2021-03-29T10:42:01-05:00 2020-06-30 593070669 MSL PA 500 E BROWARD BLVD SUITE 1550 FORT LAUDERDALE FL 33394 990 2019-07-01 591837338 SUSANNA WESLEY HEALTH CENTER INC SUSA 3055563500 5345 WEST 18TH AVENUE HIALEAH FL 33012 MADELYN SIMON LOZANO EXECUTIVE DIRECTOR 3055563500 2021-03-29 1 COURTNEY HOGBEN P01619105 9548478910 2019 2022-09-23 18:48:47Z MADELYN SIMON LOZANO 5345 WEST 18TH AVENUE HIALEAH FL 33012 1776881 0 X WWW.EPWORTHVILLAGERC.COM X 1978 FL PROVIDE ELDERLY AND HANDICAPPED PERSONS WITH HOUSING AND SERVICES DESIGNED TO MEET THEIR NEEDS. 10 9 0 9 0 0 0 500000 0 1274052 1953 2829 63662 0 65615 1776881 0 0 0 0 0 40000 0 0 0 3093 1162949 3093 1202949 62522 573932 6580955 6770265 11735229 11350607 -5154274 -4580342 THE ORGANIZATION PROVIDES ELDERLY PERSONS AND HANDICAPPED PERSONS WITH HOUSING AND SERVICES ESPECIALLY DESIGNED TO MEET THEIR PHYSICAL, SOCIAL AND PSYCHOLOGICAL NEEDS THROUGH THE LEASE OF A SKILLED NURSING FACILITY TO ITS SUPPORTED 501(C)(3) TAX-EXEMPT AFFILIATE. 0 0 1004773 1274052 THE ORGANIZATION LEASES A FACILITY USED AS A SKILLED CARE NURSING HOME FOR THE HOUSING AND CARE OF THE ELDERLY AND SUPPORTS THE LESSEE IN OPERATING THE FACILITY IN A CHARITABLE MANNER. 1004773 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 8 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 10 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X CHANTAL FALBY 3055563500 5345 WEST 18TH AVENUE HIALEAH FL 33012 X MADELYN SIMON LOZANO EXECUTIVE DIRECTOR 10.00 25.00 X X 0 0 0 BELINDA BACON CHAIR 5.00 10.00 X X 0 0 0 REV RUBEN VELASCO VICE-CHAIR 5.00 10.00 X X 0 0 0 GEORGE PEDLAR SECRETARY/TREASURER 5.00 10.00 X X 0 0 0 GEORGE FERNANDEZ DIRECTOR (END 12/31/2019) 5.00 10.00 X 0 0 0 JAKE ROUDENBUSH DIRECTOR (END 12/31/2019) 5.00 10.00 X 0 0 0 JONAH PRUITT DIRECTOR (END 12/31/2019) 5.00 10.00 X 0 0 0 OPAL WINEBRENNER DIRECTOR 5.00 10.00 X 0 0 0 REV CYNTHIA WEEMS DIRECTOR 5.00 10.00 X 0 0 0 REV DANILO QUEVEDO DIRECTOR 5.00 10.00 X 0 0 0 REV RENE RAMIREZ DIRECTOR (END 12/31/2019) 5.00 10.00 X 0 0 0 JUDITH PIERRE-OKERSON DIRECTOR (BEG. 01/01/2020) 5.00 10.00 X 0 0 0 JESSICA RODRIGUEZ DIRECTOR (BEG. 01/01/2020) 5.00 10.00 X 0 0 0 KENNETH VICTOR DIRECTOR (BEG. 01/01/2020) 5.00 10.00 X 0 0 0 0 0 0 0 0 0 0 TURNER CONSTRUCTION COMPANY 7235 CORPORATE CENTER DRIVE SUITE MIAMI FL 33126 RENOVATION SERVICES 758132 1 500000 500000 RENTAL INCOME FROM AFFILIATE 531110 1274052 1274052 1274052 2829 2829 1776881 1274052 0 2829 40000 40000 40200 40200 2240 2240 420168 420168 383731 367647 16084 316610 216958 99652 1202949 1004773 198176 0 116417 100092 96805 196515 13138728 7822698 4508705 5316030 1859028 1157628 6580955 6770265 57853 46190 11663910 11190386 13466 114031 11735229 11350607 X -5154274 -4580342 -5154274 -4580342 6580955 6770265 573932 0 X X 0 1 X 1 1 1 X X 1 ALDERSGATE HEALTHCARE INC 161676092 10 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 X 1 1 SCHEDULE A, PART I, LINE 12, COLUMN (VI) THE FILING ORGANIZATION SUPPORTS IT SUPPORTED ORGANIZATION THROUGH THE PROVISION AND LEASE TO ITS SUPPORTED ORGANIZATION OF LAND, BUILDINGS, AND PERSONAL PROPERTY THAT CONSTITUTES THE SKILLED NURSING FACILITY OPERATED BY ITS SUPPORTED ORGANIZATION. THE FILING ORGANIZATION AND ITS SUPPORTED ORGANIZATION ARE RELATED TAX-EXEMPT ORGANIZATIONS. SCHEDULE A, PART IV, SECTION A, LINE 1 THE GOVERNING DOCUMENTS OF THE FILING ORGANIZATION STATE THAT SUSANNA WESLEY HEALTH CENTER, INC. IS ORGANIZED TO PROVIDE ELDERLY PERSONS AND HANDICAPPED PERSONS WITH HOUSING AND SERVICES ESPECIALLY DESIGNED TO MEET THEIR PHYSICAL, SOCIAL AND PSYCHOLOGICAL NEEDS. IN ACCORDANCE WITH ITS CHARITABLE PURPOSE, THE FILING ORGANIZATION LEASES REAL AND PERSONAL PROPERTY THAT CONSTITUTES A SKILLED NURSING FACILITY TO ALDERSGATE HEALTHCARE, INC., A RELATED 501(C)(3) ORGANIZATION, THAT OPERATES THE FACILITY. SCHEDULE A, PART IV, SECTION D, LINE 3 THE FILING ORGANIZATION SUPPORTS ALDERSGATE HEALTHCARE, INC. (THE SUPPORTED ORGANIZATION). THE PRIMARY ACTIVITY OF THE FILING ORGANIZATION IS TO OWN REAL AND PERSONAL PROPERTY THAT CONSTITUTES A SKILLED NURSING FACILITY AND LEASE SUCH PROPERTY TO THE SUPPORTED ORGANIZATION THAT OPERATES THE FACILITY. THE SUPPORTED ORGANIZATION HAS A SIGNIFICANT VOICE IN DIRECTING THE USE OF THE FILING ORGANIZATION'S ASSETS THROUGH THE OVERLAP OF THE EXECUTIVE DIRECTOR AND CERTAIN BOARD MEMBERS THAT PARTICIPATE IN THE GOVERNANCE OF BOTH ORGANIZATIONS. AS PRESCRIBED IN THE LEASE AGREEMENT PERTAINING TO THE SKILLED NURSING FACILITY, THE FILING ORGANIZATION IS RESPONSIVE TO THE NEEDS OF ITS SUPPORTED ORGANIZATION THAT OPERATES THE FACILITY. SCHEDULE A, PART IV, SECTION E, LINE 2A THE FILING ORGANIZATION SUPPORTS ALDERSGATE HEALTHCARE, INC. (THE SUPPORTED ORGANIZATION). THE SOLE ACTIVITY OF THE FILING ORGANIZATION IS THE LEASE OF REAL AND PERSONAL PROPERTY CONSTITUTING A SKILLED NURSING FACILITY TO THE SUPPORTED ORGANIZATION THAT OPERATES THE FACILITY. THE ACTIVITY OF HOLDING TITLE TO AND LEASING THE SKILLED NURSING FACILITY TO THE SUPPORTED ORGANIZATION IS A DIRECT FURTHERANCE ACTIVITY AS THE FILING ORGANIZATION'S ASSETS ARE USED IN CARRYING OUT THE EXEMPT PURPOSE OF PROVIDING HOUSING AND SERVICES TO ELDERLY PERSONS AND HANDICAPPED PERSONS. PLEASE SEE OUR RESPONSE FOR SCHEDULE A, PART IV, SECTION D, QUESTION 3 REGARDING HOW THE FILING ORGANIZATION IS RESPONSIVE TO THE NEEDS AND DEMANDS OF THE SUPPORTED ORGANIZATION. SCHEDULE A, PART IV, SECTION E, LINE 2B THE ACTIVITY OF OWNING TITLE TO AND LEASING REAL AND PERSONAL PROPERTY CONSTITUTING A SKILLED NURSING FACILITY TO ITS SUPPORTED ORGANIZATION IS AN ACTIVITY THAT, BUT FOR THE INVOLVEMENT OF THE FILING ORGANIZATION, THE SUPPORTED ORGANIZATION WOULD BE REQUIRED TO ENGAGE IN. WERE IT NOT FOR THE FILING ORGANIZATION, THE SUPPORTED ORGANIZATION WOULD EITHER BE REQUIRED TO PURCHASE THE REAL AND PERSONAL PROPERTY CONSTITUTING A SKILLED NURSING FACILITY OR LEASE SUITABLE PROPERTY IN ORDER TO CONDUCT ITS BUSINESS OF OPERATING A SKILLED NURSING FACILITY AND PROVIDING THESE NECESSARY SERVICES TO THE COMMUNITY. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 261000 261000 10996501 6112584 4883917 1773986 1710114 63872 107241 107241 5316030 CAPITAL RESERVE 1157628 1157628 DUE TO AFFILIATES 114031 114031 X 1776881 0 1776881 0 1776881 1202949 0 1202949 0 1202949 PART X, LINE 2: THE COMPANY IS EXEMPT FROM FEDERAL INCOME TAXES, AS IT IS ORGANIZED UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN INCLUDED IN THE FINANCIAL STATEMENTS. MSL PUBLIC RELATIONS LLC ENTITY MORE THAN 35% OWNED BY MADELYN SIMON LOZANO, EXECUTIVE DIRECTOR 40000 INDEPENDENT CONTRACTOR COMPENSATION 0 FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS REVIEWED AND APPROVED BY THE EXECUTIVE DIRECTOR. A COPY OF THE FORM 990 IS PROVIDED TO EACH VOTING MEMBER OF THE BOARD OF DIRECTORS BEFORE ITS FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION'S BOARD OF DIRECTORS MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY ANNUALLY. THE BOARD REVIEWS ACTUAL CONFLICTS THAT ARE IDENTIFIED BY THE ANNUAL DISCLOSURE PROCESS AND PROHIBITS OFFICERS AND DIRECTORS FROM VOTING ON MATTERS WHERE ACTUAL CONFLICTS OF INTEREST EXIST. FORM 990, PART VI, SECTION B, LINE 15A THE EXECUTIVE DIRECTOR OF THE FILING ORGANIZATION IS COMPENSATED AS AN INDEPENDENT CONTRACTOR AS APPROVED BY THE BOARD OF DIRECTORS. SEE SCHEDULE L, PART IV FOR FURTHER INFORMATION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C THE FINANCIAL COMMITTEE OF THE BOARD OF DIRECTORS IS RESPONSIBLE FOR THE SELECTION, MONITORING AND EVALUATION OF AN INDEPENDENT AUDIT FIRM AND OVERSIGNT OF ITS FINANCIAL STATEMENTS. THERE WAS NO CHANGE IN THIS PROCESS FROM THE PRIOR YEAR. EPWORTH VILLAGE INC 5300 WEST 16TH AVENUE HIALEAH FL 33012 590589990 FUND RAISING FOR RELATED TAX-EXEMPT ORGANIZATIONS FL 501(C)(3) LINE 12B, II N/A 0 EPWORTH VILLAGE WEST INC 5300 WEST 16TH AVENUE HIALEAH FL 33012 591920293 LEASE OF RETIREMENT LIVING FACILITY TO RELATED ORGANIZATION FL 501(C)(3) LINE 12C, III-FI N/A 0 ALDERSGATE HEALTHCARE INC 5300 WEST 16TH AVENUE HIALEAH FL 33012 161676092 OPERATES SKILLED NURSING FACILITY FL 501(C)(3) LINE 10 N/A 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0