2020-11-15T20:12:56-06:00 2019-12-31 450250958 EIDE BAILLY LLP 3130 CROW CANYON PL STE 300 SAN RAMON CA 945831386 990 2019-01-01 951652915 MONTE VISTA GROVE HOMES MONT 6267966135 2889 SAN PASQUAL STREET PASADENA CA 91107 DEBORAH A HEBERT CHIEF EXECUTIVE OFFICER 6267966135 2020-11-11 1 THERESA MONTGOMERY CPA P00232100 9254804000 2020-11-11 99.110.55.147 2020-11-11 19:13:21 PS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 327E456370A643C83A1BB4325D39191A230D016A 2019 2021-01-29 14:40:06Z DEBORAH A HEBERT 2889 SAN PASQUAL STREET PASADENA CA 91107 15856843 0 X WWW.MVGH.ORG X 1924 CA A HOLISTIC AND VIBRANT SENIOR COMMUNITY COMMITTED TO APPLY THE DISCIPLINES OF STEWARDSHIP IN OUR CARE FOR PEOPLE, FINANCES, TIME AND THE ENVIRONMENT. 23 22 134 50 0 0 1137570 1387517 6551763 7301198 485974 792454 333807 7836 8509114 9489005 0 0 0 0 5279082 5969357 0 0 147879 3618528 3811927 8897610 9781284 -388496 -292279 26332753 27957570 4994461 5581516 21338292 22376054 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 4370722 4157251 OPERATION OF A 40 BED MEDICARE CERTIFIED SKILLED NURSING FACILITY. 2146483 1595045 PROVIDE NON-LICENSED INDEPENDENT HOUSING IN 76 APARTMENTS ON CAMPUS. 1051975 779855 OPERATION OF 10 ROOM RESIDENTIAL CARE FACILITY FOR MEMORY CARE, PROVIDE DIETARY ASSISTANCE, AND OTHER PROGRAM SERVICES. 901112 769047 OPERATION OF 16-APARTMENT RESIDENTIAL CARE FACILITY. 901112 769047 8470292 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 1 0 0 0 1 1 0 0 0 1 55 0 1 134 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 23 22 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 151629 0 17161 KIM HOUSER CHIEF FINANCIAL OFFICER 40.00 X 144027 0 15450 EDEN CONORA DIRECTOR OF NURSING 40.00 X 133639 0 17417 JANET WELLS PRESIDENT 2.00 X X 0 0 0 SANDRA MADER VICE PRESIDENT 2.00 X X 0 0 0 AL BOEGH TREASURER 2.00 X X 0 0 0 JANET LOUIE 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 CHRIETINE DURYEE TREASURER 2.00 X 0 0 0 JOANNE HINCH TRUSTEE 2.00 X 0 0 0 WANDY JUNG TRUSTEE 2.00 X 0 0 0 REX MCDANIEL TRUSTEE 2.00 X 0 0 0 REBECCA POTTER 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 KATHLEEN TINGUS TRUSTEE 2.00 X 0 0 0 KAREN WALTER 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 MARIKO YANAGIHARA TRUSTEE 2.00 X 0 0 0 REV DR JOHN TOAY PRESIDENT OF RESIDENT'S AS 2.00 X 0 0 0 429295 0 50028 3 0 1 0 SODEXO INC & AFFILIATES PO BOX 360170 PITTSBURG PA 152516170 FOOD SERVICE OPERATIONS: SERVICES, LABO 400802 MAZUR CONSTRUCTION CO 1608 FAIR PARK AVENUE LOS ANGELES CA 90041 CONSTRUCTION CONTRACTOR 302505 SUSAN J HARRIS INC DBA THERAPY SPECIA 3760 CONVOY ST SUITE 204 SAN DIEGO CA 92111 THERAPY SERVICE PROVIDER (FOR PHYSICAL, 280788 INTERIOR IMAGES INC 160 S OLD SPRINGS RD STE 160 ANAHEIM HILLS CA 92808 INTERIOR DESIGNER: SERVICES AND PRODUCT 148530 REYNOLDS ROOFING COMPANY PO BOX 920312 SYLMAR CA 913920312 ROOFING CONTRACTOR 116641 5 168640 1218877 78714 1387517 SKILLED NURSING-HEALTH 623000 3504302 3504302 DIETARY REVENUES 623000 1183135 1183135 INDEPENDENT LIVING 623000 1055617 1055617 MEMORY CARE 623000 614732 614732 ASSISTED LIVING 623000 527309 527309 416103 416103 7301198 442324 442324 6678550 6309194 19226 369356 -19226 350130 350130 47254 168640 39418 7836 7836 9489005 7301198 0 800290 364907 97441 247978 19488 4478765 4115477 272397 90891 106281 88179 15927 2175 701225 650075 49502 1648 318179 278264 34420 5495 11711 11711 62259 62259 60934 60934 827629 733288 94341 8821 8821 57657 18819 27172 11666 317539 299743 17796 28882 11239 17161 482 20073 7632 11479 962 104290 104290 1144291 1125996 18295 176612 142888 33724 DIETARY FOOD SUPPLY 361604 361604 SUPPLIES AND EQUIPMENT 326347 298010 27687 650 RESIDENTIAL FINANCIAL A 140348 140348 LICENSE AND PERMITS 96955 65353 24347 7255 65975 35936 22872 7167 9781284 8470292 1163113 147879 308203 580117 45281 71883 212082 191671 896653 1057555 2048000 2048000 57610 57610 186618 205711 32281279 21783735 10781603 10497544 11116326 12607882 550172 503346 130205 136251 26332753 27957570 675984 783266 1030125 1336061 2367736 2567736 920616 894453 4994461 5581516 X 19266335 20301923 2071957 2074131 21338292 22376054 26332753 27957570 X -292279 1355051 -25010 X 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 2813137 11351 353661 135173 15556 3027420 3078718 11812 -133265 -129068 -15060 2813137 2810104 190203 154963 -58120 -18432 3078718 2688196 12341 232159 -101845 -20747 2810104 3119135 11470 -103842 317867 20700 2688196 0.33650 0.66350 0.00000 0 0 97108 97108 26750044 18110309 8639735 1676901 917049 759852 3755326 2756377 998949 1900 1900 10497544 LIABILITY FOR REFUNDABLE AND REPAYABLE ENTRANCE FEES 531792 DEPOSITS AND OTHER LIABILITIES 362661 894453 X 10828423 1355051 5883 1360934 9467489 60934 -39418 21516 9489005 9790661 70311 70311 9720350 60934 60934 9781284 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 THE TAX POSITIONS TAKEN MORE LIKELY THAN NOT WILL BE SUSTAINED UNDER EXAMINATION BY THE APPLICABLE TAX AUTHORITIES. EXAMPLES OF TAX POSITIONS INCLUDE TAXEXEMPT STATUS OF THE ORGANIZATION AND VARIOUS POSITIONS RELATED TO THE POTENTIAL SOURCES OF UNRELATED BUSINESS TAXABLE INCOME. SINCE TAX MATTERS ARE SUBJECT TO SOME DEGREE OF UNCERTAINTY, THERE CAN BE NO ASSURANCE THAT THE ORGANIZATION'S TAX RETURNS WILL NOT BE CHALLENGED BY THE TAXING AUTHORITIES, AND THAT THE ORGANIZATION WILL NOT BE SUBJECT TO TAX, PENALTIES, AND INTEREST AS A RESULT OF SUCH CHALLENGE. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN VALUE - SPLIT INTEREST AGREEMENTS 5,883. PART XI, LINE 4B - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSE INCLUDED WITH THE FUNCTIONAL EXPENSES -39,418. PART XII, LINE 2D - OTHER ADJUSTMENTS: LOSS ON UNCOLLECTIBLE PROGRAM REVENUE 30,893. SPECIAL EVENT EXPENSE INCLUDED WITH THE FUNCTIONAL EXPENSES 39,418. GALA 210362 168560 41802 1710 25130 11664 PANCAKE BREAKFAST 5532 80 5452 914 215894 168640 47254 1710 25130 12578 39418 7836 X 1 1 X X X 0 0 0 0 0 0 0 0 0 DEBORAH HERBERT CHIEF EXECUTIVE OFFICER 151629 0 0 0 0 0 5463 0 11698 0 168790 0 0 0 KIM HOUSER CHIEF FINANCIAL OFFICER 144027 0 0 0 0 0 5118 0 10332 0 159477 0 0 0 EDEN CONORA DIRECTOR OF NURSING 133639 0 0 0 0 0 4833 0 12584 0 151056 0 0 0 PART I, LINE 1A ALL REIMBURSEMENTS FOR SOCIAL CLUB DUES ARE SUBSTANTIATED AND APPROVED IN ACCORDANCE WITH ORGANIZATION POLICY. X 1 15994 MARKET VALUE X BUILDING IMPROVEMENTS 1 62720 FMV - REPLACEMENT CO 0 1 0 PART I, COLUMN (B): THE NUMBER OF CONTRIBUTIONS REPRESENTS THE NUMBER OF CONTRIBUTORS MAKING CONTRIBUTIONS OF EACH TYPE. 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, AN EX-OFFICIO MEMBER OF THE BOARD OF TRUSTEES, 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 5,883. LOSS ON UNCOLLECTIBLE PROGRAM REVENUE -30,893. FORM 990 PART XII LINE 2C THE ORGANIZATION HAS AN AUDIT COMMITTEE THAT ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND THE SELECTION OF AN INDEPENDENT ACCOUNTANT AND THERE HAVE BEEN NO CHANGES MADE TO THIS PROCESS FOR THE CURRENT TAX YEAR. THE GROVE CAMPUS LLC 2889 SAN PASQUAL STREET PASADENA CA 91107 462229596 OPERATION OF UNLICENSED SENIOR HOUSING (INDEPENDENT LIVING) CA 1193162 7024920 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