2020-06-09T12:38:24-05:00 2019-06-30 910189318 MOSS ADAMS LLP 101 SECOND STREET SUITE 900 SAN FRANCISCO CA 94105 990 2018-07-01 941156579 MERCY RETIREMENT AND CARE CENTER MERC 5107692700 1301 MARINA VILLAGE PARKWAY NO 210 ALAMEDA CA 94501 ROBIN EVITTS CFO 5107692700 2020-06-04 1 LESLIE VAN P01294411 4159561500 2020-06-04 98.210.126.210 2020-06-04 17:16:19 PD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 38D2F50D294D7FF929294DC7DB19A49EB4956B3D 2018 2021-01-29 14:40:06Z ADRIENE IVERSON 1301 MARINA VILLAGE PARKWAY NO 210 ALAMEDA CA 94501 18099934 0 X WWW.ELDERCAREALLIANCE.ORG X 1872 CA MERCY RETIREMENT AND CARE CENTER SERVES & ENRICHES THE LIVES OF OLDER ADULTS BY PROVIDING HOUSING AND SERVICES IN ITS SKILLED NURSING, ASSISTED LIVING, AND MEMORY CARE NEIGHBORHOODS. 14 14 215 50 0 0 2045908 1593395 16364442 16081297 336718 374356 28437 50886 18775505 18099934 0 0 0 0 8741795 9347880 0 0 548837 7740843 8351025 16482638 17698905 2292867 401029 31914206 32470599 3808250 3926396 28105956 28544203 X A NONPROFIT ORGANIZATION COMMITTED TO SERVING AND ENRICHING THE PHYSICAL, EMOTIONAL, AND SPIRITUAL WELL-BEING OF OLDER ADULTS THROUGH A PROFESSIONAL, FAITH-CENTERED CARE COMMUNITY AND SERVICES. 0 0 7982842 8234306 MERCY RETIREMENT AND CARE CENTER IS LICENSED FOR 59 SKILLED NURSING RESIDENTS. THIS YEAR, THE CARE CENTER PROVIDED SKILLED NURSING CARE TO 51.29 OLDER ADULT RESIDENTS EACH MONTH (ON AVERAGE) FOR AN ANNUAL TOTAL OF OVER 18,721 RESIDENTS DAYS. OF OUR RESIDENTS, 29.90% WERE PRIVATE PAY, 48.6% HAD MEDI-CAL, 16.52% HAD MEDICARE, AND 4.98% HAD OTHER INSURANCE COVERAGE. 5133962 5525766 MERCY'S ASSISTED LIVING PROVIDES HOUSING AND SERVICES FOR UP TO 85 OLDER ADULT RESIDENTS THAT REQUIRE SOME ASSISTANCE WITH MEDICATION OR DAILY ACTIVITIES. THIS YEAR, WE PROVIDED ASSISTED LIVING HOUSING FOR 75.98 RESIDENTS EACH MONTH (ON AVERAGE), EXCLUDING SECOND PERSONS IN EACH APARTMENT, FOR AN ANNUAL TOTAL OF 27,707 RESIDENT DAYS. THE ASSISTED LIVING RESIDENTS ARE OFFERED FIVE LEVELS OF CARE IN ADDITION TO THE BASE LEVEL OF CARE SO THAT THEIR INDIVIDUAL NEEDS CAN BE MET. THERE ARE MANY ACTIVITIES PROVIDED FOR OUR ASSISTED LIVING RESIDENTS, INCLUDING MANY THAT REFLECT OUR FAITH-CENTERED MISSION. 1587419 2008743 MERCY'S MEMORY CARE NEIGHBORHOOD PROVIDES HOUSING AND SERVICES FOR UP TO 22 OLDER ADULT RESIDENTS WHO HAVE DEMENTIA OR MEMORY LOSS. THIS YEAR, WE PROVIDED MEMORY CARE HOUSING FOR 21.15 RESIDENTS EACH MONTH (ON AVERAGE) FOR A TOTAL OF 7,719 RESIDENT DAYS. THE MEMORY CARE NEIGHBORHOOD HAS MANY DAILY ACTIVITIES DESIGNED FOR DEMENTIA OR MEMORY LOSS RESIDENTS. 501116 312482 OTHER PROGRAM SERVICES INCLUDE MERCY'S BROWN BAG PROGRAM. SINCE 1982, OUR VOLUNTEERS HAVE LOVINGLY FILLED AND DISTRIBUTED BAGS OF FRESH PRODUCE, HEALTHY GRAINS, CANNED GOODS, LEAN PROTEINS, AND MORE. WE SORT, PACK, AND DISTRIBUTE GROCERIES TO 17 SITES THROUGHOUT ALAMEDA COUNTY. LAST YEAR, THE MERCY BROWN BAG PROGRAM DISTRIBUTED AN ESTIMATED 120,000 GROCERY BAGS STUFFED WITH MORE THAN ONE MILLION POUNDS OF FOOD TO NEARLY 5,000 HUNGRY SENIORS. 501116 312482 15205339 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 59 0 1 215 1 0 0 0 0 0 0 0 0 0 0 0 0 X 14 14 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 CA X ROBIN EVITTS 5108582902 1301 MARINA VILLAGE PARKWAY SUITE ALAMEDA CA 94501 CHRISTINE WHELAN CHAIR 2.00 8.00 X X 0 0 0 VERN STIGGE VICE CHAIR (THRU 11/18)/DIRECTOR 2.00 8.00 X X 0 0 0 JOY MOORE VICE CHAIR (START 11/18) 2.00 8.00 X X 0 0 0 SISTER KATHLEEN KEARNEY SECRETARY (THRU 11/18) 2.00 8.00 X X 0 0 0 ERICKA RYAN SECRETARY (START 11/18) 2.00 8.00 X X 0 0 0 DENISE ALLEN DIRECTOR 2.00 2.00 X 0 0 0 JESSE BEAN DIRECTOR 2.00 2.00 X 0 0 0 SISTER PAULINE BORGHELLO DIRECTOR (START 11/18) 2.00 2.00 X 0 0 0 J THOMAS BRIODY DIRECTOR 2.00 2.00 X 0 0 0 SISTER PHYLLIS HUGHES DIRECTOR 2.00 2.00 X 0 0 0 TRACY JENSEN DIRECTOR 2.00 2.00 X 0 0 0 LYNNE KATZMANN DIRECTOR 2.00 2.00 X 0 0 0 STEVEN KIM DIRECTOR 2.00 2.00 X 0 0 0 RAJA SEKARAN DIRECTOR 2.00 2.00 X 0 0 0 MICHAEL TELLEEN DIRECTOR (THRU 11/18) 2.00 2.00 X 0 0 0 LE ANNE TRACHOK DIRECTOR (START 11/18) 2.00 2.00 X 0 0 0 ADRIENE IVERSON CEO 2.00 45.00 X 0 367815 14592 MARJORIE BAILEY CFO (THRU 5/19) 2.00 45.00 X 0 302074 4980 ROBIN EVITTS INTERIM CFO (START 5/19) 1.00 28.00 X 0 0 0 TAMRA TSANOS EXECUTIVE DIRECTOR 40.00 0.00 X 154878 0 5042 BLAINE LYONS HEALTH CARE ADMIN. (THRU 2/19) 40.00 0.00 X 156113 0 8629 SHAWNA RYAN DIRECTOR OF NURSING (THRU 11/19) 40.00 0.00 X 137487 0 8059 AIDA TSEGAY REGISTERED NURSE 40.00 0.00 X 118059 0 8995 566537 669889 50297 4 0 1 0 REHABCARE GROUP EAST INC PO BOX 503534 ST LOUIS MO 631503534 REHAB CARE 1071480 DEACON CONSTRUCTION LLC 7745 GREENBACK LANE CITRUS HEIGHTS CA 95610 GENERAL CONTRACTOR 939609 DOUGLAS PANCAKE ARCHITECTS INC 19000 MACARTHUR BLVD SUITE 500 IRVINE CA 92612 ARCHITECT 837335 ECOLOGICALLY SOUND MEDICAL SERVICES PO BOX 1029 TRACY CA 953781029 MEDICAL SERVICES 191320 ELISEO C GARCIA JR (4K CONSTRUCTION) 600 KENTUCKY STREET 136 FAIRFIELD CA 94533 GENERAL CONTRACTOR 100114 5 78334 1515061 1593395 NET RESIDENT SERV REV 623000 16081297 16081297 16081297 374356 374356 50886 0 50886 50886 50886 18099934 16081297 0 425242 7490987 7187393 157430 146164 124128 124128 1169277 1165136 -45 4186 563488 543109 10180 10199 1184833 1184833 10986 10986 35896 35896 88967 88967 781475 178045 231142 372288 151293 7286 131993 12014 613420 534498 78029 893 390116 378049 9088 2979 884773 884773 54409 54139 156 114 36 36 872023 872023 185970 185970 CC ANCILLIARIES 1142258 1142258 FOOD 540882 540882 MEDICAL SUPPLIES/DRUGS 434333 434333 UBI TAX EXPENSE 6074 6074 973281 973281 17698905 15205339 1944729 548837 1765454 2279713 1222773 1563134 98688 425380 29835350 17352721 8476687 12482629 19419897 15311491 867184 63523 408252 31914206 32470599 1274711 1425342 2533539 2501054 3808250 3926396 X 23395748 23425887 1765925 2178442 2944283 2939874 28105956 28544203 31914206 32470599 401029 40697 -3479 0 X 0 1 X 1 0 X 1159746 625552 1025855 2045908 1593395 6450456 15204765 15061330 15684652 16364442 16081297 78396486 16364511 15686882 16710507 18410350 17674692 84846942 0 0 0 84846942 224766 212358 585670 365155 425242 1813191 224766 212358 585670 365155 425242 1813191 16589277 15899240 17296177 18775505 18099934 86660133 0.97910 0.98120 0.02090 0.01880 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 824 824 0 PART II-B, LINE 1: THE ORGANIZATION IS A MEMBER OF SEVERAL ORGANIZATIONS WHOSE PURPOSE IS TO DIRECT, DEVELOP, OR AFFECT PUBLIC POLICY AND LEGISLATION WITH REGARDS TO HEALTHCARE ISSUES. A PORTION OF THE DUES IS ALLOCATED TO LOBBYING. 6033876 344819 6378695 7507745 -1473869 6033876 4313754 2477735 716256 7507745 4190069 123685 4313754 4119137 70932 4190069 0.45420 0.46090 0.08490 0 1 1 201489 201489 18435906 12059020 6376886 4163133 3310799 852334 7034822 1982902 5051920 12482629 ASSET RETIREMENT OBLIGATION 810365 DUE TO RELATED ORGANIZATION 1690689 2501054 PART V, LINE 4: THERE ARE SIX ENDOWMENT FUNDS, ALL OF WHICH REQUIRE THE INCOME FROM THE FUNDS TO BE USED FOR CHARITY CARE OF RESIDENTS. X X X X X 1 CCS FUNDRAISING 100 MONTGOMERY ST 2270 SAN FRANCISCO CA 94104 CAMPAIGN CONSULTING 0 1143500 372000 771500 1143500 372000 771500 CA 0 0 0 0 0 0 0 0 0 ADRIENE IVERSON CEO 0 313431 0 53667 0 717 0 7373 0 7219 0 382407 0 0 MARJORIE BAILEY CFO (THRU 5/19) 0 273309 0 27107 0 1658 0 4980 0 0 0 307054 0 0 TAMRA TSANOS EXECUTIVE DIRECTOR 143786 0 10402 0 690 0 2305 0 2737 0 159920 0 0 0 BLAINE LYONS HEALTH CARE ADMIN. (THRU 2/19) 146306 0 9133 0 674 0 0 0 8629 0 164742 0 0 0 PART I, LINE 3 THE MANAGEMENT COMPANY RELATED ORGANIZATION, ELDER CARE ALLIANCE (ECA), USES THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION OF THE TOP MANAGEMENT OFFICIAL: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. FORM 990, PART VI, SECTION A, LINE 3 MERCY HAS A MANAGEMENT CONTRACT WITH ELDER CARE ALLIANCE, A NON-PROFIT PUBLIC BENEFIT CORPORATION THAT IS THE SOLE CORPORATE MEMBER OF MERCY, TO PROVIDE MANAGEMENT SERVICES INCLUDING, BUT NOT LIMITED TO, MARKETING, HUMAN RESOURCES, ACCOUNTING, INFORMATION TECHNOLOGY SERVICES, RISK MANAGEMENT, CLINICAL OVERSIGHT AND INSURANCE. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION'S SOLE CORPORATE MEMBER IS ELDER CARE ALLIANCE. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS OF THE CORPORATION SHALL INCLUDE NO GREATER THAN TWELVE (12) INDIVIDUALS APPOINTED IN ACCORDANCE WITH THE FOLLOWING: (I) FIVE (5) INDIVIDUALS APPOINTED BY THE FACILITY AND PROGRAM SPONSOR, THE SISTERS OF MERCY OF THE AMERICAS, WEST MIDWEST COMMUNITY, INC., A DIVISION OF THE SISTERS OF MERCY OF THE AMERICAS, A RELIGIOUS INSTITUTE AND PUBLIC JURIDIC PERSON OF THE ROMAN CATHOLIC CHURCH; (II) FIVE (5) INDIVIDUALS APPOINTED BY THE CO-SPONSOR OF THE CORPORATE MEMBER, THE SIERRA PACIFIC SYNOD OF THE EVANGELICAL LUTHERAN CHURCH IN AMERICA. (III) A MAXIMUM OF TWO (2) INDIVIDUALS JOINTLY APPOINTED BY THE FACILITY AND PROGRAM SPONSOR AND BY THE CO-SPONSOR OF THE CORPORATE MEMBER. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING ACTIONS OF MERCY RETIREMENT AND CARE CENTER (THE CORPORATION) SHALL NOT BE IMPLEMENTED WITHOUT THE APPROVAL OF THE CORPORATE MEMBER: (A) ADOPTION OR AMENDMENT OF PHILOSOPHY AND MISSION OF THE CORPORATION; (B) APPROVAL OF STRATEGIC AND LONG RANGE PLANS OF THE CORPORATION; (C) REORGANIZATION, MERGER, CONSOLIDATION OR CHANGE OF CONTROL OF THE CORPORATION; (D) ANY CHANGE IN THE ARTICLES OF INCORPORATION OR BYLAWS OF THE CORPORATION; (E) ADOPTION OF AND ANY CHANGE IN THE MISSION STATEMENT OR VALUES STATEMENT OF THE CORPORATION; (F) ADOPTION OF AND ANY CHANGE IN CHARITABLE CARE POLICIES OF THE CORPORATION; (G) SALE OR DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION; (H) DISSOLUTION OF THE CORPORATION; (I) ADOPTION OR APPROVAL OF OPERATING AND CAPITAL BUDGETS OF THE CORPORATION, AND ANY CAPITAL EXPENDITURES OR BORROWINGS IN EXCESS OF LIMITS ESTABLISHED BY ELDER CARE ALLIANCE POLICY; (J) CREATION OF A NEW CORPORATION, OR PARTICIPATION IN JOINT VENTURE REQUIRING CAPITAL COMMITMENTS IN EXCESS OF LIMITS ESTABLISHED BY ELDER CARE ALLIANCE POLICY; OR (K) ANY UNBUDGETED ACQUISITION OF ASSETS WITH A PURCHASE PRICE IN EXCESS OF LIMITS ESTABLISHED BY ELDER CARE ALLIANCE POLICY. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. BEFORE FILING, THE FORM 990 DRAFT RETURNS ARE REVIEWED BY THE CEO AND CFO, FOLLOWED BY THE AUDIT COMMITTEE OF THE BOARD. UPON THE AUDIT COMMITTEE'S RECOMMENDATION, THE FULL BOARD REVIEWS THE FORM 990'S TO PROVIDE THEIR APPROVAL, UPON WHICH THE TAX RETURNS ARE FILED. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, THE SECRETARY OF ELDER CARE ALLIANCE REQUESTS UPDATED CONFLICT OF INTEREST DISCLOSURE FORMS FROM THE BOARD OF DIRECTORS, OFFICERS, KEY EMPLOYEES, AND MEMBERS OF COMMITTEES WITH BOARD-DELEGATED AUTHORITY. THE SECRETARY PREPARES A TABLE SUMMARIZING THE DISCLOSURES MADE AND PRESENTS THE TABLE TO THE BOARD OF DIRECTORS FOR THEIR INFORMATION. IF AN APPARENT CONFLICT OF INTEREST IS IDENTIFIED, THE MATTER IS REFERRED TO A COMMITTEE OF THE BOARD FOR REVIEW AND ACTION. IF DEEMED NECESSARY, THE BOARD OR COMMITTEE MAY TAKE ACTION SUCH AS REQUIRING AN INTERESTED DIRECTOR TO RECUSE HIMSELF FROM A VOTE ON THE MATTER OR TERMINATING A BUSINESS RELATIONSHIP ENTERED INTO IN VIOLATION OF THE POLICY. FORM 990, PART VI, SECTION B, LINE 15 FORM 990, PART VI, SECTION B, LINES 15A AND 15B HAVE BOTH BEEN ANSWERED NO (AS MANDATED BY THE FORM 990 INSTRUCTIONS), AS THE CEO, OFFICERS, AND KEY EMPLOYEES OF THE ORGANIZATION ARE COMPENSATED BY A RELATED ORGANIZATION. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE ON WRITTEN REQUEST TO ELDER CARE ALLIANCE, MERCY'S MANAGEMENT COMPANY, AND WILL BE RESPONDED TO VIA EMAIL, US MAIL, OR BY FAX IF SO REQUESTED. ELDER CARE ALLIANCE 1301 MARINA VILLAGE PKWY SUITE 210 ALAMEDA CA 94501 943260975 MANAGEMENT CA 501(C)(3) LINE 12B, II N/A 1 ELDER CARE ALLIANCE OF CAMARILLO 1301 MARINA VILLAGE PKWY SUITE 210 ALAMEDA CA 94501 943351613 SENIOR LIVING CA 501(C)(3) LINE 10 ECA 1 ELDER CARE ALLIANCE OF SAN FRANCISCO 1301 MARINA VILLAGE PKWY SUITE 210 ALAMEDA CA 94501 943351615 SENIOR LIVING CA 501(C)(3) LINE 10 ECA 1 ELDER CARE ALLIANCE OF SAN RAFAEL 1301 MARINA VILLAGE PKWY SUITE 210 ALAMEDA CA 94501 760730971 SENIOR LIVING CA 501(C)(3) LINE 10 ECA 1 ELDER CARE ALLIANCE OF UNION CITY 1301 MARINA VILLAGE PKWY SUITE 210 ALAMEDA CA 94501 943377985 SENIOR LIVING CA 501(C)(3) LINE 10 ECA 1 ELDER CARE ALLIANCE OF SAN MATEO 1301 MARINA VILLAGE PKWY SUITE 210 ALAMEDA CA 94501 940831870 AGE-RESTRICTED APARTMENTS CA 501(C)(3) LINE 10 ECA 1 0 0 0 0 1 0 0 0 0 0 0 0 1 1 1 1 0 0 0 ELDER CARE ALLIANCE E 1690689 BOOK VALUE ELDER CARE ALLIANCE M 1184833 BOOK VALUE ELDER CARE ALLIANCE P 443000 BOOK VALUE