2025-05-13T17:45:35-05:00 2024-06-30 410746749 CLIFTONLARSONALLEN LLP 420 SOUTH ORANGE AVENUE SUITE 900 ORLANDO FL 32801 990 2023-07-01 710876594 HOLLENBECK PALMS HOLL 3232636195 573 SOUTH BOYLE AVENUE LOS ANGELES CA 90033 JOHNNY YOUNG CFO 3232636195 2025-05-13 1 1 TINA HENTON P00630282 4078021200 2025-05-13 2023 2025-03-06 01:10:19Z JOHNNY YOUNG 573 SOUTH BOYLE AVENUE LOS ANGELES CA 90033 36743547 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. 9 9 267 9 0 0 3869016 602648 17045960 21272243 3893980 4375610 212267 201231 25021223 26451732 0 0 0 0 12617710 13931971 0 0 181521 11128972 11773148 23746682 25705119 1274541 746613 87844249 86206813 41406803 39214775 46437446 46992038 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 20587834 21272243 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 220 MEMBERS. 20587834 1 1 0 0 0 0 0 0 0 1 1 1 0 0 1 1 1 0 0 0 0 0 0 0 1 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 42 0 1 267 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 CA X X JOHNNY YOUNG 3232636195 573 SOUTH BOYLE AVE LOS ANGELES CA 90033 CAROL JOHNSTON BOARD CHAIR 1.00 X X 0 0 0 EDWARD GARLOCK TRUSTEES 1.00 X 0 0 0 MICHAEL DAVIS TRUSTEES 1.00 X 0 0 0 WILLIAM KUMAGAI TRUSTEES 1.00 X 0 0 0 KATHERINE A KIRCHHOFF TRUSTEES 1.00 X 0 0 0 KEVIN ONISHI TRUSTEES 1.00 X 0 0 0 ELLEN PIERCE TERM END 424 RESIDENT TRUSTEE 1.00 X 0 0 0 LINDA CHIAVAROLI-ROSENBLOOM RESIDENT REPRESENTATIVE 1.00 X 0 0 0 JANE NAKAMURATERM START 424 RESIDENT REPRESENTATIVE 1.00 X 0 0 0 MORRIS SHOCKLEY PRESIDENT & CEO 40.00 X 238721 0 26312 JOHNNY YOUNG CFO/SECRETARY/TREASURER 40.00 X 169453 0 33649 IVANIA RAMIREZ DIRECTOR OF NURSING 40.00 X 183909 0 72267 ZHANA DUBIN DIRECTOR OF ADMISSIONS 40.00 X 186308 0 16323 GARY ZUPPARDO CHIEF ENGINEER 40.00 X 193764 0 23398 AKHERE OSEZUA ASST. DIRECTOR OF NURSING 40.00 X 189131 0 22242 JESSE ALEJANDRINO RN CHARGE NURSE 40.00 X 149527 0 5665 1310813 0 199856 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 167589 435059 602648 SKILLED NURSING/RESIDE 623000 15422375 15422375 MEDICARE/MEDICAID 623000 5849868 5849868 21272243 1283207 1283207 44885 44885 84808 0 84808 84808 84808 13366014 10257755 15856 3108259 -15856 3092403 3092403 9125 167589 18204 -9079 -9079 OTHER REVENUE 623000 80617 80617 80617 26451732 21272243 0 4576841 X 479837 383870 71975 23992 9650365 8324340 1216622 109403 451412 250919 198472 2021 2537303 2215087 290027 32189 813054 709161 93252 10641 247401 247401 113129 113129 94325 94325 3493021 2650328 841829 864 294295 294295 57994 57994 953030 930542 21697 791 49947 19875 30058 14 19444 2644 16800 1303830 1303830 1886028 1852927 31937 1164 532389 519826 12121 442 VARIOUS MEDICAL EXPENSE 1830163 1830163 FOOD EXPENSE 898152 898152 25705119 20587834 4935764 181521 1082601 1608428 1753388 2194708 3887911 2593804 121913 101938 383779 400620 67707791 29783923 39049469 37923868 32698314 30578181 8866874 10805266 87844249 86206813 4694466 3909977 4921174 5098008 14520457 21765702 13402046 4840861 3868660 3600227 41406803 39214775 X 44554188 44827486 1883258 2164552 46437446 46992038 87844249 86206813 X 746613 -844844 652823 X X 0 1 X 1 0 X 326015 3453587 739891 3869016 611773 9000282 13803684 14618615 15467949 17045960 21272243 82208451 14129699 18072202 16207840 20914976 21884016 91208733 25957 952516 109541 54541 37000 1179555 0 25957 952516 109541 54541 37000 1179555 90029178 4116072 4247106 5217724 4050738 4521159 22152799 4116072 4247106 5217724 4050738 4521159 22152799 63593 32361 53547 55509 64761 269771 18309364 22351669 21479111 25021223 26469936 113631303 0.79230 0.78200 0.19500 0.20300 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: ICE CREAM AND GUEST MEALS AND ROOM - 2019 AMOUNT: $ 22,338. 2020 AMOUNT: $ 1,714. BAZAAR - 2019 AMOUNT: $ 6,084. 2020 AMOUNT: $ 4,451. BEAUTY AND BARBER SHOP - 2019 AMOUNT: $ 32,974. 2020 AMOUNT: $ 12,957. MISCELLANEOUS - 2019 AMOUNT: $ 2,197. 2020 AMOUNT: $ 13,239. 2021 AMOUNT: $ 53,547. 2022 AMOUNT: $ 55,509. 2023 AMOUNT: $ 64,761. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1672799 253603 1926402 1507608 165191 1672799 3121288 -1013680 600000 1507608 2737479 683809 300000 3121288 2759362 152116 173999 2737479 0.00000 0.40143 0.59857 0 0 32412 32412 61050022 25146814 35903208 6583616 4637109 1946507 41741 41741 37923868 CORPORATE BONDS 7304896 F MORTGAGE-BACKED SECURITIES 3371961 F ANNUITY AND LIFE INSURANCE POLICIES 126578 F OIL INTEREST 1831 F 10805266 ASSIGNED ASSETS, NET 3600227 3600227 X 26183590 -844844 652823 -192021 26375611 94325 -18204 76121 26451732 25628998 0 25628998 94325 -18204 76121 25705119 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: HOLLENBECK IS A NONPROFIT CORPORATION AND IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(A) OF THE INTERNAL REVENUE CODE (IRC) AND IS EXEMPT FROM CALIFORNIA FRANCHISE TAXES SECTION 23701D OF THE CALIFORNIA REVENUE AND TAXATION CODE. HOLLENBECK IS DESCRIBED IN SECTION 501(C)(3) OF THE IRC AND IS LISTED IN INTERNAL REVENUE SERVICE PUBLICATION 78 AS A CHARITABLE ORGANIZATION QUALIFIED TO RECEIVE DONATIONS. HOLLENBECK 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. HOLLENBECK 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 HOLLENBECKS 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. HOLLENBECK 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 652,823. PART XI, LINE 4B - OTHER ADJUSTMENTS: FUNDRAISING EXPENSE -18,204. PART XII, LINE 4B - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES -18,204. SANTA ANITA RACE 176714 167589 9125 6500 7392 4312 176714 167589 9125 6500 7392 4312 18204 -9079 X X X 0 0 0 0 0 0 0 0 0 MORRIS SHOCKLEY PRESIDENT & CEO 238721 0 0 0 0 0 23870 0 2442 0 265033 0 0 0 IVANIA RAMIREZ DIRECTOR OF NURSING 183909 0 0 0 0 0 5117 0 67150 0 256176 0 0 0 GARY ZUPPARDO CHIEF ENGINEER 193764 0 0 0 0 0 4727 0 18671 0 217162 0 0 0 AKHERE OSEZUA ASST. DIRECTOR OF NURSING 189131 0 0 0 0 0 4508 0 17734 0 211373 0 0 0 JOHNNY YOUNG CFO/SECRETARY/TREASURER 169453 0 0 0 0 0 19652 0 13997 0 203102 0 0 0 ZHANA DUBIN DIRECTOR OF ADMISSIONS 186308 0 0 0 0 0 4318 0 12005 0 202631 0 0 0 JESSE ALEJANDRINO RN CHARGE NURSE 149527 0 0 0 0 0 5424 0 241 0 155192 0 0 0 A CALIFORNIA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY 680164610 2016-12-01 20435000 RETIRE SERIES 2007 BONDS 0 0 0 B CALIFORNIA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY 680164610 2014-07-01 10000000 CONSTRUCTION OF MEMORY CARE UNIT 0 0 0 A 6605000 20435000 304908 20130092 2017 1 0 1 1 B 1715000 10000000 1048521 200000 8751479 2023 0 0 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 0 0 1 0 0 0 0 1 A 1 B 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: CALIFORNIA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 04/26/2021 ISSUER NAME: CALIFORNIA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 08/23/2020 FORM 990, PART VI, SECTION A, LINE 1A THE GOVERNING BODY HAS DELEGATED TO THE AUDIT COMMITTEE, CONSISTING OF MICHAEL 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 THE ORGANIZATION MAINTAINS A CONFLICT OF INTERESTS POLICY FOR BOARD MEMBERS, OFFICERS, AND EMPLOYEES. IN CONNECTION WITH ANY ACTUAL OR POTENTIAL CONFLICT OF INTERESTS, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE AND NATURE OF ANY OUTSIDE INTEREST, OUTSIDE ACTIVITY, AND FINANCIAL INTEREST TO THE BOARD OF DIRECTORS, OR THE BOARD COMMITTEE DELEGATED THE AUTHORITY TO RECEIVE SUCH DISCLOSURES. 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. THE PROCESS DESCRIBED HERE WAS LAST COMPLETED IN 2024. 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 1,726,078. MANAGEMENT AND GENERAL EXPENSES 354,547. FUNDRAISING EXPENSES 695. TOTAL EXPENSES 2,081,320. OTHER CONTRACTOR FEES FOR SERVICE : PROGRAM SERVICE EXPENSES 796,257. MANAGEMENT AND GENERAL EXPENSES 486,373. FUNDRAISING EXPENSES 136. TOTAL EXPENSES 1,282,766. PROGRAM ACTIVITIES CONTRACTOR : PROGRAM SERVICE EXPENSES 84,660. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 84,660. REPAIRS AND MAINTENANCE CONTRACTOR: PROGRAM SERVICE EXPENSES 43,333. MANAGEMENT AND GENERAL EXPENSES 909. FUNDRAISING EXPENSES 33. TOTAL EXPENSES 44,275. FORM 990, PART XI, LINE 9: CHANGE IN PENSION LIABILITY 652,823. FORM 990, PART XII, LINE 2C THE ORGANIZATION DID NOT CHANGE ITS OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE YEAR.