2024-04-03T16:34:34-05:00 2023-06-30 410746749 CLIFTONLARSONALLEN LLP 420 SOUTH ORANGE AVENUE SUITE 900 ORLANDO FL 32801 990 2022-07-01 710876594 HOLLENBECK PALMS HOLL 3232636195 573 SOUTH BOYLE AVENUE LOS ANGELES CA 90033 MORRIS SHOCKLEY PRESIDENT/CEO 3232636195 2024-04-01 1 MORRIS SHOCKLEY 999009999 0 TINA HENTON P00630282 4078021200 2024-04-01 3 AAL1 IAL1 2022 2023-04-26 12:10:37Z MORRIS SHOCKLEY 573 SOUTH BOYLE AVENUE LOS ANGELES CA 90033 33905650 0 X WWW.HOLLENBECKPALMS.COM X 2001 CA THE VERY FIRST NON-PROFIT, LICENSED CONTINUING CARE RETIREMENT COMMUNITY IN CALIFORNIA, HOLLENBECK PALMS PROVIDES FOR AND SERVES ITS ELDERLY RESIDENTS WITH GREAT COMPASSION, HONEST DIGNITY AND GENUINE LOVE THROUGH RESIDENTIAL, ASSISTED MEMORY ENHANCEMENT AND SKILLED NURSING LIVING. WE OFFER A REWARDING AND GRATIFYING LIFESTYLE, FULL OF ACTIVITIES, PROGRAMS AND SERVICES, AND ALL LEVELS OF CARE THEY MAY NEED AT VARIOUS STAGES OF THEIR LIVES. 7 7 235 7 0 0 739891 3869016 15467949 17045960 5100383 3893980 170888 212267 21479111 25021223 0 0 0 0 10848751 12617710 0 0 196980 9649788 11128972 20498539 23746682 980572 1274541 86831720 87844249 41854153 41406803 44977567 46437446 HOLLENBECK PALMS IS COMMITTED TO PROVIDING A RESIDENCE FOR THOSE IN THE LATER YEARS OF THEIR LIVES THAT ENCOMPASSES A HEALTHY ENVIRONMENT OF COMFORT, SAFETY, AND ENJOYMENT; THAT ATTENDS TO THEIR PHYSICAL, MENTAL, AND SPIRITUAL NEEDS. 0 0 18674001 17101469 HOLLENBECK PALMS PROVIDES CARE FOR THE AGING, INCLUDING RESIDENTIAL, ASSISTED LIVING, MEMORY ENHANCEMENT AND SKILLED NURSING CARE LIVING ARRANGEMENTS FOR THEIR MEMBERS. DURING THE YEAR, SERVICES WERE PROVIDED TO APPROXIMATELY 200 MEMBERS. 18674001 1 1 0 0 0 0 0 0 0 1 1 1 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 0 0 0 0 0 0 0 0 0 1 33 0 1 235 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 CA X JOHNNY YOUNG 3232636195 573 SOUTH BOYLE AVENUE LOS ANGELES CA 90033 CAROL JOHNSTON BOARD CHAIR 1.00 X X 0 0 0 CASEY ADAMS SECRETARY 1.00 X X 0 0 0 MICHAEL DAVIS BOARD MEMBER 1.00 X 0 0 0 WILLIAM KUMAGAI BOARD MEMBER 1.00 X 0 0 0 EDWARD GARLOCK BOARD MEMBER 1.00 X 0 0 0 KATHERINE A KIRCHHOFF BOARD MEMBER 1.00 X 0 0 0 ELLEN PIERCE BOARD MEMBER 1.00 X 0 0 0 MORRIS SHOCKLEY PRESIDENT & CEO 40.00 X 220033 0 21280 PATRICIA MURPHY VICE-PRESIDENT 40.00 X 168762 0 44976 JOHNNY YOUNG CFO 40.00 X 152037 0 27348 GARY ZUPPARDO CHIEF ENGINEER 40.00 X 191390 0 20171 IVANIA RAMIREZ DIRECTOR OF NURSING 40.00 X 165489 0 3500 AKHERE OSEZUA ASST. DIRECTOR OF NURSING 40.00 X 158305 0 17921 ZHANA DUBIN ADMISSIONS DIRECTOR 40.00 X 150655 0 12695 MARI ORTEGA-RUEDA RN CHARGE NURSE 40.00 X 143423 0 17835 1350094 0 165726 17 0 1 0 BELLE HOME CARE INC 1055 E VOLORADO BL STE 500 PASADENA CA 91106 NURSE REGISTRY 749617 TEAM REHAB INC 6531 SILENT HARBOR DR HUNTINGTON BCH CA 92648 PT,OT & ST STAFFING 346840 IMPRESSION THE SHADE DESIGN 1900 E OCEAN BLVD LONG BCH CA 90802 RESIDENTS' APTS' DESIGN & INSTALLATION 256925 CREATIVE LANDSCAPE & MAINTENANCE 23944 NOMAR ST WOODLAND HILLS CA 91367 LANDSCAPING & CAMPUS GARDEN MAINTENANCE 126086 4 3438227 430789 24541 3869016 SKILLED NURSING/RESIDENTIAL 623000 11800426 11800426 MEDICARE/MEDICAID 623000 5245534 5245534 17045960 1007599 1007599 74420 74420 82338 0 82338 82338 82338 11770808 8884427 2886381 2886381 2886381 OTHER REVENUE 623000 55509 55509 55509 25021223 17101469 0 4050738 X 726020 580816 108903 36301 8595268 7364473 1119790 111005 88725 79259 9182 284 2448077 2140064 273660 34353 759620 657191 90403 12026 225532 225532 113129 113129 91721 91721 3179431 2097973 1080721 737 245792 245792 67489 67489 992062 968653 22586 823 48913 28807 20086 20 16080 4547 11533 1355923 1355923 1797092 1765922 30074 1096 403110 393598 9177 335 VARIOUS MEDICAL EXPENSE 1667570 1667570 FOOD EXPENSE 925128 925128 23746682 18674001 4875701 196980 1077917 1082601 2012097 1753388 100000 0 1569485 3887911 126191 121913 328248 383779 67038534 27989065 39765098 39049469 33183679 32698314 8669005 8866874 86831720 87844249 4702465 4694466 4095083 4921174 23948211 14520457 5236001 13402046 3872393 3868660 41854153 41406803 X 43124512 44554188 1853055 1883258 44977567 46437446 86831720 87844249 X 1274541 -251829 437167 X X 0 1 X 1 0 X 235937 326015 3453587 739891 3869016 8624446 13261109 13803684 14618615 15467949 17045960 74197317 13497046 14129699 18072202 16207840 20914976 82821763 70042 25957 952516 109541 54541 1212597 0 70042 25957 952516 109541 54541 1212597 81609166 3552103 4116072 4247106 5217724 4050738 21183743 3552103 4116072 4247106 5217724 4050738 21183743 143015 63593 32361 53547 55509 348025 17192164 18309364 22351669 21479111 25021223 104353531 0.78200 0.76150 0.20300 0.22170 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: ICE CREAM AND GUEST MEALS AND ROOM - 2018 AMOUNT: $ 27,142. 2019 AMOUNT: $ 22,338. 2020 AMOUNT: $ 1,714. BAZAAR - 2018 AMOUNT: $ 10,992. 2019 AMOUNT: $ 6,084. 2020 AMOUNT: $ 4,451. BEAUTY AND BARBER SHOP - 2018 AMOUNT: $ 42,496. 2019 AMOUNT: $ 32,974. 2020 AMOUNT: $ 12,957. MISCELLANEOUS - 2018 AMOUNT: $ 62,385. 2019 AMOUNT: $ 2,197. 2020 AMOUNT: $ 13,239. 2021 AMOUNT: $ 53,547. 2022 AMOUNT: $ 55,509. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1507608 165191 1672799 3121288 -1013680 600000 1507608 2737479 683809 300000 3121288 2759362 152116 173999 2737479 2604960 154402 2759362 0.46230 0.53770 0 0 32412 32412 60523020 23641134 36881886 6438723 4347931 2090792 44379 44379 39049469 CORPORATE BONDS 6678773 F MORTGAGE-BACKED SECURITIES 1215848 F MUNICIPAL BONDS 849503 F ANNUITY AND LIFE INSURANCE POLICIES 120919 F OIL INTEREST 1831 F 8866874 ASSIGNED ASSETS, NET 3868660 3868660 X 25114840 -251829 437167 185338 24929502 91721 91721 25021223 23654961 0 23654961 91721 91721 23746682 PART V, LINE 4: THE PALMS' ENDOWMENT CONSISTS OF FUNDS ESTABLISHED TO PROVIDE LIFE CARE MEMBERSHIP FOR SENIORS WHOSE LIMITED RESOURCES PREVENT THEIR ENTRY INTO THE PALMS WITHOUT SUCH ASSISTANCE. PART X, LINE 2: THE PALMS IS A NOT-FOR-PROFIT CORPORATION AND IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(A) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM CALIFORNIA FRANCHISE TAXES SECTION 23701D OF THE CALIFORNIA REVENUE AND TAXATION CODE. THE PALMS IS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS LISTED IN INTERNAL REVENUE SERVICE PUBLICATION 78 AS A CHARITABLE ORGANIZATION QUALIFIED TO RECEIVE DONATIONS. THE PALMS MAINTAINS ITS TAX-EXEMPT STATUS THROUGH DEVOTING ITS RESOURCES TO MEET THE PRIMARY NEEDS OF AGED PERSONS. THESE NEEDS ARE FOR HOUSING, HEALTH CARE, AND FINANCIAL SECURITY. THE PALMS 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 THE PALMS' CONTINUED QUALIFICATION AS A TAX-EXEMPT ORGANIZATION AND WHETHER THERE ARE UNRELATED BUSINESS INCOME ACTIVITIES CONDUCTED THAT WOULD BE TAXABLE. MANAGEMENT HAS DETERMINED THAT ALL INCOME TAX POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED UPON POTENTIAL AUDIT OR EXAMINATION; THEREFORE, NO DISCLOSURES OF UNCERTAIN INCOME TAX POSITIONS ARE REQUIRED. THE PALMS FILES INFORMATIONAL RETURNS IN THE U.S. FEDERAL JURISDICTION AND THE STATE OF CALIFORNIA. THE STATUTE OF LIMITATIONS FOR FEDERAL AND CALIFORNIA STATE PURPOSES IS GENERALLY THREE AND FOUR YEARS, RESPECTIVELY. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN PENSION LIABILITY 437,167. X X X 0 0 0 0 0 0 0 0 0 MORRIS SHOCKLEY PRESIDENT & CEO 220033 0 0 0 0 0 20416 0 864 0 241313 0 0 0 PATRICIA MURPHY VICE-PRESIDENT 168762 0 0 0 0 0 2690 0 42286 0 213738 0 0 0 GARY ZUPPARDO CHIEF ENGINEER 191390 0 0 0 0 0 3260 0 16911 0 211561 0 0 0 JOHNNY YOUNG CFO 152037 0 0 0 0 0 16443 0 10905 0 179385 0 0 0 AKHERE OSEZUA ASST. DIRECTOR OF NURSING 158305 0 0 0 0 0 2680 0 15241 0 176226 0 0 0 IVANIA RAMIREZ DIRECTOR OF NURSING 165489 0 0 0 0 0 3500 0 0 0 168989 0 0 0 ZHANA DUBIN ADMISSIONS DIRECTOR 150655 0 0 0 0 0 2444 0 10251 0 163350 0 0 0 MARI ORTEGA-RUEDA RN CHARGE NURSE 143423 0 0 0 0 0 2594 0 15241 0 161258 0 0 0 A CALIFORNIA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY 680164610 2016-12-01 20435000 RETIRE SERIES 2007 BONDS 0 0 0 A 5710000 20435000 304908 20130092 2017 1 0 1 1 A 0 0 0 0 0 0 1 A 0 1 0 0 0 0 0 0 1 A 1 FORM 990, PART VI, SECTION A, LINE 1A THE GOVERNING BODY HAS DELEGATED TO THE AUDIT COMMITTEE, CONSISTING OF MIKE DAVIS AND EDWARD GARLOCK, THE AUTHORITY TO OVERSEE THE FINANCIAL AND DISCLOSURE PROCESS, MONITOR ACCOUNTING POLICIES, AND THE HIRING AND PERFORMANCE OF THE EXTERNAL AUDITORS. FORM 990, PART VI, SECTION B, LINE 11B THE GOVERNING BODY HAS DELEGATED TO THE AUDIT COMMITTEE THE AUTHORITY TO REVIEW THE FORM 990. A COMPLETE COPY OF THE FORM 990 WAS PROVIDED TO ALL MEMBERS OF THE AUDIT COMMITTEE FOR REVIEW PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C MONITORING IS DONE REGULARLY BY THE OFFICERS TO IDENTIFY POTENTIAL CONFLICTS OF INTEREST AS ISSUES ARISE. IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, ANY INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE TRUSTEES. AFTER DISCLOSURE AND DISCUSSION, THE TRUSTEES WILL DETERMINE IF A CONFLICT OF INTEREST EXISTS, AND IF SO, DETERMINE THE PROPER COURSE OF ACTION. FORM 990, PART VI, SECTION B, LINE 15 BOARD OF TRUSTEES DETERMINES COMPENSATION FOR ALL OFFICERS AND KEY EMPLOYEES, BASED ON COMPARABLE SALARIES IN THE LOCAL AREA. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G PROFESSIONAL AND CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 1,425,295. MANAGEMENT AND GENERAL EXPENSES 546,589. FUNDRAISING EXPENSES 568. TOTAL EXPENSES 1,972,452. PROGRAM ACTIVITIES: PROGRAM SERVICE EXPENSES 80,340. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 80,340. REPAIRS AND MAINTENANCE: PROGRAM SERVICE EXPENSES 60,276. MANAGEMENT AND GENERAL EXPENSES 2,882. FUNDRAISING EXPENSES 44. TOTAL EXPENSES 63,202. MISCELLANEOUS EXPENSES: PROGRAM SERVICE EXPENSES 532,062. MANAGEMENT AND GENERAL EXPENSES 531,250. FUNDRAISING EXPENSES 125. TOTAL EXPENSES 1,063,437. FORM 990, PART XI, LINE 9: CHANGE IN PENSION LIABILITY 437,167. FORM 990, PART XII, LINE 2C THE ORGANIZATION DID NOT CHANGE ITS OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE YEAR.