2023-03-23T12:08:07-05:00 2022-06-30 910189318 MOSS ADAMS LLP 101 SECOND STREET SUITE 900 SAN FRANCISCO CA 94105 990 2021-07-01 941156579 MERCY RETIREMENT AND CARE CENTER MERC 5107692700 1301 MARINA VILLAGE PARKWAY 210 ALAMEDA CA 94501 ROBIN EVITTS CFO 5107692700 2023-03-23 1 ROBIN EVITTS 999009999 QI WEN LIANG P01270238 4159561500 2023-03-23 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z ADRIENE IVERSON 1301 MARINA VILLAGE PARKWAY 210 ALAMEDA CA 94501 21929961 0 X WWW.ELDERCAREALLIANCE.ORG X 1872 CA MERCY RETIREMENT AND CARE CENTER SERVES & ENRICHES THE LIVES OF OLDER ADULTS BY PROVIDING HOUSING AND SERVICES IN ITS SKILLED NURSING, ASSISTED LIVING, AND MEMORY CARE NEIGHBORHOODS. 9 9 232 50 0 0 8543656 7361002 14589990 13984050 2340712 247257 61549 60049 25535907 21652358 0 0 0 0 9895935 9558842 0 0 157169 12243064 13604701 22138999 23163543 3396908 -1511185 56197158 60174692 21880941 28284691 34316217 31890001 A NONPROFIT ORGANIZATION COMMITTED TO SERVING AND ENRICHING THE PHYSICAL, EMOTIONAL, AND SPIRITUAL WELL-BEING OF OLDER ADULTS THROUGH A PROFESSIONAL, FAITH-CENTERED CARE COMMUNITY AND SERVICES. 0 0 8535313 7980349 MERCY RETIREMENT AND CARE CENTER IS LICENSED FOR 59 SKILLED NURSING RESIDENTS. THIS YEAR, THE CARE CENTER PROVIDED SKILLED NURSING CARE TO 42.5 OLDER ADULT RESIDENTS EACH MONTH (ON AVERAGE) FOR AN ANNUAL TOTAL OF OVER 15,520 RESIDENTS DAYS. OF OUR RESIDENTS,15.76% WERE PRIVATE PAY, 39.11% HAD MEDI-CAL, 31.29% HAD MEDICARE, AND 13.84% HAD OTHER INSURANCE COVERAGE. 5693780 3784849 MERCY'S ASSISTED LIVING PROVIDES HOUSING AND SERVICES FOR UP TO 85 OLDER ADULT RESIDENTS THAT REQUIRE SOME ASSISTANCE WITH MEDICATION OR DAILY ACTIVITIES. THIS YEAR, WE PROVIDED ASSISTED LIVING HOUSING FOR 46.5 RESIDENTS EACH MONTH (ON AVERAGE), EXCLUDING SECOND PERSONS IN EACH APARTMENT, FOR AN ANNUAL TOTAL OF 1,971 RESIDENT DAYS. MERCY TOOK A FLOOR OFFLINE AND BEGAN ROOM RENOVATIONS JULY 2020, WHICH CONTRIBUTED TO LOWER NUMBER OF AVERAGE RESIDENTS AND RESIDENT DAYS FOR THE YEAR. CONSTRUCTION IS EXPECTED TO CONTINUE THROUGH SEPTEMBER 2022. THE ASSISTED LIVING RESIDENTS ARE OFFERED FIVE LEVELS OF CARE IN ADDITION TO THE BASE LEVEL OF CARE SO THAT THEIR INDIVIDUAL NEEDS CAN BE MET. THERE ARE MANY ACTIVITIES PROVIDED FOR OUR ASSISTED LIVING RESIDENTS, INCLUDING MANY THAT REFLECT OUR FAITH-CENTERED MISSION. 2199918 2218852 MERCY'S MEMORY CARE NEIGHBORHOOD PROVIDES HOUSING AND SERVICES FOR UP TO 22 OLDER ADULT RESIDENTS WHO HAVE DEMENTIA OR MEMORY LOSS. THIS YEAR, WE PROVIDED MEMORY CARE HOUSING FOR 21.4 RESIDENTS EACH MONTH (ON AVERAGE) FOR A TOTAL OF 7,809 RESIDENT DAYS. THE MEMORY CARE NEIGHBORHOOD HAS MANY DAILY ACTIVITIES DESIGNED FOR DEMENTIA OR MEMORY LOSS RESIDENTS. 4494072 4494072 20923083 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 52 0 1 232 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 CA X ROBIN EVITTS 5108582902 1301 MARINA VILLAGE PARKWAY SUITE ALAMEDA CA 94501 CHRISTINE WHELAN CHAIR (THROUGH 11/21) 1.00 5.00 X X 0 0 0 GERALDINE MCGRATH VICE CHAIR 1.00 5.00 X X 0 0 0 JOY MOORE SECRETARY / CHAIR (AS OF 12/21) 1.00 5.00 X X 0 0 0 JACKIE EJUWA SECRETARY (AS OF 12/21) 1.00 5.00 X X 0 0 0 ERICKA RYAN DIRECTOR 1.00 1.00 X 0 0 0 LYNNE KATZMANN DIRECTOR (THROUGH 11/21) 1.00 1.00 X 0 0 0 J THOMAS BRIODY DIRECTOR 1.00 1.00 X 0 0 0 RAJA SEKARAN DIRECTOR (THROUGH 11/21) 1.00 1.00 X 0 0 0 SISTER PHYLLIS HUGHES DIRECTOR 1.00 1.00 X 0 0 0 SISTER PAULINE BORGHELLO DIRECTOR 1.00 1.00 X 0 0 0 STEVEN KIM DIRECTOR 1.00 1.00 X 0 0 0 SUE MALLEY DIRECTOR (AS OF 12/21) 1.00 0.00 X 0 0 0 ADRIENE IVERSON CEO 1.00 44.00 X 0 327249 20518 ROBIN EVITTS CFO 1.00 44.00 X 0 0 0 TAMRA TSANOS EXECUTIVE DIRECTOR 40.00 0.00 X 190809 0 13454 NICOLE FOREMAN HEALTH CARE ADMINISTRATOR 40.00 0.00 X 169131 0 8477 AIDA TSEGAY REGISTERED NURSE 40.00 0.00 X 144182 0 6551 MALINDA FAY DIRECTOR OF NURSING 40.00 0.00 X 125041 0 7514 NATALIE BROWN DIRECTOR OF FUND DEVELOPME 40.00 0.00 X 105893 0 8477 735056 327249 64991 10 0 1 0 SELECT REHABILITATION LLC PO BOX 71985 CHICAGO IL 606941985 OCCUPATIONAL/PHYSICAL THERAPY 777729 STAHL COMPANIES INC 2998 DOUGLAS BLVD SUITE 325 ROSEVILLE CA 95661 CONSTRUCTION 434240 WARNER DESIGN ASSOCIATES 1510 FASHION ISLAND BLCD 240 SAN MATEO CA 94404 CONSTRUCTION 408731 DOUGLAS PANCAKE ARCHITECTS INC 19000 MACARTHUR BLVD SUITE 500 IRVINE CA 92612 ARCHITECT - CONSTRUCTION 179357 MISSION LINEN SERVICE 6590 CENTRAL AVE NEWARK CA 94560 LAUNDRY SERVICES 118530 5 2218067 5142935 3686564 7361002 HEALTH SERVICES REVENU 623000 9616139 9616139 RESIDENT SERVICES 623000 4367911 4367911 13984050 440702 440702 60049 0 60049 60049 60049 84158 74188 203415 9970 -203415 -193445 -193445 21652358 13984050 0 307306 8131056 8028531 102525 115369 115369 702816 695887 6929 609601 601751 7850 1242960 21329 1221631 160828 160828 86596 2536 84060 123776 123776 540080 518030 22050 152276 141523 10753 395181 390201 3260 1720 451957 451357 600 1177029 1177029 22231 22231 112736 112736 1734498 1734498 228651 228651 FOOD 4582241 4582241 MEDICAL SUPPLIES/DRUGS 1347229 1347229 ECA EXPENSE ALLOCATION 749300 372300 377000 SUPPLIES 166972 166972 330160 325418 4742 23163543 20923083 2083291 157169 5914769 1635540 1517019 559262 1610153 1983106 31318 157978 46884140 6680699 32045023 40203441 15019266 14061552 59610 1573813 56197158 60174692 3275602 3542527 14498952 0 1835070 22438612 2271317 2303552 21880941 28284691 X 25018488 26417507 9297729 5472494 34316217 31890001 56197158 60174692 -1511185 -915031 0 X 0 1 X 1 1 1 X 2045908 1593395 5415953 8543656 7361002 24959914 16364442 16081297 15917233 14589990 13984050 76937012 18410350 17674692 21333186 23133646 21345052 101896926 5000 8432 13432 0 5000 8432 13432 101883494 365155 425242 390693 1019282 500751 2701123 365155 425242 390693 1019282 500751 2701123 18775505 18099934 21723879 24152928 21845803 104598049 0.97400 0.97210 0.02580 0.02780 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3891430 94228 -638594 94517 3252547 3032483 205447 790464 136964 3891430 3481363 152483 116759 718122 3032483 3915778 112394 344264 891073 3481363 4367286 229109 54000 734617 3915778 0.00000 0.90000 0.10000 0 1 1 201489 201489 39293203 4367677 34925526 2416835 1588092 828743 4972613 724930 4247683 40203441 DUE TO RELATED ORGANIZATION 2303552 2303552 20816966 -915031 203415 -711616 21528582 123776 123776 21652358 23243182 203415 203415 23039767 123776 123776 23163543 PART V, LINE 4: THERE ARE SIX ENDOWMENT FUNDS, ALL OF WHICH REQUIRE THE INCOME FROM THE FUNDS TO BE USED FOR CHARITY CARE OF RESIDENTS. PART XI, LINE 2D - OTHER ADJUSTMENTS: LOSS ON ASSET DISPOSAL 203,415. PART XII, LINE 2D - OTHER ADJUSTMENTS: LOSS ON ASSET DISPOSAL 203,415. 0 0 0 0 0 0 0 0 0 ADRIENE IVERSON CEO 0 325232 0 750 0 1267 0 11820 0 8698 0 347767 0 0 TAMRA TSANOS EXECUTIVE DIRECTOR 182019 0 7500 0 1290 0 4977 0 8477 0 204263 0 0 0 NICOLE FOREMAN HEALTH CARE ADMINISTRATOR 165651 0 3245 0 235 0 0 0 8477 0 177608 0 0 0 AIDA TSEGAY REGISTERED NURSE 143409 0 773 0 0 0 0 0 6551 0 150733 0 0 0 PART I, LINE 3 THE MANAGEMENT COMPANY RELATED ORGANIZATION, ELDER CARE ALLIANCE (ECA), USES THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION OF THE TOP MANAGEMENT OFFICIAL: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. X 1 3686564 FMV 0 0 0 0 FORM 990, PART VI, SECTION A, LINE 3 MERCY HAS A MANAGEMENT CONTRACT WITH ELDER CARE ALLIANCE, A NON-PROFIT PUBLIC BENEFIT CORPORATION THAT IS THE SOLE CORPORATE MEMBER OF MERCY, TO PROVIDE MANAGEMENT SERVICES INCLUDING, BUT NOT LIMITED TO, MARKETING, HUMAN RESOURCES, ACCOUNTING, INFORMATION TECHNOLOGY SERVICES, RISK MANAGEMENT, CLINICAL OVERSIGHT AND INSURANCE. ELDER CARE ALLIANCE HIRED ROBIN EVITTS AS CFO THROUGH REACH PARTNERS LLC, A MANAGEMENT CONSULTING FIRM. AS ELDER CARE ALLIANCE'S CFO, ROBIN REPORTS TO THE CEO AND BOARD OF DIRECTORS AND HER RESPONSIBILITIES INCLUDE: OVERSEEING ALL FINANCIAL AND ACCOUNTING FUNCTIONS INCLUDING FINANCIAL CLOSE, FINANCIAL PLANNING & ANALYSIS, CASH MANAGEMENT, FINANCING, TAX AND REGULATORY FINANCIAL COMPLIANCE, PAYROLL AND ACCOUNTS PAYABLE; LEADING THE INFORMATION TECHNOLOGY FUNCTION, RESPONSIBLE FOR STRATEGY AND DELIVERY, INCLUDING INFRASTRUCTURE AND APPLICATION SUPPORT OPERATIONS; MANAGING INSURANCE STRATEGY AND BROKER PARTNERS. THE PROFESSIONAL SERVICES EXPENSE TO REACH PARTNERS IS PAID BY ELDER CARE ALLIANCE DIRECTLY. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION'S SOLE CORPORATE MEMBER IS ELDER CARE ALLIANCE. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS OF THE CORPORATION SHALL INCLUDE NO GREATER THAN TWELVE (12) INDIVIDUALS APPOINTED IN ACCORDANCE WITH THE FOLLOWING: (I) FIVE (5) INDIVIDUALS APPOINTED BY THE FACILITY AND PROGRAM SPONSOR, THE SISTERS OF MERCY OF THE AMERICAS, A RELIGIOUS INSTITUTE AND PUBLIC JURIDIC PERSON; (II) FIVE (5) INDIVIDUALS APPOINTED BY THE CO-SPONSOR OF THE CORPORATE MEMBER, THE SIERRA PACIFIC SYNOD OF THE EVANGELICAL LUTHERAN CHURCH IN AMERICA. (III) A MAXIMUM OF TWO (2) INDIVIDUALS JOINTLY APPOINTED BY THE FACILITY AND PROGRAM SPONSOR AND BY THE CO-SPONSOR OF THE CORPORATE MEMBER. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING ACTIONS OF MERCY RETIREMENT AND CARE CENTER (THE CORPORATION) SHALL NOT BE IMPLEMENTED WITHOUT THE APPROVAL OF THE CORPORATE MEMBER: (A) ADOPTION OR AMENDMENT OF PHILOSOPHY AND MISSION OF THE CORPORATION; (B) APPROVAL OF STRATEGIC AND LONG RANGE PLANS OF THE CORPORATION; (C) REORGANIZATION, MERGER, CONSOLIDATION OR CHANGE OF CONTROL OF THE CORPORATION; (D) ANY CHANGE IN THE ARTICLES OF INCORPORATION OR BYLAWS OF THE CORPORATION; (E) ADOPTION OF AND ANY CHANGE IN THE MISSION STATEMENT OR VALUES STATEMENT OF THE CORPORATION; (F) ADOPTION OF AND ANY CHANGE IN CHARITABLE CARE POLICIES OF THE CORPORATION; (G) SALE OR DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION; (H) DISSOLUTION OF THE CORPORATION; (I) ADOPTION OR APPROVAL OF OPERATING AND CAPITAL BUDGETS OF THE CORPORATION, AND ANY CAPITAL EXPENDITURES OR BORROWINGS IN EXCESS OF LIMITS ESTABLISHED BY ELDER CARE ALLIANCE POLICY; (J) CREATION OF A NEW CORPORATION, OR PARTICIPATION IN JOINT VENTURE REQUIRING CAPITAL COMMITMENTS IN EXCESS OF LIMITS ESTABLISHED BY ELDER CARE ALLIANCE POLICY; OR (K) ANY UNBUDGETED ACQUISITION OF ASSETS WITH A PURCHASE PRICE IN EXCESS OF LIMITS ESTABLISHED BY ELDER CARE ALLIANCE POLICY. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. BEFORE FILING, THE FORM 990 DRAFT RETURNS ARE REVIEWED BY THE CEO AND CFO, FOLLOWED BY THE AUDIT COMMITTEE OF THE BOARD. UPON THE AUDIT COMMITTEE'S RECOMMENDATION, THE FULL BOARD REVIEWS THE FORM 990'S TO PROVIDE THEIR APPROVAL, UPON WHICH THE TAX RETURNS ARE FILED. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, THE SECRETARY OF ELDER CARE ALLIANCE CAUSES TO BE PREPARED UPDATED CONFLICT OF INTEREST DISCLOSURE FORMS FROM THE BOARD OF DIRECTORS, OFFICERS, KEY EMPLOYEES, AND MEMBERS OF COMMITTEES WITH BOARD-DELEGATED AUTHORITY. THE SECRETARY PREPARES A TABLE SUMMARIZING THE DISCLOSURES MADE AND PRESENTS THE TABLE TO THE BOARD OF DIRECTORS FOR THEIR INFORMATION. IF AN APPARENT CONFLICT OF INTEREST IS IDENTIFIED, THE MATTER IS REFERRED TO A COMMITTEE OF THE BOARD FOR REVIEW AND ACTION. IF DEEMED NECESSARY, THE BOARD OR COMMITTEE MAY TAKE ACTION SUCH AS REQUIRING AN INTERESTED DIRECTOR TO RECUSE HIMSELF FROM A VOTE ON THE MATTER OR TERMINATING A BUSINESS RELATIONSHIP ENTERED INTO IN VIOLATION OF THE POLICY. FORM 990, PART VI, SECTION B, LINE 15 FORM 990, PART VI, SECTION B, LINES 15A AND 15B HAVE BOTH BEEN ANSWERED NO (AS MANDATED BY THE FORM 990 INSTRUCTIONS), AS THE CEO, OFFICERS, AND KEY EMPLOYEES OF THE ORGANIZATION ARE COMPENSATED BY A RELATED ORGANIZATION. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE ON WRITTEN REQUEST TO ELDER CARE ALLIANCE, MERCY'S MANAGEMENT COMPANY, AND WILL BE RESPONDED TO VIA EMAIL, US MAIL, OR BY FAX IF SO REQUESTED. ELDER CARE ALLIANCE 1301 MARINA VILLAGE PKWY SUITE 210 ALAMEDA CA 94501 943260975 MANAGEMENT CA 501(C)(3) LINE 12B, II N/A 0 ELDER CARE ALLIANCE OF CAMARILLO 1301 MARINA VILLAGE PKWY SUITE 210 ALAMEDA CA 94501 943351613 SENIOR LIVING CA 501(C)(3) LINE 10 ECA 0 ELDER CARE ALLIANCE OF SAN FRANCISCO 1301 MARINA VILLAGE PKWY SUITE 210 ALAMEDA CA 94501 943351615 SENIOR LIVING CA 501(C)(3) LINE 10 ECA 0 ELDER CARE ALLIANCE OF SAN RAFAEL 1301 MARINA VILLAGE PKWY SUITE 210 ALAMEDA CA 94501 760730971 SENIOR LIVING CA 501(C)(3) LINE 10 ECA 0 ELDER CARE ALLIANCE OF UNION CITY 1301 MARINA VILLAGE PKWY SUITE 210 ALAMEDA CA 94501 943377985 SENIOR LIVING CA 501(C)(3) LINE 10 ECA 0 ELDER CARE ALLIANCE OF SAN MATEO 1301 MARINA VILLAGE PKWY SUITE 210 ALAMEDA CA 94501 940831870 AGE-RESTRICTED APARTMENTS CA 501(C)(3) LINE 10 ECA 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1 1 1 0 0 0