2021-05-13T13:08:39-05:00 2020-06-30 410746749 CLIFTONLARSONALLEN LLP 2210 EAST ROUTE 66 GLENDORA CA 91740 990 2019-07-01 710876594 HOLLENBECK PALMS HOLL 3232636195 573 SOUTH BOYLE AVENUE LOS ANGELES CA 90033 MORRIS SHOCKLEY PRESIDENT/CEO 3232636195 2021-04-28 1 TIMOTHY D EVANS P00050546 6268577300 2021-04-28 2019 2022-09-23 18:48:47Z MORRIS SHOCKLEY 573 SOUTH BOYLE AVENUE LOS ANGELES CA 90033 35556669 0 X WWW.HOLLENBECKPALMS.COM X 2001 CA HOLLENBECK PALMS IS A CONTINUING CARE RETIREMENT COMMUNITY OFFERING INDEPENDENT LIVING, ASSISTED LIVING, AND SKILLED NURSING FOR INDIVIDUALS IN THEIR LATER YEARS OF LIFE. 7 7 186 0 0 0 338883 326015 13261109 13803684 3471899 3955946 114600 227809 17186491 18313454 0 0 0 0 9243142 9933493 0 0 154454 8335012 8891130 17578154 18824623 -391663 -511169 85510383 83559690 39670328 41945222 45840055 41614468 X 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; AND THAT IS QUICK TO RESPOND TO AND ASSIST IN THOSE NEEDS WHETHER IMMEDIATE OR LONG TERM, AND TO DO SO WITH GREAT COMPASSION, HONESTY, DIGNITY AND GENUINE LOVE. 0 0 14430082 13864867 HOLLENBECK PALMS PROVIDES CARE FOR THE AGING, INCLUDING RESIDENTIAL AND SKILLED NURSING CARE LIVING ARRANGEMENTS FOR THEIR MEMBERS. DURING THE YEAR, SERVICES WERE PROVIDED TO APPROXIMATELY 200 MEMBERS. 14430082 1 1 0 0 0 0 0 0 0 1 1 1 0 0 1 1 1 0 0 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 0 0 0 0 0 0 1 40 0 1 186 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 CA X JOHNNY YOUNG 3232636195 573 SOUTH BOYLE AVENUE LOS ANGELES CA 90033 CAROL A JOHNSTON BOARD CHAIR 1.00 X 0 0 0 MICHAEL DAVIS BOARD MEMBER 1.00 X 0 0 0 CASEY ADAMS SECRETARY 1.00 X 0 0 0 EDWARD S GARLOCK BOARD MEMBER 1.00 X 0 0 0 WILLIAM KUMAGAI BOARD MEMBER 1.00 X 0 0 0 ROSAMOND FLORES RESIDENT REPRESENTATIVE 1.00 X 0 0 0 KATHERINE A KIRCHHOFF BOARD MEMBER 1.00 X 0 0 0 MORRIS SHOCKLEY PRESIDENT/CEO & VP/TREASUR 40.00 X 183533 0 20952 JOHNNY YOUNG CONTROLLER/ASSISTANT SECRE 40.00 X 131971 0 19711 IVANIA RAMIREZ DIRECTOR OF NURSING 40.00 X 134954 0 3955 PEGGY L HEIDEMAN DIR OF MKT & COMM RELATIONS 40.00 X 118834 0 17876 ZHANA DUBIN ADMISSIONS DIRECTOR 40.00 X 113361 0 13387 MARIA ORTEGA RUEDAA REGISTERED NURSE 40.00 X 112519 0 13608 IRMA CABALLERO STAFF DEVELOPER 40.00 X 109662 0 8001 WILLIAM HEIDEMAN FORMER PRESIDENT/CEO THRU 3/31/19 40.00 X 146812 0 8481 1051646 0 105971 8 1 1 0 PACIFIC NATIONAL GROUP 2392 SOUTH BATEMAN AVENUE IRWINDALE CA 91010 CONSTRUCTION 1560659 SODEXO AMERICA LLC 600 CITY PARKWAY WEST SUITE 610 ORANGE CA 92868 FOOD SERVICES 1345113 DJMB SERVICES 122 E WALNUT AVENUE MONROVIA CA 91016 MEDICAL 792095 TEAM REHAB INC 6531 SILENT HARBOR DR HUNTINGTON BEACH CA 92648 THERAPY 523787 JT GENERAL CONSTRUCTION INC 33336 N AGUA DULCE CANYON 106 SANTA CLARITA CA 91390 CONSTRUCTION 406500 11 326015 15957 326015 SKILLED NURSING/RESIDENTIAL 623000 9501126 9501126 MEDICARE/MEDICAID 623000 4302558 4302558 13803684 1003081 1003081 94995 94995 71631 0 71631 71631 71631 20189580 6500 17243215 0 2946365 6500 2952865 2952865 OTHER REVENUE 623000 61183 61183 61183 18313454 13864867 0 4122572 X 414393 190601 211879 11913 6566912 5485794 986491 94627 187834 178419 6645 2770 2177712 1819431 324752 33529 586642 487852 89710 9080 127483 127483 113129 113129 90300 90300 2515163 1846634 667865 664 262414 262414 54069 54069 732042 714901 16538 603 52932 24290 28626 16 11060 3716 7344 1218508 1218508 1455700 1426625 28052 1023 278080 271569 6282 229 VARIOUS MEDICAL EXPENSE 1126671 1126671 FOOD EXPENSE 853579 853579 18824623 14430082 4240087 154454 4025430 2946910 1080835 4924341 3965 3993 1340150 1374312 138111 105848 235833 295354 59136493 23456859 34652886 35679634 36353484 33931150 7679689 4298148 85510383 83559690 4847655 5565856 3736468 5100343 17724476 16964721 9189999 9104737 1479100 4171730 3730465 39670328 41945222 X 42544403 38876989 3295652 2737479 45840055 41614468 85510383 83559690 X -511169 -3106902 -607516 X X 0 1 X 1 0 X 231151 193524 241915 235937 326015 1228542 15989024 13261109 13803684 13261109 13803684 70118610 16220175 13454633 14045599 13497046 14129699 71347152 20000 40000 51766 70042 25957 207765 0 20000 40000 51766 70042 25957 207765 71139387 2171672 2485757 4436749 3552103 4116072 16762353 2171672 2485757 4436749 3552103 4116072 16762353 130310 137491 131420 143015 63593 605829 18522157 16077881 18613768 17192164 18309364 88715334 0.80190 0.84580 0.18890 0.14600 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: ICE CREAM AND GUEST MEALS AND ROOM - 2015 AMOUNT: $ 33,655. 2016 AMOUNT: $ 32,349. 2017 AMOUNT: $ 32,534. 2018 AMOUNT: $ 27,142. 2019 AMOUNT: $ 22,338. BAZAAR - 2015 AMOUNT: $ 11,705. 2016 AMOUNT: $ 26,020. 2017 AMOUNT: $ 9,406. 2018 AMOUNT: $ 10,992. 2019 AMOUNT: $ 6,084. BEAUTY AND BARBER SHOP - 2015 AMOUNT: $ 57,652. 2016 AMOUNT: $ 47,449. 2017 AMOUNT: $ 54,550. 2018 AMOUNT: $ 42,496. 2019 AMOUNT: $ 32,974. MISCELLANEOUS - 2015 AMOUNT: $ 27,298. 2016 AMOUNT: $ 31,673. 2017 AMOUNT: $ 34,930. 2018 AMOUNT: $ 62,385. 2019 AMOUNT: $ 2,197. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2759362 152116 173999 2737479 2604960 154402 2759362 2361530 243430 2604960 2087491 274039 2361530 2079255 8236 2087491 0 0 32412 32412 53499655 19739564 33760091 5604426 3717295 1887131 35679634 CORPORATE BONDS 2527893 F MORTGAGE-BACKED SECURITIES 756164 F MUNICIPAL BONDS 849420 F ANNUITY AND LIFE INSURANCE POLICIES 162840 F OIL INTEREST 1831 F 4298148 ASSIGNED ASSETS, NET 3730465 3730465 X 14508736 -3106902 -607516 -3714418 18223154 90300 90300 18313454 18734323 0 18734323 90300 90300 18824623 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: THE PALMS IS A NOT-FOR-PROFIT CORPORATION AND IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(A) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM CALIFORNIA FRANCHISE TAXES SECTION 23701D OF THE CALIFORNIA REVENUE AND TAXATION CODE. THE PALMS IS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS LISTED IN INTERNAL REVENUE SERVICE PUBLICATION 78 AS A CHARITABLE ORGANIZATION QUALIFIED TO RECEIVE DONATIONS. THE PALMS 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. THE PALMS 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 THE PALMS' 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. THE PALMS 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 -607,516. X X X 0 0 0 0 0 0 0 0 0 MORRIS SHOCKLEY PRESIDENT/CEO & VP/TREASUR 183533 0 0 0 0 0 15095 0 5857 0 204485 0 0 0 JOHNNY YOUNG CONTROLLER/ASSISTANT SECRE 131971 0 0 0 0 0 10289 0 9422 0 151682 0 0 0 WILLIAM HEIDEMAN FORMER PRESIDENT/CEO THRU 3/31/19 146812 0 0 0 0 0 1087 0 7394 0 155293 0 0 0 A CALIFORNIA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY 680164610 2016-12-01 20435000 RETIRE SERIES 2007 BONDS 0 0 0 A 3220000 20435000 304908 20130092 2017 1 0 1 1 A 0 0 0 0 0 0 1 A 0 1 0 0 0 0 0 0 1 A 1 FORM 990, PART VI, SECTION A, LINE 1 THE GOVERNING BODY HAS DELEGATED TO THE AUDIT COMMITTEE, CONSISTING OF MIKE 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 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. 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 1,153,725. MANAGEMENT AND GENERAL EXPENSES 313,632. FUNDRAISING EXPENSES 477. TOTAL EXPENSES 1,467,834. PROGRAM ACTIVITIES: PROGRAM SERVICE EXPENSES 57,723. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 57,723. REPAIRS AND MAINTENANCE: PROGRAM SERVICE EXPENSES 69,332. MANAGEMENT AND GENERAL EXPENSES 1,590. FUNDRAISING EXPENSES 19. TOTAL EXPENSES 70,941. MISCELLANEOUS EXPENSES: PROGRAM SERVICE EXPENSES 565,854. MANAGEMENT AND GENERAL EXPENSES 352,643. FUNDRAISING EXPENSES 168. TOTAL EXPENSES 918,665. FORM 990, PART XI, LINE 9: CHANGE IN PENSION LIABILITY -607,516. FORM 990, PART XII, LINE 2C THE ORGANIZATION DID NOT CHANGE ITS OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE YEAR.