2022-08-15T10:05:30-05:00 2021-09-30 390758449 WIPFLI LLP 7733 FORSYTH BLVD SUITE 1200 ST LOUIS MO 63105 990 2020-10-01 941636507 ST JOHNS RETIREMENT VILLAGE STJO 5306621290 135 WOODLAND AVENUE WOODLAND CA 95695 MARILYN MITCHELL BOARD PRESIDENT 5306621290 2022-08-11 1 MARILYN MITCHELL 999009999 KARYN A NUNN P00096490 3148622070 2022-08-11 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z BILL SCHARBACH 135 WOODLAND AVENUE WOODLAND CA 95695 5406958 0 X WWW.SJRV.ORG X 1964 CA TO HONOR THE ORGANIZATION'S RESIDENTS' DIGNITY, INDEPENDENCE AND SPIRITUALITY BY PROVIDING THEM WITH A SAFE, SUPPORTIVE AND CARING ENVIRONMENT IN WHICH TO LIVE. THE ORGANIZATION'S MISSION IS TO PROVIDE HOUSING, HEALTH CARE, AND OTHER RELATED SERVICES TO RESIDENTS IN ITS MULTI-LEVEL ASSISTED LIVING FACILITIES. 8 7 220 7 0 0 1680404 34435 9620951 5338287 358 270 6497 33966 11308210 5406958 0 0 0 0 6703619 3752757 0 0 27862 4179760 2991251 10883379 6744008 424831 -1337050 6358631 5423553 3043649 3823023 3314982 1600530 X TO HONOR THE ORGANIZATION'S RESIDENTS' DIGNITY, INDEPENDENCE AND SPIRITUALITY BY PROVIDING THEM WITH A SAFE, SUPPORTIVE AND CARING ENVIRONMENT IN WHICH TO LIVE. THE ORGANIZATION'S MISSION IS TO PROVIDE HOUSING, HEALTH CARE, AND OTHER RELATED SERVICES TO RESIDENTS IN ITS MULTI-LEVEL ASSISTED LIVING FACILITIES. 0 1 5856106 5338287 MULTI-LEVEL ASSISTED LIVING FACILITIES. ASSISTED LIVING FOR ACTIVE RESIDENTS WITH MINIMAL CARE NEEDS IN COTTAGES AND APARTMENTS CALLED THE VILLAGE. ASSISTED LIVING FOR RESIDENTS WITH MODERATE CARE NEEDS IN THE PERSONAL CARE UNIT (PCU). HIGH LEVEL OF CARE FOR RESIDENTS IN NEED OF COGNITIVE AND MEMORY SUPPORT IN THE MANORS. RESPITE CARE IS AVAILABLE FOR A MINIMUM OF TWO WEEKS PRO-RATED AT THE MONTHLY RATE. - APPROXIMATELY 31,000 RESIDENT/PATIENT DAYS 5856106 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 37 0 1 220 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 7 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X THE ORGANIZATION 5306621290 135 WOODLAND AVENUE WOODLAND CA 95695 SEAN BELOUD ED (THRU 11/20), MEMBER (FROM 11/20) 40.00 X X 127493 0 21194 BILL SCHARBACH EXECUTIVE DIRECTOR (FROM 10/2020) 40.00 X 0 0 0 MARILYN MITCHELL PRESIDENT 2.00 X X 0 0 0 SUZANNE ANDERSON VICE PRESIDENT 0.13 X X 0 0 0 JENEE RAWLINGS TREASURER 0.13 X X 0 0 0 ERIC DOWDY SECRETARY 0.13 X X 0 0 0 JANE MARTIN MEMBER 0.13 X 0 0 0 LISA SMITH-YOUNGS MEMBER 0.13 X 0 0 0 UTE TURNER MEMBER 0.13 X 0 0 0 127493 0 21194 1 0 0 0 SYSCO FOOD SERVICES OF SACRAMENTO PO BOX 138007 SACRAMENTO CA 958138007 FOOD & SUPPLIES FOR KITCHEN 319724 AMERICAN MEDICAL RESPONSE WEST PO BOX 841439 DALLAS TX 752841439 AMBULANCE AND COVID RELATED EXPENSES 227265 DYNAMIC MEDICAL MANAGEMENT INC 4605 W IMPERIAL VIEW CT ROCKLIN CA 95677 PHYSICAL THERAPY FOR PATIENTS 167380 ESKATON PROPERTIES INC 5105 MANZANITA AVENUE CARMICHAEL CA 95608 ACCOUNTING & IT SERVICES 148166 4 34435 34435 ASSISTED LIVING REVENU 623000 5309260 5309260 OTHER PROGRAM REVENUE 623000 29027 29027 5338287 270 270 33966 0 33966 33966 33966 5406958 5338287 0 34236 30172 30172 2980075 2628820 336154 15101 394882 344853 48048 1981 347628 303586 42298 1744 231823 173867 57956 29886 29886 50328 50328 492380 401004 91376 12918 12918 84118 70547 5428 8143 118697 94958 23739 463983 417585 46398 15659 15659 99226 89303 9923 443799 399419 44380 238513 214662 23851 FOOD SERVICES 242488 242488 SUPPLIES 211130 206632 4498 REPAIRS & MAINTENANCE 110425 110425 DUES & SUBSCRIPTIONS 74722 74722 71156 67576 2687 893 6744008 5856106 860040 27862 453578 133639 1368806 1298930 344648 80861 78665 110354 13978898 10190664 4101399 3788234 11535 11535 6358631 5423553 458022 480402 53697 20861 2530301 3320671 1629 1089 3043649 3823023 X 3285372 1575432 29610 25098 3314982 1600530 6358631 5423553 X -1337050 -377402 X 0 0 0 X 370099 229314 114127 1680404 34435 2428379 10312136 10473880 10722634 9620951 5338287 46467888 74048 15035 8106 97189 10756283 10718229 10844867 11301355 5372722 48993456 11184 3022 14206 0 11184 3022 14206 48979250 15087 19681 18014 20206 34236 107224 15087 19681 18014 20206 34236 107224 10771370 10737910 10862881 11321561 5406958 49100680 0.99750 0.99810 0.00220 0.00160 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 75430 75430 11558815 8310301 3248514 2344653 1880363 464290 3788234 RESIDENT TRUST 1089 1089 FORM 990, PART III, LINE 3 THE SKILLED NURSING FACILITY PROGRAM WAS CEASED ON 9/30/2020. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION USED A MANAGEMENT COMPANY, PEER SERVICES, INC., TO PERFORM MANAGEMENT AND OTHER DUTIES BEGINNING IN OCTOBER 2020. BILL SCHARBACH, EXECUTIVE DIRECTOR OF THE ORGANIZATION, WAS COMPENSATED BY PEER SERVICES, INC. TOTAL FEES PAID TO THE MANAGEMENT COMPANY FOR SERVICES PROVIDED TO THE ORGANIZATION, INCLUDING THE EXECUTIVE DIRECTOR POSITION, DURING THE REPORTING PERIOD WERE $231,823. FORM 990, PART VI, SECTION B, LINE 11B THE DRAFT OF THE FORM 990 IS DISTRIBUTED TO THE BOARD MEMBERS. THE BOARD DESIGNATES AND ASSIGNS ONE OF ITS QUALIFIED MEMBERS TO REVIEW THE RETURN. UPON RESOLUTION OF QUESTIONS AND ISSUES, AND APPROVAL BY THAT DESIGNATED BOARD MEMBER, THE BOARD APPROVES THE RETURN FOR FILING. FORM 990, PART VI, SECTION B, LINE 12C ONGOING CONSIDERATION OF ANY EXISTING OR POTENTIAL BOARD MEMBERS, EMPLOYEES, VENDORS, VOLUNTEERS AND OTHER BUSINESS CONNECTIONS WITH POSSIBLE CONFLICTS IN MIND BY ALL EXISTING BOARD MEMBERS AND KEY EMPLOYEES. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS CAREFULLY CONSIDERS SELECTION AND SALARY FOR THE CHIEF EXECUTIVE OFFICER/EXECUTIVE DIRECTOR, INCLUDING COMPARING TO CURRENT MARKET QUALIFICATIONS AND COMPENSATION. THE CHIEF EXECUTIVE OFFICER IS NOT COMPENSATED FOR SERVICE ON THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATION MAKES ITS FORM 1023 AND FORM 990 AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, WHISTLEBLOWER POLICY, AND ANNUAL FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: ADJUSTMENT DUE TO DISCONTINUED OPERATIONS AND ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS RECEIVABLES OF THE SKILLED NURSING FACILITY PROGRAM -377,402.