2012-05-22T18:45:13-05:00 2011-09-30 MOSS ADAMS LLP 101 SECOND STREET 9TH FLOOR SAN FRANCISCO CA 94105 990 2010-10-01 952047121 CONGREGATIONAL HOMES INC CONG 9096245061 900 E HARRISON AVE POMONA CA 91767 RANDELL K STOLL 9096245061 2012-05-14 1 RENIE BURBANK 4159561500 2010 2016-02-24 21:20:13Z MT SAN ANTONIO GARDENS RANDELL K STOLL 900 E HARRISON AVE POMONA CA 91767 25755724 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. 26 26 329 300 0 0 1436639 1291429 18498509 18805779 821115 814708 1204636 1330647 21960899 22242563 0 0 0 0 10358134 10673616 0 0 0 10510493 10434656 20868627 21108272 1092272 1134291 82098904 86384586 49564685 54498625 32534219 31885961 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 6276138 5434842 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. 4181528 2288644 HEALTH SERVICES - PROVIDED MEDICAL CARE AND OUTPATIENT SERVICES TO OUR AGED POPULATION AND 35 ELDERLY PEOPLE IN THE COMMUNITY. TOTAL PATIENT DAYS THIS YEAR WAS 18,660 AND INCLUDES 2,323 FOR THE COMMUNITY PATIENTS. 17,679 OF THE TOTAL DAYS WERE FOR CUSTODIAL CARE WHICH IS NOT REIMBURSED BY MEDICARE OR HEALTH INSURANCE COMPANIES. WE AVERAGED 51.1 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. 4043130 3501162 DIETARY SERVICES - PROVIDED THREE MEALS PER DAY TO OVER 565 ELDERLY PEOPLE PLUS STAFF, GUESTS, AND OTHERS. OVER 442,513 MEALS AND NUTRITIONAL SUPPLEMENTS WERE SERVED PLUS AN ADDITIONAL 9,632 MEALS WERE PROVIDED TO THE LOCAL MEALS ON WHEELS PROGRAM THAT PROVIDES MEALS TO SHUT-INS IN THE NEIGHBORING COMMUNITY. 3782033 7581131 OTHER PERSONAL CARE FACILITY, HOUSEKEEPING SERVICES, GROUNDS MAINTENANCE, WELLNESS CENTER, PHYSICAL THERAPY, AND SECURITY. 3782033 7581131 18282829 1 1 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 0 0 0 0 0 1 138 0 1 329 1 0 0 0 0 0 0 0 0 0 0 X 26 26 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X LAURIE A LUTHER 9096245061 900 E HARRISON AVE POMONA CA 91767 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 1.00 X 0 0 0 GWEN CARR 2.00 X 0 0 0 RAOUL CERVANTES 1.00 X 0 0 0 DAVID COONS 2.00 X 0 0 0 MARY DYER 2.00 X 0 0 0 MARGARET EVANS 1.00 X 0 0 0 STEPHEN FARROW 2.00 X 0 0 0 AMY FASS 3.00 X X 0 0 0 JAMES GAMB 2.00 X 0 0 0 LEE HARLAN 1.00 X 0 0 0 CARLENE MILLER 1.00 X 0 0 0 HELEN-JEANEE MUNTER 1.00 X 0 0 0 JANE O'DONNELL 1.00 X 0 0 0 CAROLE PELTON 2.00 X X 0 0 0 RANDY PROUT 2.00 X 0 0 0 VIJAY SATHE 2.00 X X 0 0 0 EUGENE STCLAIR 1.00 X 0 0 0 PATRICK SULLIVAN 2.00 X 0 0 0 JESS SWICK 1.00 X 0 0 0 NANCY THUM 1.00 X 0 0 0 ROBERT TRANQUADA 2.00 X 0 0 0 FREDERICK WEIS 1.00 X 0 0 0 NICK WINSLOW 2.00 X X 0 0 0 RANDELL K STOLL 40.00 X 190597 0 30954 DAVID L PEARCE 40.00 X 131486 0 13149 LAURIE LUTHER 40.00 X 142800 0 14280 464883 0 58383 3 0 1 0 YVONNE ZUCHOWSKI 305 N SECOND AVE 135 UPLAND CA 91786 CARPET AND DRAPES 278365 RARE CONSTRUCTION 12223 HIGHLAND AVE 106 RANCHO CUCAMONGA CA 91739 CONSTRUCTION 205515 EWING ARCHITECTS 723 E CALIFORNIA BLVD PASADENA CA 91106 ARCHITECT 195759 MICHAEL J KATT 628 S BON VIEW AVE ONTARIO CA 91761 CONSTRUCTION 109245 ROBERT BARNETT 6198 INDIGO ALTA LOMA CA 91701 PHYSICAL THERAPIST 106990 6 1291429 159029 1291429 CARE AND SERVICE FEES 623000 14115740 14115740 AMORT OF ADVANCE FEES 623000 4410106 4410106 HMO/MEDICARE INSURANCE 623000 279933 279933 18805779 1000563 1000563 2358102 969204 1983345 1529816 374757 -560612 -185855 -185855 NON-MEMBER PATIENTS 623000 970863 970863 OTHER REVENUE 623000 224447 224447 NON-RESIDENT MEALS 623000 135337 135337 1330647 22242563 18805779 0 2145355 576341 576341 7733420 6886764 846656 349913 249083 100830 1401878 1277125 124753 612064 517188 94876 1720 1720 53580 53580 68301 68301 2927161 2790446 136715 78586 78586 412754 256123 156631 54497 4960 49537 2848681 2575508 273173 56558 24946 31612 13986 3666 10320 8748 8748 2657545 2620294 37251 283437 265931 17506 OTHER EXPENSES 277056 214950 62106 PHARMACEUTICALS 245224 245224 OTHER EMPLOYEE EXPENSES 162276 66075 96201 MED SUPPLIES/EQUIPMENT 161935 161935 RESIDENT ACTIVITY PRGMS 122611 122611 21108272 18282829 2825443 0 717745 996384 2832041 2939704 122267 155323 37888 39565 615086 879436 77474508 32148022 46262544 45326486 31511333 35271204 0 776484 82098904 86384586 1369904 1469946 28083603 29374802 18645000 21775000 200774 358040 1265404 1520837 49564685 54498625 X 22489841 21328029 3894445 3865772 6149933 6692160 32534219 31885961 82098904 86384586 X 1134291 -1782549 X X 0 1 1 X 0 X 2914770 1692247 933126 1436639 1291429 8268211 16880280 16994209 18160128 18498509 18805779 89338905 19795050 18686456 19093254 19935148 20097208 97607116 0 0 0 97607116 1280034 1064826 781348 876055 1000563 5002826 1280034 1064826 781348 876055 1000563 5002826 1023956 1132350 1518777 1204636 1330647 6210366 22099040 20883632 21393379 22015839 22428418 108820308 0.89700 0.87620 0.04600 0.06870 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 14019487 51433 309203 610800 13769323 13171001 151000 1308286 610800 14019487 13448347 27219 309835 614400 13171001 0.57000 0.43000 0.00000 0 0 1438330 1438330 63329879 25693548 37636331 4144541 3398830 745711 8561758 3055644 5506114 45326486 REFUNDABLE DEPOSITS 99451 SPLIT-INTEREST AGREEMENTS 1319934 ASSET RETIREMENT OBLIGATION 101452 1520837 22242563 21108272 1134291 -625993 -1156556 -1782549 -648258 19946460 -417892 -537235 -955127 20901587 1340976 1340976 22242563 21108272 0 21108272 0 21108272 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: 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 8 - OTHER ADJUSTMENTS: CHANGE IN FAIR VALUE OF INTEREST RATE CAP -995,016. CHANGES IN ACTUARIAL VALUE OF SPLIT-INTEREST AGREEMENTS -161,540. PART XII, LINE 2D - OTHER ADJUSTMENTS: NET ASSETS RELEASED FROM RESTRICTIONS 457,781. CHANGE IN FAIR VALUE OF INTEREST RATE CAP -995,016. PART XII, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTION REVENUE RECLASSED FROM RESTRICTED NET ASSET ACTIVITY 1,122,400. REALIZED GAIN ON INVESTMENTS RECLASSED FROM RESTRICTED NET ASSET ACTIVITY 67,173. INVESTMENT INCOME RECLASSED FROM RESTRICTED NET ASSET ACTIVITY 151,403. X 1 1 X X X X X 0 0 0 0 0 0 0 0 0 RANDELL K STOLL 190597 0 0 0 0 0 19060 0 11894 0 221551 0 0 0 LAURIE LUTHER 142800 0 0 0 0 0 14280 0 0 0 157080 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. JP MORGAN CHASE BANK 134994650 2010-12-01 21775000 BUILD HOUSING 0 0 0 18645000 21775000 370605 2010 0 0 1 1 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 0 0 0 0 X BUILDING IMPROVEMENTS 20 159029 FAIR MARKET VALUE 0 1 0 FORM 990, PART VI, SECTION B, LINE 11 THE TAX RETURNS ARE FIRST SUBMITTED TO THE AUDIT COMMITTEE (ALL BOARD MEMBERS) IN PAPER FORMAT A WEEK BEFORE THEIR SCHEDULED MEETING (IN THE SPRING, 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 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 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -625,993. CHANGE IN FAIR VALUE OF INTEREST RATE CAP -995,016. CHANGES IN ACTUARIAL VALUE OF SPLIT-INTEREST AGREEMENTS -161,540. TOTAL TO FORM 990, PART XI, LINE 5: -1,782,549. AUDIT COMMITTEE AND OVERSIGHT FORM 990, PART XII, LINE 2C THERE HAVE BEEN NO CHANGES TO THIS PROCESS FROM PRIOR YEAR.