2021-10-18T16:37:37-05:00 2020-12-31 410746749 CLIFTONLARSONALLEN LLP 5001 SPRING VALLEY ROAD SUITE 600W DALLAS TX 75244 990 2020-01-01 751094140 GRACE PRESBYTERIAN MINISTRIES INC GRAC 9722395300 12477 MERIT DRIVE DALLAS TX 75251 STEVE AILEY CHIEF FINANCIAL OFFICER 9722395300 2021-10-18 1 STEVE AILEY 999009999 MICHAEL SIEGEL P01587323 9723835700 2021-10-11 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z TIM MALLAD 12467 MERIT DRIVE DALLAS TX 75251 20367198 0 X WWWW.FAITHPRESHOSPICE.ORG X 1962 TX GRACE PRESBYTERIAN MINISTRIES (GPM), AS A MEMBER OF THE PRESBYTERIAN COMMUNITIES AND SERVICES FAMILY OF NON-PROFIT ORGANIZATIONS, HAS A MISSION TO MAKE EACH MOMENT MATTER FOR THOSE IT SERVES. FAITH PRESBYTERIAN HOPSICE IS PART OF GPM AND PROVIDES HOSPICE AND PALLIATIVE CARE IN AN OUTPATIENT SETTING AND HAS A 36 BED INPATIENT HOSPICE FACILITY. 3 3 207 56 0 0 2480922 2092301 15215579 17630756 12515 -82 186226 561450 17895242 20284425 428658 649276 0 0 10792011 11590273 0 0 0 6963418 7490961 18184087 19730510 -288845 553915 36132160 39579515 1263889 2332969 34868271 37246546 GRACE PRESBYTERIAN MINISTRIES (GPM), AS A MEMBER OF THE PRESBYTERIAN COMMUNITIES AND SERVICES FAMILY OF NON-PROFIT ORGANIZATIONS, PLEDGES TO MAKE EACH MOMENT MATTER FOR THOSE IT SERVES. 0 0 15400256 649276 17630756 PROVIDED HOSPICE SERVICES THROUGH FAITH PRESBYTERIAN HOSPICE IN THE DALLAS-FORT WORTH METROPLEX. 15400256 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 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 1 0 0 0 1 50 0 207 1 0 0 0 0 0 0 0 0 0 0 0 0 X 3 3 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X STEVEN AILEY 2144131561 12467 MERIT DRIVE DALLAS TX 75251 KEVIN JACKSON TRUSTEE AND SECRETARY 1.00 1.00 X 0 0 0 BRAD NITSCHKE TRUSTEE 1.00 1.00 X 0 0 0 LAURA WRIGHT TRUSTEE AND VICE PRESIDENT 1.00 1.00 X 0 0 0 TIM MALLAD CHIEF EXECUTIVE OFFICER/PRESIDENT 10.00 30.00 X 0 426139 51543 STEVEN AILEY CHIEF FINANCIAL OFFICER 10.00 30.00 X 0 261838 43299 JOHN MEZO EXECUTIVE DIRECTOR - FPH 40.00 0.00 X 186389 0 39245 SCOTT POLZIN CORPORATE DIRECTOR OF OPERATIONS 10.00 30.00 X 0 254193 14037 BRYAN COOPER EXECUTIVE DIRECTOR - PVN 0.00 40.00 X 0 206870 38924 CHRISTOPHER SONGER DIRECTOR OF PROJECT DEVELOPMENT 0.00 40.00 X 0 162660 19228 MARK RICHARDSON CORPORATE DIRECTOR OF HEALTHCARE SERVICES 0.00 40.00 X 0 161284 19721 BARBARA MATAMOROS CORPORATE DIRECTOR OF SALES AND MARKETING 0.00 40.00 X 0 158251 19313 186389 1631235 245310 10 0 1 0 HOSPICE SOURCE LLC PO BOX 219168 KANSAS CITY MO 64121 DME SERVICES 477590 CARESTAF OF DALLAS LLC 235 S DENTON TAP ROAD COPPELL TX 75019 HOME HEALTHCARE STAFFING SERVICES 235822 PROTOTYPE IT LLC 400 W MAIN STREET LEWISVILLE TX 75057 IT SUPPORT SERVICES 196763 MICHAEL BOND MD 7100 TWIN KNOLL LANE PLANO TX 75024 MEDICAL SERVICES 138181 ACADIAN AMBULANCE SERVICES PO BOX 92970 LAFAYETTE LA 70509 AMBULANCE SERVICES 108048 5 2092301 2092301 RESIDENT REVENUE 623000 17630756 17630756 17630756 -82 -82 196796 82773 114023 114023 114023 PROVIDER RELIEF FUNDS 900099 345658 345658 INSURANCE PROCEEDS 900099 72413 72413 EMPLOYEE & GUEST MEALS 900099 29356 29356 447427 20284425 17630756 0 561368 649276 649276 186389 186389 9350327 7245089 2105238 169522 128728 40794 1131731 866289 265442 752304 582617 169687 1054734 1054734 2193 2193 10504 10504 1013091 799135 213956 136075 136075 58688 35710 22978 352641 352641 220031 145149 74882 288644 239176 49468 7732 1860 5872 1546303 1001948 544355 166443 166443 MEDICAL / THERAPY EXPEN 1932785 1932785 COVID-19 PREPAREDNESS 242122 242122 SUPPLIES 127686 89586 38100 MAINTENANCE & EQUIPMENT 102454 55201 47253 228835 164408 64427 19730510 15400256 4330254 0 1659360 3708366 518598 1819309 1768369 46398 45539 31405851 6820922 25974759 24584929 6632334 8953714 36132160 39579515 1056649 1596997 518598 207240 217374 1263889 2332969 X 28369428 28897323 6498843 8349223 34868271 37246546 36132160 39579515 X 553915 1824360 X X 0 1 X 1 0 X 17328340 2908940 8168246 2480922 2092301 32978749 29166815 30197597 19999268 15676018 17630756 112670454 46495155 33106537 28167514 18156940 19723057 145649203 0 0 0 145649203 2 242065 160283 113941 516291 2 242065 160283 113941 516291 357710 356296 128342 67939 447427 1357714 46852867 33462833 28537921 18385162 20284425 147523208 0.98730 0.99040 0.00350 0.00240 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2016 AMOUNT: $ 56,575. 2017 AMOUNT: $ 128,030. 2018 AMOUNT: $ 51,510. RESIDENT SERVICES - 2016 AMOUNT: $ 55,238. 2017 AMOUNT: $ 37,838. 2018 AMOUNT: $ 5,299. BEAUTY SHOP - 2016 AMOUNT: $ 69,183. 2017 AMOUNT: $ 74,429. 2018 AMOUNT: $ 20,063. CHARGEABLE SUPPLIES - 2016 AMOUNT: $ 78,491. 2017 AMOUNT: $ 23,009. 2018 AMOUNT: $ 10,084. EMPLOYEE GUEST MEALS - 2016 AMOUNT: $ 35,384. 2017 AMOUNT: $ 41,685. 2018 AMOUNT: $ 34,053. 2019 AMOUNT: $ 67,939. 2020 AMOUNT: $ 29,356. WELLNESS CENTER - 2016 AMOUNT: $ 37,735. 2017 AMOUNT: $ 33,475. 2018 AMOUNT: $ 5,190. VILLAGE STORE INCOME - 2016 AMOUNT: $ 25,104. 2017 AMOUNT: $ 17,830. 2018 AMOUNT: $ 2,143. INSURANCE PROCEEDS - 2020 AMOUNT: $ 72,413. PROVIDER RELIEF FUNDS - 2020 AMOUNT: $ 345,658. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 17580627 2265792 15314835 4480393 829652 3650741 4770624 1738610 3032014 4574207 1986868 2587339 24584929 INTEREST IN NET ASSETS-PC&SF 8349223 CONSTRUCTION IN PROGRESS 32456 INTERCOMPANY 572035 8953714 RELATED PARTY PAYABLE 217374 217374 X 20367198 0 20367198 -82773 -82773 20284425 19813283 0 19813283 -82773 -82773 19730510 PART X, LINE 2: THE ORGANIZATION'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS. THE ORGANIZATION REPORTS ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAXES AND FILES ALL PROPER RETURNS RELATED TO THESE ACTIVITIES. PART XI, LINE 4B - OTHER ADJUSTMENTS: RELATED PARTY RENT EXPENSE -82,773. PART XII, LINE 4B - OTHER ADJUSTMENTS: RELATED PARTY RENT EXPENSE -82,773. 1 SUPPLEMENTAL ASSISTANCE 77 649276 PART I, LINE 2: THE ORGANIZATION PROVIDES ASSISTANCE TO PATIENTS WHO REACH FINANCIAL HARDSHIP AND ARE UNABLE TO PAY A PORTION OF THEIR FEES. AN APPLICATION FOR ASSISTANCE IS COMPLETED AND SUBMITTED TO THE EXECUTIVE DIRECTOR FOR REVIEW AND APPROVAL PRIOR TO PROVIDING ASSISTANCE. THE PATIENT'S FINANCIAL CIRCUMSTANCES ARE REVIEWED TO DETERMINE IF THE PATIENT STILL QUALIFIES FOR ASSISTANCE. X X X X 0 1 0 0 0 0 0 0 0 TIM MALLAD CHIEF EXECUTIVE OFFICER/PRESIDENT 0 351534 0 70529 0 4076 0 15106 0 36437 0 477682 0 0 STEVEN AILEY CHIEF FINANCIAL OFFICER 0 215620 0 42142 0 4076 0 8768 0 34531 0 305137 0 0 JOHN MEZO EXECUTIVE DIRECTOR - FPH 158736 0 24036 0 3617 0 4002 0 35243 0 225634 0 0 0 SCOTT POLZIN CORPORATE DIRECTOR OF OPERATIONS 0 209773 0 40493 0 3927 0 9037 0 5000 0 268230 0 0 BRYAN COOPER EXECUTIVE DIRECTOR - PVN 0 172614 0 30784 0 3472 0 5966 0 32958 0 245794 0 0 CHRISTOPHER SONGER DIRECTOR OF PROJECT DEVELOPMENT 0 158357 0 1000 0 3303 0 5832 0 13396 0 181888 0 0 MARK RICHARDSON CORPORATE DIRECTOR OF HEALTHCARE SER 0 149869 0 7750 0 3665 0 5785 0 13936 0 181005 0 0 BARBARA MATAMOROS CORPORATE DIRECTOR OF SALES AND MARK 0 146775 0 7148 0 4328 0 5666 0 13647 0 177564 0 0 PART I, LINE 4B THE ORGANIZATION PARTICIPATES IN A NONQUALIFIED 457(F) RETIREMENT PLAN. DURING 2020, TIM MALLAD, STEVE AILEY, AND SCOTT POLZIN RECEIVED EMPLOYER CONTRIBUTIONS INTO THEIR 457(F) PLAN ACCOUNTS IN THE AMOUNT OF $17,187, $10,980, AND $9,909, RESPECTIVELY. FORM 990, PART VI, SECTION A, LINE 3 ON 5/1/2008, PRESBYTERIAN COMMUNITIES & SERVICES WAS FORMED TO PROVIDE MANAGEMENT AND SHARED SERVICES TO PRESBYTERIAN COMMUNITIES AND SERVICES FOUNDATION AND OTHER AFFILIATED ORGANIZATIONS. FORM 990, PART VI, SECTION B, LINE 11B THE CFO AND CEO WILL REVIEW. THE DRAFT REPORT WILL BE PROVIDED TO ALL BOARD MEMBERS FOR REVIEW. ONE BOARD MEMBER WITH PARTICULAR KNOWLEDGE IN THIS AREA WILL REVIEW THE FINAL RETURN BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A COMPLIANCE OFFICER (CO) WHO REVIEWS ALL TRANSACTIONS OF THE ORGANIZATION THAT MAY RESULT IN A CONFLICT OF INTEREST. THE CO DETERMINES IF THE TRANSACTION WOULD RESULT IN UNDUE INFLUENCE AS A RESULT OF THE RELATIONSHIP AND NOT BE PURSUED. THE CO REPORTS ALL CONFLICTS OF INTEREST TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD HAS A COMPENSATION COMMITTEE THAT REVIEWS THE CURRENT COMPENSATION WITH AN OUTSIDE CONSULTANT WHICH INCLUDES COMPARISONS TO LIKE ENTITIES AND SALARY SURVEYS. THE COMPENSATION COMMITTEE RECOMMENDS CHANGES TO THE BOARD. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON WRITTEN REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN NET ASSETS OF PC&S FOUNDATION 1,850,380. NET ASSET TRANSFER TO RELATED PARTY -26,020. FORM 990, PART XII, LINE 2C: THE ORGANIZATION DOES HAVE A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT. NEITHER THE OVERSIGHT PROCESS NOR THE SELECTION PROCESS HAS CHANGED DURING THE FILING YEAR. PRESBYTERIAN COMMUNITIES AND SERVICES 12467 MERIT DRIVE DALLAS TX 75251 261459224 SHARED SERVICES/MANAGEMENT TX 501(C)(3) LINE 12B, II N/A 0 PRESBYTERIAN COMMUNITIES AND SERVICES FOUNDATION 12467 MERIT DRIVE DALLAS TX 75251 751910084 FOUNDATION FOR AFFILIATES TX 501(C)(3) LINE 7 PRESBYTERIAN COMMUNITIES & SERVICES 0 FAITH PRESBYTERIAN PROVIDERS INC 12477 MERIT DRIVE DALLAS TX 75251 383800779 PALLATIVE/HOSPICE SERVICES TX 501(C)(3) LINE 10 PRESBYTERIAN COMMUNITIES & SERVICES 0 PRESBYTERIAN VILLAGE NORTH 8600 SKYLINE DRIVE DALLAS TX 75243 510190369 CCRC TX 501(C)(3) LINE 10 PRESBYTERIAN COMMUNITIES & SERVICES 0 FOREFRONT LIVING PLANO 12477 MERIT DRIVE DALLAS TX 75251 851339418 CCRC TX 501(C)(3) LINE 10 PRESBYTERIAN COMMUNITIES & SERVICES 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0