2020-07-14T18:59:26-05:00 2019-06-30 910189318 MOSS ADAMS LLP 101 SECOND STREET SUITE 900 SAN FRANCISCO CA 94105 990 2018-07-01 940545320 HEBREW HOME FOR AGED DISABLED HEBR 4153342500 302 SILVER AVENUE SAN FRANCISCO CA 941121510 DANIEL RUTH PRESIDENT AND CEO 4153342500 2020-07-13 1 MICHAEL LUMSDEN P01262236 4159561500 2020-07-13 76.14.38.113 2020-07-13 17:01:02 PD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 00C4359F54289D19625D58AABAD73364CEA05A5F 2018 2020-09-22 18:59:49Z SAN FRANCISCO CAMPUS FOR JEWISH LIVING DANIEL RUTH 302 SILVER AVENUE SAN FRANCISCO CA 941121510 88337707 0 X WWW.SFCJL.ORG X 1871 CA WE ARE A LICENSED NURSING HOME THAT PROVIDES TO SENIORS LIFE ENRICHING SERVICES THAT PROMOTE INDIVIDUAL DIGNITY, ENCOURAGE INDEPENDENCE, AND REFLECT THE SOCIAL, CULTURAL, AND SPIRITUAL VALUES OF THE JEWISH TRADITION. 12 12 737 150 0 0 13765691 18225340 66999478 69382480 -72344 2064 354606 545336 81047431 88155220 0 0 0 0 42425083 45368324 0 0 545342 29318671 34140706 71743754 79509030 9303677 8646190 314025310 324441112 153571419 156523335 160453891 167917777 X ENRICHING THE QUALITY OF LIFE OF OLDER ADULTS. 0 0 65097495 69382480 SEE SCHEDULE OTHE ORGANIZATION PROVIDES LONG-TERM CARE, SHORT-TERM REHABILITATION, AND ACUTE PSYCH CARE SERVICES. IT PROVIDES PROFESSIONAL AND COMPREHENSIVE PROGRAMS THAT INCLUDES PERSONAL HEALTH CARE TO RESIDENTS IN ITS 374 BED FACILITY. IN THE CURRENT FISCAL YEAR, THE ORGANIZATION SERVED AN AVERAGE OF 357 RESIDENTS A DAY. THERE WERE 52 NEW ADMISSIONS FOR LONG-TERM CARE, 1,361 SHORT-TERM CARE PATIENTS, AND 183 PATIENTS THAT REQUIRED ACUTE PSYCH HOSPITALIZATION. THE ORGANIZATION IS A LICENSED, SKILLED NURSING FACILITY, 8-ACRE COMPREHENSIVE SENIOR CARE CENTER WITH FOUR DISTINCT BUILDINGS SPECIALIZING IN SERVING MORE THAN 270 RESIDENTS WITH DIVERSE CARE NEEDS, AND PROVIDING REHABILITATION SERVICES TO NUMEROUS OTHERS SEEKING SHORT-TERM CARE STAYS. 65097495 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 1 1 0 0 0 1 93 0 1 737 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 1 0 CA X MARY CONNICK 4155622650 302 SILVER AVENUE SAN FRANCISCO CA 94112 X HOWARD F FINE CHAIR 2.00 0.00 X X 0 0 0 STEVEN FAYNE VICE-CHAIR 2.00 0.00 X X 0 0 0 DAVID LOWI TREASURER 2.00 0.00 X X 0 0 0 SOPHIE SHARP SECRETARY 2.00 0.00 X X 0 0 0 JAMES A DAVIS MD TRUSTEE 2.00 0.00 X 0 0 0 MICHAEL EISLER TRUSTEE 2.00 0.00 X 0 0 0 MATTHEW D GERSHUNY TRUSTEE 2.00 0.00 X 0 0 0 ADRIENNE GREEN MD TRUSTEE 2.00 0.00 X 0 0 0 ALEX MANN TRUSTEE 2.00 0.00 X 0 0 0 BRIAN PERLMAN TRUSTEE 2.00 0.00 X 0 0 0 LYNN SEDWAY TRUSTEE 2.00 0.00 X 0 0 0 HOWARD ZACK TRUSTEE 2.00 0.00 X 0 0 0 DANIEL RUTH PRESIDENT AND CEO 24.00 12.00 X 0 760865 109998 VICTOR MEINKE CHIEF FINANCIAL OFFICER 29.00 1.00 X 0 311262 14752 MARK FRIEDLANDER EXECUTIVE DIRECTOR 40.00 0.00 X 197858 0 11944 SHERIE KOSHOVER CHIEF ADVANCEMENT OFFICER 24.00 3.00 X 0 286541 40435 MICHAEL SKAFF CHIEF OPERATING OFFICER 4.00 34.00 X 0 351659 18562 ELLIOTT STEIN MEDICAL DIRECTOR, APU 8.00 0.00 X 220779 0 872 MARIO LEMAY DIRECTOR OF UTILIZATION MANAGEMENT 40.00 0.00 X 187441 0 11669 STEPHEN T HALL ASSOCIATE MEDICAL DIRECTOR 8.00 0.00 X 174389 0 15920 JAN REICHER EXECUTIVE DIRECTOR, BYER SQUARE 40.00 0.00 X 93849 88200 5898 ROEL PAROCHA LICENSED VOCATIONAL NURSE 40.00 0.00 X 167836 0 7236 MATTHEW POWONDRA RCFE ADMINISTRATOR 40.00 0.00 X 150365 0 17728 1192517 1798527 255014 47 0 1 0 CANNON CONSTRUCTORS INC 6000 SHORELINE COURT 206 SOUTH SAN FRANCISCO CA 94080 CONTRACTORS 16557162 JEWISH SENIOR LIVING GROUP 302 SILVER AVENUE SAN FRANCISCO CA 94112 MANAGEMENT/ADMINISTRATIVE SERVICES 7311456 ONR INC 1101 S CAPITAL OF TEXAS HWY BLDG AUSTIN TX 78746 CONTRACT PHYSICAL/OCCUPATIONAL THERAPIST 4123696 GONSALVES & SANTUCCI INC DBA CONCO 5141 COMMERCIAL CIRCLE CONCORD CA 94520 CONTRACTORS 3427832 BROADWAY MECHANICAL 873 81ST AVENUE OAKLAND CA 94621 CONTRACTORS 1603787 38 18225340 70689 18225340 NET PATIENT SERV. REV. 623000 68960437 68960437 OTHER OPERATING REV. 623000 254043 254043 RENTAL INCOME - JSLG 900099 168000 168000 69382480 2064 2064 128851 182487 -53636 -53636 REIMBURSEMENTS 900099 451788 451788 CAFETERIA 722514 43733 43733 PARKING REVENUE 812930 20790 20790 82661 82661 598972 88155220 69382480 0 547400 X 434399 434399 34485524 33780531 376922 328071 956637 939971 7598 9068 6907836 6788034 54618 65184 2583928 2540269 19879 23780 280617 238485 42132 73450 73450 15809180 8138470 7640982 29728 1051450 1050157 1293 4104568 3534716 540837 29015 2051630 1717269 334361 16099 16099 121438 78646 35369 7423 496818 337836 158982 2941770 2851876 69974 19920 755833 755833 LITIGATION LOSS RESERVE 3425224 3425224 MED./NURSING SUPPLIES 2393485 2393485 LICENSES AND FEES 284221 284221 UBI TAX EXPENSE 35145 35145 299778 267355 563 31860 79509030 65097495 13866193 545342 15848 18668 13036846 17442045 12000513 12000513 9825168 11042103 800000 800000 185860 184169 346414 357099 190611702 51376834 97189978 139234868 180624683 143361647 314025310 324441112 9113647 12766884 140000 140000 56369 56369 132553289 131994292 5528925 5192607 6179189 6373183 153571419 156523335 X 83094525 90630365 68833747 68761793 8525619 8525619 160453891 167917777 314025310 324441112 X 8646190 -1182304 X 0 1 X 1 0 X 15152450 42390660 13461638 13765691 18225340 102995779 15152450 42390660 13461638 13765691 18225340 102995779 26428581 76567198 4341 3351 2638 2041 2064 14435 300619 425681 712059 296606 598972 2333937 105344151 359285934 0.72680 0.84410 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER REVENUE - 2014 AMOUNT: $ 300,619. 2015 AMOUNT: $ 425,681. 2016 AMOUNT: $ 712,059. 2017 AMOUNT: $ 296,606. 2018 AMOUNT: $ 598,972. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 13365303 1396696 14761999 12664908 739632 39237 13365303 10534341 1000000 1130567 12664908 10566044 -31703 10534341 10048442 125000 392602 10566044 0.00000 0.57750 0.42250 1 0 90849 90849 77087739 36881967 40205772 15713487 12370698 3342789 97719627 2124169 95595458 139234868 BENEFICIAL INTEREST IN JHSLF 19669725 SPLIT INTEREST AGREEMENTS 5225481 CAPITALIZED GIFTS IN KIND 13164 INTEREST IN NET ASSETS OF JHSLF 48382393 DUE FROM RELATED PARTIES 453683 UNSPENT BOND PROCEEDS HELD BY TRUSTEE 67184896 ACCRUED INTEREST RECEIVABLE 77594 WORKERS COMP DEPOSITS 2265007 OTHER RECEIVABLES 86289 CASH HELD FOR RESIDENTS 3415 143361647 DEPOSITS 364860 DUE TO RELATED PARTIES 120823 RELATED PARTY LOANS PAYABLE 5887500 6373183 X 83730179 -4607528 -4607528 88337707 -182487 -182487 88155220 76266293 182487 182487 76083806 3425224 3425224 79509030 PART V, LINE 4: THE ORGANIZATION'S ENDOWMENT ASSETS CONSISTS OF FUNDS ESTABLISHED TO GENERATE OPERATING SUPPORT TO THE ORGANIZATION AND CAPITAL CAMPAIGN FUNDS WHICH THE BOARD OF TRUSTEES MAY USE TO REPAY THE PRINCIPAL PORTION OF THE CONSTRUCTION DEBT AND INCLUDES ACCUMULATED EARNINGS THEREON THAT HAVE NOT YET BEEN EXPENDED. PART X, LINE 2: THE ORGANIZATION FOLLOWS THE U.S. GAAP ACCOUNTING STANDARD REGARDING ACCOUNTING FOR UNCERTAIN TAX POSITIONS. THIS ACCOUNTING STANDARD PROVIDES DETAILED GUIDANCE FOR FINANCIAL STATEMENT RECOGNITION, MEASUREMENT, AND DISCLOSURE OF UNCERTAIN TAX POSITIONS RECOGNIZED IN THE ORGANIZATION'S FINANCIAL STATEMENTS. THE STANDARD REQUIRES AN ENTITY TO RECOGNIZE THE FINANCIAL STATEMENT IMPACT OF A TAX POSITION WHEN IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL NOT BE SUSTAINED UPON EXAMINATION. THE ORGANIZATION HAS REVIEWED ITS TAX POSITIONS FOR ALL OPEN YEARS AND BELIEVES THAT IT HAS APPROPRIATE SUPPORT FOR THE TAX POSITIONS TAKEN. THEREFORE, NO LIABILITY HAS BEEN RECORDED. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN VALUE OF SPLIT INTEREST AGREEMENTS -162,422. CHANGE IN BENEFICIAL INTEREST IN JHSLF -1,019,882. LOSS CONTINGENCY FOR PENDING LITIGATION -3,425,224. PART XI, LINE 4B - OTHER ADJUSTMENTS: COST OF GOODS SOLD -182,487. PART XII, LINE 2D - OTHER ADJUSTMENTS: COST OF GOODS SOLD 182,487. PART XII, LINE 4B - OTHER ADJUSTMENTS: LOSS CONTINGENCY FOR PENDING LITIGATION 3,425,224. 1 1 X 1 X 1 X 1 1 0 1 1 973687 973687 0.01220 52152676 38547038 13605638 0.17110 53126363 38547038 14579325 0.18330 84100 84100 0.00110 84100 84100 0.00110 53210463 38547038 14663425 0.18440 1 906597 11396 15610463 13968281 1642182 X 1 1 1 1 HEBREW HOME FOR AGED DISABLED 302 SILVER AVENUE SAN FRANCISCO CA 94112 WWW.SFCJL.ORG 220000224 X ACUTE PSYCHIATRIC HOSPITAL HEBREW HOME FOR AGED DISABLED 1 0 0 1 X X X X X X X X X 18 1 1 1 1 X HTTPS://SFCJL.ORG/ABOUT-COMMUNITY-BENEFIT.HTM X 1 16 1 HTTPS://SFCJL.ORG/ABOUT-COMMUNITY-BENEFIT.HTM 1 1 50000 1 X 100.000000000000 350.000000000000 X X X 1 1 X X X 1 X HTTPS://SFCJL.ORG/ABOUT-CHARITABLE.HTM X HTTPS://SFCJL.ORG/ABOUT-CHARITABLE.HTM X HTTPS://SFCJL.ORG/ABOUT-CHARITABLE.HTM X X X X X 1 X 0 X X X X 1 X 0 0 HEBREW HOME FOR AGED DISABLED PART V, SECTION B, LINE 5: THE CITY AND COUNTY OF SAN FRANCISCO'S CHNA IS CONDUCTED BY THE HEALTH DEPARTMENT AND OVERSEEN BY THE SAN FRANCISCO HEALTH IMPROVEMENT PARTNERSHIP (SFHIP), A MULTISECTOR COLLABORATION THAT INCLUDES SAN FRANCISCO'S HOSPITALS. THIS CHNA SERVES AS THE COMMON BASIS FOR ALL SAN FRANCISCO'S HOSPITAL CHNAS, INCLUDING OURS. WE HAVE SUPPLEMENTED THE SFHIP CHNA WITH OUR OWN ASSESSMENT OF NEEDS, DUE TO THE FACT THAT WE SERVE A HIGHLY SPECIALIZED POPULATION AND MANY OF OUR PATIENTS LIVE OUTSIDE OF SAN FRANCISCO.TO SUPPLEMENT THE SFHIP CHNA, SFCJL IMPLEMENTED THE FOLLOWING METHODS IN JUNE 2019:(I) REVIEW OF THE LITERATURE PERTAINING TO OLDER ADULTS WITH PSYCHIATRIC DISORDERS. SEVERAL PUBLISHED BOOK AND JOURNAL ARTICLES, AS WELL AS NEWS ARTICLES, SERVED AS SOURCES FOR IDENTIFYING POPULATION NEEDS.(II) KEY INFORMANT INTERVIEWS WITH EXPERTS. IT WAS NOT FEASIBLE FOR US TO GATHER DIRECT INPUT FROM PATIENTS DUE TO THE CHALLENGES INHERENT IN CONDUCTING INTERVIEWS OR FOCUS GROUPS WITH PATIENTS WITH ACUTE MENTAL HEALTH DISORDERS, INCLUDING PATIENT ABILITY TO PROVIDE INFORMED CONSENT AND BE SUFFICIENTLY STABLE, BOTH MEDICALLY AND PSYCHIATRICALLY, TO PARTICIPATE. IN LIEU OF PATIENT INPUT, WE CONDUCTED NINE KEY INFORMANT INTERVIEWS WITH PEOPLE WHO REPRESENT THE BROAD INTERESTS OF OUR POPULATION: FOUR GERIATRIC PSYCHIATRISTS; TWO GERIATRIC PSYCHIATRY HOSPITAL PROGRAM DIRECTORS/ADMINISTRATORS; ONE NURSE MANAGER; ONE RECREATION THERAPIST; AND ONE SOCIAL SERVICES DIRECTOR. SIX OF THE KEY INFORMANTS WERE EXPERTS FROM SFCJL, THREE WERE FROM OTHER INSTITUTIONS WITH REPUTABLE GERIATRIC PSYCHIATRY PROGRAMS, AND ONE WAS AN INDEPENDENT PSYCHIATRY CONSULTANT. COLLECTIVELY, THE INTERVIEW PARTICIPANTS HAVE EXTENSIVE EXPERIENCE AND A LONG HISTORY OF SERVING OLDER ADULTS WITH MENTAL HEALTH DISORDERS ACROSS THE SOCIOECONOMIC SPECTRUM, INCLUDING PEOPLE OF ALL GENDERS AND FROM ALL RACIAL/ETHNIC BACKGROUNDS. DATA FROM THESE INTERVIEWS WAS ANALYZED USING BASIC THEMATIC ANALYSIS TECHNIQUES. HEBREW HOME FOR AGED DISABLED PART V, SECTION B, LINE 6A: SFCJL CONDUCTED ITS MOST RECENT CHNA IN CONJUNCTION WITH SAN FRANCISCO HEALTH PLAN (SFHIP), A MULTISECTOR COLLABORATION THAT INCLUDES THE FOLLOWING SAN FRANCISCO HOSPITALS (OTHER THAN SAN FRANCISCO CAMPUS FOR JEWISH LIVING): CHINESE HOSPITAL; DIGNITY HEALTH--SAINT FRANCIS MEMORIAL HOSPITAL; DIGNITY HEALTH--ST. MARY'S MEDICAL CENTER; KAISER PERMANENTE; SUTTER HEALTH; AND UCSF HEALTH. HEBREW HOME FOR AGED DISABLED PART V, SECTION B, LINE 6B: OTHER NON-HOSPITAL FACILITIES WHO COLLABORATED WITH SFHIP IN DEVELOPING THE MOST RECENT CHNA INCLUDE THE SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH, THE CLINICAL AND TRANSLATIONAL SCIENCE INSTITUTE'S COMMUNITY ENGAGEMENT AND HEALTH POLICY PROGRAM AT UCSF, THE SAN FRANCISCO UNIFIED SCHOOL DISTRICT, THE OFFICE OF THE MAYOR, HUMAN SERVICES NETWORK, CHICANO/LATINO/INDIGENA HEALTH EQUITY COALITION, THE AFRICAN AMERICAN COMMUNITY HEALTH COUNCIL, THE COMMUNITY CLINIC CONSORTIUM, THE HOSPITAL COUNCIL OF NORTHERN CALIFORNIA, AND FAITH-BASED AND OTHER PHILANTHROPIC PARTNERS. HEBREW HOME FOR AGED DISABLED PART V, SECTION B, LINE 11: ACCESS TO HEALTH CARE:TO ADDRESS THE HEALTH NEED OF "ACCESS TO CARE AND SERVICES", SFCJL IS MAKING SIGNIFICANT PROGRESS WITH THE REDEVELOPMENT OF ITS CAMPUS TO SERVE A SIGNIFICANTLY BROADER RANGE AND A MUCH LARGER NUMBER OF THE BAY AREA'S GROWING OLDER ADULT POPULATION (AS WELL AS THEIR FAMILIES AND CAREGIVERS) THAN IT DOES CURRENTLY--EITHER ON ITS CAMPUS OR IN INDIVIDUALS' OWN HOMES AND THE COMMUNITY. SFCJL IS ALSO ACTIVELY INVOLVED IN SAN FRANCISCO'S POST-ACUTE CARE COLLABORATIVE, THE CITY-WIDE ADVISORY BOARD FOR HEALTH CARE WORKING TO DEVELOP COMPREHENSIVE AND ACTIONABLE SOLUTIONS TO THE CITY'S URGENT POST-ACUTE CARE ACCESS AND OTHER CHALLENGES. IN ADDITION TO SFCJL EXPANDING ACCESS TO OUR GENERAL SERVICES, OUR HOSPITAL ALSO ADDRESSES ACCESS BARRIERS. FOR EXAMPLE, ALL PATIENTS ARE DISCHARGED WITH EXTENSIVE RESOURCES FOR CONTINUED SUCCESS IN THE GREATER COMMUNITY, INCLUDING PRE-SET INITIAL PRIMARY CARE AND PSYCHIATRY APPOINTMENTS, AND OTHER APPOINTMENTS AS WARRANTED. WE CONDUCT EDUCATIONAL OUTREACH TO COMMUNITY FACILITIES AND PROGRAMS TO DISPEL THE STIGMA OF PSYCHIATRIC NEED AS WELL AS TO PUT A HUMAN FACE TO THE PROCESS OF INPATIENT PSYCHIATRY. WE MEET WITH PATIENTS AND THEIR FAMILY MEMBERS TO DECREASE THE STIGMA AND MYTHS AROUND INDIVIDUAL PATIENT'S SYMPTOMATOLOGY AND INCREASE SUCCESS WHEN RETURNING TO THE COMMUNITY. TO HELP ADDRESS THE DWINDLING AVAILABILITY OF PROVIDERS SPECIALIZING IN GERIATRIC MENTAL HEALTH, WE SERVE AS A TRAINING SITE FOR FUTURE GERIATRIC PSYCHIATRISTS. EXEMPLIFYING THIS VALUABLE OPPORTUNITY, SFCJL'S GERIATRIC PSYCHIATRY DEPARTMENT AND THE UNIVERSITY OF CALIFORNIA, SAN FRANCISCO'S DEPARTMENT OF PSYCHIATRY CONTINUE THEIR PROGRAM OF TRAINING AND MEDICAL EDUCATION FOR DOCTORS IN THEIR FIFTH YEAR AFTER MEDICAL SCHOOL GRADUATION FULFILL PART OF THEIR SPECIALTY TRAINING IN GERIATRIC MEDICINE AND GERIATRIC PSYCHIATRY. ADDITIONALLY, A FOURTH-YEAR PSYCHIATRIC RESIDENT FROM CPMC BENEFITED FROM A SIX-WEEK TRAINING AT THE CAMPUS'S PSYCHIATRY HOSPITAL. LEARNING OPPORTUNITIES ARE NOT LIMITED TO THE FIELD OF GERIATRIC PSYCHIATRY, HOWEVER. THE EXPERTISE AND EXPERIENCE OF THE ACUTE GERIATRIC PSYCHIATRY HOSPITAL'S STAFF LENDS ITSELF TO THE TRAINING OF STUDENTS (FROM MULTIPLE COMMUNITY AND REGIONAL EDUCATIONAL INSTITUTIONS) IN THE AREAS OF SOCIAL WORK AND RECREATIONAL THERAPY AS WELL. OPPORTUNITIES TO EXPAND SFCJL'S GERIATRIC PSYCHIATRY TRAINING PROGRAM TO OTHER BAY AREA MEDICAL TEACHING INSTITUTIONS CONTINUE TO BE EXPLORED. IN ORDER TO ADDRESS FINANCIAL BARRIERS TO CARE AMONG THIS FRAIL, ELDERLY POPULATION WHO HAVE VERY LITTLE OR NO FINANCIAL RESOURCES, OUR ADMISSIONS POLICY FACILITATES ADMISSION TO THE NEEDIEST, REGARDLESS OF THEIR ABILITY TO PAY. FOR FISCAL YEAR ENDING JUNE 30, 2018, 95% OF OUR LONG-TERM CARE RESIDENTS ARE FINANCIALLY COMPROMISED AND/OR MEDI-CAL RECIPIENTS, OR WITHOUT THE ABILITY TO PAY THE FULL COST OF CARE. SIXTY-NINE PERCENT OF OUR LONG-TERM CARE, SHORT-TERM REHABILITATION, AND ACUTE GERIATRIC PSYCHIATRY PATIENTS FALL INTO THIS CATEGORY.FOOD SECURITY, HEALTHY EATING, AND ACTIVE LIVING; AND HOUSING INSECURITY AND AN END TO HOMELESSNESS:TO ADDRESS THE ABOVE HEALTH NEED, SFCJL SOCIAL SERVICES STAFF CONTINUALLY ASSESS PATIENT NEEDS AROUND FOOD AND HOUSING. ALL HOSPITAL PATIENTS SEE A NUTRITIONIST WITHIN 72 HOURS OF ADMISSION. WE MAINTAIN AN EXTENSIVE DATABASE OF HOUSING OPTIONS IN THE DIFFERENT COUNTIES WE SERVE. OUR TEAM TAILORS INDIVIDUALIZED DISCHARGE PLANS THAT CAN INCREASE SUPPORTS WITHIN THE HOME (E.G., IN-HOME SUPPORTIVE SERVICES, MEAL DELIVERY PROGRAMS). ALTHOUGH ONLY A HANDFUL OF OUR PATIENTS ARE HOMELESS, THESE PATIENTS ARE MORE LIKELY TO RELAPSE; SOCIAL SERVICES STAFF MAKE SPECIAL EFFORT TO CONNECT ALL HOMELESS PATIENTS TO HOUSING AND CASE MANAGEMENT SERVICES TO REDUCE THE CHANCES OF READMISSION. BECAUSE WE MAINTAIN ACTIVE RELATIONSHIPS WITH HOUSING PROVIDERS, WE RARELY HAVE TO DISCHARGE PATIENTS TO SHELTERS OR MOTELS, WHICH IS A SIGNIFICANT ACCOMPLISHMENT IN A REGION WITH SUCH AN ACUTE HOUSING CRISIS. SAFETY FROM VIOLENCE AND TRAUMA:TO ADDRESS THE HEALTH NEED OF "SAFETY FROM VIOLENCE AND TRAUMA", SFCJL PROVIDES A HAVEN TO SUPPORT THESE PATIENTS DURING THEIR CRISIS, STABILIZE THEM, AND TREAT THEIR PSYCHIATRIC SYMPTOMS. PHYSICAL SAFETY IS PROMOTED BY BEING IN A LOCATION WITH OTHER SENIORS, AS OPPOSED TO A GENERAL PSYCHIATRIC UNIT WHERE THEY MAY BE VULNERABLE TO OTHER YOUNGER AND STRONGER PATIENTS' VIOLENT BEHAVIOR. SOCIAL, EMOTIONAL, AND BEHAVIORAL HEALTH:SFCJL PLACES A PARTICULAR EMPHASIS ON BUILDING PATIENT'S CAPACITY FOR RESILIENCE. EACH PATIENT UNDERGOES AN EXTENSIVE NEEDS EVALUATION DURING THEIR STAY. THE TREATMENT TEAM WORKS WITH THE PATIENT TO PLAN FOR CONTINUED SOCIAL AND EMOTIONAL WELL-BEING UPON DISCHARGE, INCLUDING SELF-CARE STRATEGIES AND MAKING LINKAGES TO COMMUNITY-BASED MENTAL HEALTH AND SOCIAL PROGRAMS THAT BEST FIT THEIR NEEDS AND LEVEL OF FUNCTION. TO INSPIRE HEALTHY LIVING, PATIENTS ARE ENCOURAGED TO TAKE PART IN AS MANY GROUPS AS APPROPRIATE TO THEIR MEDICAL/PSYCHIATRIC ISSUES WHILE AT THE HOSPITAL. HEBREW HOME FOR AGED DISABLED PART V, SECTION B, LINE 13B: MEDICAID/MEDICARE, STATE REGULATION 1 1 - HEBREW HOME FOR AGED DISABLED 302 SILVER AVENUE SAN FRANCISCO CA 94112 SKILLED NURSING FACILITY AND REHABILITATION CENTER PART I, LINE 7: A COST TO CHARGE RATIO, AS DETERMINED BY WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS, WAS USED TO CALCULATE THE AMOUNTS REPORTED ON LINE 7A AND 7B. THE COSTING METHODOLOGY USED ON LINE 7H WAS CALCULATED BASED ON ACTUAL COSTS FROM THE ORGANIZATION'S GENERAL LEDGER.THE INFORMATION PRESENT ON SCHEDULE H, PART I, LINE 7 DOES ENCOMPASSS MANY OTHER "NON-HOSPITAL" ACTIVITIES OF THE ORGANIZATION, SUCH AS ITS SKILLED-NURSING FACILITY. PART I, LN 7 COL(F): BAD DEBT EXPENSE IS REPORTED AS A NET ADJUSTMENT TO PATIENT CHARGES AND THEREFORE, IS NOT INCLUDED AS A PART OF TOTAL EXPENSES FROM PART IX, LINE 25, COLUMN A. PART III, LINE 2: UNCOLLECTED RESIDENT ACCOUNTS ARE ANALYZED BASED ON STANDARD PROCEDURES FOR ALL RESIDENT ACCOUNTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE ORGANIZATION ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY).FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE ORGANIZATION RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES, IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.FOR UNINSURED PATIENTS THAT DO NOT QUALIFY FOR CHARITY CARE, THE ORGANIZATION RECOGNIZES REVENUE ON THE BASIS OF ITS STANDARD RATES FOR SERVICES PROVIDED. BASED ON HISTORICAL EXPERIENCE, A SIGNIFICANT PORTION OF THE ORGANIZATION'S UNINSURED PATIENTS WILL BE UNABLE OR UNWILLING TO PAY FOR THE SERVICES PROVIDED. THUS, THE ORGANIZATION RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS RELATED TO UNINSURED PATIENTS IN THE PERIOD THE SERVICES ARE PROVIDED. PART III, LINE 3: COST-TO-CHARGE RATIO METHOD PART III, LINE 4: THE FOOTNOTE IN THE AUDITED FINANCIAL STATEMENTS THAT ADDRESS "PATIENT ACCOUNTS RECEIVABLE, NET", WHICH INCLUDES A DISCUSSION OF "ALLOWANCE FOR DOUBTFUL ACCOUNTS" CAN BE FOUND ON PAGES 10-11 OF THE AUDITED FINANCIAL STATEMENTS; THERE IS NO SEPARATE FOOTNOTE FOR BAD DEBT EXPENSE. PART III, LINE 8: MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST-TO-CHARGE RATIO. THE AMOUNTS REPORTED IN LINES 5, 6, AND 7 COME FROM THE HOSPITAL'S FILED MEDICARE COST REPORT. THE TOTAL REVENUE EQUATES TO MEDICARE PAYMENTS AND THE MEDICARE ALLOWABLE COSTS ARE DETERMINED ON THE MEDICARE COST REPORT THAT UTILIZED COST TO CHARGE RATIOS APPLIED TO COVERED MEDICARE REVENUES. PART III, LINE 9B: PATIENTS WHO ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE MAY REQUEST AND NEGOTIATE THE TERMS OF AN EXTENDED PAYMENT PLAN. IF THE PATIENT AND SFCJL AGREE ON A PAYMENT PLAN, THE PATIENT MUST MAKE REGULAR, TIMELY PAYMENTS. A PATIENT WHO DOES NOT COMPLY WILL BE SENT TO COLLECTIONS, MAY HAVE ADVERSE INFORMATION REPORTED TO A CREDIT AGENCY, AND MAY BE SUBJECT TO A PROPERTY LIEN, EXCLUDING THE PATIENT'S PRIMARY RESIDENCE. HOWEVER, ASSET INFORMATION OBTAINED IN THE CHARITY CARE ELIGIBILITY DETERMINATION PROCESS ARE NOT USED FOR COLLECTION ACTIVITIES. PART VI, LINE 2: THE SFHIP CHNA REPORT DESCRIBES THE PROCESS USED TO PRIORITIZE HEALTH NEEDS. IN SUMMARY, IN OCTOBER 2018, THE SFHIP STEERING COMMITTEE PARTICIPATED IN A STRUCTURED, FACILITATED PROCESS TO IDENTIFY AND PRIORITIZE THE NEEDS BASED ON A REVIEW OF THE CHNA DATA. PRIOR TO THE MEETING, SFHIP IDENTIFIED THE FOLLOWING TWO CRITERIA TO SCREEN AND PRIORITIZE THE HEALTH NEEDS: (I) THE HEALTH NEED IS CONFIRMED BY MORE THAN ONE INDICATOR AND/OR DATA SOURCE, AND (II) THE HEALTH NEED PERFORMS POORLY AGAINST A DEFINED BENCHMARK. THE MEETING WAS FACILITATED USING THE TECHNOLOGY OF PARTICIPATION, A METHOD CREATED BY THE INSTITUTE FOR CULTURAL AFFAIRS THAT INCORPORATES "AN INTEGRATED SET OF FACILITATION METHODS, TOOLS AND APPROACHES THAT FOSTER AUTHENTIC PARTICIPATION AND MEANINGFUL COLLABORATION." THE PROCESS BEGAN WITH SMALL GROUP DISCUSSIONS OF THE DATA, FOLLOWED BY RE-CONVENING AS A LARGE GROUP TO LIST ALL THE NEEDS IDENTIFIED IN THE SMALL GROUPS, CLUSTER SIMILAR NEEDS TOGETHER, AND NAME EACH CLUSTER. THE RESULT WAS CONSENSUS AROUND FIVE PRIORITY HEALTH NEEDS: 1) ACCESS TO COORDINATED, CULTURALLY AND LINGUISTICALLY APPROPRIATE CARE AND SERVICES; 2) FOOD SECURITY, HEALTHY EATING, AND ACTIVE LIVING; 3) HOUSING SECURITY AND AN END TO HOMELESSNESS; 4) SAFETY FROM VIOLENCE AND TRAUMA; AND 5) SOCIAL, EMOTIONAL, AND BEHAVIORAL HEALTH. A WORKING GROUP OF SFCJL STAFF, INCLUDING AGPH CLINICAL AND ADMINISTRATIVE STAFF, WAS CONVENED IN JUNE 2019 TO CONDUCT OUR SUPPLEMENTAL NEEDS ASSESSMENT, WHICH FOCUSED ON IDENTIFYING THE SPECIFIC NEEDS OF OUR POPULATION WITHIN EACH OF THESE FIVE PRIORITY HEALTH NEEDS. PART VI, LINE 3: A RESIDENT SERVICES COORDINATOR STAFF IS AVAILABLE TO ASSIST RESIDENTS AND/OR THEIR FAMILY MEMBERS OR LEGAL REPRESENTATIVES THROUGH THE PROCESS OF DETERMINING THEIR ELIGIBILITY FOR ALL GOVERNMENT PROGRAMS AND ASSIST THEM IN THE APPLICATION PROCESS. PART VI, LINE 4: IN ADDITION TO SERVING AS A SKILLED NURSING FACILITY, THE ORGANIZATION IS ALSO A LICENSED 13-BED GERO-PSYCHIATRIC INPATIENT UNIT DEVOTED TO PROVIDING BEHAVIORAL HEALTH SERVICES EXCLUSIVELY DESIGNED FOR OLDER ADULTS SUFFERING FROM ACUTE PSYCHIATRIC DISORDERS. ACCORDING TO A RECENTLY PUBLISHED ARTICLE IN US NEWS AND WORLD REPORT, "ONE IN FOUR ADULTS AGES 65 AND OLDER EXPERIENCES A MENTAL HEALTH PROBLEM SUCH AS DEPRESSION, ANXIETY, SCHIZOPHRENIA OR DEMENTIA, ACCORDING TO THE AMERICAN PSYCHOLOGICAL ASSOCIATION. AND PEOPLE 85 AND OLDER HAVE THE HIGHEST SUICIDE RATE OF ANY AGE GROUPACCORDING TO THE NATIONAL COUNCIL ON AGING." IT IS ESTIMATED THAT 5.6 8.0 MILLION U.S ADULTS OVER AGE 65 EXPERIENCED A MENTAL HEALTH DISORDER (INCLUDING SUBSTANCE USE DISORDERS) IN 2010, AND THIS NUMBER IS EXPECTED TO GROW BY 80% BY 2030. A 2015 STUDY USING A NATIONALLY REPRESENTATIVE SAMPLE OF ADULTS AGES 55 AND OLDER FOUND THAT IN THE PRIOR YEAR, 6.77% EXPERIENCED A MOOD DISORDER, 11.39% AN ANXIETY DISORDER, AND 3.75% A SUBSTANCE USE DISORDER. IN ADDITION,14.53% EXPERIENCED A PERSONALITY DISORDER IN THEIR LIFETIME. INSUFFICIENT DATA EXISTS TO DEVELOP A SCIENTIFICALLY SOUND ESTIMATE OF THE SIZE OF OUR TARGET COMMUNITY IN CALIFORNIA. BASED ON NATIONAL DATA, HOWEVER, IT IS SAFE TO SAY THAT THERE ARE AT LEAST 1 MILLION OLDER ADULTS IN OUR STATE WITH MENTAL HEALTH DISORDERS, ALTHOUGH ONLY A SMALL SUBSET OF THOSE WILL EXPERIENCE SYMPTOMS ACUTE ENOUGH TO REQUIRE HOSPITALIZATION.OUR PROGRAM PROVIDES TREATMENT AND FACILITATES RECOVERY FOR ADULTS AGED 55 AND OLDER RESIDING IN CALIFORNIA WITH ACUTE PSYCHIATRIC NEEDS, INCLUDING ANXIETY, DEPRESSION, MOOD OR BEHAVIORAL DISTURBANCES, IMPAIRMENT IN LEVEL OF FUNCTIONING, THOUGHT OR OTHER EMOTIONAL DISTURBANCES, SUICIDALITY, ASSAULTIVE BEHAVIORS DUE TO A PSYCHIATRIC DISORDER, OR WHO ARE A THREAT TO OTHERS. IN 2018, 83% OF OUR PATIENTS WERE ADMITTED AS 5150 OR 5250 (DANGER TO SELF OR OTHERS, OR GRAVE DISABILITY), 15% WERE VOLUNTARY ADMISSIONS, AND 2% WERE UNDER CONSERVATORSHIP. OUR GOAL IS TO STABILIZE PATIENTS AND PROVIDE THEM WITH THE TOOLS AND RESOURCES TO BE ABLE TO RETURN TO COMMUNITY-BASED LIVING.AS WE ARE ONE OF THE ONLY FACILITIES OF ITS KIND IN THE REGION, OUR PATIENTS COME FROM ALL OVER NORTHERN AND CENTRAL CALIFORNIA. IN 2018, WE ADMITTED 170 PATIENTS FROM 18 COUNTIES. WE ACCEPT ELIGIBLE PATIENTS OF ALL RACIAL/ETHNIC IDENTITIES AND GENDERS. THE MOST COMMON PSYCHIATRIC DIAGNOSES OF OUR PATIENTS ARE MAJOR DEPRESSIVE DISORDER (63% IN 2018), ANXIETY (25%), AND BIPOLAR DISORDER (20%). OTHER DISORDERS INCLUDE SCHIZOPHRENIA, SCHIZOAFFECTIVE DISORDER, PSYCHOSIS, SUICIDAL IDEATION, SUICIDE ATTEMPT, PANIC DISORDER, POSTTRAUMATIC STRESS DISORDER (PTSD), AND OBSESSIVE COMPULSIVE DISORDER (OCD). IN ADDITION TO HAVING PSYCHIATRIC NEEDS, OUR PATIENTS ARE ALSO COPING WITH THE TRADITIONAL DISEASES OF AGING, INCLUDING HYPERTENSION (44% IN 2018), CARDIOVASCULAR DISEASE (27%), DEMENTIA AND RELATED ILLNESS (25%), TYPE 2 DIABETES (19%), ATHEROSCLEROSIS (16%), COPD (14%), AND OSTEOARTHRITIS (8%). PART VI, LINE 5: A COMMITMENT TO EXCELLENCE IN SERVICE TO OTHERS AND PROVIDING EXCEPTIONAL CARE TO FRAIL VULNERABLE SENIORS, INCLUDING CHARITABLE SUPPORT, IS SFCJL'S FOUNDING FOCUS AND REMAINS KEY TO ITS MISSION--TO ENHANCE AND ENRICH OLDER ADULTS' QUALITY OF LIFE. AS SUCH, SFCJL DEDICATES SUBSTANTIAL RESOURCES TO SERVICES, TRAINING, RESEARCH, AND OTHER ACTIVITIES THAT BENEFIT THE LARGER COMMUNITY OF OLDER ADULTS IN THE BAY AREA. MANY OF THESE RESOURCES HELP TO ADDRESS SOME OF THE NEEDS IDENTIFIED IN ITS MOST RECENTLY COMPLETED CHNA. FOR EXAMPLE, WE ARE IN THE PROCESS OF EXPANDING OUR CAMPUS TO CREATE THE NONRESIDENTIAL, MEMBERSHIP-BASED, COMMUNITY-WIDE BYER SQUARE, THE ORGANIZATION'S FORTHCOMING NEW HUB OF WELLNESS AND ACTIVITY. WE ARE BROADENING THE CONTINUUM OF LIVING OPTIONS, OFFERING INDEPENDENT LIVING, ASSISTED LIVING, AND MEMORY CARE AND SUPPORT FOR THE SURGING POPULATION OF SENIORS, AS WELL AS DEVELOPING SENIOR-ORIENTED SERVICES THAT WILL ADDRESS THIS COHORT'S CHANGING AND UNMET NEEDS. THIS EXPANSION IS DESIGNED TO BENEFIT THE ENTIRE BAY AREA COMMUNITY. OUR EXTENSIVE AND CLOSE PARTNERSHIPS WITH NUMEROUS ORGANIZATIONS HAVE ALLOWED US TO HELP SHAPE AND EXPAND THE RESOURCES AND SERVICE NETWORKS THAT ARE SO CRITICAL FOR THE HEALTH AND WELL-BEING OF SENIORS. IN ADDITION, SINCE 2012, SFCJL HAS SERVED AS A TRAINING SITE FOR FUTURE GERIATRIC PSYCHIATRISTS AND PROVIDES CLINICAL TRAINING AND INTERNSHIP OPPORTUNITIES TO MITIGATE THE CURRENT AND FUTURE PROVIDER SHORTAGES.IN ADDITION, THE ORGANIZATION IS FORTUNATE TO BE CO-LOCATED WITH NUMEROUS CLINICAL AND SUPPORT SERVICES ON OUR NINE ACRE CAMPUS. PATIENTS HAVE ACCESS TO PAIN MANAGEMENT SERVICES, CARE PLANNING, DENTAL CARE, PHARMACY, OPTOMETRY, AUDIOLOGY, PHYSICAL REHABILITATION, OCCUPATIONAL THERAPY, NUTRITION COUNSELING (ALL SFCJL PATIENTS SEE A DIETICIAN WITHIN 72 HOURS OF ADMISSION), AND A HOST OF SOCIAL, SPIRITUAL, AND ENRICHMENT OPPORTUNITIES. ALL THESE SERVICES HELP TO SOCIALIZE PATIENTS AND REDUCE THEIR SENSE OF ISOLATION. WE ALSO OFFER INDIVIDUALIZED PATIENT EDUCATION AND SKILLSBASED GROUPS TO STRENGTHEN PATIENTS' COPING SKILLS IN PREPARATION FOR SUCCESSFUL POST-DISCHARGE COMMUNITY LIVING. PART VI, LINE 7, REPORTS FILED WITH STATES CA 0 1 0 0 0 0 0 0 0 DANIEL RUTH PRESIDENT AND CEO 0 690389 0 0 0 70476 0 99977 0 10021 0 870863 0 0 VICTOR MEINKE CHIEF FINANCIAL OFFICER 0 280712 0 30550 0 0 0 8250 0 6502 0 326014 0 0 MARK FRIEDLANDER EXECUTIVE DIRECTOR 181071 0 16787 0 0 0 5470 0 6474 0 209802 0 0 0 SHERIE KOSHOVER CHIEF ADVANCEMENT OFFICER 0 232513 0 25289 0 28739 0 39445 0 990 0 326976 0 0 MICHAEL SKAFF CHIEF OPERATING OFFICER 0 315746 0 35913 0 0 0 8250 0 10312 0 370221 0 0 ELLIOTT STEIN MEDICAL DIRECTOR, APU 220779 0 0 0 0 0 0 0 872 0 221651 0 0 0 MARIO LEMAY DIRECTOR OF UTILIZATION MANAGEMENT 171495 0 15946 0 0 0 5195 0 6474 0 199110 0 0 0 STEPHEN T HALL ASSOCIATE MEDICAL DIRECTOR 174389 0 0 0 0 0 0 0 15920 0 190309 0 0 0 JAN REICHER EXECUTIVE DIRECTOR, BYER SQUARE 81652 88200 12197 0 0 0 2483 2681 367 367 96699 91248 0 0 ROEL PAROCHA LICENSED VOCATIONAL NURSE 167836 0 0 0 0 0 0 0 7236 0 175072 0 0 0 MATTHEW POWONDRA RCFE ADMINISTRATOR 137233 0 13132 0 0 0 130 0 17598 0 168093 0 0 0 PART I, LINE 3 THE ORGANIZATION RELIED ON A RELATED ORGANIZATION TO ESTABLISH THE COMPENSATION AND BENEFITS OF THE TOP MANAGEMENT OFFICIAL, WHICH UTILIZED THE FOLLOWING METHODS: INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINE 4B DURING THE 2018 CALENDAR YEAR, A RELATED ORGANIZATION CONTRIBUTED THE FOLLOWING AMOUNTS TO THE FOLLOWING INDIVIDUALS' SUPPLEMENTAL 457(F) RETIREMENT PLAN, WHICH HAS BEEN REPORTED AS "DEFERRED COMPENSATION" ON SCHEDULE J, PART II, COLUMN (C): DANIEL RUTH - $91,729 SHERIE KOSHOVER - $31,874 ADDITIONALLY, VICTOR MEINKE PARTICIPATED IN THE RELATED ORGANIZATION'S SUPPLEMENTAL 457(F) RETIREMENT PLAN, BUT RECEIVED NO CALENDAR YEAR 2018 EMPLOYER CONTRIBUTIONS TO THE PLAN. A CALIFORNIA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY 680164610 13080SPQ1 2016-11-29 142815660 CONSTRUCTION OF TWO NEW RESIDENTIAL CARE FACILITY BUILDINGS 0 0 0 A 142815660 2999973 9116709 1960461 7211174 12549544 44895835 64081964 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 1 0 0 0 1 A 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: CALIFORNIA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 12/06/2019 DANIEL RUTH PRESIDENT & CEO PART V X 800000 800000 0 1 1 800000 SCHEDULE L, PART II, COLUMN C COMPENSATION PACKAGE X 2 41000 APPRAISED VALUE X 705 FAIR MARKET VALUE X 8799 FAIR MARKET VALUE X 1 600 APPRAISED VALUE X 4 919 COST OF DONATED PROPERTY X ENTERTAINMENT PACKAGE 6 6266 FAIR MARKET VALUE X MUSICAL INSTRUMENTS 1 5000 FAIR MARKET VALUE X EXERCISE EQUIPMENT 1 2800 FAIR MARKET VALUE X SPA TREATMENT 1 1500 FAIR MARKET VALUE X WINE AND SPIRITS 2 1200 COST OF DONATED PROP X ELECTRONICS 5 1150 FAIR MARKET VALUE X GIFT CERTIFICATES 8 750 COST OF DONATED PROP 2 0 1 0 PART I, COLUMN (B): THE ORGANIZATION IS REPORTING THE NUMBER OF CONTRIBUTIONS IN SCHEDULE M, PART I, COLUMN (B). FORM 990, PART VI, SECTION B, LINE 11B A COMPLETE COPY OF THE FORM 990 IS PROVIDED TO ALL MEMBERS OF THE BOARD OF TRUSTEES PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. MANAGEMENT OF THE ORGANIZATION REVIEWS THE COMPLETED FORM 990 AND FOLLOWS UP WITH THE TAX RETURN PREPARATION FIRM TO ANSWER ANY QUESTIONS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REGULARLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. EACH PERSON WHO IS DEEMED TO HAVE SUBSTANTIAL INFLUENCE OVER THE ORGANIZATION (INCLUDING TRUSTEES, OFFICERS, AND KEY EMPLOYEES) SIGNS AN ANNUAL DISCLOSURE STATEMENT WHICH AFFIRMS THAT THE PERSON HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY, HAS READ AND UNDERSTOOD THE POLICY, AND HAS AGREED TO COMPLY WITH THE POLICY, AND DISCLOSES ANY DIRECT OR INDIRECT AFFILIATIONS. ALL ANNUAL DISCLOSURE STATEMENTS ARE SUBMITTED TO THE SECRETARY. EACH EMPLOYEE DISCLOSES TO THE CHIEF EXECUTIVE OFFICER ALL MATERIAL FACTS REGARDING THE AFFILIATION OF SUCH EMPLOYEE WITH ANY PERSON WITH WHOM THE ORGANIZATION IS CONSIDERING ENTERING A TRANSACTION; THE CHIEF EXECUTIVE OFFICER THEN DETERMINES WHETHER A CONFLICT OF INTEREST EXISTS FOR THESE EMPLOYEES. THE CHIEF EXECUTIVE OFFICER AND ANY OTHER PERSON WITH SUBSTANTIAL INFLUENCE OVER THE ORGANIZATION SHALL DISCLOSE TO THE BOARD ALL MATERIAL FACTS REGARDING HIS OR HER AFFILIATION WITH ANY PERSON WITH WHOM THE JEWISH HOME IS CONSIDERING ENTERING A TRANSACTION; THE BOARD THEN DETERMINES IF A CONFLICT OF INTEREST EXISTS FOR THE CHIEF EXECUTIVE OFFICER OR PERSON WITH SUBSTANTIAL INFLUENCE OVER THE ORGANIZATION. IF A BOARD MEMBER IS THE INDIVIDUAL WITH WHICH A CONFLICT OF INTEREST IS BEING DETERMINED, THE BOARD MEMBER IS NOT ALLOWED TO VOTE ON THE MATTER. FORM 990, PART VI, SECTION B, LINE 15B THE CHIEF EXECUTIVE OFFICER IS COMPENSATED BY JEWISH SENIOR LIVING GROUP, A RELATED ORGANIZATION. AS SUCH, PART VI, SECTION B, LINE 15A HAS BEEN MARKED "NO", AS MANDATED BY THE FORM 990 INSTRUCTIONS. PLEASE REFERENCE THE DISCLOSURE SCHEDULE J, PART III INCLUDED IN THIS FORM 990 OR PART VI, SECTION B, LINE 15A IN JEWISH SENIOR LIVING GROUP'S FORM 990 FOR A DISCUSSION ON HOW JEWISH SENIOR LIVING GROUP DETERMINES COMPENSATION FOR THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER. THE CHIEF EXECUTIVE OFFICER REVIEWS AND APPROVES THE ANNUAL COMPENSATION FOR THE OTHER EXECUTIVE TEAM MEMBERS BASED ON VARIOUS FACTORS, INCLUDING DATA COLLECTED FROM AN INDEPENDENT COMPENSATION CONSULTANT (DEPENDING ON POSITION) WHO UTILIZES COMPENSATION DATA OBTAINED FROM SURVEYS, ANNUAL COMPENSATION SURVEYS, PERFORMANCE APPRAISALS, AND OTHER NON-PROFIT RESOURCES FOR SIMILAR ORGANIZATIONS. THE BOARD OF TRUSTEES APPROVES THE ANNUAL BUDGET THAT INCLUDES COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON WRITTEN OR ORAL REQUEST. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE UPON REQUEST. 990, PART VII, SECTION A: HOURS FOR DANIEL RUTH, VICTOR MEINKE, SHERRIE KOSHOVER, MICHAEL SKAFF, AND ELLIOT STEIN APPEAR LOW AS THESE INDIVIDUALS DEVOTE A PORTION OF THEIR TIME TO AFFILIATED ORGANIZATIONS NOT RELATED (BY FORM 990 DEFINITIONS) TO THE HEBREW HOME FOR AGED DISABLED. FORM 990, PART IX, LINE 11G OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 187,638. MANAGEMENT AND GENERAL EXPENSES 125,342. FUNDRAISING EXPENSES 2,616. TOTAL EXPENSES 315,596. CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 7,950,832. MANAGEMENT AND GENERAL EXPENSES 7,515,640. FUNDRAISING EXPENSES 27,112. TOTAL EXPENSES 15,493,584. FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF SPLIT INTEREST AGREEMENTS -162,422. CHANGE IN BENEFICIAL INTEREST IN JHSLF -1,019,882. JEWISH SENIOR LIVING GROUP 302 SILVER AVENUE SAN FRANCISCO CA 94112 800291740 SEE PART VII CA 501(C)(3) LINE 12A, I N/A 0 BAY AREA JEWISH SENIOR LIFE 302 SILVER AVENUE SAN FRANCISCO CA 94112 455092344 SEE PART VII CA 501(C)(3) LINE 12A, I JEWISH SENIOR LIVING GROUP 0 CHARITABLE REMAINDER TRUSTS (3) HOLDING CO CA N/A 1 0 0 0 0 1 0 0 0 0 1 0 0 1 1 1 0 1 0 0 PART II, COLUMN (B) JEWISH SENIOR LIVING GROUP PRIMARY ACTIVITY: TO PROMOTE THE PROVISION OF JEWISH LIVING SERVICES, FACILITIES AND AGING SERVICES IN NORTHERN CALIFORNIA BY PROVIDING SERVICES DESIGNED TO ASSIST THE SUPPORTED CHARITIES IN THEIR OWN OPERATIONS AND ASSIST WITH DEVELOPING NEW SERVICES AND FACILITIES IN THE AFFILIATED NETWORK. PART II, COLUMN (B) BAY AREA JEWISH SENIOR LIFE PRIMARY ACTIVITY: TO ASSIST THE SUPPORTED CHARITIES IN THEIR OWN OPERATIONS AND ASSIST WITH DEVELOPING NEW SERVICES AND FACILITIES IN THE AFFILIATED NETWORK.