2021-11-11T13:43:26-06:00 2020-12-31 450250958 EIDE BAILLY LLP 10681 FOOTHILL BLVD STE 300 RANCHO CUCAMONGA CA 917303831 990 2020-01-01 951652915 MONTE VISTA GROVE HOMES MONT 6267966135 2889 SAN PASQUAL STREET PASADENA CA 91107 DEBORAH A HEBERT CHIEF EXECUTIVE OFFICER 6267966135 2021-11-10 1 DEBORAH HEBERT 999009999 CATHERINE L GRAY P01294460 9094664410 2021-11-10 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z DEBORAH A HEBERT 2889 SAN PASQUAL STREET PASADENA CA 91107 15302701 0 X WWW.MVGH.ORG X 1924 CA SENIOR COMMUNITY COMMITTEED TO BEST PRACTICES IN OUR CARE OF PEOPLE, FINANCES, TIME & ENVIRONMENT 20 19 129 30 0 0 1387517 1391247 7301198 7394673 792454 495650 7836 134630 9489005 9416200 0 0 0 0 5969357 6677431 0 7250 149736 3811927 4177115 9781284 10861796 -292279 -1445596 27957570 29443161 5581516 6905738 22376054 22537423 X MONTE VISTA GROVE HOMES (MVGH) IS A HOLISTIC AND VIBRANT SENIOR COMMUNITY FILLED WITH CREATIVITY, LOVE AND COMPASSION. THE HISTORIC MISSION HAS BEEN TO BE A CHRIST-CENTERED COMMUNITY THAT MEETS THE NEEDS OF QUALIFIED RETIRED CHURCH WORKERS OF THE PRESBYTERIAN CHURCH (USA). CONSISTENT WITH CHANGING VOCATIONAL PATTERNS, MVGH NOW WELCOMES RESIDENTS FROM FIVE DENOMINATIONS WITH WHICH THE PREBYTERIAN CHURCH (USA) IS IN FULL COMMUNION. IN ADDITION TO INDEPENDENT LIVING FOR THESE QUALIFIED CHURCH WORKERS, MVGH OFFERS FURTHER LEVELS OF CARE, REGARDLESS OF RELIGIOUS AFFILIATION. MVGH'S ASSISTED LIVING, MEMORY CARE, AND SKILLED NURSING ARE OPEN TO THE WIDER COMMUNITY. 0 0 4997553 4091833 OPERATION OF A 40 BED MEDICARE CERTIFIED SKILLED NURSING FACILITY. 2336675 1627081 PROVIDE NON-LICENSED INDEPENDENT HOUSING IN 76 APARTMENTS ON CAMPUS. 1238080 968839 OPERATION OF 10 ROOM RESIDENTIAL CARE FACILITY FOR MEMORY CARE, PROVIDE DIETARY ASSISTANCE, AND OTHER PROGRAM SERVICES. 1002138 834471 OPERATION OF 16-APARTMENT RESIDENTIAL CARE FACILITY. 1002138 834471 9574446 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 45 0 1 129 1 0 0 0 0 0 0 0 0 0 0 0 0 X 20 19 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 CA X MONTE VISTA GROVE HOMES - KIM HOUSER CFO 6267966135 2889 SAN PASQUAL STREET PASADENA CA 91107 DEBORAH HERBERT CHIEF EXECUTIVE OFFICER 40.00 X 171811 0 18926 KIM HOUSER CHIEF FINANCIAL OFFICER 40.00 X 162390 0 16976 EDEN CONORA DIRECTOR OF NURSING 40.00 X 149533 0 18940 SANDRA MADER PRESIDENT 2.00 X X 0 0 0 JANET LOUIE VICE PRESIDENT 2.00 X X 0 0 0 AL BOEGH TREASURER 2.00 X X 0 0 0 REX MCDANIEL SECRETARY 2.00 X X 0 0 0 MYRON OAKES ASSISTANT TREASURER 2.00 X X 0 0 0 ARNOLFO BONG BRINGAS TRUSTEE 2.00 X 0 0 0 BRUCE CALKINS TRUSTEE 2.00 X 0 0 0 REV DR JOYCE DEFRAAFF TRUSTEE 2.00 X 0 0 0 STEVEN DORSEY TRUSTEE 2.00 X 0 0 0 REV DR MARILYN MANNING TRUSTEE 2.00 X 0 0 0 KEN RILEY TRUSTEE 2.00 X 0 0 0 ALICIA ROMO TRUSTEE 2.00 X 0 0 0 REV DON SMITH TRUSTEE 2.00 X 0 0 0 REV DR NORMAN THOMAS TRUSTEE 2.00 X 0 0 0 KATHLEEN TINGUS TRUSTEE 2.00 X 0 0 0 KAREN WALTER TRUSTEE 2.00 X 0 0 0 JANET WELLS TRUSTEE 2.00 X 0 0 0 REV TOM WENTZ TRUSTEE 2.00 X 0 0 0 FRIED WILSON TRUSTEE 2.00 X 0 0 0 REV DR JOHN TOAY PRESIDENT OF RESIDENT'S AS 2.00 X 0 0 0 483734 0 54842 3 0 1 0 SODEXO INC & AFFILIATES PO BOX 360170 PITTSBURG PA 152516170 FOOD SERVICE OPERATIONS: SERVICES, LABO 712759 MAZUR CONSTRUCTION CO 1608 FAIR PARK AVENUE LOS ANGELES CA 90041 CONSTRUCTION CONTRACTOR 429805 SUSAN J HARRIS INC DBA THERAPY SPECIA 3760 CONVOY ST SUITE 204 SAN DIEGO CA 92111 THERAPY SERVICE PROVIDER (FOR PHYSICAL, 214940 US LAB 3194 A AIRPORT LOOP DRIVE COSTA MESA CA 92626 COVID-19 RT-PCR TESTING 162350 4 131014 367608 892625 11093 1391247 SKILLED NURSING-HEALTH 623000 3342711 3342711 DIETARY REVENUES 623000 1246028 1246028 INDEPENDENT LIVING 623000 1150970 1150970 MEMORY CARE 623000 755697 755697 ASSISTED LIVING 623000 541941 541941 357326 357326 7394673 397791 397791 5974585 5865683 11043 108902 -11043 97859 97859 16854 131014 9775 7079 7079 COVID RELIEF CREDITS 900099 127551 127551 127551 9416200 7522224 0 502729 408808 175154 211760 21894 5051229 4669700 288789 92740 112599 91899 18387 2313 701153 648420 51193 1540 403642 357988 40266 5388 8391 8391 65774 65774 7250 7250 62299 62299 1018268 901640 113289 3339 7522 7522 44415 23222 19931 1262 314072 296639 17365 68 5657 3705 1816 136 16953 4675 11834 444 85929 85929 1118554 1097040 21498 16 188700 153867 34833 SUPPLIES AND EQUIPMENT 415923 387176 28458 289 DIETARY FOOD SUPPLY 403554 399417 3547 590 RESIDENTIAL FINANCIAL A 242101 242101 LICENSE AND PERMITS 95996 73298 13885 8813 83007 48505 30848 3654 10861796 9574446 1137614 149736 580117 759106 71883 92538 191671 132252 1057555 889459 2048000 2048000 57610 57610 205711 248596 32739991 22733493 10497544 10006498 12607882 13648452 503346 1040411 136251 520239 27957570 29443161 783266 796863 1336061 1701577 2567736 3518736 894453 888562 5581516 6905738 X 20301923 20020339 2074131 2517084 22376054 22537423 27957570 29443161 X -1445596 1242467 364498 X 0 1 X 1 0 X X 1 PRESBYTERIAN CHURCH USA 236393377 1 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SCHEDULE A, PAGE 5, SECTION C, LINE 1: MONTE VISTA GROVE HOMES ("MVGH") IS A CONTINUING CARE RETIREMENT COMMUNITY DEDICATED TO MEETING THE NEEDS OF QUALIFIED RETIREES OF THE PRESBYTERIAN CHURCH U.S.A. MVGH IS NOT DIRECTLY CONTROLLED BY THE SAME PERSONS THAT CONTROL OR MANAGE THE PRESBYTERIAN CHURCH U.S.A.; HOWEVER, MVGH'S OFFICERS, DIRECTORS, OR TRUSTEES MAINTAIN A CLOSE AND CONTINUOUS WORKING RELATIONSHIP WITH THE OFFICERS, DIRECTORS OR TRUSTEES OF THE SUPPORTED ORGANIZATION (PRESBYTERIAN CHURCH U.S.A.) BECAUSE A MAJORITY OF THE TRUSTEES ON MVGH'S BOARD OF TRUSTEES ARE AFFILIATED WITH THE PRESBYTERIAN CHURCH U.S.A. ALSO, MVGH MEETS THE "SUPPORT REQUIREMENT" AS MVGH USES ITS INCOME TO CARRY ON INDEPENDENT ACTIVITIES AND PROGRAMS THAT SUPPORT AND BENEFIT MEMBERS OF THE PRESBYTERIAN CHURCH U.S.A. LASTLY, MVGH PERFORMS FUNCTIONS AND ACTIVITIES THAT THE PRESBYTERIAN CHURCH U.S.A. WOULD OTHERWISE PERFORM FOR ITS RETIRED MEMBERS. BASED ON THE ABOVE FACTS AND CIRCUMSTANCES AND THE EXCLUSION RULES STATED IN IRC 509 (A)(3), MVGH MAY BE CLASSIFIED AS A 509(A)(3) TYPE II ORGANIZATION. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3027420 22601 159714 137270 15549 3056916 2813137 11351 353661 135173 15556 3027420 3078718 11812 -133265 -129068 -15060 2813137 2810104 190203 154963 -58120 -18432 3078718 2688196 12341 232159 -101845 -20747 2810104 0.32190 0.67810 0.00000 0 0 97108 97108 28692881 19829773 8863108 3771770 2903720 868050 178232 178232 10006498 LIABILITY FOR REFUNDABLE AND REPAYABLE ENTRANCE FEES 531792 DEPOSITS AND OTHER LIABILITIES 356770 888562 X 10608808 1242467 2665 1245132 9363676 62299 -9775 52524 9416200 10802485 2988 2988 10799497 62299 62299 10861796 PART V, LINE 4: RICHMOND ENDOWMENT - ENDOWMENT FUNDS SUBJECT TO RESTRICTIONS REQUIRING THAT THE PRINCIPAL BE INVESTED IN PERPETUITY. INCOME FROM THE INVESTMENTS CAN BE UTILIZED AT THE DISCRETION OF THE BOARD OF TRUSTEES FOR THE HEALTH CENTER AND THE ORGANIZATION'S OPERATING EXPENSES AND IS RECORDED AS REVENUE WITHOUT DONOR RESTRICTIONS. QUALITY OF LIFE - ENDOWMENT FUNDS SUBJECT TO RESTRICTIONS REQUIRING THAT THE PRINCIPAL BE INVESTED IN PERPETUITY. INCOME IS TO BE USED TO PROVIDE HEALTH CARE SERVICES TO LOW INCOME RESIDENTS AND IS RECORDED AS REVENUE WITH DONOR RESTRICTIONS. RIDINGS FUND - ENDOWMENT FUNDS SUBJECT TO RESTRICTIONS REQUIRING THAT THE PRINCIPAL BE INVESTED IN PERPETUITY. INCOME FROM THE INVESTMENTS CAN BE UTILIZED AT THE DISCRETION OF THE BOARD OF TRUSTEES FOR THE HEALTH CENTER AND THE ORGANIZATION'S OPERATING EXPENSES AND IS RECORDED AS REVENUE WITHOUT DONOR RESTRICTIONS. PART X, LINE 2: MANAGEMENT BELIEVES THAT IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING ITS ANNUAL FILING REQUIREMENTS, AND AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. MVGH AND THE LLC WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSE IF SUCH INTEREST AND PENALTIES ARE INCURRED. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN VALUE - SPLIT INTEREST AGREEMENTS 2,665. PART XI, LINE 4B - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSE INCLUDED WITH THE FUNCTIONAL EXPENSES -9,775. PART XII, LINE 2D - OTHER ADJUSTMENTS: RECOVERY OF DOUBTFUL ACCOUNTS -6,787. SPECIAL EVENT EXPENSE INCLUDED WITH THE FUNCTIONAL EXPENSES 9,775. GALA 147868 131014 16854 9775 147868 131014 16854 9775 9775 7079 X 1 1 X X X 0 0 0 0 0 0 0 0 0 DEBORAH HERBERT CHIEF EXECUTIVE OFFICER 171811 0 0 0 0 0 6184 0 12742 0 190737 0 0 0 KIM HOUSER CHIEF FINANCIAL OFFICER 162390 0 0 0 0 0 5771 0 11205 0 179366 0 0 0 EDEN CONORA DIRECTOR OF NURSING 149533 0 0 0 0 0 5403 0 13537 0 168473 0 0 0 PART I, LINE 1A ALL REIMBURSEMENTS FOR SOCIAL CLUB DUES ARE SUBSTANTIATED AND APPROVED IN ACCORDANCE WITH ORGANIZATION POLICY. FORM 990, PART VI, SECTION A, LINE 1 THE BOARD OF DIRECTORS DELEGATES THE POWER OF AUTHORITY TO THE EXECUTIVE COMMITTEE IN ACCORDANCE WITH THE BYLAWS. THE EXECUTIVE COMMITTEE THEN HAS THE AUTHORITY TO CARRY OUT GOVERNANCE AS OUTLINED IN THE BYLAWS. FORM 990, PART VI, SECTION B, LINE 11B THE MANAGEMENT COMMITTEE OF THE BOARD OF TRUSTEES AUTHORIZES THE CHIEF FINANCIAL OFFICER TO REVIEW THE FORM 990 IN DETAIL PRIOR TO FILING THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C A COMPREHENSIVE POLICY ON CONFLICTS OF INTEREST AND DISCLOSURE OF CERTAIN INTERESTS HAS BEEN ADOPTED AS A BOARD POLICY THAT IS REVIEWED ANNUALLY BY EACH MEMBER. FORM 990, PART VI, SECTION B, LINE 15 THE PERSONNEL COMMITTEE (WHICH IS A SUB-COMMITTEE OF THE MANAGEMENT COMMITEE) COLLABORATES WITH THE EXECUTIVE COMMITEE OF THE BOARD OF DIRECTORS TO OVERSEE THE ANNUAL PERFORMANCE EVALUATION/SALARY REVIEW OF THE CHIEF EXECUTIVE OFFICER. IN ADDITION, THE PERSONNEL COMMITEE PROVIDES COUNSEL AND SUPPORT TO THE CEO IN REGARDS TO MVGH SENIOR STAFF. THE CEO IS TO MAKE PROCEDURAL AND SALARY RECOMMENDATIONS TO THE MANAGEMENT COMMITTEE AS NECESSARY. PER THE MANAGEMENT COMMITTEE POLICIES AND PROCEDURES, THE MANAGEMENT COMMITEE APPROVES THE COMPENSATION PACKAGES FOR THE CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER. FORM 990, PART VI, SECTION C, LINE 19 AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN VALUE - SPLIT INTEREST AGREEMENTS 2,665. RECOVERY OF DOUBTFUL ACCOUNTS 6,787. RESTATEMENT OF BENEFICIAL INTERESTS IN PERPETUAL TRUSTS 355,046. THE GROVE CAMPUS LLC 2889 SAN PASQUAL STREET PASADENA CA 91107 462229596 OPERATION OF UNLICENSED SENIOR HOUSING (INDEPENDENT LIVING) CA 1188182 8196866 MONTE VISTA GROVE HOMES PRESBYTERIAN CHURCH USA 100 WITHERSPOON STREET LOUISVILLE KY 40202 236393377 CHURCH KY 501(C)(3) LINE 1 N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0