2016-02-12T15:23:14-06:00 2015-09-30 061009205 BLUM SHAPIRO & COMPANY PC CPA'S 29 S MAIN STREET PO BOX 272000 WEST HARTFORD CT 061272000 990 2014-10-01 060763898 CHURCH HOMES INC CONGREGATIONAL CHUR 8605279126 217 AVERY HEIGHTS HARTFORD CT 061064200 RAYMOND A GASPERINI VICE PRESIDENT/CFO 8605279126 2016-02-11 1 ELIZABETH SOLECKI P00235171 8605614000 2016-02-11 2014 2016-08-17 19:52:53Z RAYMOND A GASPERINI 217 AVERY HEIGHTS HARTFORD CT 06106 41841487 0 X WWW.CHURCHHOMES.ORG X 1957 CT TO PROVIDE, ON A NOT-FOR-PROFIT BASIS AND WITHOUT DISCRIMINATION, A FULL RANGE OF RESIDENTIAL LIVING AND HEALTH CARE SERVICES FOR OLDER ADULTS. 13 12 506 271 0 0 593147 402859 39800091 39433947 867739 1542072 348349 442748 41609326 41821626 6400 10150 0 0 22782548 22590556 0 0 57883 17526972 17661712 40315920 40262418 1293406 1559208 57175966 55079347 20944559 19292559 36231407 35786788 X TO PROVIDE, ON A NOT-FOR-PROFIT BASIS AND WITHOUT DISCRIMINATION, A FULL RANGE OF RESIDENTIAL LIVING AND HEALTH CARE SERVICES FOR OLDER ADULTS BY PROMOTING AND IMPLEMENTING SYSTEMS THAT MAINTAIN AND SUPPORT EVERY INDIVIDUAL'S OPTIMAL INDEPENDENCE AND LIFE WISHES IN A SAFE, DIGNIFIED ATMOSPHERE CONDUCIVE TO QUALITY RETIREMENT, BY ASSURING KNOWLEDGEABLE AND CONSISTENT LEADERSHIP IN RETIREMENT LIVING, LONG-TERM CARE, HOME CARE AND SUPPORT SERVICES AND BY DEVELOPING INNOVATIVE PROGRAMS AND SERVICES WHICH RESPOND TO THE CHANGING NEEDS OF ITS RESIDENTS AND CLIENTS AND THE SOCIETY IT SERVES. 0 0 36738091 10150 39859295 CHURCH HOMES, INC. CONGREGATIONAL IS A NOT-FOR-PROFIT CORPORATION, WHICH OWNS AND OPERATES RETIREMENT AND HEALTH CARE FACILITIES IN HARTFORD, CT (AVERY HEIGHTS) AND SALISBURY, CT (NOBLE HORIZONS). AVERY HEIGHTS CONSISTS OF 130 SKILLED NURSING BEDS, 69 INTERMEDIATE CARE BEDS, 58 INDEPENDENT LIVING COTTAGES, AND 137 INDEPENDENT LIVING APARTMENTS. IN ADDITION, AVERY HEIGHTS OPERATES A HOME HEALTH AGENCY AND BETTY LARUS ADULT DAY HEALTH CENTER. NOBLE HORIZONS CONSISTS OF 61 SKILLED NURSING BEDS, 30 INTERMEDIATE CARE BEDS, 50 INDEPENDENT LIVING COTTAGES, AND 19 ACCOMMODATIONS IN A HOME FOR THE AGED. 36738091 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 112 0 1 506 1 0 0 0 0 0 1 1 0 0 0 0 X 13 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 1 1 0 CT X RAYMOND A GASPERINI 8605279126 217 AVERY HEIGHTS HARTFORD CT 061064200 PATRICK GILLAND PRESIDENT/CEO 40.00 5.00 X X 274138 0 48745 PATRICK Y YUNG DIRECTOR 1.00 X 0 0 0 ROBERT S DICKS DIRECTOR 1.00 X 0 0 0 JOSEPH C BLACK JR DIRECTOR 1.00 X 0 0 0 DAVID E CANUEL DIRECTOR 1.00 X 0 0 0 ELIZABETH S GAGNE DIRECTOR 1.00 X 0 0 0 HENRY B MCNULTY VICE CHAIRMAN 1.00 X X 0 0 0 DAVID E POLK CHAIRMAN 1.00 X X 0 0 0 GERARD J BALDWIN DIRECTOR 1.00 X 0 0 0 PETER B MATTHEWS DIRECTOR 1.00 X 0 0 0 MERCEDESE E LARGE DIRECTOR 1.00 X 0 0 0 PETER C GERALI DIRECTOR 1.00 X 0 0 0 PETER L HOLLAND DIRECTOR 1.00 X 0 0 0 PATRICK S GILLIGAN DIRECTOR 1.00 X 0 0 0 RAYMOND GASPERINI VICE PRESIDENT/CFO 40.00 X 179062 0 33653 EILEEN MULLIGAN VICE PRESIDENT 40.00 X 169562 0 25749 MIRIAM PARKER VICE PRESIDENT 40.00 X 185697 0 35168 MARJORIE K TESSMAN SECRETARY 30.00 X 35358 0 6884 BONITA GANIM DIRECTOR OF NURSING SERVICES 40.00 X 107619 0 16791 ANNA LUKAS NURSE MANAGER 40.00 X 131933 0 25571 MICHELLE PASCETTA DIR BUDGETING AND REIMBURSEMENT 40.00 X 108710 0 24925 SUSAN COSTELLO RN 40.00 X 106113 0 20124 1298192 0 237610 8 0 1 0 HEALTHCARE SERVICES GROUP INC 3220 TILLMAN DR STE 300 BENSALEM PA 19020 HOUSEKEEPING/LAUNDRY/DIETARY SERVICES 2773131 ALLIANCE REHAB OF CT 1520 KENSINGTON RD STE 110 OAK BROOKE IL 60523 REHAB THERAPY 1714164 H&H LINEN SERVICES 60 BELAMOSE AVE UNIT A10 ROCKY HILL CT 06067 LINEN SERVICE 192050 D SAYADOFF & CO PO BOX 996 BLOOMFIELD CT 06002 PAINTER 182445 QUALITY FLOORING 21 BRENNAN ROAD AMSTON CT 06231 FLOORING 148867 13 66109 336750 402859 RESIDENT SERVICES 623000 39324755 39324755 OTHER SERVICES 623000 109192 109192 39433947 189677 189677 17400 0 17400 17400 17400 1352395 0 1352395 1352395 1352395 19861 66109 19861 0 OTHER INCOME 900099 421243 421243 FEES INCOME 900099 4105 4105 425348 41821626 39859295 0 1559472 X 10150 10150 1013364 1013364 15951012 14651035 1299977 1220584 1063617 156967 3134458 2867520 266938 1271138 1107670 163468 3250 3250 88167 88167 81000 81000 6347068 6304217 24975 17876 150780 148082 2322 376 269935 142716 124316 2903 147432 71940 65106 10386 2734059 2715538 18521 12447 6789 5658 2683 1877 806 90 90 2589000 2589000 268019 268019 PROVIDER TAX 1735244 1735244 SUPPLIES 682572 669482 13090 FOOD 629056 629056 PRESCRIPTIONS & DRUGS 525981 525981 1394929 1230068 138519 26342 40262418 36738091 3466444 57883 2548296 2221989 636045 394413 2852771 2601715 222772 199997 390478 567292 81764562 53903524 28755717 27861038 20222287 20555355 664783 637830 882817 39718 57175966 55079347 3157547 3263787 17408950 15622301 378062 406471 20944559 19292559 X 26657027 26823071 6922115 6311452 2652265 2652265 36231407 35786788 57175966 55079347 1559208 -2003827 0 X 0 1 X 1 0 X 404860 598288 371877 593147 402859 2371031 40098913 40215164 40366544 40130440 39859295 200670356 40503773 40813452 40738421 40723587 40262154 203041387 0 0 0 203041387 233047 289151 158361 487434 189677 1357670 233047 289151 158361 487434 189677 1357670 64383 17525 18000 18000 17400 135308 40801203 41120128 40914782 41229021 40469231 204534365 0.99270 0.99120 0.00660 0.00630 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 10152116 131662 -262110 328714 9692954 9297884 354207 680438 180413 10152116 8485427 83398 904516 175457 9297884 6929974 401654 1344982 189371 1812 8485427 7353857 239594 -163591 493454 6432 6929974 0.53000 0.27000 0.20000 0 0 2744217 2744217 50455862 32195571 18260291 25081828 19011010 6070818 3482655 2696943 785712 27861038 ANNUITIES PAYABLE 70413 RESIDENT FUNDS AND DEPOSITS 209692 DUE TO THIRD PARTY REIMBURSEMENT AG 58948 MISCELLANEOUS 67418 406471 39684450 -2003827 -133349 -2137176 41821626 0 41821626 40129069 0 40129069 133349 133349 40262418 PART V, LINE 4: INVESTMENT INCOME UTILIZED TO SUPPORT OPERATIONS PART XI, LINE 2D - OTHER ADJUSTMENTS: DIRECT RESIDENT SUPPORT -51,783. BAD DEBTS -81,566. PART XII, LINE 4B - OTHER ADJUSTMENTS: DIRECT RESIDENT SUPPORT 51,783. BAD DEBTS 81,566. GOLF OUTING 75995 57938 18057 18057 FESTIVAL OF TREES 9975 8171 1804 1804 85970 66109 19861 19861 19861 0 1 SCHOLARSHIPS 6 10150 PART I, LINE 2: SCHOLARSHIP ASSISTANCE IS OFFERED TO EMPLOYEES OR THEIR CHILDREN WHO WISH TO PURSUE PROFESSIONAL AND VOCATIONAL COURSES OF STUDY THAT ARE RELATED TO THE EMPLOYEE'S POTENTIAL FOR PROMOTION OR MINIMUM JOB REQUIREMENTS. ALL COURSES MUST BE OFFERED THROUGH AN ACCREDITED INSTITUTION OF HIGHER LEARNING OR BE APPROVED FOR CONTINUING EDUCATION UNITS. TO QUALIFY, THE EMPLOYEE MUST BE EMPLOYED 32 HOURS OR MORE AND HAVE COMPLETED ONE YEAR OF CONTINUOUS EMPLOYMENT. THE EMPLOYEE MUST HAVE A GOOD WORK ATTENDANCE RECORD. THE EMPLOYEE OR THEIR CHILD MUST MEET THE REQUIREMENTS OF THE INSTITUTION OR AGENCY OFFERING THE COURSE. THE SCHOLARSHIP ASSISTANCE IS AVAILABLE IF THE APPLICANT IS NOT ELIGIBLE FOR ASSISTANCE FROM OTHER SOURCES OF REIMBURSEMENT. X 1 1 X X X X 0 0 0 0 0 0 0 1 0 PATRICK GILLAND PRESIDENT/CEO 249138 0 25000 0 0 0 31086 0 17659 0 322883 0 0 0 RAYMOND GASPERINI VICE PRESIDENT/CFO 176062 0 3000 0 0 0 20524 0 13129 0 212715 0 0 0 EILEEN MULLIGAN VICE PRESIDENT 165562 0 4000 0 0 0 18981 0 6768 0 195311 0 0 0 MIRIAM PARKER VICE PRESIDENT 182697 0 3000 0 0 0 21641 0 13527 0 220865 0 0 0 ANNA LUKAS NURSE MANAGER 131933 0 0 0 0 0 13806 0 11765 0 157504 0 0 0 PART I, LINE 7 BONUSES ARE AWARDED BASED ON THE ACHIEVEMENT OF SPECIFIC PERFORMANCE GOALS. D SAYADOFF & CO SUBSTANTIAL CONTRIBUTOR 256005 COMPENSATION FOR SERVICES 0 FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS REVIEWED WITH THE BOARD OF DIRECTORS AT REGULARLY SCHEDULED BOARD OF DIRECTORS MEETING. FORM 990, PART VI, SECTION B, LINE 12C THE PRESIDENT OF CHURCH HOMES, INC. REVIEWS THE RESPONSES TO THE ANNUAL CONFLICT OF INTEREST QUESTIONNAIRE WITH THE COMMITTEE ON DIRECTORS. WHERE AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST EXISTS, THE COMMITTEE ON DIRECTORS IS AUTHORIZED TO TAKE APPROPRIATE CORRECTIVE ACTION. FORM 990, PART VI, SECTION B, LINE 15 CHURCH HOMES, INC. PERSONNEL COMMITTEE REVIEWS AND APPROVES OFFICER COMPENSATION ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G MEDICAL THERAPY: PROGRAM SERVICE EXPENSES 1,740,963. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,740,963. DIETARY SERVICES: PROGRAM SERVICE EXPENSES 1,770,786. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,770,786. HOUSEKEEPING: PROGRAM SERVICE EXPENSES 797,169. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 797,169. TEMPORARY NURSING: PROGRAM SERVICE EXPENSES 364,564. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 364,564. SECURITY: PROGRAM SERVICE EXPENSES 143,737. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 143,737. LAUNDRY: PROGRAM SERVICE EXPENSES 478,835. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 478,835. MAINTENANCE & REPAIRS: PROGRAM SERVICE EXPENSES 634,015. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 634,015. OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 374,148. MANAGEMENT AND GENERAL EXPENSES 24,975. FUNDRAISING EXPENSES 17,876. TOTAL EXPENSES 416,999. CONNECTICUT ALLIANCE FOR LONG TERM CARE 217 AVERY HEIGHTS HARTFORD CT 06106 061465316 ADMINISTER PROVIDER BASED NETWORK TO PROVIDE COST-EFFECTIVE HEALTH CARE CT 501(C)(3) LINE 11A, I N/A 0 0 0 1 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0