2020-03-31T17:03:42-05:00 2019-06-30 410746749 CLIFTONLARSONALLEN LLP 2210 EAST ROUTE 66 GLENDORA CA 91740 990 2018-07-01 710876594 HOLLENBECK PALMS HOLL 3232636195 573 SOUTH BOYLE AVENUE LOS ANGELES CA 90033 MORRIS SHOCKLEY CFO 3232636195 2020-03-31 1 TIMOTHY D EVANS P00050546 6268577300 2020-03-18 67.137.57.251 2020-03-31 14:07:58 PD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 80266BCFA5E1B3E3CFD616D959E2F840DD671D9F 2018 2020-11-06 18:47:13Z MORRIS SHOCKLEY 573 SOUTH BOYLE AVENUE LOS ANGELES CA 90033 24937071 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 7 188 4 0 0 1060732 338883 13134990 13261109 4369156 3471899 201996 114600 18766874 17186491 0 0 0 0 9230157 9243142 0 0 171547 8007479 8335012 17237636 17578154 1529238 -391663 86146302 85510383 40003787 39670328 46142515 45840055 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 13369629 15375664 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. 13369629 1 1 0 0 0 0 0 0 0 1 1 1 0 0 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 36 0 1 188 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 WILLIAM HEIDEMAN PRESIDENT/CEO 40.00 X 309548 0 70284 MORRIS SHOCKLEY PRESIDENT/CEO & VP/TREASURER 40.00 X 200673 0 56094 JOHNNY YOUNG CONTROLLER/ASSISTANT SECRETARY 40.00 X 127921 0 39365 RAY SHIVELY CHIEF ENGINEER 40.00 X 124400 0 24505 IVANIA RAMIREZ DIRECTOR OF NURSING 40.00 X 132732 0 17389 JOHN M SHIVELY ENGINEER 40.00 X 108780 0 26073 PEGGY L HEIDEMAN ADMISSIONS DIRECTOR 40.00 X 115799 0 35843 IRMA CABALLERO STAFF DEVELOPER 40.00 X 103363 0 18488 1223216 0 288041 8 0 1 0 PACIFIC NATIONAL GROUP 2392 SOUTH BATEMAN AVENUE IRWINDALE CA 91010 CONSTRUCTION 1777665 SODEXO AMERICA LLC 600 CITY PARKWAY WEST SUITE 610 ORANGE CA 92868 FOOD SERVICES 1321655 DJMB SERVICES 122 E WALNUT AVENUE MONROVIA CA 91016 MEDICAL 743131 TEAM REHAB INC 6531 SILENT HARBOR DR HUNTINGTON BEACH CA 92648 THERAPY 439717 SKILLED NURSING PHARMACY 16666 E JOHNSON DRIVE CITY OF INDUSTRY CA 91745 PHARMACY 310976 15 102946 235937 338883 SKILLED NURSING/RESIDENTIAL 623000 9159915 9159915 MEDICARE/MEDICAID 623000 4101194 4101194 13261109 1416562 1416562 55382 55382 9794982 7739645 2055337 2055337 2055337 10935 102946 10935 0 OTHER REVENUE 623000 59218 59218 59218 17186491 15375664 0 1471944 X 617782 172216 408664 36902 6170228 5157613 919799 92816 201193 194781 5144 1268 1715259 1439432 247650 28177 538680 436024 92691 9965 105422 105422 113129 113129 90315 90315 2390416 1752863 636955 598 217614 217614 57814 57814 726281 709786 15914 581 50923 23523 27384 16 11137 2760 8377 1072539 16000 1056539 1286312 1257099 28185 1028 245623 240045 5382 196 VARIOUS MEDICAL EXPENSE 1142429 1142429 0 0 FOOD EXPENSE 825058 825058 0 0 17578154 13369629 4036978 171547 5763263 4025430 1818915 1080835 109104 3965 1336145 1340150 151472 138111 216663 235833 56689953 22037067 33704220 34652886 34529757 36353484 8516763 7679689 86146302 85510383 4399771 4847655 3252020 3736468 18449230 17724476 9374000 9189999 4528766 4171730 40003787 39670328 X 40689604 42544403 4679588 3295652 773323 0 46142515 45840055 86146302 85510383 X -391663 448693 -359490 X X 0 1 X 1 0 X 507524 231151 193524 241915 235937 1410051 13874368 15989024 14497822 13134990 13261109 70757313 14381892 16220175 14691346 13376905 13497046 72167364 30000 20000 40000 51766 70042 211808 0 30000 20000 40000 51766 70042 211808 71955556 1011754 1009371 2462308 4412633 3527281 12423347 1011754 1009371 2462308 4412633 3527281 12423347 160940 155536 167837 484313 15393646 17229546 17314594 17945074 17192164 85075024 0.84580 0.87710 0.14600 0.11910 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: ICE CREAM AND GUEST MEALS AND ROOM - 2016 AMOUNT: $ 32,349. 2017 AMOUNT: $ 32,534. 2018 AMOUNT: $ 27,142. BAZAAR - 2016 AMOUNT: $ 26,020. 2017 AMOUNT: $ 9,406. 2018 AMOUNT: $ 10,992. RENT - 2016 AMOUNT: $ 23,449. 2017 AMOUNT: $ 24,116. 2018 AMOUNT: $ 24,822. BEAUTY AND BARBER SHOP - 2016 AMOUNT: $ 47,449. 2017 AMOUNT: $ 54,550. 2018 AMOUNT: $ 42,496. MISCELLANEOUS - 2016 AMOUNT: $ 31,673. 2017 AMOUNT: $ 34,930. 2018 AMOUNT: $ 62,385. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2604960 154402 2759362 2361530 243430 2604960 2087491 274039 2361530 2079255 8236 2087491 1995950 83305 2079255 0.28030 0.71970 0 0 32412 32412 51209088 18559743 32649345 5448453 3477324 1971129 34652886 CORPORATE BONDS 3690008 F MORTGAGE-BACKED SECURITIES 1504967 F MUNICIPAL BONDS 1628369 F ANNUITY AND LIFE INSURANCE POLICIES 854514 F OIL INTEREST 1831 F 7679689 ASSIGNED ASSETS, NET 4171730 4171730 X 17196314 448693 -241520 207173 16989141 90315 107035 197350 17186491 17498774 10935 10935 17487839 90315 90315 17578154 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 -252,455. FUNDRAISING REVENUE 10,935. PART XI, LINE 4B - OTHER ADJUSTMENTS: LOSS ON UNCOLLECTABLE PLEDGES 107,035. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES 10,935. DAY AT THE RACES 113881 102946 10935 6873 1067 2995 113881 102946 10935 6873 1067 2995 10935 0 X X X 0 0 0 0 0 0 0 0 0 WILLIAM HEIDEMAN PRESIDENT/CEO 309548 0 0 0 0 0 27406 0 42878 0 379832 0 0 0 MORRIS SHOCKLEY PRESIDENT/CEO & VP/TREASURER 200673 0 0 0 0 0 17401 0 38693 0 256767 0 0 0 JOHNNY YOUNG CONTROLLER/ASSISTANT SECRETARY 127921 0 0 0 0 0 11894 0 27471 0 167286 0 0 0 IVANIA RAMIREZ DIRECTOR OF NURSING 132732 0 0 0 0 0 4317 0 13072 0 150121 0 0 0 PEGGY L HEIDEMAN ADMISSIONS DIRECTOR 115799 0 0 0 0 0 13145 0 22698 0 151642 0 0 0 A CALIFORNIA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY 680164610 2016-12-01 20435000 RETIRE SERIES 2007 BONDS 0 0 0 A 2445000 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 X 2 30242 MARKET VALUE 0 0 0 FORM 990, PART VI, SECTION A, LINE 1 THE GOVERNING BODY HAS DELEGATED TO THE AUDIT COMMITTEE, CONSISTING OF MIKE DAVIS AND BILL KUMAGAI, 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 NO REVIEW WAS OR WILL BE CONDUCTED. 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 1,080,828. MANAGEMENT AND GENERAL EXPENSES 271,490. FUNDRAISING EXPENSES 443. TOTAL EXPENSES 1,352,761. PROGRAM ACTIVITIES: PROGRAM SERVICE EXPENSES 66,530. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 66,530. REPAIRS AND MAINTENANCE: PROGRAM SERVICE EXPENSES 76,246. MANAGEMENT AND GENERAL EXPENSES 2,559. FUNDRAISING EXPENSES 18. TOTAL EXPENSES 78,823. MISCELLANEOUS EXPENSES: PROGRAM SERVICE EXPENSES 529,259. MANAGEMENT AND GENERAL EXPENSES 362,906. FUNDRAISING EXPENSES 137. TOTAL EXPENSES 892,302. FORM 990, PART XI, LINE 9: CHANGE IN PENSION LIABILITY -252,455. OTHER CHANGES IN NET ASSETS-990 -107,035. FORM 990, PART XII, LINE 2C: THE ORGANIZATION DID NOT CHANGE ITS OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE YEAR.