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POMPERAUG WOODS INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
POMPERAUG WOODS INC (EIN 06-1073286)
Tax period
2010-10-01 to 2011-09-30
Filed
2012-08-07
IRS object ID
201242209349300714
Schema version
2010v3.4
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-08-07T09:47:51-05:00Timestamp
Tax Period End Date2011-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1BLUM SHAPIRO & COMPANY PC CPA'SBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line129 S MAIN STREET PO BOX 272000AddressLine1
CityWEST HARTFORDCity
StateCTState
ZIP Code061272000ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN061073286EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1POMPERAUG WOODS INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlPOMPNameControl
Phone2032626555Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line180 HERITAGE ROADAddressLine1
CitySOUTHBURYCity
StateCTState
ZIP Code06488ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameKEVIN MOSHIERName
TitleEXECUTIVE DIRECTORTitle
Phone2032626555Phone
Date Signed2012-08-02DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameELIZABETH SOLECKIName
Phone8605614000Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonKEVIN MOSHIERNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line180 HERITAGE ROADAddressLine1
CitySOUTHBURYCity
StateCTState
ZIP Code06488ZIPCode
FieldValueIRS element (for citing)
Gross Receipts10202201GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.POMPERAUGWOODS.COMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1988YearFormation
State Legal DomicileCTStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE CONTINUOUS CARE FOR RETIRED PEOPLE.ActivityOrMissionDescription
Nbr Voting Members Governing Body13NbrVotingMembersGoverningBody
Nbr Independent Voting Members13NbrIndependentVotingMembers
Total Nbr Employees185TotalNbrEmployees
Total Nbr Volunteers69TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year6090ContributionsGrantsPriorYear
Contributions Grants Current Year62403ContributionsGrantsCurrentYear
Program Service Revenue Prior Year9541594ProgramServiceRevenuePriorYear
Program Service Revenue CY10081560ProgramServiceRevenueCY
Investment Income Prior Year-21069InvestmentIncomePriorYear
Investment Income Current Year-33695InvestmentIncomeCurrentYear
Other Revenue Prior Year28867OtherRevenuePriorYear
Other Revenue Current Year41233OtherRevenueCurrentYear
Total Revenue Prior Year9555482TotalRevenuePriorYear
Total Revenue Current Year10151501TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year4680095SalariesEtcPriorYear
Salaries Etc Current Year4877870SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year4857488OtherExpensePriorYear
Other Expenses Current Year4796966OtherExpensesCurrentYear
Total Expenses Prior Year9537583TotalExpensesPriorYear
Total Expenses Current Year9674836TotalExpensesCurrentYear
Revenues Less Expenses Prior Year17899RevenuesLessExpensesPriorYear
Revenues Less Expenses CY476665RevenuesLessExpensesCY
Total Assets BOY24857290TotalAssetsBOY
Total Assets EOY24583356TotalAssetsEOY
Total Liabilities BOY28138635TotalLiabilitiesBOY
Total Liabilities EOY27388036TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY-3281345NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY-2804680NetAssetsOrFundBalancesEOY
Mission DescriptionTO PROVIDE CONTINUOUS CARE FOR RETIRED PEOPLE.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense7267017Expense
Revenue10113515Revenue
DescriptionPOMPERAUG WOODS IS A CONTINUING CARE RETIREMENT COMMUNITY CONSISTING OF 141 LIVING UNITS AND 37 NURSING BEDS. SERVICES PROVIDED INCLUDED MEDICAL CARE, FOOD, CLEANING AND LAUNDRY.Description
Total Program Service Expense7267017TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp1OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity0RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109647NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees185NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members13NbrVotingGoverningBodyMembers
Number Independent Voting Members13NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body0Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO0CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1POMPERAUG WOODS INCBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number2032626555TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line180 HERITAGE ROADAddressLine1
CitySOUTHBURYCity
StateCTState
ZIP Code06488ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (18 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployee
EDWARD H WILLIAMS
DIRECTOR1.00X000
DR MARC J TAYLOR
DIRECTOR1.00X000
WILLIAM B NEIL JR
PRESIDENT1.00X000X
ANN M PROPPER
DIRECTOR1.00X000
ALBERT S REDWAY
DIRECTOR1.00X000
LEONARD R VOLPE JR
TREASURER1.00X000X
JANE C CONNERY
DIRECTOR1.00X000
JACK PRIOR
SECRETARY1.00X000X
JANET WALKER
VICE PRESIDENT1.00X000X
MARK LANCOR
DIRECTOR1.00X000
GAIL E SEYMOUR
DIRECTOR1.00X000
JAMES R STRUB
DIRECTOR1.00X000
THOMAS M SUTNIK
DIRECTOR1.00X000
KEVIN MOSHIER
EXECUTIVE DIRECTOR40.00140900021014X
LANA SMOLITSKY
FINANCE DIRECTOR40.007823501239X
SUSAN RONALTER
DIRECTOR OF NURSING40.009128400X
JUDITH WOOD
HR DIRECTOR40.007406100X
CAROL ANN MCCORMICK
DIRECTOR OF MARKETING40.007866100X
FieldValueIRS element (for citing)
Total Reportable Comp From Org219135TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation22253TotalOtherCompensation
Number Individuals GT100 K1NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
LIFE CARE SERVICES LLC
400 LOCUST STREET SUITE 820DES MOINESIA50309MGMT CONSULTANT408642
SUNDANCE REHABILITATION
6549 PAYSPHERE CIRCLECHICAGOIL60674THERAPY SERVICES319364
ZILNER MARKETING
8725 ROSEHILL ROADLENEXAKS66215MARKETING SERVICES272210
HOME HEALTH CARE SERVICES LLC
PO BOX 402294ATLANTAGA30384HOME CARE SERVICE190394
MUELLER HOME IMPROVEMENTS
157 OAK DRIVEWATERTOWNCT06795REMODELING SERVICES139302
FieldValueIRS element (for citing)
Number Of Contractors GT100 K5NumberOfContractorsGT100K
All Other Contributions62403AllOtherContributions
Total Contributions62403TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
RESIDENT SERVICE REVEN62300055408115540811
HEALTH CENTER FEES62300025589732558973
AMORTIZATION OF ENTRAN62300019817761981776
FieldValueIRS element (for citing)
Total Program Service Revenue10081560TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column12066TotalRevenueColumn
Exclusion$12,066ExclusionAmount

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other45761Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other-45761Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-45761TotalRevenueColumn
Exclusion-$45,761ExclusionAmount
FieldValueIRS element (for citing)
Gross Sales Of Inventory36894GrossSalesOfInventory
Cost Of Goods Sold4939CostOfGoodsSold

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column31955TotalRevenueColumn
Related Or Exempt Function Income31955RelatedOrExemptFunctionIncome

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionMISC. REVENUEDescription
Business Code623000BusinessCode
Total Revenue Column9278TotalRevenueColumn
Related Or Exempt Function Income9278RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue9278TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column10151501TotalRevenueColumn
Related Or Exempt Function Income10122793RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion-$33,695ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total249209Total
Program Services81236ProgramServices
Management And General167973ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total3801416Total
Program Services3100985ProgramServices
Management And General700431ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total4732Total
Program Services4732ProgramServices

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total479688Total
Program Services423316ProgramServices
Management And General56372ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total342825Total
Program Services297557ProgramServices
Management And General45268ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total183749Total
Program Services10709ProgramServices
Management And General173040ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total75983Total
Management And General75983ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total34766Total
Management And General34766ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total263583Total
Program Services137280ProgramServices
Management And General126303ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total20630Total
Management And General20630ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total710629Total
Program Services710629ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total41346Total
Program Services38357ProgramServices
Management And General2989ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total289188Total
Program Services289188ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1203415Total
Program Services1203415ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total152365Total
Management And General152365ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
ANCILLARY EXPENSES486692138940347752
FOOD & SUPPLIES432533432533
PROMOTIONAL SALES321857925320932
THERAPY292490292490
MISCELLANEOUS238510104725133785

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total49230Total
Management And General49230ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total9674836Total
Program Services7267017ProgramServices
Management And General2407819ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY75370BOY
EOY20082EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY5091545BOY
EOY4524426EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY787600BOY
EOY1565606EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY37770BOY
EOY42301EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY279192BOY
EOY253451EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis35163629LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec17026644LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY18582726BOY
EOY18136985EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY3087BOY
EOY40505EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY24857290BOY
EOY24583356EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY4485860BOY
EOY4130849EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY18727285BOY
EOY18081333EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY4350000BOY
EOY3750000EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY575490BOY
EOY1425854EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY28138635BOY
EOY27388036EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY-3281345BOY
EOY-2836323EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
EOY31643EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY-3281345BOY
EOY-2804680EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY24857290BOY
EOY24583356EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses476665ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years9519CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years5800CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years11050CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year6090CurrentTaxYearMinus1Year
Current Tax Year62403CurrentTaxYear
Total94862Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years8054686CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years9132713CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years9027490CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year9579384CurrentTaxYearMinus1Year
Current Tax Year10118454CurrentTaxYear
Total45912727Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years8064205CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years9138513CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years9038540CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year9585474CurrentTaxYearMinus1Year
Current Tax Year10180857CurrentTaxYear
Total46007589Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total50946007589PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years101770CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years88153CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years24950CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year13949CurrentTaxYearMinus1Year
Current Tax Year12066CurrentTaxYear
Total240888Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years101770CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years88153CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years24950CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year13949CurrentTaxYearMinus1Year
Current Tax Year12066CurrentTaxYear
Total240888Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus1 Year7417CurrentTaxYearMinus1Year
Current Tax Year9278CurrentTaxYear
Total16695Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years8165975CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years9226666CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years9063490CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year9606840CurrentTaxYearMinus1Year
Current Tax Year10202201CurrentTaxYear
Total46265172Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99440PublicSupportPercentage509
Prior Year Support Percentage0.99080PriorYearSupportPercentage
Investment Income Percentage0.00520InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00900PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis962264OtherCostOrOtherBasis
Book Value962264BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis29534362OtherCostOrOtherBasis
Depreciation13201511Depreciation
Book Value16332851BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis4667003OtherCostOrOtherBasis
Depreciation3825133Depreciation
Book Value841870BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings18136985TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
ENTRANCE FEE DEPOSITS$17,000
OTHER CURRENT LIABILITIES$18,854
UNEARNED ENTRANCE FEES$1,390,000
FieldValueIRS element (for citing)
Total Of Amounts1425854TotalOfAmounts
Total Revenue10151501TotalRevenue
Total Expenses9674836TotalExpenses
Excess Or Deficit For Year476665ExcessOrDeficitForYear
Total Adjustments0TotalAdjustments
Excess Or Deficit Per FS476665ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt10151501TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal10151501RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form99010151501TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt9674836TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal9674836ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form9909674836TotalExpensesPerForm990

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII

FieldValueIRS element (for citing)
Name PersonKEVIN MOSHIERNamePerson
Base Compensation Filing Org140900BaseCompensationFilingOrg
Comp Based On Related Orgs0CompBasedOnRelatedOrgs
Bonus Filing Org0BonusFilingOrg
Bonus Related Orgs0BonusRelatedOrgs
Other Compensation Filing Org0OtherCompensationFilingOrg
Other Compensation Related Orgs0OtherCompensationRelatedOrgs
Deferred Comp Filing Org5794DeferredCompFilingOrg
Deferred Comp Related Orgs0DeferredCompRelatedOrgs
Nontaxable Benefits Filing Org15220NontaxableBenefitsFilingOrg
Nontaxable Benefits Related Orgs0NontaxableBenefitsRelatedOrgs
Total Compensation Filing Org161914TotalCompensationFilingOrg
Total Compensation Related Orgs0TotalCompensationRelatedOrgs
Comp Report Prior990 Filing Org0CompReportPrior990FilingOrg
Comp Report Prior990 Related Orgs0CompReportPrior990RelatedOrgs

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1LIFE CARE SERVICES LLC (LCS)BusinessNameLine1
FieldValueIRS element (for citing)
RelationshipKEVIN MOSHIER IS AN OFFICER OF THE ORGANIZATION AND A KEY EMPLOYEE OF LCSRelationship
Amount Of Transaction408642AmountOfTransaction
Description Of TransactionMANAGEMENT SERVICES PROVIDED BY LCSDescriptionOfTransaction
Sharing Of Revenues1SharingOfRevenues

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION A, LINE 3THE ORGANIZATION UTILIZED LIFE CARE SERVICES, LLC TO SUPERVISE OPERATIONS OF THE FACILITY. THE EXECUTIVE DIRECTOR OF POMPERAUG WOODS IS AN EMPLOYEE OF LIFE CARE SERVICES, LLC.
FORM 990, PART VI, SECTION B, LINE 11THE FORM 990 WAS REVIEWED BY WILLIAM NEIL, PRESIDENT OF THE BOARD, AND JANET WALKER, VICE PRESIDENT OF THE BOARD, BEFORE FILING.
THE ORGANIZATION PROVIDES ANNUAL EDUCATION REGARDING THE POLICY.FORM 990, PART VI, SECTION B, LINE 12C
PART VI, SECTION B, LINE 15: THE EXECUTIVE DIRECTOR IS AN EMPLOYEE OF LIFE CARE SERVICES, LLC, WHICH PROVIDES MANAGEMENT SERVICES TO POMPERAUG WOODS. THE COMPENSATION OF THE FINANCE DIRECTOR IS DETERMINED BY THE EXECUTIVE DIRECTOR USING COMPARABLE DATA, AND IS APPROVED BY THE PRESIDENT OF THE BOARD.
DOCUMENTS ARE MADE AVAILABLE UPON REQUEST.FORM 990, PART VI, SECTION C, LINE 19