2013-02-15T13:08:52-06:00 2012-03-31 910189318 MOSS ADAMS LLP 3121 WEST MARCH LANE SUITE 100 STOCKTON CA 952192303 990 2011-04-01 941251113 ODD FELLOWS HOME OF CALIFORNIA ODDF 4087417194 14414 OAK ST SUITE B SARATOGA CA 95070 DAVID ROSENBERG 4087417194 2013-02-13 1 TRACY S PAGLIA P00366884 2099556100 2011 2016-03-07 17:11:31Z DAVID ROSENBERG 14414 OAK ST SUITE B SARATOGA CA 95070 50703077 0 X N/A X 1912 CA PROVIDE RESIDENTIAL CARE, ASSISTED LIVING AND SKILLED NURSING FACILITIES. 13 11 581 173 0 0 528162 112223 46531246 45164140 1938082 4204991 301652 463476 49299142 49944830 0 0 0 0 18671166 19475919 0 0 0 29454910 29832394 48126076 49308313 1173066 636517 174561231 169360951 169006746 165445018 5554485 3915933 ENHANCE QUALITY OF LIFE, PRESERVE DIGNITY, MEET HEALTH, SOCIAL AND EMOTIONAL NEEDS OF OUR RESIDENTS CONSISTENT WITH THE BASIC PRINCIPLES OF ODD FELLOWSHIP. 0 0 41586066 0 45164140 TO PROVIDE HOUSING AND MEALS, HOUSEKEEPING AND LAUNDRY SERVICES, AND SKILLED NURSING FACILITIES FOR SENIORS. THE SARATOGA FACILITIES CONSIST OF 143 ACTIVE AND 100 ASSISTED LIVING APARTMENTS, A 94 BED SKILLED NURSING FACILITY, AND 12 SPECIAL CARE BEDS. THE NAPA FACILITIES CONSIST OF 182 ACTIVE AND 63 ASSISTED LIVING APARTMENTS, 69 BED SKILLED NURSING FACILITY, AND 20 SPECIAL CARE BEDS. 41586066 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 0 1 0 0 0 0 1 0 0 0 0 1 166 0 1 581 1 0 0 0 0 0 0 0 0 0 0 X 13 11 0 1 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X MARY SCHOEGGL (RS LLC) 5418577610 965 ELLENDALE DRIVE MEDFORD OR 97504 X MARY ANN TSCHERNOSCHA 1.00 X 0 0 0 JUDGE DAVID ROSENBERG 1.00 X X 0 0 0 RAY LINK 1.00 X X 0 51720 0 JAY JOHNSON 1.00 X X 0 50304 0 DON SMITH 1.00 X X 0 0 0 ROBIN OLIVER 1.00 X X 0 0 0 NEIL ALLEN 1.00 X 0 0 0 DOROTHY HANDY 1.00 X 0 0 0 LYNN HILL 1.00 X 0 0 0 GERALD POARCH 1.00 X X 0 0 0 JOYCE ROSGEN 1.00 X 0 0 0 GERALD WORTH 1.00 X 0 0 0 VIC BUCHER 1.00 X 0 0 0 PETER BREGMAN 1.00 X 0 0 0 KATHERINE LEDFORD 40.00 X 153512 0 22680 WAYNE PANCHESSON 40.00 X 166544 0 37358 SUSAN PLATTE 40.00 X 110356 0 16087 HEROINE GERALI 40.00 X 110656 0 23471 MARY SCHRAMM CITTONI 40.00 X 103411 0 12630 MARQUITA PALILEO 40.00 X 109774 0 2637 754253 102024 114863 6 0 1 0 CONSONUS REHAB UNIT 12 PO BOX 4800 PORTLAND OR 97208 THERAPY SERVICE 2387984 RETIREMENT SERVICES LLC 965 ELLENDALE AVE MEDFORD OR 97504 MANAGEMENT SERVICES 1599416 SYSCO FOOD SERVICES PO BOX 5019 FREMONT CA 94537 FOOD SERVICE 1085397 KAISER PERMANENTE PO BOX 60000 SAN FRANCISCO CA 94160 EMPLOYEE BENEFITS 1070395 GUARDIANCOMP INC 255 GREAT VALLEY PKWY STE 200 MALVERN PA 19355 WORKER'S COMP PROVIDER 1028022 37 112223 38000 112223 SERVICE FEES 623990 23737948 23737948 HEALTH CENTER REVENUE 623990 17348168 17348168 ENTRANCE & APP FEES 623990 3901136 3901136 RESIDENT SERVICES 623990 176888 176888 45164140 1384012 1384012 279226 279226 3300000 758247 2541753 2541753 2541753 DEPARTMENTAL REVENUE 623990 188338 188338 GUEST FEES 623990 157642 157642 DELI & CATERING 623990 79853 79853 37643 37643 463476 49944830 45164140 0 4668467 399503 399503 15107366 13943606 1163760 99812 80837 18975 2556626 2225948 330678 1312612 1189581 123031 2399124 2399124 543707 543707 352434 352434 158102 158102 5167333 4971901 195432 456008 456008 1321155 1121591 199564 86232 86232 1965686 1965686 113739 28930 84809 5910024 5910024 160928 160928 6322055 6322055 559097 559097 FOOD AND BEVERAGE 2517644 2517644 MEDICAL SUPPLIES 1038357 1038357 BOND FEES AND AMORTIZAT 402888 402888 LICENSES AND FEES 357881 269906 87975 49308313 41586066 7722247 0 15283 8053 11909289 10586367 2758961 3224913 135796 124420 885362 945920 167046292 51143752 118728891 115902540 34611225 33952891 1176446 629227 4339978 3986620 174561231 169360951 6937289 9138742 51398439 49197121 110138918 106409455 532100 699700 169006746 165445018 X 4835522 3164732 634658 666896 84305 84305 5554485 3915933 174561231 169360951 X 636517 -2275069 X 0 1 1 X 0 X 977334 573433 670966 528161 112223 2862117 39649715 41666249 42996917 46531246 45164140 216008267 40627049 42239682 43667883 47059407 45276363 218870384 0 0 0 218870384 3198414 2358793 1740375 1845514 1663238 10806334 3198414 2358793 1740375 1845514 1663238 10806334 818092 870097 575417 301652 463476 3028734 44643555 45468572 45983675 49206573 47403077 232705452 0.94050 0.90210 0.04640 0.05220 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 84305 84305 84305 84305 84305 84305 84305 84305 1.00000 0 1 1 6377100 6377100 141998370 42353269 99645101 13069265 7152010 5917255 5601557 1638473 3963084 115902540 DEPOSITS 699700 699700 49944830 49308313 636517 -2275069 -2275069 -1638552 47511659 -2275069 -2275069 49786728 158102 158102 49944830 49150211 0 49150211 158102 158102 49308313 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: ENDOWMENT FUNDS LISTED ON SCHEDULE D PART V LINE 1 WERE ESTABLISHED FOR THE BENEFIT OF THE NAPA AND SRC FACILITIES. ENDOWMENT FUNDS ARE ALSO HELD FOR THE BENEFIT OF THE FILING ORGANIZATION BY THE GRAND LODGE OF CALIFORNIA IOOF FOR THE PURPOSE OF FUNDING OPERATIONS. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE CORPORATION ADOPTED THE PROVISIONS OF THE ASC TOPIC 740-10, INCOME TAXES, RELATING TO ACCOUNTING FOR UNCERTAIN TAX POSITIONS ON APRIL 1, 2009, WHICH HAD NO FINANCIAL STATEMENT IMPACT TO THE CORPORATION. THE CORPORATION RECOGNIZES THE TAX BENEFIT FROM UNCERTAIN TAX POSITIONS ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITIONS WILL BE SUSTAINED ON EXAMINATION BY THE TAX AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE TAX BENEFIT IS MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50% LIKELIHOOD OF BEING REALIZED UPON ULTIMATE SETTLEMENT. THE CORPORATION RECOGNIZES INTEREST AND PENALTIES RELATED TO INCOME TAX MATTERS IN OPERATING EXPENSES. 0 0 0 0 0 0 0 0 0 KATHERINE LEDFORD 153512 0 0 0 0 0 16590 0 6090 0 176192 0 0 0 WAYNE PANCHESSON 166544 0 0 0 0 0 20454 0 16904 0 203902 0 0 0 ABAG FINANCE AUTHORITY FOR NONPROFIT CORPORATION 943130123 00037GAJ0 2003-01-07 80201612 CONSTRUCTION & EXPANSION OF FACILITIES 0 0 0 9780000 81424925 5639740 8453689 1380500 5239266 662368 60049361 2005 0 0 1 1 0 1 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 1 0 PART II, LINE 3 DIFFERENCE BETWEEN PART I(E) AND PART II QUESTION 3 IS DUE TO INTEREST EARNED ON INVESTED PROCEEDS. X GRAND PIANO 1 38000 APPRAISAL 0 0 1 0 FORM 990, PART VI, SECTION A, LINE 3 RETIREMENT SERVICES, LLC IS THE MANAGEMENT COMPANY. FORM 990, PART VI, SECTION A, LINE 7A SIX DIRECTORS ARE ELECTED BY THE GRAND LODGE OF CALIFORNIA, ODDFELLOWS AND FIVE DIRECTORS ARE ELECTED BY THE REBEKAH ASSEMBLY OF CALIFORNIA. FORM 990, PART VI, SECTION B, LINE 11 FORM 990 IS REVIEWED BY THE MANAGEMENT COMPANY'S CORPORATE CONTROLLER, FOLLOWED BY A REVIEW OF THE BOARD OF DIRECTORS PRIOR TO BEING FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ODD FELLOWS BOARD ISSUES THE CONFLICT OF INTEREST POLICY TO ALL BOARD MEMBERS AND KEY EMPLOYEES ON AN ANNUAL BASIS. THE CONFLICT OF INTEREST POLICY COVERS ALL BOARD MEMBERS AND KEY EMPLOYEES. IF THERE IS A QUESTION WHETHER A CONFLICT OF INTEREST EXISTS, THE MEMBER WITH THE CONFLICT WOULD PRESENT THE RELEVANT FACTS TO THE BOARD. THE MEMBER WOULD THEN BE EXCUSED FROM THE MEETING AND THE REMAINING BOARD MEMBERS WOULD HAVE DISCUSSION AND DETERMINE WHAT DUE DILIGENCE SHOULD BE PERFORMED PRIOR TO APPROVAL OF THE TRANSACTION. FORM 990, PART VI, SECTION B, LINE 15 THE PROCESS USED TO DETERMINE THE SALARY OF THE EXECUTIVE DIRECTOR INCLUDES A SALARY SURVEY WHICH IS CONDUCTED ON AT LEAST A BI-ANNUAL BASIS BY THE VP OF HUMAN RESOURCES FOR PRS. THE VP OF HUMAN RESOURCES, THE CEO AND THE COO REVIEW THE SALARY SURVEY RESULTS AND SUBMIT A RECOMMENDATION TO THE BOARD OF DIRECTORS REGARDING THE SALARY AND BONUS STRUCTURE. THE BOARD OF DIRECTORS WILL THEN MAKE A FINAL DETERMINATION OF THE APPROVED SALARY STRUCTURE. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. REQUESTS FOR GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY SHOULD BE MADE THROUGH A MEMBER OF THE FACILITY STAFF, SUCH AS THE BUSINESS OFFICE MANAGER OR ADMINISTRATIVE ASSISTANT. REQUESTS FOR THE FINANCIAL STATEMENTS SHOULD BE MADE THROUGH THE BOARD OF DIRECTORS. HOURS PER WEEK DEVOTED TO RELATED ORGANIZATIONS: FORM 990, PART VII, SECTION A, COLUMN B: RAY LINK AND JAY JOHNSON'S TIME IS DIVIDED AS FOLLOWS: ODD FELLOWS HOME OF CALIFORNIA 1 HR GRAND LODGE OF CALIFORNIA, ODD FELLOWS 32 HRS CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -2,275,069. GRAND LODGE OF CALIFORNIA ODD FELLOWS 14414-B OAK STREET SARATOGA CA 95070 940575426 FRATERNAL BENEFICIARY SOCIETY CA 501(C)(8) N/A 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 1 GRAND LODGE OF CALIFORNIA ODDFELLOWS R 438267 CASH GRAND LODGE OF CALIFORNIA ODDFELLOWS L 160928 CASH