND OPEN TO THE PUBLIC. THIS YEAR THE SENIOR SEMINARS INCLUDED A VISIT FROM CONGRESSMAN MALINOWSKI, A DIGESTION AND AGING SEMINAR, A SEMINAR REGARDING SELLING YOUR HOME, AND MANY MORE. 21179549 1 1 0 1 0 0 0 0 1 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 352 1 432 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 X 12 11 1 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 0 1 0 0 NJ X ANTHONY PUCCIO 9086845018 422 SCHOOLEYS MOUNTAIN ROAD HACKETTSTOWN NJ 078404099 CAROL MCKINNEY CHAIR 0.30 0.30 X X 0 0 0 L ALLISON GARDE VICE CHAIR 0.30 0.30 X X 0 0 0 HAROLD S LAPPIN SECRETARY/TREASURER 0.30 0.30 X X 0 0 0 SANDERS DAVIS TRUSTEE 0.30 0.30 X 0 0 0 ROBERT GALLAGHER TRUSTEE 0.30 0.00 X 0 0 0 MARY ALICE HORN TRUSTEE 0.30 0.30 X 0 0 0 HERBERT KORTE TRUSTEE 0.30 0.50 X 0 0 0 FRANK REITZ TRUSTEE-RESIDENT REPRESENTATION 0.30 0.00 X 0 0 0 ARTHUR SHENINGER TRUSTEE 0.30 0.00 X 0 0 0 TIMOTHY STEWART TRUSTEE 0.30 0.00 X 0 0 0 PETER R VAN BRUNT TRUSTEE 0.30 0.30 X 0 0 0 PATRICK E BRADY CEO/EXECUTIVE DIRECTOR 40.00 0.50 X X 647573 0 42647 MARY ELLEN BOVE CHIEF OPERATING OFFICER 40.00 0.50 X 287074 0 80742 ANTHONY PUCCIO CHIEF FINANCIAL OFFICER 40.00 0.50 X 185029 0 20084 VIVIAN BLANDURA DIRECTOR OF NURSING 40.00 0.00 X 126310 0 23862 JANICE CIPRIANI DIRECTOR OF MARKETING 40.00 0.00 X 115486 0 16831 LEAH GRAUSO OCCUPATIONAL THERAPIST 40.00 0.00 X 107017 0 5351 JONATHAN MANUEL DIRECTOR OF REHAB 40.00 0.00 X 101775 0 22626 NORMA THOMAS RN 40.00 0.00 X 101950 0 15930 1672214 0 228073 8 0 1 0 LECESSE CONSTRUCTION SERVICES LLC 15 CIRCLE STREET ROCHESTER NY 14607 CONSTRUCTION 1941497 CHRIS BRANDS CONSTRUCTION CO 710 LAUREL HILL ROAD BANGOR PA 18013 CARPENTRY 1032315 GTG BUILDERS LLC PO BOX 5356 NORTH BRANCH NJ 08876 CONSTRUCTION 592833 SODEXO INC AND AFFILIATES PO BOX 360170 PITTSBURGH PA 15251 FOOD SERVICE 409643 HOWARD BURD & SONS 300 LAFAYETTE STREET HACKETTSTOWN NJ 07840 EXCAVATING/PAVING 389771 10 64075 160621 224696 NET RESIDENT SERVICE REV 623000 26195715 26195715 26195715 436913 436913 1928334 1800 1822860 0 105474 1800 107274 107274 15000 64075 10731 4269 4269 31 80 -49 -49 14763 13942 821 821 NON-RESIDENT REVENUE 721000 54479 42048 12431 MEALS 722210 54305 54305 GUEST ROOMS 900099 28505 28505 35147 359 34788 172436 27142075 26195715 42407 679257 12959 12959 1224225 1224225 10715507 9675197 1034968 5342 388866 353544 35055 267 2238421 1906473 330933 1015 856738 711604 144703 431 172048 160048 12000 10557 10557 76931 76931 860 860 57956 57956 1059049 916596 142453 46959 46959 1003722 906843 94275 2604 223672 12958 210714 1478198 1478198 33869 28164 5705 54339 45695 8644 5547 5547 3102955 3102955 343192 11264 331928 FOOD 941245 925726 15519 PHARMACY 378647 378647 NURSING HOME ASSESMENT 265864 265864 BAD DEBT EXPENSE 180000 180000 342716 281267 61449 25215042 21179549 4025834 9659 106181 46287 6209048 3672711 1267251 1569023 144384 117994 119119 106819 94344571 44940241 34304399 49404330 13243846 17658806 301443 295419 790869 785668 56486540 73657057 4349126 8191866 3334593 3377158 10714338 781705 780111 352166 3871889 8817590 26935362 X 44170412 43464057 3498538 3257638 47668950 46721695 56486540 73657057 X 1927033 639203 -3513491 X 0 1 X 1 0 X 411019 354265 169820 974536 224696 2134336 23817593 24849551 25333396 25803215 26195715 125999470 24228612 25203816 25503216 26777751 26420411 128133806 0 0 0 128133806 475911 440907 415093 348742 436913 2117566 475911 440907 415093 348742 436913 2117566 51838 53000 48938 42407 196183 141872 127426 142762 171344 130029 713433 24846395 25823987 26114071 27346775 27029760 131160988 0.97690 0.97630 0.01610 0.01560 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MEALS - 2014 AMOUNT: $ 64,463. 2015 AMOUNT: $ 61,606. 2016 AMOUNT: $ 55,090. 2017 AMOUNT: $ 55,566. 2018 AMOUNT: $ 54,305. LATE FEE INCOME - 2014 AMOUNT: $ 13,516. 2015 AMOUNT: $ 20,551. 2016 AMOUNT: $ 34,675. 2017 AMOUNT: $ 10,417. 2018 AMOUNT: $ 7,544. GUEST ROOMS - 2014 AMOUNT: $ 27,185. 2015 AMOUNT: $ 21,700. 2016 AMOUNT: $ 23,830. 2017 AMOUNT: $ 24,840. 2018 AMOUNT: $ 28,505. FIREWOOD SALES - 2017 AMOUNT: $ 3,819. RESIDENT MAINTENANCE SERVICES - 2017 AMOUNT: $ 9,152. LOAN INCOME - GIFT SHOP - 2014 AMOUNT: $ 3,822. 2015 AMOUNT: $ 3,441. 2018 AMOUNT: $ 8,311. THRIFT STORE REVENUE - 2014 AMOUNT: $ 10,574. 2015 AMOUNT: $ 9,785. 2016 AMOUNT: $ 9,341. 2017 AMOUNT: $ 7,853. MISCELLANEOUS INCOME - 2014 AMOUNT: $ 8,878. 2015 AMOUNT: $ 11,093. 2016 AMOUNT: $ 21,377. 2017 AMOUNT: $ 49,578. 2018 AMOUNT: $ 18,933. GROSS INVENTORIES - 2014 AMOUNT: $ 16,230. PARTNERSHIP GAIN/LOSS - 2014 AMOUNT: $ -2,796. 2015 AMOUNT: $ -750. 2016 AMOUNT: $ -1,551. 2017 AMOUNT: $ -1,881. NON-RESIDENT REVENUE - 2017 AMOUNT: $ 12,000. 2018 AMOUNT: $ 12,431. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 860 860 0 PART II-B, LINE 1: HEATH VILLAGE PAID MEMBERSHIP DUES TO LEADING AGE OF NJ OF $11,567, OF WHICH AN ESTIMATED 5.5% OR $636 WENT TOWARDS LOBBYING ACTIVITY. HEATH VILLAGE PAID MEMBERSHIP DUES TO LEADING AGE NATIONAL OF $8,000, OF WHICH AN ESTIMATED 2.8% OR $224 WENT TOWARDS LOBBYING ACTIVITY. 0 1 X 4592220 4592220 56150825 35568904 20581921 9949231 7384979 2564252 23652295 1986358 21665937 49404330 ANNUITIES PAYABLE 358398 DERIVATIVE FINANCIAL INSTRUMENT 3513491 3871889 24187450 639203 -3535872 -2896669 27084119 57956 57956 27142075 25134705 -22381 -22381 25157086 57956 57956 25215042 PART IV, LINE 2B: SECURITY DEPOSITS AND PNA (PERSONAL NEEDS ALLOWANCE) FUNDS HELD IN TRUST FOR PATIENTS AND RESIDENTS. FUNDS ARE SEGREGATED AND HELD IN AN INTEREST-BEARING BANK ACCOUNT. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN FAIR VALUE OF DERIVATIVE FINANCIAL INSTRUMENTS -3,513,491. CHANGE IN THE SEGREGATED GIFT ANNUITY RESERVE -36,323. GIFT SHOP EXP 13,942. PART XII, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN THE SEGREGATED GIFT ANNUITY RESERVE -36,323. GIFT SHOP EXPENSES 13,942. BENEFIT GALA 71395 64075 7320 106 5023 500 5102 71395 64075 7320 106 5023 500 5102 10731 -3411 0 CENTENARY STAGE COMPANY 400 JEFFERSON ST HACKETTSTOWN NJ 07840 221500484 501(C)(3) 12000 SPONSORSHIP FOR THE 2018-2019 SEASON. 1 0 PART I, LINE 2: HEATH VILLAGE MADE A DONATION TO SPONSOR AN UNRELATED TAX-EXEMPT ORGANIZATION AND RECEIVED AN ACKNOWLEDGMENT LETTER FROM THE DONEE ORGANIZATION. X X X 0 1 0 0 0 0 0 1 0 PATRICK E BRADY CEO/EXECUTIVE DIRECTOR 332953 0 314620 0 0 0 13750 0 28897 0 690220 0 0 0 MARY ELLEN BOVE CHIEF OPERATING OFFICER 247074 0 40000 0 0 0 63750 0 16992 0 367816 0 0 0 ANTHONY PUCCIO CHIEF FINANCIAL OFFICER 185029 0 0 0 0 0 9284 0 10800 0 205113 0 0 0 VIVIAN BLANDURA DIRECTOR OF NURSING 118810 0 7500 0 0 0 6870 0 16992 0 150172 0 0 0 PART I, LINE 4B COO HAS A DEFERRED COMPENSATION ARRANGEMENT. THE ORGANIZATION PAID THE COO $30,000 ON 4/12/19 FOR THE DEFERRED COMPENSATION THAT WAS AWARDED ON 3/25/16. THE COO WAS AWARDED $75,000 ON 3/25/19, WHICH WILL BE VESTED ON 3/25/22. THE TOTAL DEFERRED COMPENSATION BALANCE AT 6/30/19 WAS $165,000. PART I, LINE 7 THE CEO DETERMINES THE COO'S BONUS AT THE CEO'S DISCRETION. THE CEO'S BONUS IS DETERMINED IN ACCORDANCE WITH AN EMPLOYMENT AGREEMENT. THE BOARD HAS DISCRETION TO ADJUST THE CEO'S BONUS DUE TO EXTRAORDINARY CIRCUMSTANCES. A PUBLIC FINANCE AUTHORITY 273866124 2018-08-10 38500000 TO FINANCE THE CONSTRUCTION OF A SKILLED NURSING FACILITY. 0 0 0 A 38500000 11076809 27423191 2020 0 0 0 0 A 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 1 1 BRANCH BANKING AND TRUST COMPANY 15.000000000000 0 0 0 0 1 A 1 FORM 990, PART VI, SECTION A, LINE 1 THE HEATH ALLIANCE FOR CARE, INC. EXECUTIVE COMMITTEE SHALL CONSIST OF SEVEN (7) MEMBERS, INCLUDING THE PRESIDENT, VICE-PRESIDENT, SECRETARY, TREASURER, ASSISTANT SECRETARY, ASSISTANT TREASURER, AND IMMEDIATE PAST PRESIDENT. FIVE (5) MEMBERS SHALL CONSTITUTE A QUORUM FOR THE TRANSACTION OF ALL BUSINESS. THE EXECUTIVE COMMITTEE SHALL MEET, AS NECESSARY, TO TRANSACT EMERGENCY BUSINESS BETWEEN BOARD MEETINGS. THE EXECUTIVE COMMITTEE MEETS AT THE CALL OF THE PRESIDENT OR UPON WRITTEN REQUEST OF ANY OTHER TWO MEMBERS THEREOF. THE EXECUTIVE COMMITTEE SHALL HAVE ALL POWERS AND DUTIES OF THE BOARD EXCEPT IT SHALL NOT HAVE THE POWER TO REMOVE OR ELECT A TRUSTEE OR THE CEO OR TO APPROVE OR DISAPPROVE THE OPERATING OR CAPITAL EXPENSE BUDGETS. HOWEVER, IN TIMES DEEMED BY THEM TO BE OF EMERGENCY, THE EXECUTIVE COMMITTEE MAY APPROVE EXPENDITURES NOT IN THE BUDGETS BUT NOT TO EXCEED SUCH AMOUNTS AS CURRENTLY ESTABLISHED BY THE BOARD. THE SECRETARY OF THE BOARD SHALL KEEP MINUTES OF ALL MEETINGS OF THE EXECUTIVE COMMITTEE AND SEND COPIES OF SAID MINUTES TO ALL BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 2 MARY ALICE HORN, TRUSTEE ON THE HEATH VILLAGE BOARD OF TRUSTEES, IS MARRIED TO NORRIS HORN, TRUSTEE ON THE HEATH ALLIANCE FOR CARE BOARD OF TRUSTEES. HEATH ALLIANCE FOR CARE IS THE NON-PROFIT PARENT CORP OF HEATH VILLAGE. THIS WAS IDENTIFIED ON THE CONFLICT OF INTEREST FORM COMPLETED BY MARY ALICE HORN ON 6/11/19. FORM 990, PART VI, SECTION A, LINE 4 THE CERTIFICATE OF INCORPORATION WAS AMENDED ON 7/16/18 TO REFLECT THAT HEATH ALLIANCE FOR CARE IS THE SOLE CORPORATE MEMBER OF HEATH VILLAGE (ARTICLE SIXTH), AND HAS THE RESERVED POWERS LISTED IN ARTICLE FOURTH, WHICH WAS PREVIOUSLY ONLY REFLECTED IN THE BYLAWS. HEATH ALLIANCE HAS THE RIGHTS OF ALL VOTING MEMBERS AND HAS THE FOLLOWING POWERS: ADOPTION AND AMENDMENT OF THE CERTIFICATE OF INCORPORATION AND/OR BYLAWS; ELECTION OF TRUSTEES AND REMOVAL OF TRUSTEES AND/OR OFFICERS; APPROVAL AND MONITORING OF THE ANNUAL OPERATING AND CAPITAL BUDGETS; APPROVAL OF ANY EXPENDITURE OR INCURRENCE OF INDEBTEDNESS IN EXCESS OF $250,000; AND APPROVAL OF LONG RANGE PLANS. THE BYLAWS WERE AMENDED IN MAY 2019 AS FOLLOWS: HEATH ALLIANCE IDENTIFIED AS SOLE MEMBER OF HEATH VILLAGE. THIS WAS NOT PREVIOUSLY MENTIONED IN THE BYLAWS, THOUGH HEATH VILLAGE WAS IDENTIFIED AS THE SUBSIDIARY OF HEATH ALLIANCE IN THE PRIOR VERSIONS. ARTICLE 2.2 WAS RENAME FROM "OBJECTIVES" TO "PURPOSE", AND IT WAS EXPANDED ON TO REFLECT THAT HEATH VILLAGE IS ORGANIZED AND SHALL BE OPERATED EXCLUSIVELY FOR CHARITABLE, EDUCATIONAL, SCIENTIFIC OR RELIGIOUS PURPOSES, WITHIN THE MEANING OF SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE SPECIFIC PURPOSE WAS ALSO EXPANDED UPON. THE SPECIFIC POWERS OF THE BOARD OF TRUSTEES WAS ADDED AS SECTION 2.3. THE NUMBER OF TRUSTEES IN ARTICLE 4.1 WAS UPDATED TO REFLECT THAT THE BOARD OF TRUSTEES MAY BE COMPRISED OF NOT LESS THAN 3 MEMBERS. THE LAST VERSION DID NOT REFLECT THAT MINIMUM. ARTICLE 4.6 WAS UPDATED TO INCLUDE THE ABILITY FOR THE BOARD TO TAKE ACTION THROUGH UNANIMOUS WRITTEN CONSENT INSTEAD OF A MEETING. THE ARTICLE REGARDING LIABILITY INSURANCE WAS MOVED FROM ARTICLE 4 TO ARTICLE 12.3. IT ALSO WAS UPDATED TO REFLECT THAT THE INSURANCE POLICY PURCHASED BY HEATH VILLAGE SHALL ALSO COVER THE TRUSTEES, OFFICERS AND EMPLOYEES OF HEATH ALLIANCE FOR CARE AND HEATH ALLIANCE'S SUBSIDIARY, THE HOUSE OF THE HOLY COMFORTER. BOTH OF WHICH SHALL BE RESPONSIBLE FOR THEIR OWN RESPECTIVE PORTIONS OF THE PREMIUM. THE ARTICLE REGARDING DISSOLUTION WAS UPDATED AND REWORDED TO REFLECT THAT HEATH ALLIANCE BOARD OF TRUSTEES MUST APPROVE DISTRIBUTION OF THE ASSETS UPON DISSOLUTION. THE PREVIOUS VERSION INDICATED THAT IT WAS HEATH ALLIANCE'S RESPONSIBILITY TO PAY OR MAKE PROVISIONS FOR ALL LIABILITIES AND DISPOSE OF THE ASSETS. ARTICLE 11.2 WAS ADDED REGARDING THE CHARITABLE STATUS, WHICH INDICATES THAT HEATH VILLAGE SHALL NOT CARRY OUT AN ACTIVITIES NOT PERMITTED BY EXEMPT ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF HEATH VILLAGE IS HEATH ALLIANCE FOR CARE, INC., A RELATED NOT-FOR-PROFIT ORGANIZATION THAT IS TAX-EXEMPT UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 186. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER OF HEATH VILLAGE IS HEATH ALLIANCE FOR CARE, INC. AS THE SOLE MEMBER OF HEATH VILLAGE, HEATH ALLIANCE FOR CARE, INC. HAS THE FOLLOWING MANAGEMENT POWERS: ELECTION OF THE CORPORATION'S TRUSTEES, APPROVAL OF REMOVAL OF THE CORPORATION'S TRUSTEES AND/OR OFFICERS BY THE CORPORATION'S BOARD OF TRUSTEES, AND REMOVAL OF THE CORPORATION'S TRUSTEES AND/OR OFFICERS WITH OR WITHOUT CAUSE. ALL OF THE TRUSTEES OF HEATH VILLAGE SHALL BE APPOINTED BY THE BOARD OF TRUSTEES OF HEATH ALLIANCE (THE NON-PROFIT PARENT CORPORATION). THE HEATH VILLAGE RESIDENT COUNCIL MAY NOMINATE ONE RESIDENT VOTING MEMBER TO THE BOARD OF TRUSTEES FOR A THREE YEAR TERM. A MAJORITY VOTE OF THE CURRENT TRUSTEES OF THE HEATH ALLIANCE SHALL BE REQUIRED FOR THE APPOINTMENT OF SAID RESIDENT MEMBER. THE PRESIDENT OF THE BOARD OF TRUSTEES OF HEATH ALLIANCE SHALL APPOINT BOTH THE CHAIRPERSON ("CHAIR") AND THE VICE-CHAIRPERSON ("VICE CHAIR") OF THE BOARD OF TRUSTEES OF HEATH VILLAGE FOR A ONE YEAR RENEWABLE TERM FROM AMONG THE TRUSTEES OF HEATH VILLAGE. BOTH POSITIONS SHALL BE INCLUDED IN ALL COUNTS OF TRUSTEES. VACANCIES IN THE BOARD OCCURRING BETWEEN TERMS SHALL BE FILLED FOR THE UNEXPIRED PORTION OF THE TERM BY A MAJORITY VOTE OF THE TRUSTEES OF HEATH ALLIANCE. FORM 990, PART VI, SECTION A, LINE 7B THE BOARD OF TRUSTEES OF HEATH ALLIANCE FOR CARE HAS AUTHORITY OVER THE HEATH VILLAGE BOARD OF TRUSTEES ON VARIOUS DUTIES AS IDENTIFIED IN THE HEATH VILLAGE BYLAWS AND ARTICLES OF INCORPORATION. HEATH ALLIANCE FOR CARE IS THE NON-PROFIT PARENT CORPORATION OF HEATH VILLAGE. ALL MEMBERS OF THE BOARD OF TRUSTEES SHALL BE APPOINTED BY THE BOARD OF TRUSTEES OF HEATH ALLIANCE FOR CARE. THE PRESIDENT OF THE BOARD OF HEATH ALLIANCE SHALL APPOINT THE CHAIRPERSON AND VICE-CHAIRPERSON OF THE BOARD OF TRUSTEES OF HEATH VILLAGE. HEATH ALLIANCE SHALL EMPLOY AN EXECUTIVE DIRECTOR OF HEATH VILLAGE. THE EXECUTIVE DIRECTOR SHALL REPORT TO THE CHIEF EXECUTIVE OFFICER OF HEATH ALLIANCE. THE CHIEF EXECUTIVE OFFICE OF HEATH ALLIANCE SHALL BE A TRUSTEE OF HEATH VILLAGE. THE BOARD SHALL REVIEW, ON AN ANNUAL BASIS, ALL CONSULTING CONTRACTS OR AGREEMENTS PERTAINING TO THE AFFAIRS OF HEATH VILLAGE AND PRESENT ITS FINDINGS TO THE APPROPRIATE COMMITTEE OF HEATH ALLIANCE WITH RECOMMENDATIONS TO RENEW OR NOT TO RENEW EXISTING CONTRACTS OR AGREEMENTS. ANY NEW CONTRACT OR AGREEMENT ENTERED INTO BY HEATH VILLAGE SHALL BE PRESENTED TO THE PROPER COMMITTEE OF HEATH ALLIANCE FOR RECOMMENDATION FOR APPROVAL OR DISAPPROVAL. HOWEVER, SHOULD HEATH VILLAGE BOARD OF TRUSTEES CONSIDER THE LEGAL ASPECTS OF SUCH A NATURE IN A GIVEN SITUATION THAT INVOLVES MORE THAN ROUTINE MATTERS, THE MATTER SHALL BE REFERRED TO THE BOARD OF TRUSTEES OF HEATH ALLIANCE FOR FURTHER LEGAL ACTION TO BE TAKEN IN CONJUNCTION WITH LEGAL COUNSEL. THE RECOMMENDATION OF HEATH ALLIANCE SHALL BE PRESENTED TO THE BOARD OF TRUSTEES OF HEATH VILLAGE FOR DISCUSSION AND APPROVAL. IF, FOR ANY REASON, THE HEATH VILLAGE BOARD OF TRUSTEES DOES NOT ACT, ITS DUTIES MAY BE PERFORMED BY THE APPROPRIATE COMMITTEE OF HEATH ALLIANCE. HEATH ALLIANCE HAS AUTHORITY TO APPROVE THE FOLLOWING WITH RESPECT TO RESIDENT SERVICES: POLICY DEVELOPMENT FOR PROGRAMS AND SERVICES, GUIDELINES FOR RECOGNIZING CONTRIBUTIONS OF HEATH VILLAGE, AND ANY MAJOR CHANGES AND/OR NEW POLICY RECOMMENDATIONS INCLUDING RECOMMENDATIONS OF BYLAW CHANGES. ALL AMENDMENTS TO THE HEATH VILLAGE BYLAWS ARE SUBJECT TO APPROVAL BY THE BOARD OF TRUSTEES OF HEATH ALLIANCE. HEATH ALLIANCE HAS THE AUTHORITY TO APPROVE THE FOLLOWING WITH RESPECT TO FACILITIES: CHANGES, ADDITIONS, ALTERNATIONS AND EXPENDITURES THAT SHOULD BE MADE TO MAINTAIN THE HEATH VILLAGE PROPERTY IN GOOD CONDITION, EXPANSION OF THE FACILITIES, AND THE FINAL FORMULATION OF MASTER PLAN FOR HEATH VILLAGE. AS SOLE MEMBER OF HEATH VILLAGE, HEATH ALLIANCE HAS ALL THE RIGHTS OF VOTING MEMBERS, AS PROVIDED IN THE NEW JERSEY NONPROFIT CORPORATION ACT. IN ADDITION, PURSUANT TO N.J.S.A. 15A:5-19(B) AND NOTWITHSTANDING ANY STATEMENT TO THE CONTRARY CONTAINED IN THE BYLAWS, THE FOLLOWING MANAGEMENT POWERS OF THE BOARD OF TRUSTEES SHALL BE EXERCISED BY HEATH ALLIANCE FOR CARE AS THE SOLE MEMBER OF THE CORPORATION, EXCEPT TO THE EXTENT SUCH MANAGEMENT POWERS ARE FROM TIME TO TIME DELEGATED BY THE MEMBER TO THE BOARD OF TRUSTEES OF HEATH VILLAGE: A. ADOPTION AND AMENDMENT OF THE CORPORATION'S CERTIFICATE OF INCORPORATION AND/OR BYLAWS; B. ELECTION OF THE CORPORATION'S TRUSTEES; APPROVAL OF REMOVAL OF THE CORPORATION'S TRUSTEES AND/OR OFFICERS BY THE CORPORATION'S BOARD OF TRUSTEES; AND REMOVAL OF THE CORPORATION'S TRUSTEES AND/OR OFFICER WITH OR WITHOUT CAUSE; C. APPROVAL AND MONITORING OF THE CORPORATION'S ANNUAL OPERATING AND CAPITAL BUDGETS; D. APPROVAL OF ANY EXPENDITURE OR INCURRENCE OF INDEBTEDNESS (NOT INCLUDED IN THE CORPORATION'S ANNUAL OPERATING OR CAPITAL BUDGETS) IN EXCESS OF $250,000 (INDIVIDUALLY OR IN THE AGGREGATE); AND E. APPROVAL OF THE CORPORATION'S LONG-RANGE PLANS. HEATH ALLIANCE FOR CARE, AS SOLE MEMBER, MUST ALSO APPROVE DISTRIBUTION OF ANY REMAINING ASSETS OF THE CORPORATION IN THE EVENT OF A LIQUIDATION, DISSOLUTION, TERMINATION OR WINDING UP OF HEATH VILLAGE. FORM 990, PART VI, SECTION B, LINE 11B THE SENIOR ACCOUNTANT, CFO, AND CEO REVIEW THE FORM PRIOR TO FILING. THE HEATH ALLIANCE FOR CARE FINANCE AND CORPORATE DEVELOPMENT COMMITTEE REVIEWS THE FORM AT A BOARD MEETING. THEN THE FINAL FORM IS DISTRIBUTED TO ALL MEMBERS OF THE HEATH VILLAGE BOARD PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C ALL BOARD MEMBERS AND OFFICERS ARE REQUIRED TO COMPLETE THE DISCLOSURE OF POSSIBLE CONFLICT OF INTEREST FORM ON AN ANNUAL BASIS. THE NOMINATING AND CORPORATE GOVERNANCE COMMITTEE IS RESPONSIBLE FOR DISTRIBUTING, COLLECTING AND REVIEWING ALL DISCLOSURE STATEMENTS ON AN ANNUAL BASIS. BOARD MEMBERS ARE REQUIRED TO REFRAIN FROM DISCUSSING, AS WELL AS VOTING ON, SUCH MATTERS IN WHICH A CONFLICT OF INTEREST EXISTS. IN SOME INSTANCES, THE INDIVIDUAL HAS BEEN RESPECTFULLY ASKED TO RESIGN FROM THEIR POSITION ON THE BOARD AS A RESULT OF A DISCLOSED CONFLICT. IN INSTANCES WHERE A CONFLICT OR POTENTIAL CONFLICT OF INTEREST EXISTS, THE BOARD OF TRUSTEES MUST DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED TRUSTEES PRESENT, THAT THE TRANSACTION OR ARRANGEMENT IS IN THE ORGANIZATION'S BEST INTEREST AND FOR ITS OWN BENEFIT, IS FAIR AND REASONABLE TO THE ORGANIZATION, AND THAT THE ORGANIZATION CANNOT OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT WITH REASONABLE EFFORTS. THE CEO ALSO REVIEWS THE COMPLETED FORMS AND RETAINS A FILE OF COMPLETED FORMS AFTER THE PROCESS OF COLLECTING AND REVIEWING THEM IS COMPLETED EACH YEAR. FORM 990, PART VI, SECTION B, LINE 15A THE CEO'S COMPENSATION IS DETERMINED AS FOLLOWS PER AN EXECUTED EMPLOYMENT AGREEMENT: "EMPLOYEE'S BASE SALARY IN EACH SUBSEQUENT YEAR OF THE PERIOD OF EMPLOYMENT SHALL BE REASONABLY ADJUSTED AND THE REASONABILITY OF SUCH ADJUSTMENT SHALL BE MADE WITH REFERENCE TO THE ANNUAL COMPENSATION SURVEYS PRODUCED BY THE AMERICAN ASSOCIATION OF HOMES AND SERVICES FOR THE AGING AND THE NEW JERSEY HOSPITAL ASSOCIATION FOR LIKE ORGANIZATIONS IN THE NORTHERN NEW JERSEY AREA, AND SUCH OTHER RELEVANT SALARY SURVEYS THAT MAY BE AVAILABLE FROM TIME TO TIME FROM OTHER INDEPENDENT INDUSTRY AND PROFESSIONAL ORGANIZATIONS. UPON CONSIDERATION OF RELEVANT SALARY DATA OF EMPLOYEES PERFORMING SERVICES COMMENSURATE WITH THOSE PERFORMED BY EMPLOYEE AND THE PERCENTAGE INCREASE GIVEN TO VILLAGE MANAGEMENT, THE PERSONNEL AND POLICY COMMITTEE, OR ANY SUCCESSOR COMMITTEE OF THE ALLIANCE BOARD, IN ITS SOLE DISCRETION, SUBJECT TO APPROVAL BY THE ALLIANCE BOARD, MAY ADJUST SUCH BASE SALARY INCREASES." IN ADDITION, HIS INCENTIVE BONUS IS ALSO COMPARED IN THE SAME MANNER. THE DIRECTOR OF HUMAN RESOURCES ALSO PROVIDES THE BOARD WITH INFORMATION FOR SIMILAR FACILITIES FROM GUIDESTAR. THIS WAS LAST PROVIDED TO THE BOARD ON 6/17/19 FOR THE CEO'S LAST ANNUAL REVIEW COMPLETED AT A BOARD MEETING ON 7/9/19. THIS COMPENSATION DETERMINATION PROCESS IS DOCUMENTED IN THE BOARD MINUTES. NO OTHER EMPLOYEE'S COMPENSATION IS DETERMINED IN THIS MANNER. THE COMPENSATION FOR THE COO AND CFO ARE BOTH DETERMINED BY THE CEO UPON HIRE. RAISES ARE AWARDED AT THE CEO'S DISCRETION UPON COMPLETION OF THEIR ANNUAL PERFORMANCE REVIEW. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN FAIR VALUE OF DERIVATIVE FINANCIAL INSTRUMENTS -3,513,491. HEATH ALLIANCE FOR CARE INC 422 SCHOOLEYS MOUNTAIN ROAD HACKETTSTOWN NJ 07840 223395211 SUPPORTING ORGANIZATION NJ 501(C)(3) LINE 12B, II N/A 0 THE HOUSE OF THE HOLY COMFORTER 33 MT PLEASANT AVE WEST ORANGE NJ 07052 221487578 RESIDENTIAL/ASSISTED LIVING HEALTH CARE FACILITY NJ 501(C)(3) LINE 10 HEATH ALLIANCE FOR CARE INC 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0