2019-03-18T09:13:37-05:00 2018-06-30 390859910 BAKER TILLY VIRCHOW KRAUSE LLP 1650 MARKET STREET SUITE 4500 PHILADELPHIA PA 191037341 990 2017-07-01 221717575 HEATH VILLAGE INC HEAT 9088524801 430 SCHOOLEYS MOUNTAIN ROAD HACKETTSTOWN NJ 078404099 PATRICK E BRADY CEO 9088524801 2019-03-14 1 JULIUS C GREEN CPA P00350393 2159720701 X 216.255.126.197 2019-03-14 10:26:48 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 45D50D8E3994CEF8BF8842BFE43A81B55B26F885 2017 2019-02-21 02:37:17Z PATRICK E BRADY 430 SCHOOLEYS MOUNTAIN ROAD HACKETTSTOWN NJ 078404099 30958591 0 X WWW.HEATHVILLAGE.COM X 1962 NJ RETIREMENT COMMUNITY OFFERING INDEPENDENT LIVING, ASSISTED LIVING, AND SKILLED NURSING CARE. 12 11 427 62 47057 -3648 169820 974536 25333396 25803215 852148 547448 196556 229901 26551920 27555100 12150 12947 0 0 14374209 14669141 0 0 7310 9176028 9757270 23562387 24439358 2989533 3115742 53098984 56486540 9092646 8817590 44006338 47668950 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 20598948 12947 25803215 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, 2018, THE INDEPENDENT APARTMENTS SERVED 262 RESIDENTS, THE RESIDENTIAL HEALTH CARE UNIT SERVED 55 RESIDENTS, AND THE SKILLED NURSING UNIT SERVED 398 SHORT-TERM AND LONG-TERM PATIENTS. THE FACILITY PROVIDED $1,099,625 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 ARTS & CRAFTS GROUP WAS CREATED WHICH WILL FOCUS ON MAKING ITEMS FOR RESIDENTS OF THE HEALTH CARE CENTER. VOLUNTEERS WHO RESIDE ON-CAMPUS CONTINUED THE EFFORTS OF THE FACILITY'S THRIFT STORE KNOWN AS THE FRIENDSHIP STORE, WHICH GENERATED PROCEEDS OF $7,853 TO SUPPORT THE BENEVOLENT CARE FUND. OTHER RESIDENT VOLUNTEERS ALSO RAISED $5,689 FOR THE FUND BY HOLDING BAKE SALES, A SILENT AUCTION AND A SPECIAL EVENT CALLED "REMEMBER WHEN".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-SEVEN RESIDENTS, STAFF AND COMMUNITY MEMBERS EVEN ATTENDED AN OVER-NIGHT TRIP TO ST. MICHAELS AND ANNAPOLIS WHICH INCLUDED A NARRATED CRUISE ON THE MILES RIVER, DINNER AT A WATERFRONT RESTAURANT, TOURS OF ANNAPOLIS AND THE NAVAL ACADEMY AND A VISIT TO THE CHESAPEAKE BAY MARITIME MUSEUM. 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, 2018, THE REHAB FACILITY SERVED 34 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. DURING THE FISCAL YEAR, THEY CONTINUED THEIR EFFORTS TO EDUCATE PATIENTS AND RESIDENTS ABOUT THE POLST (PRACTITIONER ORDERS FOR LIFE-SUSTAINING TREATMENT) AND ASSISTED 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 IS ALSO AVAILABLE TO ASSIST PATIENTS WITH COMPLETING LIVING WILLS AND DESIGNATING A MEDICAL POWER OF ATTORNEY. THIS DEPARTMENT ALSO CONTINUED THEIR INITIATIVE 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, 2018, THE FACILITY CONTINUED TO PROVIDE A VARIETY OF THERAPEUTIC ACTIVITIES INCLUDING VISITS FROM PET THERAPY DOGS, CERTIFIED MUSIC 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 LANCE, A CLEAR CAPTIONS HEARING IMPAIRED SEMINAR, A CONSUMER FRAUD PROTECTION SEMINAR AND MANY MORE. 20598948 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 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 342 0 427 1 1 1 0 0 0 0 1 1 0 0 0 0 X 12 11 1 0 0 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 (AS OF 10/13/17) 0.30 0.00 X 0 0 0 MARY ALLICE 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 REP (AS OF 10/13/17) 0.30 0.00 X 0 0 0 ARTHUR SHENINGER TRUSTEE 0.30 0.00 X 0 0 0 FLOYD SMITH TRUSTEE-RESIDENT REP(RESIGN10/13/17) 0.30 0.30 X 0 0 0 TIMOTHY STEWART TRUSTEE (AS OF 10/13/17) 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 616918 0 43374 MARY ELLEN BOVE CHIEF OPERATING OFFICER 40.00 0.50 X 261347 0 71384 ANTHONY PUCCIO CHIEF FINANCIAL OFFICER 40.00 0.50 X 175572 0 19527 VIVIAN BLANDURA DIRECTOR OF NURSING 40.00 0.00 X 118334 0 24325 JANICE CIPRIANI DIRECTOR OF MARKETING 40.00 0.00 X 112437 0 17120 LEAH GRAUSO OCCUPATIONAL THERAPIST 40.00 0.00 X 102958 0 5148 JONATHAN MANUEL DIRECTOR OF REHAB 40.00 0.00 X 100460 0 23341 NORMA THOMAS RN 40.00 0.00 X 100347 0 16283 1588373 0 220502 8 0 1 0 CHRIS BRANDS CONSTRUCTION CO 710 LAUREL HILL ROAD BANGOR PA 18013 CARPENTRY 1153273 GTG BUILDERS LLC PO BOX 5356 NORTH BRANCH NJ 08876 CONSTRUCTION 780806 SODEXO INC AND AFFILIATES PO BOX 360170 PITTSBURGH PA 15251 FOOD SERVICE 425411 GROTTO ENGINEERING ASSOCIATES LLC 340 NORTH AVE FIRST FL CRANFORD NJ 07016 ENGINEERING SERVICES 414940 HOWARD BURD & SONS 300 LAFAYETTE STREET HACKETTSTOWN NJ 07840 EXCAVATING/PAVING 311655 9 56150 918386 504951 974536 NET RESIDENT SERVICE REV 623000 25803215 25803215 25803215 328775 328775 19967 20112 -145 -145 -145 3559752 16305 3357384 0 202368 16305 218673 218673 12418 56150 8934 3484 3484 9772 5262 4510 4510 13569 11799 1770 1770 NON-RESIDENT REVENUE 721000 60938 48938 12000 MEALS 722210 55566 55566 MISCELLANEOUS INCOME 900099 49578 49578 54200 -1881 56081 220282 27555100 25803215 47057 730292 12947 12947 1173390 1173390 10139312 9104197 1030851 4264 366316 340394 25709 213 2183510 1897362 285338 810 806613 682719 123547 347 168387 156387 12000 13274 13274 70611 70611 851 851 47611 47611 895801 754069 141732 48313 47542 771 977444 879449 97090 905 221174 14413 206761 1455636 1455636 37561 31741 5820 47070 38147 8923 22964 22964 3397948 3397948 272009 11277 260732 FOOD 947220 931066 16154 PHARMACY 307873 307873 NURSING HOME ASSESMENT 277235 277235 BAD DEBT EXPENSE 213205 213205 335083 283124 51959 24439358 20598948 3833100 7310 171930 106181 3681030 6209048 1504904 1267251 2800026 0 110670 144384 156135 119119 76814962 42510563 34010266 34304399 9495930 13243846 307231 301443 860862 790869 53098984 56486540 4246072 4349126 3000949 3334593 674895 0 775518 781705 395212 352166 9092646 8817590 X 40610514 44170412 3395824 3498538 44006338 47668950 53098984 56486540 X 3115742 542835 4035 X 0 1 X 1 0 X 421039 411019 354265 169820 974536 2330679 23133988 23817593 24849551 25333396 25803215 122937743 23555027 24228612 25203816 25503216 26777751 125268422 0 0 0 125268422 315229 475911 440907 415093 348742 1995882 315229 475911 440907 415093 348742 1995882 51838 53000 48938 153776 303792 141872 127426 142762 171344 887196 24174048 24846395 25823987 26114071 27346775 128305276 0.97630 0.97470 0.01560 0.01620 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER REVENUE - 2013 AMOUNT: $ 3,721. MEALS - 2013 AMOUNT: $ 72,020. 2014 AMOUNT: $ 64,463. 2015 AMOUNT: $ 61,606. 2016 AMOUNT: $ 55,090. 2017 AMOUNT: $ 55,566. LATE FEE INCOME - 2013 AMOUNT: $ 11,400. 2014 AMOUNT: $ 13,516. 2015 AMOUNT: $ 20,551. 2016 AMOUNT: $ 34,675. 2017 AMOUNT: $ 10,417. GUEST ROOMS - 2013 AMOUNT: $ 26,860. 2014 AMOUNT: $ 27,185. 2015 AMOUNT: $ 21,700. 2016 AMOUNT: $ 23,830. 2017 AMOUNT: $ 24,840. FIREWOOD SALES - 2017 AMOUNT: $ 3,819. RESIDENT MAINTENANCE SERVICES - 2017 AMOUNT: $ 9,152. LOAN INCOME - 2013 AMOUNT: $ 164,155. GIFT SHOP - 2014 AMOUNT: $ 3,822. 2015 AMOUNT: $ 3,441. THRIFT STORE REVENUE - 2014 AMOUNT: $ 10,574. 2015 AMOUNT: $ 9,785. 2016 AMOUNT: $ 9,341. 2017 AMOUNT: $ 7,853. MISCELLANEOUS INCOME - 2013 AMOUNT: $ 5,947. 2014 AMOUNT: $ 8,878. 2015 AMOUNT: $ 11,093. 2016 AMOUNT: $ 21,377. 2017 AMOUNT: $ 49,578. INSURANCE RECOVERY - 2013 AMOUNT: $ 1,500. GROSS INVENTORIES - 2013 AMOUNT: $ 21,408. 2014 AMOUNT: $ 16,230. PARTNERSHIP GAIN/LOSS - 2013 AMOUNT: $ -3,219. 2014 AMOUNT: $ -2,796. 2015 AMOUNT: $ -750. 2016 AMOUNT: $ -1,551. 2017 AMOUNT: $ -1,881. NON-RESIDENT REVENUE - 2017 AMOUNT: $ 12,000. 0 0 0 0 0 0 0 0 1 851 851 0 PART II-B, LINE 1: HEATH VILLAGE PAID MEMBERSHIP DUES TO LEADING AGE OF NJ OF $11,397, OF WHICH 5.5% OR $627 WENT TOWARDS LOBBYING ACTIVITY. HEATH VILLAGE PAID MEMBERSHIP DUES TO LEADING AGE NATIONAL OF $8,005, OF WHICH 2.8% OR $224 WENT TOWARDS LOBBYING ACTIVITY. 0 1 X 4592220 4592220 54474830 33763463 20711367 9717962 6936130 2781832 8029950 1810970 6218980 34304399 ANNUITIES PAYABLE 351296 DUE TO AFFILIATES 870 352166 X 28084278 542835 -10986 531849 27552429 2671 2671 27555100 24421666 -15021 -15021 24436687 2671 2671 24439358 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 X, LINE 2: THE VILLAGE ACCOUNTS FOR UNCERTAINTY IN INCOME TAXES BY PRESCRIBING A RECOGNITION THRESHOLD OF MORE-LIKELY-THAN-NOT TO BE SUSTAINED UPON EXAMINATION BY THE APPROPRIATE TAXING AUTHORITY. MEASUREMENT OF THE TAX UNCERTAINTY OCCURS IF THE RECOGNITION THRESHOLD HAS BEEN MET. MANAGEMENT DETERMINED THAT THERE WERE NO TAX UNCERTAINTIES THAT MET THE RECOGNITION THRESHOLD IN 2018 AND 2017. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN FAIR VALUE OF DERIVATIVE FINANCIAL INSTRUMENTS 4,035. RENTAL EXPENSES 20,112. CHANGE IN THE SEGREGATED GIFT ANNUITY RESERVE -46,932. GIFT SHOP EXP 11,799. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 20,112. CHANGE IN THE SEGREGATED GIFT ANNUITY RESERVE -46,932. GIFT SHOP EXPENSES 11,799. BENEFIT GALA 62750 56150 6600 106 3952 400 4476 62750 56150 6600 106 3952 400 4476 8934 -2334 0 CENTENARY STAGE COMPANY 400 JEFFERSON ST HACKETTSTOWN NJ 07840 221500484 501(C)(3) 10000 SPONSORSHIP FOR THE 2017-2018 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 329500 0 287418 0 0 0 13500 0 29874 0 660292 0 0 0 MARY ELLEN BOVE CHIEF OPERATING OFFICER 231347 0 30000 0 0 0 53500 0 17884 0 332731 0 0 0 ANTHONY PUCCIO CHIEF FINANCIAL OFFICER 175572 0 0 0 0 0 8838 0 10689 0 195099 0 0 0 PART I, LINE 4B BOTH THE CEO AND COO HAVE A DEFERRED COMPENSATION ARRANGEMENT. THE ORGANIZATION PAID THE CEO $50,000 ON 6/8/18 FOR THE DEFERRED COMPENSATION THAT WAS AWARDED ON 7/1/15. THE COO WAS AWARDED $50,000 ON 3/25/18, BUT NO DEFERRED COMPENSATION WAS PAID TO THE COO DURING THE FISCAL YEAR. 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. X 1 504951 FMV 0 0 0 0 FORM 990, PART VI, SECTION A, LINE 1 HEATH ALLIANCE FOR CARE EXECUTIVE COMMITTEE THE 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 TO TRANSACT EMERGENCY BUSINESS BETWEEN BOARD MEETINGS AS IS NECESSARY. 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. THE EXECUTIVE COMMITTEE MEETS AT THE CALL OF THE PRESIDENT OR UPON WRITTEN REQUEST OF ANY OTHER TWO MEMBERS THEREOF. 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 5/8/18. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF HEATH VILLAGE IS HEATH ALLIANCE FOR CARE, INC. (THE "ALLIANCE"), A RELATED NOT-FOR-PROFIT ORGANIZATION THAT IS TAX-EXEMPT UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986. FORM 990, PART VI, SECTION A, LINE 7A ALL MEMBERS OF THE BOARD OF TRUSTEES 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 MEMBERS OF THE BOARD OF TRUSTEES OF 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. 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. ANY NEW CONTRACT OR AGREEMENT THAT INVOLVES AN AMOUNT IN EXCESS OF THE LIMITS CURRENTLY ESTABLISHED BY THE BOARD ENTERED INTO BY THE BOARD OF TRUSTEES OF HEATH VILLAGE OR CANTERBURY VILLAGE SHALL BE PRESENTED TO THE PROPER STANDING COMMITTEE FOR RECOMMENDATION TO THE BOARD FOR APPROVAL OR DISAPPROVAL. THEY MUST ALSO ADOPT AN ANNUAL CAPITAL BUDGET AND OPERATING BUDGET, WHICH LIMITS ANY POWERS OTHERWISE EXISTING TO DISBURSE AND TO CONTRACT TO DISBURSE FUNDS OF HEATH VILLAGE. 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 FOR CARE. 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, ALTERATIONS 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. FORM 990, PART VI, SECTION B, LINE 11B THE SENIOR ACCOUNTANT, CONTROLLER, 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 PERSONNEL AND POLICY 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 6/14/18 FOR THE CEO'S LAST ANNUAL REVIEW COMPLETED AT A BOARD MEETING ON 7/10/18. 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 CONTROLLER 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 VI, SECTION B, LINE 14: THE ORGANIZATION IS WORKING ON DEVELOPING A DOCUMENT RETENTION AND DESTRUCTION POLICY. THE ORGANIZATION HOPES TO HAVE A FINAL POLICY IN PLACE BY 6/30/19. FORM 990, PART XI, LINE 9: CHANGE IN FAIR VALUE OF DERIVATIVE FINANCIAL INSTRUMENTS 4,035. HEATH ALLIANCE FOR CARE INC 422 SCHOOLEYS MOUNTAIN ROAD HACKETTSTOWN NJ 07840 223395211 SUPPORTING ORGANIZATION NJ 501(C)(3) 11 TYPE I 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) 9 HEATH ALLIANCE FOR CARE INC 0 0 0 0 1 1 0 0 0 0 0 0 0 1 0 1 0 1 0 1