2014-02-15T14:56:13-06:00 2013-09-30 061009205 BLUM SHAPIRO & COMPANY PC CPA'S 29 S MAIN STREET PO BOX 272000 WEST HARTFORD CT 061272000 990 2012-10-01 060763898 CHURCH HOMES INC CONGREGATIONAL CHUR 8605279126 217 AVERY HEIGHTS HARTFORD CT 061064200 RAYMOND A GASPERINI 8605279126 2014-02-18 1 ELIZABETH SOLECKI P00235171 8605614000 2012 2015-11-30 17:44:51Z RAYMOND A GASPERINI 217 AVERY HEIGHTS HARTFORD CT 06106 41220258 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. 14 13 506 270 0 0 598288 371877 39865424 40061154 979479 436796 367265 323390 41810456 41193217 10550 4432 0 0 22588759 22628917 0 0 65803 17617587 17776512 40216896 40409861 1593560 783356 58360806 58207892 24996083 23337361 33364723 34870531 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 36995837 4432 40366544 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. 36995837 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 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 135 0 1 506 1 0 0 0 0 0 1 1 0 0 0 0 X 14 13 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 40.00 5.00 X X 263989 0 45946 PATRICK Y YUNG 1.00 X 0 0 0 LARRY C BROWN 1.00 X 0 0 0 JOSEPH C BLACK JR 1.00 X 0 0 0 DAVID E CANUEL 1.00 X 0 0 0 ELIZABETH S GAGNE 1.00 X 0 0 0 HENRY B MCNULTY 1.00 X X 0 0 0 DAVID E POLK 1.00 X X 0 0 0 STEPHEN E RONAI ESQUIRE 1.00 X 0 0 0 PETER B MATTHEWS 1.00 X 0 0 0 MERCEDESE E LARGE 1.00 X 0 0 0 PETER C GERALI 1.00 X 0 0 0 PETER L HOLLAND 1.00 X 0 0 0 JEFFREY H KOENIG 1.00 X 0 0 0 RAYMOND GASPERINI 40.00 X 176463 0 32569 EILEEN MULLIGAN 40.00 X 164488 0 25151 MIRIAM PARKER 40.00 X 183519 0 33617 MARJORIE K TESSMAN 40.00 X 55149 0 16353 BONITA GANIM 40.00 X 103905 0 16237 ANNA LUKAS 40.00 X 131870 0 24538 MICHELLE PASCETTA 40.00 X 105257 0 26879 SUSAN COSTELLO 40.00 X 100368 0 17029 1285008 0 238319 8 0 1 0 HEALTHCARE SERVICES GROUP INC 3220 TILLMAN DR STE 300 BENSALEM PA 19020 HOUSEKEEPING/LAUNDRY/DIETARY SERVICES 2673899 ALLIANCE REHAB OF CT 1520 KENSINGTON RD STE 110 OAK BROOKE IL 60523 REHAB THERAPY 1390228 ENTERPRISE BUILDERS 46 SHEPARD DR NEWINGTON CT 06111 CONSTRUCTION OF COTTAGES 547230 AUGUSTIN MALAYKHAN (AZTEC LANDSCAPE & RE PO BOX 320058 HARTFORD CT 06132 GROUNDS CARE, PLOWING, SANDING 185311 D SAYADOFF & CO PO BOX 996 BLOOMFIELD CT 06002 PAINTER 172345 10 69594 302283 371877 RESIDENT SERVICES 623000 39952199 39952199 OTHER SERVICES 623000 108955 108955 40061154 158361 158361 18000 0 18000 18000 18000 279205 0 770 279205 -770 278435 278435 26271 69594 26271 0 OTHER INCOME 900099 302279 302279 FEES INCOME 900099 3111 3111 305390 41193217 40366544 0 454796 X 4432 4432 1006047 1006047 16042655 14756763 1285892 1230352 1074712 155640 3037720 2789536 248184 1312143 1146157 165986 1000 1000 31681 31681 75200 75200 6418600 6314936 79273 24391 145611 143079 1966 566 263621 169541 82220 11860 107535 30058 70042 7435 2867562 2876534 -8972 12044 6674 5370 8971 6846 2125 10940 10940 2448980 2448980 261051 261051 PROVIDER TAX 1781823 1781823 SUPPLIES 672964 659216 13748 FOOD 612290 612290 PRESCRIPTIONS & DRUGS 435218 435218 1621421 1467051 132819 21551 40409861 36995837 3348221 65803 10855236 11071372 1726280 241711 3530266 2665841 197690 220028 572408 390404 78292125 48878218 29656758 29413907 11117448 12082937 652608 660078 52112 1461614 58360806 58207892 2812505 3003379 21842487 19959943 341091 374039 24996083 23337361 X 24241363 25354158 6471095 6864108 2652265 2652265 33364723 34870531 58360806 58207892 783356 722452 0 X 0 1 X 1 0 X 995528 929762 404860 598288 371877 3300315 39944247 39756122 40098913 40215164 40366544 200380990 40939775 40685884 40503773 40813452 40738421 203681305 0 0 0 203681305 184505 121341 233047 289151 158361 986405 184505 121341 233047 289151 158361 986405 386093 398997 64383 17525 18000 884998 41510373 41206222 40801203 41120128 40914782 205552708 0.99090 0.98460 0.00480 0.00880 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 8485427 83398 904516 175457 9297884 6929974 401654 1344982 189371 1812 8485427 7353857 239594 -163591 493454 6432 6929974 7975094 228623 702811 1550231 2440 7353857 8172455 51035 30490 276168 2718 7975094 0.51000 0.29000 0.20000 0 0 2744217 2744217 49546667 29321694 20224973 22634402 17146500 5487902 3366839 2410024 956815 29413907 ANNUITIES PAYABLE 71087 RESIDENT FUNDS AND DEPOSITS 205357 DUE TO THIRD PARTY REIMBURSEMENT AG 43954 MISCELLANEOUS 53641 374039 41487117 722452 -428552 293900 41193217 0 41193217 39981309 0 39981309 428552 428552 40409861 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: INVESTMENT INCOME UTILIZED TO SUPPORT OPERATIONS PART XI, LINE 2D - OTHER ADJUSTMENTS: DIRECT RESIDENT SUPPORT -8,741. BAD DEBTS -419,811. PART XII, LINE 4B - OTHER ADJUSTMENTS: DIRECT RESIDENT SUPPORT 8,741. BAD DEBTS 419,811. GOLF OUTING 70949 52971 17978 17978 FESTIVAL OF TREES 24916 16623 8293 8293 95865 69594 26271 26271 26271 0 X 1 1 X X X X 0 0 0 0 0 0 0 1 0 PATRICK GILLAND 241489 0 22500 0 0 0 30533 0 15413 0 309935 0 0 0 RAYMOND GASPERINI 173963 0 2500 0 0 0 20384 0 12185 0 209032 0 0 0 EILEEN MULLIGAN 161488 0 3000 0 0 0 18713 0 6438 0 189639 0 0 0 MIRIAM PARKER 181019 0 2500 0 0 0 21495 0 12122 0 217136 0 0 0 ANNA LUKAS 131870 0 0 0 0 0 13981 0 10557 0 156408 0 0 0 PART I, LINE 7 BONUSES ARE AWARDED BASED ON THE ACHIEVEMENT OF SPECIFIC PERFORMANCE GOALS. 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. OTHER FEES FORM 990, PART IX, LINE 11G MEDICAL THERAPY: PROGRAM SERVICE EXPENSES 1,813,009. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,813,009. DIETARY SERVICES: PROGRAM SERVICE EXPENSES 1,733,684. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,733,684. HOUSEKEEPING: PROGRAM SERVICE EXPENSES 763,576. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 763,576. TEMPORARY NURSING: PROGRAM SERVICE EXPENSES 483,965. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 483,965. SECURITY: PROGRAM SERVICE EXPENSES 144,331. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 144,331. LAUNDRY: PROGRAM SERVICE EXPENSES 441,170. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 441,170. MAINTENANCE & REPAIRS: PROGRAM SERVICE EXPENSES 516,058. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 516,058. OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 419,143. MANAGEMENT AND GENERAL EXPENSES 79,273. FUNDRAISING EXPENSES 24,391. TOTAL EXPENSES 522,807. 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