2015-02-10T10:51:49-06:00 2014-09-30 061009205 BLUM SHAPIRO & COMPANY PC CPA'S 29 S MAIN STREET PO BOX 272000 WEST HARTFORD CT 061272000 990 2013-10-01 060763898 CHURCH HOMES INC CONGREGATIONAL CHUR 8605279126 217 AVERY HEIGHTS HARTFORD CT 061064200 RAYMOND A GASPERINI VICE PRESIDENT/CFO 8605279126 2015-02-04 1 ELIZABETH SOLECKI P00235171 8605614000 2013 2016-02-25 16:41:14Z RAYMOND A GASPERINI 217 AVERY HEIGHTS HARTFORD CT 06106 41639227 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. 16 15 510 270 0 0 371877 593147 40061154 39800091 436796 867739 323390 348349 41193217 41609326 4432 6400 0 0 22628917 22782548 0 0 73290 17776512 17526972 40409861 40315920 783356 1293406 58207892 57175966 23337361 20944559 34870531 36231407 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 36813909 6400 40130440 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, 14 ACCOMMODATIONS IN A HOME FOR THE AGED, 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. 36813909 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 0 1 0 0 0 0 1 0 0 0 1 117 0 1 510 1 0 0 0 0 0 1 1 0 0 0 0 X 16 15 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 268678 0 45946 ROBERT S DICKS DIRECTOR 1.00 X 0 0 0 PATRICK Y YUNG DIRECTOR 1.00 X 0 0 0 LARRY C BROWN 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 JEFFREY H KOENIG 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 178315 0 32569 EILEEN MULLIGAN VICE PRESIDENT 40.00 X 167929 0 25151 MIRIAM PARKER VICE PRESIDENT 40.00 X 185016 0 33617 MARJORIE K TESSMAN SECRETARY 38.00 X 52524 0 16353 BONITA GANIM DIRECTOR OF NURSING SERVICES 40.00 X 107172 0 16237 ANNA LUKAS NURSE MANAGER 40.00 X 132934 0 24538 MICHELLE PASCETTA DIR BUDGETING AND REIMBURSEMENT 40.00 X 107110 0 26879 SUSAN COSTELLO RN 40.00 X 103714 0 17029 1303392 0 238319 8 0 1 0 HEALTHCARE SERVICES GROUP INC 3220 TILLMAN DR STE 300 BENSALEM PA 19020 HOUSEKEEPING/LAUNDRY/DIETARY SERVICES 2655657 ALLIANCE REHAB OF CT 1520 KENSINGTON RD STE 110 OAK BROOKE IL 60523 REHAB THERAPY 1728692 ENTERPRISE BUILDERS 46 SHEPARD DR NEWINGTON CT 06111 CONSTRUCTION OF COTTAGES 657237 H&H LINEN SERVICES 60 BELAMOSE AVE UNIT A10 ROCKY HILL CT 06067 LINEN SERVICE 162285 D SAYADOFF & CO PO BOX 996 BLOOMFIELD CT 06002 PAINTER 154953 12 74717 518430 79319 593147 RESIDENT SERVICES 623000 39681156 39681156 OTHER SERVICES 623000 118935 118935 39800091 487434 487434 18000 0 18000 18000 18000 377505 2800 0 0 377505 2800 380305 380305 29901 74717 29901 0 OTHER INCOME 900099 326865 326865 FEES INCOME 900099 3484 3484 330349 41609326 40130440 0 885739 X 6400 6400 997392 997392 16250118 14918518 1331600 1269145 1107456 161689 2986990 2738563 248427 1278903 1115971 162932 1550 1550 31719 31719 74600 74600 6406812 6312257 72985 21570 148120 143512 3274 1334 238304 139697 89235 9372 162699 79750 74062 8887 2829797 2821119 8678 18896 10263 8633 16445 8633 7812 620 620 2538708 2538708 268368 268368 PROVIDER TAX 1770892 1770892 SUPPLIES 649194 630938 18256 FOOD 627283 627283 PRESCRIPTIONS & DRUGS 494159 494159 1248806 1080802 135877 32127 40315920 36813909 3428721 73290 11071372 2548296 241711 636045 2665841 2852771 220028 222772 390404 390478 80089153 51333436 29413907 28755717 12082937 20222287 660078 664783 1461614 882817 58207892 57175966 3003379 3157547 19959943 17408950 374039 378062 23337361 20944559 X 25354158 26657027 6864108 6922115 2652265 2652265 34870531 36231407 58207892 57175966 1293406 67470 0 X 0 1 X 1 0 X 929762 404860 598288 371877 593147 2897934 39756122 40098913 40215164 40366544 40130440 200567183 40685884 40503773 40813452 40738421 40723587 203465117 0 0 0 203465117 121341 233047 289151 158361 487434 1289334 121341 233047 289151 158361 487434 1289334 398997 64383 17525 18000 18000 516905 41206222 40801203 41120128 40914782 41229021 205271356 0.99120 0.99090 0.00630 0.00480 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 9297884 354207 680438 180413 10152116 8485427 83398 904516 175457 9297884 6929974 401654 1344982 189371 1812 8485427 7353857 239594 -163591 493454 6432 6929974 7975094 228623 702811 1550231 2440 7353857 0.53000 0.26000 0.21000 0 0 2744217 2744217 49864031 30761760 19102271 23604822 18013175 5591647 3876083 2558501 1317582 28755717 ANNUITIES PAYABLE 80543 RESIDENT FUNDS AND DEPOSITS 193643 DUE TO THIRD PARTY REIMBURSEMENT AG 40458 MISCELLANEOUS 63418 378062 41618359 67470 -58437 9033 41609326 0 41609326 40257483 0 40257483 58437 58437 40315920 PART V, LINE 4: INVESTMENT INCOME UTILIZED TO SUPPORT OPERATIONS PART XI, LINE 2D - OTHER ADJUSTMENTS: DIRECT RESIDENT SUPPORT -57,496. BAD DEBTS -941. PART XII, LINE 4B - OTHER ADJUSTMENTS: DIRECT RESIDENT SUPPORT 57,496. BAD DEBTS 941. GOLF OUTING 79495 57246 22249 22249 FESTIVAL OF TREES 15148 9300 5848 5848 1 9975 8171 1804 1804 104618 74717 29901 29901 29901 0 1 SCHOLARSHIPS 8 6400 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 243678 0 25000 0 0 0 30533 0 15413 0 314624 0 0 0 RAYMOND GASPERINI VICE PRESIDENT/CFO 175315 0 3000 0 0 0 20384 0 12185 0 210884 0 0 0 EILEEN MULLIGAN VICE PRESIDENT 163929 0 4000 0 0 0 18713 0 6438 0 193080 0 0 0 MIRIAM PARKER VICE PRESIDENT 182016 0 3000 0 0 0 21495 0 12122 0 218633 0 0 0 ANNA LUKAS NURSE MANAGER 132934 0 0 0 0 0 13981 0 10557 0 157472 0 0 0 PART I, LINE 7 BONUSES ARE AWARDED BASED ON THE ACHIEVEMENT OF SPECIFIC PERFORMANCE GOALS. X 2 79319 FAIR MARKET VALUE 0 0 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 1,822,962. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,822,962. DIETARY SERVICES: PROGRAM SERVICE EXPENSES 1,752,569. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,752,569. HOUSEKEEPING: PROGRAM SERVICE EXPENSES 778,929. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 778,929. TEMPORARY NURSING: PROGRAM SERVICE EXPENSES 409,819. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 409,819. SECURITY: PROGRAM SERVICE EXPENSES 146,941. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 146,941. LAUNDRY: PROGRAM SERVICE EXPENSES 452,926. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 452,926. MAINTENANCE & REPAIRS: PROGRAM SERVICE EXPENSES 548,248. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 548,248. OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 399,863. MANAGEMENT AND GENERAL EXPENSES 72,985. FUNDRAISING EXPENSES 21,570. TOTAL EXPENSES 494,418. 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