2016-05-16T00:00:00-05:00 2014-06-30 910189318 MOSS ADAMS LLP 101 SECOND STREET SUITE 900 SAN FRANCISCO CA 94105 990 2013-07-01 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 2016-05-16 1 LINDSEY PARNELL P00546853 4159561500 2013 2016-08-17 19:52:53Z X JEWISH HOME OF SAN FRANCISCO DANIEL RUTH 302 SILVER AVENUE SAN FRANCISCO CA 941121510 46570114 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 11 773 173 0 0 5353094 4883137 56807953 41317929 6164 5288 341201 210614 62508412 46416968 0 0 0 0 44649123 38165531 0 0 203930 26501813 27650718 71150936 65816249 -8642524 -19399281 125953405 133875979 49949985 71220268 76003420 62655711 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 52094005 41317929 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 400-BED FACILITY. IN THE CURRENT FISCAL YEAR, THE ORGANIZATION SERVED AN AVERAGE OF 348 RESIDENTS A DAY. THERE WERE 77 NEW ADMISSIONS FOR LONG-TERM CARE, 922 SHORT-TERM CARE PATIENTS AND 136 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. 52094005 1 1 0 1 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 0 0 0 0 1 0 0 0 1 77 0 773 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 BRIAN PERLMAN TRUSTEE 2.00 0.00 X 0 0 0 JORDAN SILLS TRUSTEE (THROUGH 10/13) 2.00 0.00 X 0 0 0 MATTHEW SLEPIN TRUSTEE, SECRETARY 2.00 0.00 X X 0 0 0 JEFFREY STEIN TRUSTEE 2.00 0.00 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 2.00 0.00 X 0 0 0 SUSAN LOWENBERG TRUSTEE (THROUGH 9/13) 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 DANIEL RUTH PRESIDENT AND CEO 23.90 7.30 X 0 538530 178257 VICTOR MEINKE CFO 20.00 8.00 X 0 229267 36857 SANDRA SIMON CHIEF ADMINISTRATIVE OFFICER 40.00 0.00 X 213236 0 51090 ELLIOTT STEIN MEDICAL DIRECTOR 8.00 0.00 X 209730 0 537 EDWIN CABIGAO CHIEF NURSING OFFICER 32.00 0.00 X 190402 0 9291 SHERIE KOSHOVER CHIEF ADVANCEMENT OFFICER 33.80 6.00 X 0 214778 94135 BARBARA KAMHOLZ CHIEF OF GERIATRIC PSYCHIATRY 40.00 0.00 X 169998 0 5082 MARIO LEMAY DIRECTOR UTILIZATION MANAGEMENT 40.00 0.00 X 165027 0 10580 JANICE B SCHWARTZ RESEARCH DIRECTOR 40.00 0.00 X 145415 0 36517 CARINA MA PHARMACIST 40.00 0.00 X 146660 0 10755 MARK FRIEDLANDER ADMINISTRATOR 40.00 0.00 X 134557 0 13472 1375025 982575 446573 30 0 1 0 ONR INC 1101 S CAPITAL OF TEXAS HWY BLDG G AUSTIN TX 78746 REHAB CONTRACT SERVICE 2301758 ECOLOGICALLY SOUND MED SERVICES 1865 N MACARTHUR DRIVE TRACY CA 95376 MEDICAL SUPPLY 879322 BIRITE FOODSERVICE 123 S HILL DRIVE BRISBANE CA 94105 RESIDENT FOOD SVCS 780128 ANGELICA PO BOX 84677 LOS ANGELES CA 90084 LAUNDRY SERVICE 759991 LITTLER MENDELSON PC 650 CALIFORNIA STREET SAN FRANCISCO CA 94108 LEGAL 341799 22 4883137 50867 4883137 PATIENT SERVICE 623000 41317929 41317929 41317929 5288 5288 129363 153146 -23783 -23783 SHARED FACILITY REIMB. 900099 168000 168000 PARKING REVENUE 900099 44985 44985 MISCELLANEOUS REVENUE 900099 21412 21412 234397 46416968 41317929 0 215902 700088 700088 28247667 27957406 116765 173496 1472391 14186 1458205 5612112 828025 4785173 -1086 2133273 2113376 7580 12317 5255730 5255730 594151 101036 493115 105465 105465 6532032 5976852 544577 10603 100056 5102 94922 32 2434464 2088978 339388 6098 132644 132644 1778278 1629981 146910 1387 46042 45369 565 108 2507709 2507709 2847830 2847830 562280 562280 WRITEOFF PRECONSTRUCT. 2135776 2135776 MEDICAL SUPPLIES 1818579 1818579 REPAIRS AND MAINTENANCE 507904 507756 148 291778 253676 37127 975 65816249 52094005 13518314 203930 17617 17582 5605824 8606850 2210882 1002611 9077945 11543493 800000 800000 320021 396535 427194 423895 104778000 51658080 54862160 53119920 52631762 57965093 125953405 133875979 7879995 9244409 700000 600000 41369990 61375859 49949985 71220268 X 63157552 43821478 5813851 11394377 7032017 7439856 76003420 62655711 125953405 133875979 X -19399281 6051572 X 0 1 X 1 0 X 10672721 11467323 12236762 5353094 4883137 44613037 10672721 11467323 12236762 5353094 4883137 44613037 2614496 41998541 18564 1640 4906 6164 5288 36562 334797 225856 286206 234399 1081258 45730857 272380870 0.91840 0.95790 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. REIMBURSEMENTS FOR SHARED FACILITIES - 2010 AMOUNT: $ 56,000. 2011 AMOUNT: $ 168,000. 2012 AMOUNT: $ 168,000. 2013 AMOUNT: $ 168,000. ALL OTHER REVENUE - 2010 AMOUNT: $ 16,560. 2011 AMOUNT: $ 5,535. 2012 AMOUNT: $ 66,084. 2013 AMOUNT: $ 21,414. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 51016 51016 0 PART II-B, LINE 1: LOBBYING THE STATE REPRESENTATIVES THRU CHA ON THE STATES PLANNED REDUCTION IN MEDICAL RATES THAT WOULD NEGATIVELY IMPACT THE ORGANIZATION. 41023535 275075 5978748 37228916 10048442 37738914 168831 3820790 705000 41023535 37446593 561020 401301 670000 37738914 32381562 689786 5010245 635000 37446593 29666200 122775 3192587 600000 32381562 0.00000 0.25960 0.74040 1 0 90849 90849 80003652 38089843 41913809 16785245 12149275 4635970 7898254 1418962 6479292 53119920 BENEFICIAL INTEREST IN JHSLF 51131210 TRUSTEE ACCOUNTS 5430374 OTHER ASSETS 20639 INTEREST IN NET ASSETS - JHSLF 1382870 57965093 DERIVATIVE FINANCIAL INSTRUMENTS 351015 RESIDENTS' TRUST ACCOUNT 84794 LOANS PAYABLE FROM JHSLF 41980000 PROVISIONS PAYABLE 18741148 DUE TO JSLG 178358 DUE TO FDN 40544 61375859 X 52668549 6251581 6251581 46416968 0 46416968 65969396 153147 153147 65816249 0 65816249 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: U.S. GAAP REQUIRES THE ORGANIZATION TO EVALUATE TAX POSITIONS TAKEN BY THE ORGANIZATION AND RECOGNIZE A TAX LIABILITY IF THE ORGANIZATION HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE APPLICABLE TAX AUTHORITY. THE ORGANIZATION HAS REVIEWED ITS TAX POSITIONS FOR ALL OPEN TAX 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 -41,593. INCREASE IN BENEFICIAL INTEREST IN JEWISH HOME 5,978,748. UNREALIZED GAIN ON DERIVATIVE FINANCIAL INSTRUMENT 133,147. IMPUTED INTEREST ON OTHER RECEIVABLES 28,132. COST OF GOODS SOLD 153,147. PART XII, LINE 2D - OTHER ADJUSTMENTS: COST OF GOODS SOLD 153,147. 1 1 X 1 X 1 X 1 1 0 1 1 474832 474832 0.00720 23930846 19949993 3980853 0.06050 24405678 19949993 4455685 0.06770 58770 58770 0.00090 58770 58770 0.00090 24464448 19949993 4514455 0.06860 1 596240 20940 15176584 13657724 1518860 X 1 1 1 1 ACUTE PSYCHIATRIC HOSPITAL 302 SILVER AVENUE SAN FRANCISCO CA 94112 X NONE ACUTE PSYCHIATRIC HOSPITAL 1 1 X X X X X X X X 12 1 1 1 X HTTP://JHSF.ORG/ABOUT-COMMUNITY-BENEFIT.H X X X 1 0 1 1 100.000000000000 1 350.000000000000 1 X X X X X 1 1 X X X X X X 1 X X X 1 X X X X 0 X X 0 0 ACUTE PSYCHIATRIC HOSPITAL PART V, SECTION B, LINE 3: 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 4: 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 16E: PHONE CALLS, EMAILS, LETTERS ACUTE PSYCHIATRIC HOSPITAL PART V, SECTION B, LINE 17E: PHONE CALLS, EMAILS, LETTERS ACUTE PSYCHIATRIC HOSPITAL PART V, SECTION B, LINE 20D: 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 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 $20,940 FOR THE YEAR ENDED JUNE 30, 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 DANIEL RUTH PRESIDENT AND CEO 0 538530 0 0 0 0 0 127241 0 51016 0 716787 0 0 VICTOR MEINKE CFO 0 216767 0 12500 0 0 0 7072 0 29785 0 266124 0 0 SANDRA SIMON CHIEF ADMINISTRATIVE OFFICER 200736 0 12500 0 0 0 10802 0 40288 0 264326 0 0 0 ELLIOTT STEIN MEDICAL DIRECTOR 209730 0 0 0 0 0 0 0 537 0 210267 0 0 0 EDWIN CABIGAO CHIEF NURSING OFFICER 175820 0 12500 0 2082 0 3608 0 5683 0 199693 0 0 0 SHERIE KOSHOVER CHIEF ADVANCEMENT OFFICER 0 191136 0 12500 0 11142 0 79055 0 15080 0 308913 0 0 BARBARA KAMHOLZ CHIEF OF GERIATRIC PSYCHIATRY 169998 0 0 0 0 0 4000 0 1082 0 175080 0 0 0 MARIO LEMAY DIRECTOR UTILIZATION MANAGEMENT 133304 0 31723 0 0 0 4725 0 5855 0 175607 0 0 0 JANICE B SCHWARTZ RESEARCH DIRECTOR 145415 0 0 0 0 0 7059 0 29458 0 181932 0 0 0 CARINA MA PHARMACIST 146660 0 0 0 0 0 5121 0 5634 0 157415 0 0 0 PART I, LINE 4B DANIEL RUTH: CONTRIBUTION TO 457(F) PLAN $113,791 SHERIE KOSHOVER: CONTRIBUTION TO 457(F) PLAN $66,063 DANIEL RUTH CEO/PRESIDENT PART V X 800000 800000 0 1 1 800000 SCHEDULE L, PART II, COLUMN C COMPENSATION PACKAGE X 1 50 FMV X 50 COST OF DONATED PROPERTY X 5660 COST OF DONATED PROPERTY X 3 45045 FMV ON DATE OF TRANSFER X 2 62 COST OF DONATED PROPERTY 8 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 -41,593. INCREASE IN BENEFICIAL INTEREST IN JEWISH HOME 5,978,748. UNREALIZED GAIN ON DERIVATIVE FINANCIAL INSTRUMENT 133,147. IMPUTED INTEREST ON OTHER RECEIVABLES 28,132. BOOK/TAX DIFFERENCE IN FUNCTIONAL EXPENSES -46,862. ADDITIONAL INFORMATION REGARDING AMENDED FORM 990: WE ARE AMENDING THE 990 TO ATTACH THE FINALIZED/ISSUED AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED JUNE 30, 2014 IN ACCORDANCE WITH THE INSTRUCTIONS TO IRS FORM 990. THE AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED JUNE 30, 2014 HAD NOT YET BEEN FINALIZED/ISSUED AT THE TIME ORIGINAL RETURN WAS FILED. WE ARE ALSO AMENDING FORM 990, PAGE 11, PART X - BALANCE SHEET, LINES 27-29, COLUMNS A AND B FOR UNRESTRICTED, TEMPORARILY RESTRICTED, AND PERMANENTLY RESTRICTED NET ASSETS PER AUDIT ADJUSTMENTS. ADDITIONALLY, WE ARE AMENDING PAGE 2, SCHEDULE D, PART V, ENDOWMENT FUNDS FOR LINE 1E, COLUMN A, PER AUDIT ADJUSTMENT. JEWISH SENIOR LIVING GROUP 302 SILVER AVENUE SAN FRANCISCO CA 94112 800291740 SEE PART VII CA 501(C)(3) 11A N/A 0 BAY AREA JEWISH SENIOR LIFE 302 SILVER AVENUE SAN FRANCISCO CA 94112 455092344 SEE PART VII CA 501(C)(3) 11A N/A 0 CHARITABLE REMAINDER TRUSTS (3) HOLDING CO CA N/A 1 0 1 0 0 0 0 0 0 0 1 0 0 1 1 0 1 1 0 1 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.