2016-05-16T16:14:14-05:00 2015-06-30 910189318 MOSS ADAMS LLP 101 SECOND STREET SUITE 900 SAN FRANCISCO CA 94105 990 2014-07-01 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 2016-05-13 1 LINDSEY PARNELL P00546853 4159561500 2014 2016-08-17 19:52:53Z JEWISH HOME OF SAN FRANCISCO DANIEL RUTH 302 SILVER AVENUE SAN FRANCISCO CA 941121510 100252913 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. 9 9 719 138 0 0 4883137 15152450 41317929 84666220 5288 6000 210614 278871 46416968 100103541 0 0 0 0 38165531 50077178 0 0 357174 27650718 27374049 65816249 77451227 -19399281 22652314 133875979 108728135 71220268 21728886 62655711 86999249 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 67878216 84666220 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. 67878216 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 1 1 0 0 0 1 0 0 0 1 77 0 1 719 1 0 0 0 0 0 0 0 0 0 0 X 9 9 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 BRIAN PERLMAN TRUSTEE 2.00 0.00 X 0 0 0 MATTHEW SLEPIN TRUSTEE, SECRETARY 2.00 0.00 X X 0 0 0 RICHARD BAUM TRUSTEE, CHAIR 2.00 0.00 X X 0 0 0 MICHAEL EISLER TRUSTEE 2.00 0.00 X 0 0 0 HOWARD FINE TRUSTEE, TREASURER 2.00 0.00 X X 0 0 0 ALEX GERSZNOWICZ TRUSTEE 2.00 1.00 X 0 0 0 STEPHAN KRIEGER TRUSTEE (THRU 10/2014) 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 JAMES DAVIS TRUSTEE 2.00 0.00 X 0 0 0 LYNN SEDWAY TRUSTEE 2.00 0.00 X 0 0 0 SOPHIE SHARP 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 148522 0 14869 DANIEL RUTH PRESIDENT AND CEO 20.00 20.00 X 0 688181 179692 VICTOR MEINKE CFO 16.00 24.00 X 0 261475 12902 ELLIOTT STEIN MEDICAL DIRECTOR 8.00 0.00 X 209730 0 11796 EDWIN CABIGAO CHIEF NURSING OFFICER 40.00 0.00 X 202653 0 5544 SHERIE KOSHOVER CHIEF ADVANCEMENT OFFICER 32.00 8.00 X 0 247381 100580 KEVIN WARD CHIEF OPERATIONS OFFICER 40.00 0.00 X 0 196522 3570 MARIO LEMAY DIRECTOR UTILIZATION MANAG 40.00 0.00 X 166862 0 9805 CARINA MA PHARMACIST 40.00 0.00 X 166984 0 10563 MARILOU ESPANOL REGISTERED NURSE PSYCH 32.00 0.00 X 123467 0 18689 DANIEL HOEBEKE SD/GP OFFICER 38.00 0.00 X 130964 0 7373 EDEN GARPHAR REGISTERED NURSE SUPERVISOR 40.00 0.00 X 119721 0 18488 1268903 1393559 393871 25 0 1 0 LITTLER MENDELSON PC 650 CALIFORNIA STREET SAN FRANCISCO CA 94108 LEGAL SERVICE 394922 DM&A 871 BOWSPRIT ROAD CHULA VISTA CA 91914 RECRUITING AGENCY 318813 COBLENTZ PATCH DUFFY & BASS LLP ONE MONTGOMERY STREET 3000 SAN FRANCISCO CA 94104 LEGAL SERVICE 165982 RANDSTAD US LP PO BOX 894217 LOS ANGELES CA 90189 PROFESSIONAL STAFFING SERVICES 151501 SUTTER HEALTH PO BOX 7999 SAN FRANCISCO CA 94120 LAB SERVICE 133446 6 15152450 44206 15152450 PATIENT SERVICE 623000 84666220 84666220 84666220 4341 4341 1659 0 1659 1659 1659 127624 149372 -21748 -21748 SHARED FACILITY REIMB. 900099 168000 168000 MISCELLANEOUS REVENUE 900099 82433 82433 PARKING REVENUE 900099 50186 50186 300619 100103541 84666220 0 284871 594898 594898 28214691 27959247 79851 175593 13654134 13532965 37877 83292 5482186 5433450 15235 33501 2131269 2113062 5466 12741 6428457 6428457 143896 143896 69380 69380 7354742 6674959 667907 11876 94523 93238 1285 2469027 2032902 430487 5638 99458 99458 1956782 1801947 153559 1276 34029 33287 635 107 2116410 1439159 677251 3062992 2756693 275669 30630 627406 627406 MEDICAL SUPPLIES 2190514 2190514 REPAIRS AND MAINTENANCE 514831 514831 211602 172896 37471 1235 77451227 67878216 9215837 357174 17582 19294 8606850 9048752 1002611 2068940 11543493 14189958 800000 800000 396535 364763 423895 2618042 108601876 54721071 53119920 53880805 57965093 25737581 133875979 108728135 9244409 6727182 600000 500000 61375859 14501704 71220268 21728886 X 43821478 65195126 11394377 14239267 7439856 7564856 62655711 86999249 133875979 108728135 X 22652314 1691224 X 0 1 X 1 0 X 11467323 12236762 5353094 4883137 15152450 49092766 11467323 12236762 5353094 4883137 15152450 49092766 2323527 46769239 1640 4906 6164 5288 4341 22339 334797 225856 286206 234399 300619 1381877 50496982 302116962 0.92620 0.91840 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: SETTLEMENT INCOME - 2010 AMOUNT: $ 200,000. PARKING REVENUE - 2010 AMOUNT: $ 62,237. 2011 AMOUNT: $ 52,321. 2012 AMOUNT: $ 52,122. 2013 AMOUNT: $ 44,985. 2014 AMOUNT: $ 50,186. REIMBURSEMENTS FOR SHARED FACILITIES - 2010 AMOUNT: $ 56,000. 2011 AMOUNT: $ 168,000. 2012 AMOUNT: $ 168,000. 2013 AMOUNT: $ 168,000. 2014 AMOUNT: $ 168,000. ALL OTHER REVENUE - 2010 AMOUNT: $ 16,560. 2011 AMOUNT: $ 5,535. 2012 AMOUNT: $ 66,084. 2013 AMOUNT: $ 21,414. 2014 AMOUNT: $ 82,433. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 10048442 125000 392602 10566044 41023535 275075 5978748 37228916 10048442 37738914 168831 3820790 705000 41023535 37446593 561020 401301 670000 37738914 32381562 689786 5010245 635000 37446593 0.71600 0.28400 1 0 90849 90849 82955618 39985268 42970350 17198222 13103061 4095161 8357187 1632742 6724445 53880805 BENEFICIAL INTEREST IN JHSLF 15574885 TRUSTEE ACCOUNTS 5380240 OTHER ASSETS 904750 INTEREST IN NET ASSETS - JHSLF 3877706 25737581 DERIVATIVE FINANCIAL INSTRUMENTS 115053 RESIDENTS' TRUST ACCOUNT 202475 LOANS PAYABLE FROM JHSLF 650000 DUE TO JSLG 474575 DUE TO FDN 888158 PENSION PLAN LIABILITY 12171443 14501704 X 101942478 1840596 1840596 100101882 1659 1659 100103541 77598940 147713 147713 77451227 0 77451227 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 -50,134. INCREASE IN BENEFICIAL INTEREST IN JEWISH HOME 1,496,021. UNREALIZED GAIN ON DERIVATIVE FINANCIAL INSTRUMENT 235,962. IMPUTED INTEREST ON OTHER RECEIVABLES 9,375. COST OF GOODS SOLD 149,372. PART XI, LINE 4B - OTHER ADJUSTMENTS: GAIN ON SALE OF ASSET 1,659. PART XII, LINE 2D - OTHER ADJUSTMENTS: COST OF GOODS SOLD 149,372. GAIN ON SALE OF ASSET -1,659. 1 1 X 1 X 1 X 1 1 0 1 1 352093 352093 0.00450 59449026 58526916 922110 0.01190 59801119 58526916 1274203 0.01640 43284 43284 0.00060 43284 43284 0.00060 59844403 58526916 1317487 0.01700 1 403270 41717 16722450 14522988 2199462 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 13 1 1 0 1 X HTTP://JHSF.ORG/ABOUT-COMMUNITY-BENEFIT.HTM X 1 13 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 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 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 V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY ACUTE PSYCHIATRIC HOSPITAL PART V, SECTION B, LINE 16A WEBSITE: HTTP://JHSF.ORG/ABOUT-CHARITABLE.HTM ACUTE PSYCHIATRIC HOSPITAL PART V, SECTION B, LINE 16B WEBSITE: HTTP://JHSF.ORG/ABOUT-CHARITABLE.HTM 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 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 ORGANIZATION ACCEPTS RESIDENTS OF THE SAN FRANCISCO BAY AREA WHO MEET CERTAIN 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 $41,718 AND $20,940 FOR THE YEARS ENDED JUNE 30, 2015 AND 2014. 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 X 0 1 0 0 0 0 0 0 0 MARK FRIEDLANDER EXEC DIRECTOR, NURSING HOME ADMIN 127646 0 14145 0 6731 0 3868 0 11001 0 163391 0 0 0 DANIEL RUTH PRESIDENT AND CEO 0 581903 0 80000 0 26278 0 169518 0 10174 0 867873 0 0 VICTOR MEINKE CFO 0 233185 0 28290 0 0 0 7415 0 5487 0 274377 0 0 ELLIOTT STEIN MEDICAL DIRECTOR 209730 0 0 0 0 0 0 0 11796 0 221526 0 0 0 EDWIN CABIGAO CHIEF NURSING OFFICER 188071 0 12500 0 2082 0 0 0 5544 0 208197 0 0 0 SHERIE KOSHOVER CHIEF ADVANCEMENT OFFICER 0 203630 0 23985 0 19766 0 99394 0 1186 0 347961 0 0 KEVIN WARD CHIEF OPERATIONS OFFICER 0 179642 0 11900 0 4980 0 3094 0 476 0 200092 0 0 MARIO LEMAY DIRECTOR UTILIZATION MANAG 141551 0 25311 0 0 0 4307 0 5498 0 176667 0 0 0 CARINA MA PHARMACIST 166984 0 0 0 0 0 5065 0 5498 0 177547 0 0 0 PART I, LINE 4B DANIEL RUTH: CONTRIBUTION TO 457(F) PLAN $162,955.72 SHERIE KOSHOVER: CONTRIBUTION TO 457(F) PLAN $93,172.56 DANIEL RUTH CEO/PRESIDENT PART V X 800000 800000 0 1 1 800000 SCHEDULE L, PART II, COLUMN C COMPENSATION PACKAGE X 1 1 FMV X 100 COST OF DONATED PROPERTY X 1945 COST OF DONATED PROPERTY X 3 41940 FMV ON DATE OF TRANSFER X 1 220 COST OF DONATED PROPERTY 7 0 1 1 PART I, LINE 32B: CENTER FOR CAR DONATIONS, 1445 NW PORTLAND AVE., BEND, OR 97701. THEY HANDLE THE TRANSACTION WHENEVER ANYONE WISHES TO DONATE A MOTOR VEHICLE. 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 WRITIEN 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 XI, LINE 9: DECREASE IN VALUE OF SPLIT INTEREST AGREEMENTS -50,134. INCREASE IN BENEFICIAL INTEREST IN JEWISH HOME 1,496,021. UNREALIZED GAIN ON DERIVATIVE FINANCIAL INSTRUMENT 235,962. IMPUTED INTEREST ON OTHER RECEIVABLES 9,375. 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 0 0 1 0 0 0 0 1 0 0 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.