2020-11-13T13:17:34-06:00 2019-12-31 390859910 BAKER TILLY US LLP 1570 FRUITVILLE PIKE SUITE 400 LANCASTER PA 17601 990 2019-01-01 223146725 FELLOWSHIP SENIOR LIVING INC FELL 9085803805 8000 FELLOWSHIP VILLAGE ROAD BASKING RIDGE NJ 07920 MARK F MAZZELLA CFO 9085803805 2020-11-13 1 KERRI N BOGDA CPA P00760402 7177404863 73.101.37.214 2020-11-13 10:43:22 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 F58787FA80410BAE38B710EAF9FCC5760AD3BCDF 2019 2021-01-29 14:40:06Z BRIAN G LAWRENCE 8000 FELLOWSHIP VILLAGE ROAD BASKING RIDGE NJ 07920 49617522 0 X WWW.FELLOWSHIPSENIORLIVING.ORG X 1992 NJ TO SERVE SENIORS OF VARIED BACKGROUNDS THROUGH OUR CHRIST-CENTERED COMMUNITY. 10 10 510 150 -11910 -11910 408980 493010 40438620 40595102 1509240 1333110 2270192 2325419 44627032 44746641 59363 19398 0 0 20507130 22231399 0 0 337701 20607525 22814410 41174018 45065207 3453014 -318566 140929286 178365675 104009109 135967965 36920177 42397710 X TO SERVE SENIORS OF VARIED BACKGROUNDS THROUGH OUR CHRIST-CENTERED COMMUNITY, BRINGING THEM TOGETHER IN MUTUAL RESPECT AND UNITY. WE PROVIDE SENIORS IN NEED WITH THE HIGHEST QUALITY OF SERVICES THAT FOSTER LONG-TERM HEALTH, PERSONAL INDEPENDENCE, SPIRITUAL GROWTH, AND FELLOWSHIP. OUR FOUNDATION IS THE WORD OF GOD, BOTH THE OLD AND NEW TESTAMENTS, WHICH GOVERNS OUR FAITH AND LIFE. 0 0 35075066 19398 40595102 FELLOWSHIP SENIOR LIVING, INC, OPERATING OUT OF BASKING RIDGE, NEW JERSEY, IS A NOT-FOR-PROFIT FAITH BASED PROVIDER OF SENIOR LIVING COMMUNITIES, SERVICES AND PROGRAMS AND EMBODIES A CULTURE OF HOSPITALITY AND EXCELLENCE. WE SERVE SENIORS OF ALL BELIEFS AND BACKGROUNDS WHO WISH TO ENJOY INDEPENDENCE, FELLOWSHIP, COMPASSIONATE CARE AND ACCESS TO A WIDE RANGE OF SERVICES INCLUDING LIFE PLAN COMMUNITY (CONTINUING CARE RETIREMENT COMMUNITY/CCRC), INDEPENDENT LIVING, ASSISTED LIVING, MEMORY CARE, SKILLED NURSING, REHABILITATION, THERAPY AT HOME, FITNESS TRAINING, HOME CARE, CONCIERGE SERVICES, HOSPICE, ON-SITE MEDICAL CENTER, CARE MANAGEMENT AND LONG TERM CARE PLANS.FELLOWSHIP SENIOR LIVING SERVES OVER 400 RESIDENTS AND ON ITS CAMPUS HAS 257 APARTMENTS, VILLAS, COTTAGES, AND FREESTANDING HOMES THAT COMPRISE THE INDEPENDENT LIVING SECTION OF THE COMMUNITY. FELLOWSHIP SENIOR LIVING OFFERS A FULL CONTINUUM OF SERVICES FROM INDEPENDENT LIVING TO RESPITE CARE. FELLOWSHIP HAS 81 ASSISTED LIVING ROOMS WHICH ALSO HAVE A SPECIALIZED MEMORY CARE PROGRAM AND 54 SKILLED NURSING BEDS. RESIDENTS ARE SUPPORTED BY THE REHABILITATION AND WELLNESS CENTER AND MEDICAL CENTER OF THE COMMUNITY. FELLOWSHIP SENIOR LIVING ALSO OFFERS HOME COMMUNITY BASED SERVICES THAT ARE DESIGNED TO DELIVER SERVICES TO SENIORS INSIDE THEIR OWN HOME. FELLOWSHIP SENIOR LIVING OFFERS MORE THAN 30 RESIDENT AND MEMBER DRIVEN CLUBS, ACTIVITIES, AND COMMITTEES FOR THOSE WANTING A MORE ACTIVE LIFESTYLE. 35075066 1 1 0 1 0 0 0 0 1 1 1 0 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 1 0 0 0 1 131 0 510 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 1 0 NJ CA X MARK F MAZZELLA 9085803845 8000 FELLOWSHIP ROAD BASKING RIDGE NJ 07920 BRIAN G LAWRENCE PRESIDENT & CEO 40.00 X 687362 0 99443 MARK F MAZZELLA CHIEF FINANCIAL OFFICER 40.00 X 221319 0 42941 JACK ELLIAS VP HEALTH SERVICES 40.00 X 206014 0 43207 ELIZABETH FANDEL VP HCBS 40.00 X 195045 0 27078 LAURA SHARP DIRECTOR OF CLINICAL OPERATIONS 40.00 X 159895 0 36351 JUDY AMIR CLIENT SERVICES MANAGER 40.00 X 136538 0 23059 VERA ADDY REGISTERED NURSE 40.00 X 148888 0 5211 RAYCHELL MIDDLEBROOKS REGISTERED NURSE 40.00 X 151936 0 0 LEANDRE RABANO DIRECTOR OF IT 40.00 X 131002 0 19963 STANLEY MORIN CPA CHAIRMAN 4.00 X 0 0 0 PAUL ACHENBACH VICE CHAIRMAN 1.00 X 0 0 0 TED HARVEY DIRECTOR 1.00 X 0 0 0 RICK MORLEY DIRECTOR 1.00 X 0 0 0 JEFF ZENNA DIRECTOR 1.00 X 0 0 0 BRIAN KIRKPATRICK DIRECTOR (TERM EXP. MAY '19) 1.00 X 0 0 0 DR ANN MASTERSON DIRECTOR (TERM EXP. MAY '19) 1.00 X 0 0 0 GEORGE FRICKE DIRECTOR 1.00 X 0 0 0 CHARLES MILLER DIRECTOR 1.00 X 0 0 0 JOHN WOODS DIRECTOR 1.00 X 0 0 0 JAMES P HUETHER DIRECTOR 1.00 X 0 0 0 SUZANNE SHUGG DIRECTOR 1.00 X 0 0 0 2037999 0 297253 23 0 1 0 MORRISON SENIOR DINING PO BOX 102289 ATLANTA GA 30268 DINING MGMT FEES 5803658 FLICK CW PO BOX 102289 ATLANTA GA 30268 PLANT OPERATIONS & HOUSEKEEPING MGMT 2187178 PRESIDIO NETWORKED SOLUTIONS INC PO BOX 677638 DALLAS TX 75267 IT SERVICES 568920 KDA ARCHITECTS 227 LAUREL RD VOORHEES NJ 08043 ARCHITECT 386094 LECESSE CONSTRUCTION SERVICES 15 CIRCLE STREET ROCHESTER NY 14607 CONSTRUCTION 351500 22 96680 396330 26316 493010 RESIDENT SERVICES 623000 22897080 22897080 HOME/ COMMUNITY SVCS 623000 8460618 8460618 NON RESIDENT PATIENTS SERVICES 623000 4819055 4819055 MEDICARE PAYMENTS 623000 2694304 2694304 THERAPY 623000 918540 918540 805505 805505 40595102 1179615 -11910 1191525 113372 0 113372 113372 113372 4994669 4827780 13394 166889 -13394 153495 153495 17690 96680 28032 -10342 -10342 3090 1675 1415 1415 CAFETERIA 623000 1094401 1094401 CABLE 623000 364915 364915 SALON 623000 143813 143813 617845 617845 2220974 44746641 40595102 -11910 3670439 19398 19398 983994 766775 217219 17495555 14203720 3144188 147647 319777 259610 60167 1513900 1225873 258051 29976 1918173 1483150 423088 11935 2627447 2047432 580015 195165 2911 192254 223193 223193 922 922 28957 28957 203853 37112 60719 106022 794565 535509 217629 41427 1176091 897601 278490 143824 143824 2406493 2310233 96260 127519 71064 55761 694 385381 289036 96345 8523867 6393463 2130404 420489 403669 16820 FOOD SERVICES 4690854 3655337 1035517 REPAIRS & MAINTENANCE 722592 427711 294881 BAD DEBTS 90912 90912 LICENSES & FEES 52286 45462 6824 45065207 35075066 9652440 337701 2295 2549 3148914 5449684 3858395 4491839 20104 20104 999297 954459 180370088 79239590 87619714 101130498 45192035 62258372 3977241 50055 50055 38477 30874 140929286 178365675 4328479 3781800 21098258 19566018 56614539 87334137 275045 309919 9218331 123150 588218 21569638 15169542 104009109 135967965 X 34821802 40810515 2098375 1587195 36920177 42397710 140929286 178365675 X -318566 4407730 3406168 -2017799 X 0 1 X 1 0 X 278114 270674 237440 408980 493010 1688218 37965258 38625258 38412044 40437564 40595102 196035226 2008554 2011683 2111011 2152508 1984091 10267847 40251926 40907615 40760495 42999052 43072203 207991291 5000 5000 5000 15000 899170 298708 760193 304952 2263023 899170 298708 765193 309952 5000 2278023 205713268 1508859 1463258 1796256 1462913 1304897 7536183 51583 6524 58107 1560442 1469782 1796256 1462913 1304897 7594290 257663 257663 41812368 42377397 42556751 44461965 44634763 215843244 0.95310 0.94820 0.03520 0.03820 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: GROSS FUNDRAISING RECEIPTS - 2019 AMOUNT: $ 17,690. GAMING RECEIPTS - 2019 AMOUNT: $ 3,090. SOLAR REC INCOME - 2019 AMOUNT: $ 119,043. DEFERRED CONTRACT REVENUE - 2019 AMOUNT: $ 117,840. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 922 922 0 PART II-B, LINE 1: FELLOWSHIP SENIOR LIVING (FSL) IS A MEMBER OF NATIONAL LEADINGAGE AND LEADINGAGE NEW JERSEY. FSL PAID COMBINED DUES OF $24,975 TO LEADINGAGE AND LEADINGAGE NJ. THE PORTION OF DUES ALLOCATED TO LOBBYING IS $922. 0 1 X 2098375 410583 362838 1284601 1587195 1960594 432377 -193385 101211 2098375 1637500 279293 158570 114769 1960594 1303233 305775 156090 79211 48387 1637500 1191632 272896 -58500 55406 47389 1303233 0.00000 0.00000 1.00000 0 0 6400000 6400000 142601349 63319075 79282274 28625495 15920515 12704980 2743244 2743244 101130498 REFUNDABLE ADVANCE FEES 15169542 15169542 X 47137322 4407730 -2046756 2360974 44776348 -29707 -29707 44746641 45065957 29707 29707 45036250 28957 28957 45065207 PART IV, LINE 2B: ESCROW IS USED TO HOLD 10% OF LIFECARE ENTRANCE FEE CONTRACT AMOUNTS. THESE AMOUNTS ARE APPLIED TO ENTRANCE FEES THAT ARE DUE WHEN RESIDENTS MOVE INTO FELLOWSHIP VILLAGE. PART V, LINE 4: THE AMOUNTS REPORTED ABOVE ARE ASSETS WITH DONOR RESTRICTIONS. THE ORGANIZATION MAINTAINS FOUR FUNDS FOR THE FOLLOWING USES: CAPITAL FUND, RESIDENT'S BENEVOLENT FUND, COMMUNITY RENEWAL FUND, AND THE LEGACY ENDOWMENT FUND. PART X, LINE 2: FSL ACCOUNTS FOR UNCERTAINTY IN INCOME TAXES USING A RECOGNITION THRESHOLD OF MORE LIKELY THAN NOT TO BE SUSTAINED UPON EXAMINATION BY THE APPROPRIATE TAXING AUTHORITY. MEASUREMENT OF THE TAX UNCERTAINTY OCCURS IF THE RECOGNITION THRESHOLD IS MET. PART XI, LINE 2D - OTHER ADJUSTMENTS: NET CHANGE IN FAIR VALUE OF DERIVATIVE INSTRUMENT -2,168,177. CONTRIBUTED CAPITAL 1,189,415. LOSS ON REFINANCE -1,039,037. INVESTMENT FEES -28,957. PART XI, LINE 4B - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES -28,032. GAMING EXPENSES -1,675. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES 28,032. GAMING EXPENSES 1,675. PART XII, LINE 4B - OTHER ADJUSTMENTS: RESIDENT SUBSIDIES INVESTMENT FEES 28,957. ANNUAL GALA 114370 96680 17690 1540 1625 14445 2200 8222 114370 96680 17690 1540 1625 14445 2200 8222 28032 -10342 X X X X X 0 0 0 0 0 0 0 1 0 BRIAN G LAWRENCE PRESIDENT & CEO 491407 0 70000 0 125955 0 59450 0 39993 0 786805 0 0 0 MARK F MAZZELLA CHIEF FINANCIAL OFFICER 199436 0 21883 0 0 0 8023 0 34918 0 264260 0 0 0 JACK ELLIAS VP HEALTH SERVICES 193764 0 12250 0 0 0 7650 0 35557 0 249221 0 0 0 ELIZABETH FANDEL VP HCBS 183612 0 11433 0 0 0 6989 0 20089 0 222123 0 0 0 LAURA SHARP DIRECTOR OF CLINICAL OPERATIONS 159895 0 0 0 0 0 5749 0 30602 0 196246 0 0 0 JUDY AMIR CLIENT SERVICES MANAGER 136538 0 0 0 0 0 5057 0 18002 0 159597 0 0 0 VERA ADDY REGISTERED NURSE 148888 0 0 0 0 0 5211 0 0 0 154099 0 0 0 RAYCHELL MIDDLEBROOKS REGISTERED NURSE 151936 0 0 0 0 0 0 0 0 0 151936 0 0 0 LEANDRE RABANO DIRECTOR OF IT 131002 0 0 0 0 0 4670 0 15293 0 150965 0 0 0 PART I, LINE 7 BONUSES ARE NON-FIXED PAYMENTS WHICH ARE BASED UPON PERFORMANCE AND ATTAINING GOALS SET DURING THE YEAR. A PUBLIC FINANCE AUTHORITY 273866124 74443UCD3 2019-12-19 80055000 SEE SUPPLEMENTAL INFORMATION 0 0 0 A 85618896 1486117 57924940 28450700 1 0 0 1 A 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 0 A 0 1 0 0 0 0 0 0 0 A 0 SCHEDULE K, PART I, COLUMN F: PROCEEDS OF THE 2019 BOND A INCLUDE A) ADVANCE REFUND OF ALL OF THE OUTSTANDING SERIES 2013 A BONDS IN THE AMOUNT OF $32,027,666 AND 2013 SERIES B BONDS IN THE AMOUNT OF $33,513,092; (B) FINANCING FOR PHASE III OF THE HEALTH CENTER EXPANSION AND RENOVATION PROJECT; (C) PAY ASSOCIATED COSTS WITH THE ISSUANCE OF THE SERIES 2019 BONDS INCLUDING THE TERMINATION OF RELATED RATE SWAP AGREEMENT; AND (D) RECOVER A PORTION OF EQUITY CONTRIBUTIONS AS SPECIFIED UNDER THE 2013 SERIES A AGREEMENT FOR PHASES I AND II. SCHEDULE K, PART III, LINE 9, PART IV, LINE 7, PART V: THE ORGANIZATION IS A PRUDENT AND CONSCIENTIOUS TAXPAYER THAT UNDERSTANDS ITS OBLIGATIONS REGARDING MONITORING THE USES AND INVESTMENT OF BOND ISSUANCE PROCEEDS. THE ORGANIZATION FOLLOWS THE SAFE HARBOR REGULATIONS REGARDING BOND ISSUES AND IS IN THE PROCESS OF ESTABLISHING WRITTEN POLICIES TO FORMALIZE POST-BOND ISSUANCE PROCEDURES. X 1 26316 NYSE 0 0 1 0 PART I, COLUMN (B): THE AMOUNT IN PART I, COLUMN REPRESENTS THE NUMBER OF CONTRIBUTORS. FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION DOES CONTEMPORANEOUSLY DOCUMENT THE MEETINGS OF THE ORGANIZATION'S COMMITTEES, BUT THE COMMITTEES DO NOT HAVE AUTHORITY TO ACT ON BEHALF OF THE ORGANIZATION, AND THEREFORE QUESTION 8B HAS BEEN ANSWERED "NO". FORM 990, PART VI, SECTION B, LINE 11B THE CFO REVIEWS THE DRAFT AND THEN PROVIDES THE DRAFT OF THE RETURN TO ALL BOARD MEMBERS PRIOR TO A SCHEDULED BOARD MEETING. COMMENTS ARE ACCEPTED DURING THIS REVIEW PROCESS. DURING THE BOARD MEETING, THE CHIEF FINANCIAL OFFICER REVIEWS THE FINAL FORM 990 WITH THE BOARD MEMBERS PRIOR TO FILING THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C ALL EMPLOYEES ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE AT THE BEGINNING OF THEIR EMPLOYMENT. THE BOARD OF DIRECTORS SUBMIT A CONFLICT OF INTEREST FORM ANNUALLY. THE CFO AND CEO OF FELLOWSHIP SENIOR LIVING, INC. REVIEW TRANSACTIONS PERFORMED BY THE BOARD, OFFICERS, AND KEY EMPLOYEES FOR A CONFLICT OF INTEREST ON AN ONGOING BASIS. IF THERE IS A CONFLICT AT THE BOARD LEVEL THAT INDVIDUAL WOULD ABSTAIN FROM VOTING. FAMILY AND BUSINESS RELATIONSHIPS ARE EXPRESSLY MENTIONED IN THE POLICY. THE HUMAN RESOURCES DEPARTMENT REVIEWS AND RETAINS THE FORMS AND NOTIFIES SENIOR MANAGMENT OR THE BOARD IF ANY CONFLICTS EXIST. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION COMMITTEE REVIEWS COMPENSATION FOR THE CEO BY COMPARING TO OTHER CEOS IN THE CCRC AND HEALTHCARE INDUSTRY THAT ARE IN THE LOCAL REGION. THE COMPENSATION COMMITTEE RECOMMENDS TO THE WHOLE BOARD THE CEO SALARY INCREASES FOR FULL BOARD APPROVAL. THE CEO AND HUMAN RESOURCES REVIEW COMPENSATION FOR THE OTHER OFFICERS AND KEY EMPLOYEES. THE ORGANIZATION USES COMPARATIVE DATA FOR THE INDUSTRY AND REGION FROM AN OUTSIDE PROFESSIONAL SOURCE FOR DETERMINING COMPENSATION TO ENSURE COMPENSATION IS IN LINE WITH FAIR MARKET VALUE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES THE REQUESTED INFORMATION AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: NET CHANGE IN THE FAIR VALUE OF DERIVATIVE INSTRUMENT -2,168,177. CONTRIBUTED CAPITAL 1,189,415. LOSS ON REFINANCING -1,039,037. FELLOWSHIP FOUNDATION INC 8000 FELLOWSHIP VILLAGE ROAD BASKING RIDGE NJ 07920 842975643 FUNDRAISING NJ 501(C)(3) LINE 7 N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0