2017-02-15T11:11:12-06:00 2016-06-30 910189318 Moss Adams LLP 101 Second Street Suite 900 San Francisco CA 94105 990 2015-07-01 940545320 Hebrew Home for Aged Disabled DBA Jewish Home of San Francisco HEBR 4153342500 302 Silver Avenue San Francisco CA 941121510 Daniel Ruth President and CEO 4153342500 2017-02-13 1 Joua V Lo P01225144 4159561500 2017-02-13 2015 2021-01-29 14:40:06Z Jewish home of san francisco Daniel Ruth 302 Silver Avenue San Francisco CA 941121510 112952353 0 X www.JHSF.ORG X 1871 CA WE ARE A LICENSED NURSING HOME THAT PROVIDES TO SENIORS LIFE ENRICHING SERVICES THAT PROMOTE INDIVIDUAL DIGNITY, ENCOURAGE INDEPENDENCE, AND REFLECT THE SOCIAL, CULTURAL AND SPIRITUAL VALUES OF JEWISH TRADITION. 11 11 721 279 0 0 15152450 42390660 84666220 69972850 6000 26056 278871 415501 100103541 112805067 0 0 0 0 50077178 37719830 0 4127 269153 27374049 26370395 77451227 64094352 22652314 48710715 108728135 154756566 21728886 18858114 86999249 135898452 X See Schedule O.THE ORGANIZATION IS A LICENSED SKILLED NURSING FACILITY SPECIALIZING IN PROGRAMS, SERVICES, AND CARE FOR OLDER ADULTS. THE ORGANIZATION IS A NINE-ACRE COMPREHENSIVE SENIOR CARE CENTER WITH FIVE DISTINCT BUILDINGS, SERVING MORE THAN 420 RESIDENTS WITH DIVERSE CARE NEEDS, AND PROVIDING REHABILITATION SERVICES TO NUMEROUS OTHERS SEEKING SHORT-TERM CARE STAYS. OUR MISSION IS TO BECOME A REGIONAL RESOURCE AS AN INTEGRAL PART OF A CONTINUUM OF CARE THROUGHOUT THE BAY AREA THAT PROVIDES SENIOR ADULTS WITH A VARIETY OF LIFE ENRICHING PROGRAMS AND SERVICES THAT ARE ACCESSIBLE, PROMOTE INDIVIDUAL DIGNITY, ENCOURAGE INDEPENDENCE, CONNECT THEM TO THEIR COMMUNITY, AND REFLECT THE SOCIAL, CULTURAL, AND SPIRITUAL VALUES OF JEWISH TRADITION. NON-RESIDENTIAL CARE IS OFFERED THROUGH THE HOME'S SHORT-TERM AND REHABILITATION SERVICES UNIT (STARS) AND ACUTE PSYCHIATRIC SERVICES. 0 0 55180757 69972850 See Schedule OTHE ORGANIZATION PROVIDES LONG-TERM CARE, SHORT- TERM REHABILITATION, AND ACUTE PSYCH CARE SERVICES. IT PROVIDES PROFESSIONAL AND COMPREHENSIVE PROGRAMS THAT INCLUDE PERSONAL AND HEALTH CARE TO RESIDENTS IN ITS OVER 374-BED FACILITY. IN THE CURRENT FISCAL YEAR, THE ORGANIZATION SERVED AN AVERAGE OF 360 RESIDENTS A DAY. THERE WERE 67 NEW ADMISSIONS FOR LONG-TERM CARE, 1,277 SHORT-TERM CARE PATIENTS AND 173 PATIENTS THAT REQUIRED ACUTE PSYCH HOSPITALIZATION. THE ORGANIZATION IS A LICENSED SKILLED NURSING FACILITY SPECIALIZING IN PROGRAMS, SERVICES, AND CARE FOR OLDER ADULTS. THE ORGANIZATION IS A NINE-ACRE COMPREHENSIVE SENIOR CARE CENTER WITH FIVE DISTINCT BUILDINGS SERVING MORE THAN 400 RESIDENTS WITH DIVERSE CARE NEEDS, AND PROVIDING REHABILITATION SERVICES TO NUMEROUS OTHERS SEEKING SHORT-TERM CARE STAYS. 55180757 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 64 0 1 721 1 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X VICTOR MEINKE 4155622690 302 silver avenue san francisco CA 94112 X Richard Baum Trustee, Chair 2.00 0.00 X X 0 0 0 Howard Fine Trustee, Vice Chair/Treasurer 2.00 0.00 X X 0 0 0 Sophie Sharp Trustee, Secretary 2.00 0.00 X X 0 0 0 MATTHEW SLEPIN Trustee, Secretary (THRU 12/15) 2.00 0.00 X X 0 0 0 James Davis Trustee 2.00 0.00 X 0 0 0 Michael Eisler Trustee 2.00 0.00 X 0 0 0 David Lowi Trustee 2.00 0.00 X 0 0 0 Alex Mann Trustee 2.00 0.00 X 0 0 0 Jack Munson Trustee 2.00 0.00 X 0 0 0 Brian Perlman Trustee 2.00 0.00 X 0 0 0 Lynn Sedway Trustee 2.00 0.00 X 0 0 0 Howard Zack Trustee 2.00 0.00 X 0 0 0 Mark Friedlander Exec Director, Nursing Home Admin 40.00 0.00 X 182412 0 11160 Daniel Ruth President and CEO 24.00 16.00 X 0 762159 231174 Victor Meinke CFO 18.00 4.00 X 0 282170 13339 Sherie Koshover Chief Advancement Officer 24.00 3.20 X 0 245865 78960 KATHY BURKLE Chief Information Officer 32.00 4.00 X 0 244338 8356 Edwin Cabigao Chief Nursing Officer 40.00 0.00 X 218295 0 6117 Elliott Stein Medical Director 8.00 0.00 X 217797 0 561 Daniel Hoebeke SD/GP Officer 24.00 0.00 X 148635 0 5291 Mario Lemay Director Utilization Manag 40.00 0.00 X 179531 0 10583 Carina Ma Pharmacist 40.00 0.00 X 168156 0 11382 Ran Malool Director, Facilities 40.00 0.00 X 138526 0 12844 MATTHEW POWONDRA Director, Admissions & Marketing 40.00 0.00 X 134608 0 17769 Kevin Ward through 62515 Chief Operating Officer 40.00 X 101931 0 3326 1489891 1534532 410862 33 1 1 0 COBLENTZ PATCH DUFFY & BASS LLP ONE MONTGOMERY STREET 3000 SAN FRANCISCO CA 94104 Legal service 361190 1 42390660 42390660 Patient Service 623000 69972850 69972850 69972850 3351 3351 22705 0 22705 22705 22705 137106 147286 -10180 -10180 miscellaneous revenue 900099 232084 232084 Shared facility reimb. 900099 168000 168000 PARKING REVENUE 900099 25597 25597 425681 112805067 69972850 0 441557 X 655636 655636 2123 2123 28772017 28512570 88069 171378 761385 754621 2296 4468 5355859 5308499 16076 31284 2172810 2154864 6434 11512 6447398 6447398 75927 75927 89886 89886 4127 4127 7763014 6981784 773019 8211 98270 98176 94 2524830 2218937 298715 7178 145722 39 145683 1868421 1707301 159647 1473 58895 47160 11460 275 412834 280727 132107 2774470 2497023 249702 27745 645896 645896 Medical Supplies 2402130 2402130 repairs and maintenance 607462 606931 531 EMPLOYEE TRAINING 20505 19725 780 434735 384791 48536 1408 64094352 55180757 8644442 269153 19294 21986 9048752 14779307 2068940 12100974 14189958 15604133 800000 800000 364763 405994 2618042 2595785 113814307 57310734 53880805 56503573 0 95259 25737581 51849555 108728135 154756566 6727182 6073163 500000 400000 14501704 12384951 21728886 18858114 X 65195126 76286514 14239267 52047082 7564856 7564856 86999249 135898452 108728135 154756566 X 48710715 188488 X 0 1 X 1 0 X 12236762 5353094 4883137 15152450 42390660 80016103 12236762 5353094 4883137 15152450 42390660 80016103 9881503 70134600 4906 6164 5288 4341 3351 24050 225856 286206 234399 300619 425681 1472761 81512914 310453449 0.86040 0.92620 X Schedule A, Part II, Line 10, Explanation of Other Income: parking revenue - 2011 Amount: $ 52,321. 2012 Amount: $ 52,122. 2013 Amount: $ 44,985. 2014 Amount: $ 50,186. 2015 Amount: $ 25,597. Reimbursements for Shared Facilities - 2011 Amount: $ 168,000. 2012 Amount: $ 168,000. 2013 Amount: $ 168,000. 2014 Amount: $ 168,000. 2015 Amount: $ 168,000. All Other Revenue - 2011 Amount: $ 5,535. 2012 Amount: $ 66,084. 2013 Amount: $ 21,414. 2014 Amount: $ 82,433. 2015 Amount: $ 232,084. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 10566044 -31703 10534341 10048442 125000 392602 10566044 41023535 275075 5978748 37228916 10048442 37738914 168831 3820790 705000 41023535 37446593 561020 401301 670000 37738914 0.00000 0.71100 0.28900 1 0 90849 90849 82982061 41884795 41097266 17235452 13670062 3565390 13505945 1755877 11750068 56503573 Beneficial interest in JHSLF 15686162 Trustee accounts 5342401 Other assets 63331 INTEREST IN NET ASSETS - JHSLF 30757661 51849555 residents' trust account 174638 Due to RELATED PARTIES 12210313 12384951 X 113118139 335777 335777 112782362 22705 22705 112805067 64218937 124585 124585 64094352 0 64094352 Part V, Line 4: THE ORGANIZATION'S ENDOWMENT ASSETS CONSIST OF FUNDS ESTABLISHED TO GENERATE OPERATING SUPPORT TO THE ORGANIZATION AND CAPITAL CAMPAIGN FUNDS WHICH THE BOARD OF TRUSTEES MAY USE TO REPAY THE PRINCIPAL PORTION OF THE CONSTRUCTION DEBT AND INCLUDES ACCUMULATED EARNINGS THEREON THAT HAVE NOT YET BEEN EXPENDED. AS REQUIRED BY ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA, NET ASSETS ASSOCIATED WITH ENDOWMENT FUNDS ARE CLASSIFIED AND REPORTED BASED ON THE EXISTENCE OR ABSENCE OF DONOR-IMPOSED RESTRICTIONS. Part X, Line 2: The Organization follows the U.S. GAAP accounting standard regarding accounting for uncertain tax positions. This accounting standard provides detailed guidance for financial statement recognition, measurement, and disclosure of uncertain tax positions recognized in the Organization's financial statements. The standard requires an entity to recognize the financial statement impact of a tax position when it is more likely than not that the position will not be sustained upon examination. The Organization has reviewed its tax positions for all open years and believes that it has appropriate support for the tax positions taken. Therefore, no liability has been recorded. Part XI, Line 2d - Other Adjustments: DECREASE IN VALUE OF SPLIT INTEREST AGREEMENTS -37,839. INCREASE IN BENEFICIAL INTEREST IN JEWISH HOME 111,277. UNREALIZED GAIN ON DERIVATIVE FINANCIAL instrument 115,053. Cost of Goods sold 147,286. Part XI, Line 4b - Other Adjustments: Gain on Sale of Asset 22,705. Part XII, Line 2d - Other Adjustments: Cost of Goods sold 147,286. gain on sale of asset -22,705. rounding 4. 1 1 X 1 X 1 X 1 1 0 1 1 75010 75010 0.00120 32053462 41574001 -9520539 0.00000 32128472 41574001 -9445529 0.00120 66535 66535 0.00100 66535 66535 0.00100 32195007 41574001 -9378994 0.00220 1 112214 735 17753276 15177330 2575946 X 1 1 1 1 ACUTE PSYCHIATRIC HOSPITAL 302 silver avenue san francisco CA 94112 X None ACUTE PSYCHIATRIC HOSPITAL 1 0 0 1 X X X X X X X X 15 1 1 0 1 X HTTP://JHSF.ORG/ABOUT-COMMUNITY-BENEFIT.HTM X 1 15 0 0 0 1 X 100.000000000000 350.000000000000 X X X 1 1 X X X 1 X http://jhsf.org/about-charitable.htm X http://jhsf.org/about-charitable.htm X X X X 1 X X 1 X X X X 0 X X 0 0 ACUTE PSYCHIATRIC HOSPITAL Part V, Section B, Line 5: NEEDS ASSESSMENTTHE ORGANIZATION IS A MEMBER OF SAN FRANCISCO COMMUNITY HEALTH IMPROVEMENTPARTNERSHIP (SFHIP), A COLLABORATION OF SAN FRANCISCO HOSPITALS, THEDEPARTMENT OF PUBLIC HEALTH, UNITED WAY, HUMAN SERVICES PROVIDERS,PHILANTHROPIC FOUNDATIONS, AND NUMEROUS COMMUNITY-BASEDORGANIZATIONS. SFHIP IS COMMITTED TO WORKING TOWARD IMPROVINGTHE HEALTH STATUS OF ALL PEOPLE IN SAN FRANCISCO. TO THAT END,SFHIP NEEDS-ASSESSMENT PROCESS UTILIZES THE BEST SECONDARYDATA AVAILABLE ON SELECTED INDICATORS OF THE HEALTH ORCONDITIONS AFFECTING THE WELLBEING OF SAN FRANCISCO'SPOPULATION AND SUBPOPULATIONS, AND SEEKS FEEDBACK ANDINPUT FROM THE COMMUNITY TO GUIDE THE ASSESSMENT ANDDIRECT THE CALL TO ACTION. THE RESULTS OF THIS ONGOINGASSESSMENT ARE AVAILABLE AT THEIR WEBSITE:https://www.dignityhealth.org/saintfrancis/documents/community-benefit-reports/chna-2016-needsassessment ACUTE PSYCHIATRIC HOSPITAL Part V, Section B, Line 6a: THE JEWISH HOME HAS PARTNERED WITH THE HOSPITAL COUNCIL OF NORTHERN AND CENTRAL CALIFORNIA AND OTHER HOSPITAL FACILITIES IN CONDUCTING ITS MOST RECENT CHNA. THESE OTHER HOSPITAL FACILITIES ARE AS FOLLOWS:CALIFORNIA PACIFIC MEDICAL CENTERCHINESE HOSPITAL OF SAN FRANCISCOKAISER PERMANENTE HOSPITALLAGUNA HONDA HOSPITAL AND REHABILITATION CENTERSAINT FRANCIS MEMORIAL HOSPITALST. MARY'S MEDICAL CENTERUCSF MEDICAL CENTERVA MEDICAL CENTER SAN FRANCISCOFURTHER INFORMATION ON THESE FACILITIES MAY BE FOUND ON THE WEBSITEHTTP://WWW.SFHIP.ORG/ AND SELECTING THE HOSPITAL COUNCIL OF NORTHERN AND CENTRAL CALIFORNIA FROM THE LIST OF SPONSORS. ACUTE PSYCHIATRIC HOSPITAL Part V, Section B, Line 11: THE JEWISH HOME HAS A 140-PLUS-YEAR HISTORY OF COMMUNITY BENEFIT TO THE ELDERLY POPULATION OF THE BAY AREA. OBJECTIVES TO CONTINUE THIS HISTORY OF SERVICE ARE A PRINCIPAL PART OF THE HOME'S ORGANIZATIONAL PHILOSOPHY AND STRATEGIC PLANNING INITIATIVES. SPECIFIC ACTIVITIES TO ADDRESS COMMUNITY BENEFITS INCLUDE:-PLANNING TO REVITALIZE THE JEWISH HOME'S CAMPUS INTO A MODEL OF CARE THAT WILL BENEFIT MORE OLDER ADULTS IN THE BAY AREA (INCLUDING THE FRAIL AND VULNERABLE), ADDRESS URGENT SOCIETAL CHALLENGES (SUCH AS THE HUGE WAVE OF BABY BOOMERS REACHING RETIREMENT AGE), AND HELP SUSTAIN THE JEWISH HOME'S CHARITABLE MISSION BY BEING FINANCIALLY VIABLE. THIS DEVELOPMENT OF FINANCIALLY SUSTAINABLE FACILITIES, SERVICES, AND PROGRAMS WILL SERVE AND SUPPORT A BROADER CROSS-SECTION OF OLDER ADULTS RESIDING ON THE JEWISH HOME'S CAMPUS, OR IN THEIR OWN HOMES AND THE COMMUNITY.-EXPLORING COLLABORATIONS WITH ORGANIZATIONS WHOSE MISSIONS ARE SIMILAR TO THAT OF THE JEWISH HOME'S, WITH THE INTENT OF EXTENDING THE BREADTH OF CARE, PROGRAMS, AND SERVICES SO AS TO BETTER SERVE CONSTITUENT MEMBERS.-CONTINUING FUNDRAISING INITIATIVES TO ENSURE CONTINUED ABILITY TO SERVE THE FRAIL AND INDIGENT ELDERLY IN THE FUTURE.-COORDINATING WITH NEW AND ESTABLISHED RESIDENTIAL CARE FACILITIES AND PROGRAMS THROUGHOUT THE BAY AREA.-COORDINATING SERVICES AMONG OTHER JEWISH-SPONSORED ORGANIZATIONS.-DEVELOPING PROGRAMS AS THE NEEDS OF RESIDENTS CHANGE.-AS PART OF THE JEWISH SENIOR LIVING GROUP NETWORK, WORKING COLLABORATIVELY TO FURTHER DEVELOP A BROAD AND INTEGRATED NETWORK OF SENIOR LIVING COMMUNITIES, PROGRAMS, AND SERVICES IN THE BAY AREA.THE BOARD OF TRUSTEES OF THE JEWISH HOME IS COMMITTED TO ITS LONG TRADITION OF SERVICE TO THE ENTIRE COMMUNITY AND, IN PARTICULAR, THE UNDERSERVED. IT WILL CONTINUE TO IDENTIFY AND PLAN FOR NEEDS AS THE AGES AND DEMOGRAPHICS OF BOTH MEMBERS OF THE COMMUNITY AND THE HOME'S POPULATION UNDERGO GROWTH AND CHANGE. ACUTE PSYCHIATRIC HOSPITAL Part V, Section B, Line 13b: Medicaid/Medicare, State Regulation ACUTE PSYCHIATRIC HOSPITAL Part V, Section B, Line 18d: phone calls, emails, letters ACUTE PSYCHIATRIC HOSPITAL Part V, Section B, Line 19d: PHONE CALLS, EMAILS, LETTERS ACUTE PSYCHIATRIC HOSPITAL Part V, Section B, Line 22d: MEDI-CAL STATE RATE Part I, Line 7: COST TO CHARGE RATIOTHE COST TO CHARGE RATIO AS DETERMINED BY WORKSHEET 2 WAS USED TO CALCULATE THE AMOUNTS REPORTED ON LINE 7A AND 7B. THE COSTING METHODOLOGY USED ON LINE 7H WAS CALCULATED BASED ON ACTUAL COSTS FROM THE ORGANIZATION'S GENERAL LEDGER. Part I, Ln 7 Col(f): BAD DEBT EXPENSE IS REPORTED AS A NET ADJUSTMENT TO PATIENT CHARGES AND THEREFORE NOT INCLUDED AS PART OF TOTAL EXPENSES FROM PART IX, LINE 25, COLUMN A. Part III, Line 2: UNCOLLECTED RESIDENT ACCOUNTS ARE ANALYZED BASED ON STANDARD PROCEDURES FOR ALL RESIDENT ACCOUNTS. THE RESULT OF THE ANALYSIS IS WHAT IS RECOGNIZED AS BAD DEBT EXPENSE. THE ORGANIZATION FOLLOWS HFMA STATEMENT 15 AND THEREFORE NO PART OF BAD DEBT, AS DEFINED BY STATEMENT 15, REPRESENTS AMOUNTS ATTRIBUTABLE TO PATIENTS ELIGIBLE TO RECEIVE FINANCIAL ASSISTANCE. Part III, Line 3: Cost-to-charge ratio method was used. Part III, Line 4: THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. THE AUDITED FINANCIAL STATEMENTS CONTAIN A FOOTNOTE DESCRIBING PATIENT SERVICE REVENUES AND CHARITY CARE WHICH READS AS FOLLOWS:PATIENT SERVICE REVENUE IS RECORDED ON THE ACCRUAL BASIS IN THE PERIODSERVICES ARE PROVIDED AT ESTABLISHED RATES REGARDLESS OF WHETHER COLLECTION IN FULL IS ANTICIPATED. CONTRACTUAL ALLOWANCES AND THE PROVISION FOR BAD DEBTS ARE REPORTED AS DEDUCTIONS FROM PATIENT SERVICE REVENUE. CONTRACTUAL ALLOWANCES INCLUDE DIFFERENCES BETWEEN ESTABLISHED BILLING RATES AND AMOUNTS ESTIMATED BY MANAGEMENT AS PAYABLE UNDER VARIOUS CONTRACTUAL ARRANGEMENTS IN EFFECT, INCLUDING THOSE WITH THE MEDICARE AND MEDICAL PROGRAMS. ESTIMATION DIFFERENCES BETWEEN FINAL SETTLEMENTS AND AMOUNTS ACCRUED IN PREVIOUS YEARS ARE REPORTED AS ADJUSTMENTS TO THE CURRENT YEAR'S CONTRACTUAL ALLOWANCES.THE ORGANIZATION ACCEPTS RESIDENTS OF THE SAN FRANCISCO BAY AREA WHO MEETCERTAIN HEALTHCARE REQUIREMENTS REGARDLESS OF THEIR ABILITY TO PAY. A RESIDENT IS CLASSIFIED AS A CHARITY RESIDENT BY REFERENCE TO ESTABLISHED POLICIES OF THE ORGANIZATION. THE ORGANIZATION DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE BASED ON THESE ESTABLISHED POLICIES. ESSENTIALLY, THESE POLICIES DEFINE CHARITY SERVICES AS THOSE SERVICES FOR WHICH LESSER OR NO PAYMENT IS ANTICIPATED. CHARITY CARE IS INCLUDED IN GROSS PATIENT SERVICE REVENUE AND A CORRESPONDING ALLOWANCE IS REFLECTED IN DETERMINING NET PATIENT SERVICE REVENUE. THE AMOUNT OF CHARITY CARE PROVIDED, DETERMINED ON THE BASIS OF COST, WAS $735 AND $41,718 FOR THE YEARS ENDED JUNE 30, 2016 AND 2015, RESPECTIVELY. THE ORGANIZATION ESTIMATES THE COST OF PROVIDING CHARITY CARE USING THE RATIO OF AVERAGE PATIENT CARE COST TO GROSS CHARGES, AND THEN APPLYING THAT RATIO TO THE GROSS UNCOMPENSATED CHARGES ASSOCIATED WITH PROVIDING CHARITY CARE. Part III, Line 8: MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST-TO-CHARGE RATIO. THE AMOUNTS REPORTED IN LINES 5, 6 AND 7 COME FROM THE HOSPITAL'S FILED MEDICARE COST REPORT. THE TOTAL REVENUE EQUATES TO MEDICARE PAYMENTS AND THE MEDICARE ALLOWABLE COSTS ARE DETERMINED ON THE MEDICARE COST REPORT THAT UTILIZED COST TO CHARGE RATIOS APPLIED TO COVERED MEDICARE REVENUES. Part III, Line 9b: UNCOLLECTED RESIDENT ACCOUNTS ARE ANALYZED BASED ON STANDARD PROCEDURES FOR ALL RESIDENT ACCOUNTS. THE RESULT OF THE ANALYSIS IS WHAT IS RECOGNIZED AS BAD DEBT EXPENSE. THE ORGANIZATION FOLLOWS HFMA STATEMENT 15 AND THEREFORE NO PART OF BAD DEBT, AS DEFINED BY STATEMENT 15, REPRESENTS AMOUNTS ATTRIBUTABLE TO PATIENTS ELIGIBLE TO RECEIVE FINANCIAL ASSISTANCE. THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. THE AUDITED FINANCIAL STATEMENTS CONTAIN A FOOTNOTE DESCRIBING PATIENT SERVICE REVENUES AND CHARITY CARE WHICH READS AS FOLLOWS: PATIENT SERVICE REVENUES ARE RECORDED ON THE ACCRUAL BASIS IN THE PERIOD SERVICES ARE PROVIDED AT ESTABLISHED RATES REGARDLESS OF WHETHER COLLECTION IN FULL IS ANTICIPATED. CONTRACTUAL ALLOWANCES AND THE PROVISION FOR UNCOLLECTIBLE_ ACCOUNTS ARE REPORTED AS DEDUCTIONS FROM PATIENT SERVICE REVENUES. CONTRACTUAL ALLOWANCES INCLUDE DIFFERENCES BETWEEN ESTABLISHED BILLING RATES AND AMOUNTS ESTIMATED BY MANAGEMENT AS PAYABLE UNDER VARIOUS CONTRACTUAL ARRANGEMENTS IN EFFECT, INCLUDING THOSE WITH THE MEDICARE AND MEDI-CAL PROGRAMS. ESTIMATION DIFFERENCES BETWEEN FINAL SETTLEMENTS AND AMOUNTS ACCRUED IN PREVIOUS YEARS ARE REPORTED AS ADJUSTMENTS TO THE CURRENT YEAR'S CONTRACTUAL ALLOWANCES. THE HOME ACCEPTS RESIDENTS OF THE SAN FRANCISCO BAY AREA WHO MEET CERTAIN REQUIREMENTS REGARDLESS OF THEIR ABILITY TO PAY. A RESIDENT IS CLASSIFIED AS A CHARITY RESIDENT BY REFERENCE TO ESTABLISHED POLICIES OF THE HOME. ESSENTIALLY, THESE POLICIES DEFINE CHARITY SERVICES AS THOSE SERVICES FOR WHICH LESSER PAYMENT IS ANTICIPATED. CHARITY CARE IS INCLUDED IN GROSS PATIENT SERVICE REVENUE AND A CORRESPONDING ALLOWANCE IS REFLECTED IN DETERMINING NET PATIENT SERVICE REVENUE. Part VI, Line 2: NEEDS ASSESSMENTTHE ORGANIZATION IS A MEMBER OF BUILDING A HEALTHIER SAN FRANCISCO (BHSF), A COLLABORATION OF SAN FRANCISCO HOSPITALS, THE DEPARTMENT OF PUBLIC HEALTH, UNITED WAY, HUMAN SERVICES PROVIDERS, PHILANTHROPIC FOUNDATIONS, AND NUMEROUS COMMUNITY-BASED ORGANIZATIONS. BHSF IS COMMITTED TO WORKING TOWARD IMPROVING THE HEALTH STATUS OF ALL PEOPLE IN SAN FRANCISCO. TO THAT END, BHSF NEEDS-ASSESSMENT PROCESS UTILIZES THE BEST SECONDARY DATA AVAILABLE ON SELECTED INDICATORS OF THE HEALTH OR CONDITIONS AFFECTING THE WELL-BEING OF SAN FRANCISCO'S POPULATION AND SUBPOPULATIONS, AND SEEKS FEEDBACK AND INPUT FROM THE COMMUNITY TO GUIDE THE ASSESSMENT AND DIRECT THE CALL TO ACTION. THE ONGOING RESULTS OF THIS ONGOING ASSESSMENT ARE AVAILABLE AT THEIR WEBSITE: HTTP://WWW.SFHIP.ORG/INDEX.PHP? MODULE=ARTICLE&FUNC=COLLECTION&CID=3 Part VI, Line 3: Patient Education of Eligibility for AssistanceA RESIDENT SERVICES COORDINATOR STAFF IS AVAILABLE TO ASSIST RESIDENTS AND/OR THEIR FAMILY MEMBERS OR LEGAL REPRESENTATIVES THROUGH THE PROCESS OF DETERMINING THEIR ELIGIBILITY FOR ALL GOVERNMENT PROGRAMS AND ASSIST THEM IN THE APPLICATION PROCESS. Part VI, Line 4: Community informationTHE ORGANIZATION SERVES THE MOST MEDICALLY/COGNITIVELY FRAIL, AS WELL AS FINANCIALLY INDIGENT ELDERS (82 PERCENT OF THE ORGANIZATION RESIDENTS ARE INDIGENT AND/OR MEDI-CAL RECIPIENTS WHO DO NOT PAY THE FULL COST OF CARE), WITH AN AVERAGE AGE OF 87. IT PROVIDES PROFESSIONAL AND COMPREHENSIVE PROGRAMS THAT INCLUDE PERSONAL AND HEALTH CARE TO THE ELDERLY WHO PRIMARILY RESIDE IN THE GREATER SAN FRANCISCO BAY AREA. Part VI, Line 5: Promotion of Community HealthTHE ORGANIZATION IS INVOLVED IN NUMEROUS COMMUNITY BUILDING ACTIVITIES TO PROMOTE THE HEALTH AND WELL-BEING OF THE COMMUNITIES IT SERVES AS WELL AS TO PROVIDE TRAINING AND INTERNSHIP OPPORTUNITIES TO THE FUTURE CARETAKERS AND LEADERS OF THE COMMUNITIES. FOLLOWING IS A LIST OF SOME OF THOSE ACTIVITIES: THE ORGANIZATION'S STAFF ATTENDED AND PRESENTED IN CONFERENCES RELATED TO ISSUES ON THE CARE FOR THE ELDERLY. OVER THE PAST 39 YEARS, THE ORGANIZATION HAS PARTNERED WITH SAN FRANCISCO CITY COLLEGE IN OFFERING SEVERAL ADULT EDUCATION CLASSES TO THE GENERAL COMMUNITY. APPROXIMATELY 20 TO 25 STUDENTS ENROLL EACH SEMESTER IN THE CREATIVE ARTS CLASS. THE ORGANIZATION PARTNERS WITH LOCAL HIGH SCHOOLS THAT AIM TO INVOLVE YOUTH IN THEIR COMMUNITY BY ENCOURAGING THEM TO FULFILL NEEDS IN THEIR RESPECTIVE MILIEUS. MUTUAL GOALS INCLUDE THE PROMOTION OF CIVIC RESPONSIBILITY AND THE DEVELOPMENT OF LEADERSHIP SKILLS. STUDENTS FROM UNIVERSITY OF CALIFORNIA, SAN FRANCISCO, SAMUEL MERRITT COLLEGE, DOMINICAN UNIVERSITY, SAN JOSE STATE UNIVERSITY, AND SAN FRANCISCO STATE UNIVERSITY CONTINUE TO INTERN WITH THE ORGANIZATION'S PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPISTS. THE ORGANIZATION REGULARLY OPENS ITS DOORS TO PROFESSIONAL ORGANIZATIONS AND COMMUNITY GROUPS, OFFERING THEM FREE MEETING SPACE, AND CONTINUING EDUCATION CREDITS. THE ORGANIZATION PARTNERS WITH LOCAL ORGANIZATIONS, FOSTERING DIALOGUE, COLLABORATIONS, AND ONGOING COMMUNICATIONS WITH ITS NEIGHBORS. GERIATRIC FELLOWS FROM THE HEBREW UNION COLLEGE - JEWISH INSTITUTE OF RELIGION IN LOS ANGELES, CALIF. (IN COOPERATION WITH THE KALSMAN INSTITUTE ON JUDAISM AND HEALTH), AND HEBREW UNION COLLEGE- JEWISH INSTITUTE OF RELIGION (HUC-JIR) IN NEW YORK RECEIVE TRAINING AT THE ORGANIZATION. FOURTH-YEAR PHARMACY STUDENTS AT UCSF SPEND 12 HOURS A WEEK, IN 12-WEEK ROTATIONS, IN THE ORGANIZATION'S PHARMACY DEPARTMENT. THROUGH ITS AFFILIATION WITH THE ORGANIZATION, SIX TO SEVEN TOURO UNIVERSITY SCHOOL OF PHARMACY STUDENTS PER ACADEMIC YEAR RECEIVE A SIX-WEEK TRAINING IN LONG-TERM CARE PHARMACY. THEY LEARN HOW THE GERIATRIC PATIENT PROCESSES DRUGS DIFFERENTLY FROM A YOUNGER POPULATION, ARE EXPOSED TO HOW DRUGS ARE DISPENSED AND UTILIZED, AND GAIN AN UNDERSTANDING OF THIRD-PARTY PAYERS. THE ORGANIZATION COLLABORATES WITH THE SAN FRANCISCO JEWISH COMMUNITY CENTER TO PROVIDE HOT, NUTRITIOUS MEALS TO JEWISH SENIORS. Part VI, Line 7, Reports Filed With States CA X X X X 0 1 0 0 0 0 0 0 0 Mark Friedlander Exec Director, Nursing Home Admin 156097 0 18382 0 7933 0 4975 0 6185 0 193572 0 0 0 Daniel Ruth President and CEO 0 627910 0 100000 0 34249 0 222076 0 9098 0 993333 0 0 Victor Meinke CFO 0 246403 0 32825 0 2942 0 7629 0 5710 0 295509 0 0 Sherie Koshover Chief Advancement Officer 0 207328 0 27162 0 11375 0 78586 0 374 0 324825 0 0 KATHY BURKLE Chief Information Officer 0 213263 0 27573 0 3502 0 6524 0 1832 0 252694 0 0 Edwin Cabigao Chief Nursing Officer 191621 0 24519 0 2155 0 0 0 6117 0 224412 0 0 0 Elliott Stein Medical Director 217797 0 0 0 0 0 0 0 561 0 218358 0 0 0 Daniel Hoebeke SD/GP Officer 141135 0 7500 0 0 0 4272 0 1019 0 153926 0 0 0 Mario Lemay Director Utilization Manag 159352 0 20179 0 0 0 4834 0 5749 0 190114 0 0 0 Carina Ma Pharmacist 168156 0 0 0 0 0 5632 0 5750 0 179538 0 0 0 Ran Malool Director, Facilities 122771 0 15755 0 0 0 2493 0 10351 0 151370 0 0 0 MATTHEW POWONDRA Director, Admissions & Marketing 118978 0 15630 0 0 0 2700 0 15069 0 152377 0 0 0 Kevin Ward through 62515 Chief Operating Officer 101931 0 0 0 0 0 3139 0 187 0 105257 0 0 0 Part I, Line 4b DANIEL RUTH: CONTRIBUTION TO 457(F) PLAN $214,126.09 SHERIE KOSHOVER: CONTRIBUTION TO 457(F) PLAN $72,208.19 Daniel Ruth CEO/President Part V X 800000 800000 0 1 1 800000 Schedule L, Part II, Column C Compensation Package Form 990, Part VI, Section B, line 11 A COPY OF THE FORM 990 IS PROVIDED TO ALL BOARD OF TRUSTEES PRIOR TO FILING. MANAGEMENT OF THE ORGANIZATION REVIEWS THE COMPLETED FORM 990 AND FOLLOWS UP WITH THE TAX RETURN PREPARATION FIRM TO ANSWER ANY QUESTIONS PRIOR TO FILING. Form 990, Part VI, Section B, line 12c THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. EACH TRUSTEE AND PRINCIPAL OFFICER OF THE ORGANIZATION AND EACH MEMBER OF A COMMITTEE WITH BOARD-DELEGATED POWERS ANNUALLY SIGNS THE CONFLICT OF INTEREST STATEMENT AND DISCLOSURE FORM. THE BOARD OF TRUSTEES REVIEWS AND DETERMINES IF ANY CONFLICTS OF INTEREST EXIST AND TAKES THE APPROPRIATE ACTION AS OUTLINED IN THE ORGANIZATION'S CONFLICT OF INTEREST POLICY. Form 990, Part VI, Section B, line 15 THE COMPENSATION COMMITTEE REVIEWS AND APPROVES THE ANNUAL COMPENSATION PACKAGE FOR THE CHIEF EXECUTIVE OFFICER AND THE CHIEF FINANCIAL OFFICER BASED ON VARIOUS FACTORS SUCH AS: COMPENSATION DATA OBTAINED FROM SURVEYS, PERFORMANCE APPRAISALS AND NON-PROFIT RESOURCES FOR SIMILAR ORGANIZATIONS IN THE SAME GEOGRAPHICAL AREA. THE BOARD OF TRUSTEES APPROVES THE CHIEF EXECUTIVE OFFICER'S EMPLOYMENT CONTRACT. THE CHIEF EXECUTIVE OFFICER REVIEWS AND APPROVES THE ANNUAL COMPENSATION FOR THE OTHER EXECUTIVE TEAM MEMBERS BASED ON VARIOUS FACTORS SUCH AS ANNUAL COMPENSATION SURVEYS, PERFORMANCE APPRAISALS AND OTHER NON-PROFIT RESOURCES FOR SIMILAR ORGANIZATIONS. THE BOARD OF TRUSTEES APPROVES THE ANNUAL BUDGET THAT INCLUDES COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES. Form 990, Part VI, Section C, line 19 THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON WRITTEN OR ORAL REQUEST. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE UPON REQUEST. 990, Part VII, Compensation Hours for Daniel Ruth and Victor Meinke may appear low due to exclusion of hours devoted to organizations in the group that don't meet the IRS definition of "related." Form 990, Part IX, line 11g Medical Billing Service: Program service expenses 85,761. Management and general expenses 0. Fundraising expenses 0. Total expenses 85,761. Other professional fees: Program service expenses 19,238. Management and general expenses 144,888. Fundraising expenses 0. Total expenses 164,126. Contract Services: Program service expenses 6,876,785. Management and general expenses 628,131. Fundraising expenses 8,211. Total expenses 7,513,127. Form 990, Part XI, line 9: DECREASE IN VALUE OF SPLIT INTEREST AGREEMENTS -37,840. INCREASE IN BENEFICIAL INTEREST IN JEWISH HOME 111,275. UNREALIZED GAIN ON DERIVATIVE FINANCIAL instrument 115,053. Jewish senior living group 302 Silver avenue san francisco CA 94112 800291740 See Part VII CA 501(c)(3) Line 11a, I JEWISH HOME AND SENIOR LIVING FOUNDATION 0 Bay area jewish senior life 302 Silver avenue san francisco CA 94112 455092344 See Part VII CA 501(c)(3) Line 11a, I Jewish Senior Living Group 0 Charitable Remainder Trusts (3) Holding co CA N/A 1 0 0 1 0 1 0 0 0 0 1 0 1 1 1 0 0 1 0 0 PART II, LINE 1, COL (B) JEWISH SENIOR LIVING GROUP PRIMARY ACTIVITY TO PROMOTE THE PROVISION OF JEWISH LIVING SERVICES, FACILITIES AND AGING SERVICES IN NORTHERN CALIFORNIA BY PROVIDING SERVICES DESIGNED TO ASSIST THE SUPPORTED CHARITIES IN THEIR OWN OPERATIONS AND ASSIST WITH DEVELOPING NEW SERVICES AND FACILITIES IN THE AFFILIATED NETWORK. PART II, LINE 2, COL (B) BAY AREA JEWISH SENIOR LIFE PRIMARY ACTIVITY TO ASSIST THE SUPPORTED CHARITIES IN THEIR OWN OPERATIONS AND ASSIST WITH DEVELOPING NEW SERVICES AND FACILITIES IN THE AFFILIATED NETWORK.