2014-08-13T10:47:21-05:00 2013-09-30 910189318 MOSS ADAMS LLP 101 SECOND STREET 9TH FLOOR SAN FRANCISCO CA 94105 990 2012-10-01 952047121 CONGREGATIONAL HOMES INC CONG 9096245061 900 E HARRISON AVE POMONA CA 91767 MAUREEN BEITH 9096245061 2014-08-06 1 RENIE BURBANK P00159653 4159561500 2012 2015-11-30 17:44:51Z MT SAN ANTONIO GARDENS MAUREEN BEITH 900 E HARRISON AVE POMONA CA 91767 31933121 0 X WWW.MSAGARDENS.ORG X 1957 CA THE MISSION OF CONGREGATIONAL HOMES, INC IS TO HELP ENSURE A HIGH QUALITY OF LIFE FOR OLDER ADULTS BY PROVIDING COMPREHENSIVE AND SECURE SERVICES THAT PROMOTE WELLNESS, INDEPENDENCE, PARTICIPATION AND DIGNITY. 27 27 339 300 0 0 723561 656531 19915939 19919904 1159497 1185347 1579866 1742830 23378863 23504612 0 0 0 0 11103135 12252442 0 0 0 10342036 10966637 21445171 23219079 1933692 285533 90305736 91492604 53662903 53692904 36642833 37799700 X THE MISSION OF CONGREGATIONAL HOMES, INC IS TO HELP ENSURE A HIGH QUALITY OF LIFE FOR OLDER ADULTS BY PROVIDING COMPREHENSIVE AND SECURE SERVICES THAT PROMOTE WELLNESS, INDEPENDENCE, PARTICIPATION AND DIGNITY. 0 0 6306856 6204310 MAINTENANCE/FACILITY SERVICES - PROVIDES THE UPKEEP OF THE BUILDINGS AND PLANT OPERATIONS INCLUDING ALL OCCUPANCY EXPENSES - HEAT, LIGHT, POWER, PROPERTY INSURANCE AND REAL ESTATE TAXES. THIS HOME FOR THE AGED FACILITY COVERS OVER 30 ACRES AND ALL BUILDINGS (86) ARE MAINTAINED TO FIT THE SPECIAL NEEDS OF THE ELDERLY POPULATION THAT LIVE HERE. THIS FACILITY WAS BUILT IN 1959-1961 WITH MANY RENOVATIONS OVER THE YEARS TO KEEP A MODERN YET SAFE AND COMFORTABLE FEEL FOR SENIOR LIVING THAT INCLUDES NOT ONLY RESIDENTIAL LIVING BUT ALSO ASSISTED LIVING AND SKILLED NURSING. 5211914 5127171 HEALTH SERVICES - PROVIDED MEDICAL CARE AND OUTPATIENT SERVICES TO OUR AGED POPULATION AND 61 ELDERLY PEOPLE IN THE COMMUNITY. TOTAL PATIENT DAYS THIS YEAR WAS 18,427 AND INCLUDES 3,386 FOR THE COMMUNITY PATIENTS. 16,050 OF THE TOTAL DAYS WERE FOR CUSTODIAL CARE WHICH IS NOT REIMBURSED BY MEDICARE OR HEALTH INSURANCE COMPANIES. WE AVERAGED 50.5 ELDERLY PATIENTS IN OUR SKILLED NURSING FACILITY PER DAY. THE CLINIC AND HOME HEALTH DEPARTMENTS TRANSPORTED PATIENTS TO THEIR DOCTOR APPOINTMENTS AND PROVIDED HEALTH AND ASSISTANCE IN EACH OF OUR ELDER'S HOMES. 4100326 4033657 DIETARY SERVICES - PROVIDED THREE MEALS PER DAY TO OVER 600 ELDERLY PEOPLE PLUS STAFF, GUESTS, AND OTHERS. OVER 470,600 MEALS AND NUTRITIONAL SUPPLEMENTS WERE SERVED PLUS AN ADDITIONAL 9,043 MEALS WERE PROVIDED TO THE LOCAL MEALS ON WHEELS PROGRAM THAT PROVIDES MEALS TO SHUT-INS IN THE NEIGHBORING COMMUNITY. 4630050 4554766 OTHER PERSONAL CARE FACILITY, HOUSEKEEPING SERVICES, GROUNDS MAINTENANCE, WELLNESS CENTER, PHYSICAL THERAPY, AND SECURITY. 4630050 4554766 20249146 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 1 124 0 1 339 1 0 0 0 0 0 0 0 0 X 27 27 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X MAUREEN BEITH 9096245061 900 E HARRISON AVE POMONA CA 91767 AMY FASS 3.00 X X 0 0 0 NICK WINSLOW 2.00 X X 0 0 0 CAROLE PELTON 1.00 X X 0 0 0 BRENDA BARHAM-HILL 1.00 X 0 0 0 RANDY PROUT 2.00 X X 0 0 0 MARGIE BEAL 1.00 X 0 0 0 ADAR BELINKOFF 4.00 X 0 0 0 GENE BLOCK 2.00 X 0 0 0 RON BOLDING 2.00 X 0 0 0 RAOUL CERVANTES 1.00 X 0 0 0 CINDA CLAPROOD 2.00 X 0 0 0 RON COLEMAN 1.00 X 0 0 0 DAVID COONS 2.00 X 0 0 0 MARY DYER 1.00 X 0 0 0 MARTINA EBERT 1.00 X 0 0 0 MEG EVANS 1.00 X 0 0 0 STEPHEN FARROW 2.00 X 0 0 0 JIM GAMB 2.00 X 0 0 0 PAT HAUDUCOEUR 1.00 X 0 0 0 FRANK HUNGERFORD 1.00 X 0 0 0 CARLENE MILLER 1.00 X 0 0 0 JACK MILLER 1.00 X 0 0 0 CURT MORRIS 1.00 X 0 0 0 PAULA PITZER 1.00 X 0 0 0 PEGGY SPEAR 1.00 X 0 0 0 ROBERT TRANQUADA 1.00 X 0 0 0 FRITZ WEIS 1.00 X 0 0 0 RANDELL K STOLL 40.00 X 213376 0 40641 LAURIE A LUTHER 40.00 X 166677 0 16668 DAVID L PEARCE 40.00 X 141327 0 22500 521380 0 79809 4 0 1 0 SOUTHERN CALIF BUILDERS 790 HAMPSHIRE ROAD STE G WESTLAKE VILLAGE CA 91361 CONSTRUCTION 1192761 YVONNE ZUCHOWSKI 905 N SECOND AVE 135 UPLAND CA 91786 FLOOR & WINDOW COVERINGS 275159 EWING ARCHITECTS 723 E CALIFORNIA BLVD PASADENA CA 91106 BUILDING ARCHITECTS 212474 RARE CONSTRUCTION 12223 HIGHLAND AVE 106 RANCHO CUCAMONGA CA 91739 CONSTRUCTION 146135 GL JACKMAN TILE 2039 MAIN STREET GOODING ID 83330 TILE 121035 6 656531 76960 656531 CARE AND SERVICE FEES 623000 14987419 14987419 AMORT OF ADVANCE FEES 623000 4476927 4476927 HMO/MEDICARE INSURANCE 623000 455558 455558 19919904 898582 898582 8712259 3015 8325384 103125 386875 -100110 286765 286765 NON-MEMBER PATIENTS 623000 1115181 1115181 OTHER REVENUE 623000 487870 487870 NON-RESIDENT MEALS 623000 139779 139779 1742830 23504612 19919904 0 2928177 X 424999 424999 8932934 8018535 914399 347707 287770 59937 1852655 1678573 174082 694147 595283 98864 7256 7256 65031 65031 78031 78031 3217114 2961237 255877 201445 201445 642298 390174 252124 64724 987 63737 2804045 2559252 244793 75239 47808 27431 108367 95263 13104 10391 10391 2662455 2620388 42067 271566 254060 17506 PHARMACEUTICALS 260857 260857 MED SUPPLIES/EQUIPMENT 178873 178873 OTHER EMPLOYEE EXPENSES 146417 133635 12782 RESIDENT ACTIVITY PRGMS 107269 107269 65259 59182 6077 23219079 20249146 2969933 0 957031 688289 3819547 1523311 632137 1043822 38518 44094 789974 702017 89024274 36814908 45491093 52209366 38178861 34651765 398575 629940 90305736 91492604 1893409 1903076 28677558 29181114 21210000 20600000 365804 373461 1516132 1635253 53662903 53692904 X 25797597 26569862 4019108 4298241 6826128 6931597 36642833 37799700 90305736 91492604 X 285533 672054 199280 X X 0 1 X 1 0 X 933126 1436639 1291429 723561 656531 5041286 18160128 18498509 18805779 19915939 19919904 95300259 19093254 19935148 20097208 20639500 20576435 100341545 0 0 0 100341545 781348 876055 1000563 1007363 898582 4563911 781348 876055 1000563 1007363 898582 4563911 1518777 1204636 1330647 1579866 1742830 7376756 21393379 22015839 22428418 23226729 23217847 112282212 0.89370 0.89540 0.04060 0.04300 X SCHEDULE A, PART IV, SUPPLEMENTAL INFORMATION: SCHEDULE A, PART III, LINE 12, EXPLANATION FOR OTHER INCOME: NON-MEMBER PATIENTS: ROOM AND BOARD FOR PEOPLE IN THE COMMUNITY WHO NEED A HIGHER LEVEL OF CARE BUT ARE NOT A CONTRACT RESIDENT OF MSAG; NON-RESIDENT MEALS: VISITORS AND GUESTS OF OUR CONTRACT RESIDENTS AND NON-MEMBER PATIENTS MAY PURCHASE MEALS (A LA A RESTAURANT OR TRAY LIKE IN A HOSPITAL) SO THAT THEY MAY EAT WITH THEIR FRIENDS AND FAMILIES; AND DEPARTMENT REIMBURSEMENT FOR PRIVATE WORK: CONTRACT RESIDENTS AND NON-MEMBER PATIENTS MAY REQUEST ADDITIONAL STAFF SERVICES THAT GO BEYOND OUR CONTRACTED SERVICES (I.E., REPAIR A PERSONAL ITEM, WASHING OF CLOTHES, RUN ERRANDS, EXTRA HOUSECLEANING, ETC.) RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 13956850 60792 1437028 609029 14845641 13769323 10900 2343747 2167120 13956850 14019487 51433 309203 610800 13769323 13171001 151000 1308286 610800 14019487 13448347 27219 309835 614400 13171001 0.58000 0.42000 0 0 1438330 1438330 71918327 29332892 42585435 5283896 3939090 1344806 10383721 3542926 6840795 52209366 REFUNDABLE DEPOSITS 93774 SPLIT-INTEREST AGREEMENTS 808910 ASSET RETIREMENT OBLIGATION 80870 WORKERS' COMPENSATION LIABILITY 651699 1635253 X 23517831 802180 802180 22715651 788961 788961 23504612 23219079 0 23219079 0 23219079 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: TO GENERATE INCOME TO OFFSET OPERATING EXPENSES AND PROVIDE A SAVINGS ACCOUNT WITH A MORE AGGRESSIVE LONG-TERM INVESTMENT STRATEGY. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: MSAG HAS EVALUATED ITS TAX POSITIONS AND THE CERTAINTY AS TO WHETHER THOSE POSITIONS WILL BE SUSTAINED IN THE EVENT OF AN AUDIT BY TAXING AUTHORITIES AT THE FEDERAL AND STATE LEVELS. THE PRIMARY TAX POSITIONS EVALUATED ARE RELATED TO MSAG'S CONTINUED QUALIFICATION AS A TAX-EXEMPT ORGANIZATION AND WHETHER THERE IS UNRELATED BUSINESS INCOME ACTIVITIES CONDUCTED THAT WOULD BE TAXABLE. MANAGEMENT HAS DETERMINED THAT ALL INCOME TAX POSITIONS ARE MORE LIKELY THAN NOT (>50%) OF BEING SUSTAINED UPON POTENTIAL AUDIT OR EXAMINATION; THEREFORE, NO DISCLOSURES OF UNCERTAIN INCOME TAX POSITIONS ARE REQUIRED. PART XI, LINE 2D - OTHER ADJUSTMENTS: NET ASSETS RELEASED FROM RESTRICTIONS 507,718. CHANGE IN FAIR VALUE OF INTEREST RATE CAP 294,462. PART XI, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTION REVENUE RECLASSED FROM RESTRICTED NET ASSET ACTIVITY 573,207. REALIZED GAIN ON INVESTMENTS RECLASSED FROM RESTRICTED NET ASSET ACTIVITY 64,700. INVESTMENT INCOME RECLASSED FROM RESTRICTED NET ASSET ACTIVITY 151,054. X 1 1 X X X X X 0 0 0 0 0 0 0 0 0 RANDELL K STOLL 195091 0 18285 0 0 0 22500 0 18141 0 254017 0 0 0 LAURIE A LUTHER 153571 0 13106 0 0 0 16668 0 0 0 183345 0 0 0 DAVID L PEARCE 141327 0 0 0 0 0 22500 0 0 0 163827 0 0 0 PART I, LINE 1A SPOUSE TRAVEL IS REIMBUSED BY THE ORGANIZATION FOR THE CEO AND EXECUTIVE VP UPON APPROVAL OF THE BOARD CHAIR. A JP MORGAN CHASE BANK 134994650 2010-12-01 21775000 BUILD HOUSING 0 0 0 A 18645000 21775000 1905000 370605 816000 38395 2010 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 1 1 0 0 0 0 A 0 SCHEDULE K PART IV, ARBITRAGE, LINE 2C DATE REBATE COMPUTATION PERFORMED ISSUER NAME: JP MORGAN CHASE BANK DATE THE REBATE COMPUTATION WAS PERFORMED: 03/27/2009 FORM 990, SCHEDULE K, PART III, LINE 2C, ARBITRAGE BOND GROSS PROCEEDS HAVE BEEN SPENT. THE LAST ARBITRAGE REBATE COMPUTATION WAS PERFORMED MARCH 2009. LAURIE LUTHER OFFICER/BOARD MEMBER GUARDIANCOMP 796734 WORKER'S COMPENSATION INSURANCE 0 X BUILDING IMPROVEMENTS 21 76961 FAIR MARKET VALUE 0 0 1 0 FORM 990, PART VI, SECTION B, LINE 11 THE TAX RETURNS ARE FIRST SUBMITTED TO THE AUDIT COMMITTEE (ALL BOARD MEMBERS) VIA EMAIL WHEN A DRAFT IS AVAILABLE, BUT PRIOR TO ITS IRS DUE DATE OR EXTENDED DUE DATE. QUESTIONS ARE ASKED OF THE CFO AND CEO. IF ACCEPTED, THE FORM 990 IS EMAILED VIA PDF FORMAT BY THE CFO TO ALL BOARD MEMBERS FOR THEIR REVIEW. QUESTIONS ARE EMAILED TO CFO. THE BOARD MEMBERS REPLY BY EMAIL IF THEY ACCEPT THE 990. THESE EMAILS ARE KEPT ON FILE. WHEN A QUORUM IS REACHED, THE 990 IS TRANSMITTED TO THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C THE CEOS SECRETARY DISTRIBUTES THE FORMS AT THE START OF EACH CALENDAR YEAR. SHE IS RESPONSIBLE FOR ENSURING THAT ALL ARE RETURNED. THE COMPLETED FORMS ARE THEN REVIEWED BY THE CHAIR AND SECRETARY OF THE BOARD OF DIRECTORS. IT IS THE RESPONSIBILITY OF EACH DIRECTOR TO IDENTIFY WHEN POTENTIAL CONFLICTS OF INTEREST MAY OCCUR DURING BOARD PROCEEDINGS. THE CHAIR AND THE SECRETARY MAY FIND IT NECESSARY TO REMIND INDIVIDUAL MEMBERS OF POTENTIAL CONFLICTS, AS NECESSARY. IN THE EVENT A POTENTIAL CONFLICT ARISES THE CHAIR DECIDES IF THE INDIVIDUAL MEMBER SHOULD RECUSE HIM OR HERSELF FROM THE DISCUSSION AND/OR VOTE. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMMITTEE SERVES AS THE MANAGEMENT COMPENSATION COMMITTEE. SALARY ADJUSTMENTS ARE BASED ON GENERAL SALARY ADJUSTMENTS FOR ALL EMPLOYEES, POSITION IN THE MARKET, INDIVIDUAL PERFORMANCE AND VALUE TO THE ORGANIZATION. COMPETITIVE SALARY REVIEWS ARE CONDUCTED ON A PERIODIC BASIS USING AN INDEPENDENT COMPENSATION CONSULTANT AND FORM 990 OF OTHER ORGANIZATIONS. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE KEPT IN THE ADMINISTRATION OFFICE IN A BINDER - FOR PUBLIC REVIEW - THAT CONTAINS IRS TAX EXEMPTION LETTER, ARTICLES OF INCORPORATION, BYLAWS, CONFLICT OF INTEREST POLICY, CODE OF ETHICAL CONDUCT, AND THREE YEARS OF 990'S AND AUDITED FINANCIAL STATEMENTS. OTHER FEES FORM 990, PART IX, LINE 11G OTHER FEES FOR SERVICES (NON-EMPLOYEES): PROGRAM SERVICE EXPENSES 2,961,237. MANAGEMENT AND GENERAL EXPENSES 255,877. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,217,114. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CHANGE IN FAIR VALUE OF INTEREST RATE CAP 294,462. CHANGE IN ACTUARIAL VALUE OF SPLIT-INTEREST AGREEMENTS -95,173. AUDITED FINANCIAL STATEMENT ROUNDING -9. AUDIT COMMITTEE AND OVERSIGHT FORM 990, PART XII, LINE 2C THERE HAVE BEEN NO CHANGES TO THIS PROCESS FROM PRIOR YEAR.