2023-05-11T20:30:18-05:00 2022-06-30 410746749 CLIFTONLARSONALLEN LLP 2210 EAST ROUTE 66 GLENDORA CA 91740 990 2021-07-01 710876594 HOLLENBECK PALMS HOLL 3232636195 573 SOUTH BOYLE AVENUE LOS ANGELES CA 90033 MORRIS SHOCKLEY PRESIDENT/CEO 3232636195 2023-05-04 1 MORRIS SHOCKLEY 999009999 TINA HENTON P00630282 6268577300 2023-05-04 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z MORRIS SHOCKLEY 573 SOUTH BOYLE AVENUE LOS ANGELES CA 90033 31718011 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 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. 8 8 217 8 0 0 3453587 739891 14618615 15467949 4116762 5100383 162702 170888 22351666 21479111 0 0 0 0 10188118 10848751 0 0 204562 9710181 9649788 19898299 20498539 2453367 980572 91601425 86831720 40867722 41854153 50733703 44977567 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 16051825 15521496 HOLLENBECK PALMS PROVIDES CARE FOR THE AGING, INCLUDING RESIDENTIAL, ASSISTED LIVING, AND SKILLED NURSING CARE LIVING ARRANGEMENTS FOR THEIR MEMBERS. DURING THE YEAR, SERVICES WERE PROVIDED TO APPROXIMATELY 200 MEMBERS. 16051825 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 39 0 1 217 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 8 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 0 0 0 CASEY ADAMS BOARD MEMBER 1.00 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 LINDA CHIAVAROLI-ROSENBLOOM BOARD MEMBER 1.00 X 0 0 0 MORRIS SHOCKLEY PRESIDENT & CEO 40.00 X 219194 0 22083 PATRICIA MURPHY VICE-PRESIDENT 40.00 X 78252 0 2603 JOHNNY YOUNG CFO 40.00 X 149196 0 28024 GARY ZUPPARDO CHIEF ENGINEER 40.00 X 185742 0 20344 IVANIA RAMIREZ DIRECTOR OF NURSING 40.00 X 160478 0 2917 ZHANA DUBIN ADMISSIONS DIRECTOR 40.00 X 148393 0 13953 BROOKE YOSHINAGA RN CHARGE NURSE 40.00 X 130301 0 6644 JESSE ALEJANDRINO RN CHARGE NURSE 40.00 X 127578 0 3172 1199134 0 99740 15 0 1 0 TEAM REHAB INC 6531 SILENT HARBOR DR HUNTINGTON BCH CA 92648 PT, OT AND ST STAFFING 438434 BELLE HOME CARE INC 1055 E COLORADO BL STE 500 PASADENA CA 91106 NURSE REGISTRY 148261 CREATIVE LANDSCAPE & MAINTENANCE 23944 NOMAR ST WOODLAND HILLS CA 91367 LANDSCAPING & CAMPUS GARDENS MAINTENANCE 121488 3 71386 668505 24541 739891 SKILLED NURSING/RESIDENTIAL 623000 10682715 10682715 MEDICARE/MEDICAID 623000 4785234 4785234 15467949 925425 925425 37401 37401 79940 0 79940 79940 79940 14413858 10238900 4174958 4174958 4174958 OTHER REVENUE 623000 53547 53547 53547 21479111 15521496 0 5217724 X 814419 651535 122163 40721 7450031 6206524 1128471 115036 57925 50688 7237 1855253 1569195 252790 33268 671123 566851 91633 12639 79176 79176 113129 113129 90184 90184 2658802 1893748 764356 698 128825 128825 81624 81624 896718 875559 20415 744 59450 22513 36922 15 21597 2260 19337 1266370 1266370 1606142 1575389 29671 1082 432607 422399 9849 359 VARIOUS MEDICAL EXPENSE 1315827 1315827 FOOD EXPENSE 899337 899337 20498539 16051825 4242152 204562 1989955 1077917 2815865 2012097 103982 100000 1556804 1569485 97570 126191 284735 328248 66209982 26444884 38501500 39765098 39149031 33183679 7101983 8669005 91601425 86831720 4387883 4702465 3689697 4095083 16179967 23948211 12826945 5236001 3783230 3872393 40867722 41854153 X 46735421 43124512 3998282 1853055 50733703 44977567 91601425 86831720 X 980572 -6371564 -365144 X X 0 1 X 1 0 X 241915 235937 326015 3453587 739891 4997345 13134990 13261109 13803684 14618615 15467949 70286347 13376905 13497046 14129699 18072202 16207840 75283692 51766 70042 25957 952516 109541 1209822 0 51766 70042 25957 952516 109541 1209822 74073870 4436749 3552103 4116072 4247106 5217724 21569754 4436749 3552103 4116072 4247106 5217724 21569754 131420 143015 63593 32361 53547 423936 17945074 17192164 18309364 22351669 21479111 97277382 0.76150 0.78000 0.22170 0.20230 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: ICE CREAM AND GUEST MEALS AND ROOM - 2017 AMOUNT: $ 32,534. 2018 AMOUNT: $ 27,142. 2019 AMOUNT: $ 22,338. 2020 AMOUNT: $ 1,714. BAZAAR - 2017 AMOUNT: $ 9,406. 2018 AMOUNT: $ 10,992. 2019 AMOUNT: $ 6,084. 2020 AMOUNT: $ 4,451. BEAUTY AND BARBER SHOP - 2017 AMOUNT: $ 54,550. 2018 AMOUNT: $ 42,496. 2019 AMOUNT: $ 32,974. 2020 AMOUNT: $ 12,957. MISCELLANEOUS - 2017 AMOUNT: $ 34,930. 2018 AMOUNT: $ 62,385. 2019 AMOUNT: $ 2,197. 2020 AMOUNT: $ 13,239. 2021 AMOUNT: $ 53,547. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3121288 -1013680 600000 1507608 2737479 683809 300000 3121288 2759362 152116 173999 2737479 2604960 154402 2759362 2361530 243430 2604960 0.51290 0.48710 0 0 32412 32412 60076978 22269007 37807971 6037956 4175877 1862079 62636 62636 39765098 CORPORATE BONDS 6828973 F MORTGAGE-BACKED SECURITIES 735055 F MUNICIPAL BONDS 943723 F ANNUITY AND LIFE INSURANCE POLICIES 159423 F OIL INTEREST 1831 F 8669005 ASSIGNED ASSETS, NET 3872393 3872393 X 28125635 6371564 365144 6736708 21388927 90184 90184 21479111 20408355 0 20408355 90184 90184 20498539 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 365,144. X X X 0 0 0 0 0 0 0 0 0 MORRIS SHOCKLEY PRESIDENT & CEO 219194 0 0 0 0 0 21219 0 864 0 241277 0 0 0 GARY ZUPPARDO CHIEF ENGINEER 185742 0 0 0 0 0 2587 0 17757 0 206086 0 0 0 JOHNNY YOUNG CFO 149196 0 0 0 0 0 17442 0 10582 0 177220 0 0 0 IVANIA RAMIREZ DIRECTOR OF NURSING 160478 0 0 0 0 0 2917 0 0 0 163395 0 0 0 ZHANA DUBIN ADMISSIONS DIRECTOR 148393 0 0 0 0 0 2068 0 11885 0 162346 0 0 0 A CALIFORNIA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY 680164610 2016-12-01 20435000 RETIRE SERIES 2007 BONDS 0 0 0 A 4850000 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 1,228,642. MANAGEMENT AND GENERAL EXPENSES 334,456. FUNDRAISING EXPENSES 533. TOTAL EXPENSES 1,563,631. PROGRAM ACTIVITIES: PROGRAM SERVICE EXPENSES 76,481. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 76,481. REPAIRS AND MAINTENANCE: PROGRAM SERVICE EXPENSES 40,126. MANAGEMENT AND GENERAL EXPENSES 1,417. FUNDRAISING EXPENSES 26. TOTAL EXPENSES 41,569. MISCELLANEOUS EXPENSES: PROGRAM SERVICE EXPENSES 548,499. MANAGEMENT AND GENERAL EXPENSES 428,483. FUNDRAISING EXPENSES 139. TOTAL EXPENSES 977,121. FORM 990, PART XI, LINE 9: CHANGE IN PENSION LIABILITY -365,144. FORM 990, PART XII, LINE 2C THE ORGANIZATION DID NOT CHANGE ITS OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE YEAR.