2019-06-14T16:53:51-05:00 2018-12-31 410746749 CLIFTONLARSONALLEN LLP 370 INTERLOCKEN BLVD SUITE 500 BROOMFIELD CO 80021 990 2018-01-01 742376546 SHALOM PARK SHAL 3036805000 14800 EAST BELLEVIEW DRIVE AURORA CO 800152258 MARC PENNER PRESIDENT/CEO 3036805000 2019-06-08 1 KURT BENNION P01469618 3034668822 2019-06-08 67.137.57.251 2019-06-08 14:36:40 PD P 6536C806F53B74C078C7EC9B2427BCB239CA21E7 5FDBAA4BB10DC37B886353302A6A7E613F599072 2018 2019-02-21 02:37:17Z SHALOM CARES MARC PENNER 14800 EAST BELLEVIEW DRIVE AURORA CO 800152258 23042560 0 X WWW.SHALOMPARK.ORG X 1984 CO DELIVERY AND INNOVATION OF COMMUNITY AND RESIDENTIAL HEALTH AND SOCIAL SERVICES. 18 17 486 157 0 0 0 9427314 13162703 13433948 11485787 110846 10498 2250 24658988 22974358 5636 3747 0 0 8349717 8362333 0 0 257221 6810907 6137736 15166260 14503816 9492728 8470542 8961154 11204739 8898835 2671878 62319 8532861 SHALOM PARK OPERATES A NURSING CARE FACILITY AND CENTER FOR CARE OF THE AGED. IT PROVIDES HEALTH CARE AND OTHER RELATED SERVICES TO RESIDENTS THROUGH THE OPERATION OF A MULTI-LEVEL SKILLED NURSING FACILITY. 0 0 12656065 3747 13431153 SHALOM PARK OPERATES A NURSING HOME. DURING 2018, THE ORGANIZATION PROVIDED CARE FOR 255 PATIENTS. 12656065 1 1 0 0 0 0 0 0 1 1 1 0 0 0 0 1 0 1 0 0 0 0 0 0 1 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 0 486 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 18 17 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 0 0 X MARC PENNER 3036805000 14800 E BELLEVIEW DRIVE AURORA CO 800152258 MICHAEL STREAR CHAIR & PAST CHAIR 10.00 1.00 X X 0 0 0 ANDY HEINS CHAIR-ELECT & CHAIR 10.00 1.00 X X 0 0 0 GARY YOURTZ VICE CHAIR & DIRECTOR 5.00 1.00 X X 0 0 0 BRUCE BENDELL TREASURER & VICE CHAIR 5.00 1.00 X X 0 0 0 LISA COOK SECRETARY, TREASURER & DIRECTOR 5.00 1.00 X X 0 0 0 NEIL OBERFELD DIRECTOR & TREASURER 5.00 0.00 X X 0 0 0 ELISA ROBYN DIRECTOR & SECRETARY 5.00 1.00 X X 0 0 0 JOE BORUS DIRECTOR (THROUGH JUNE 2018) 1.00 0.00 X 0 0 0 ROBIN CHOTIN DIRECTOR 1.00 0.00 X 0 0 0 KEN FEILER DIRECTOR 1.00 0.00 X 0 0 0 JAN FISHER DIRECTOR 1.00 0.00 X 0 0 0 SUSY GRAZI DIRECTOR 1.00 0.00 X 0 0 0 ANDY MILLER DIRECTOR 1.00 0.00 X 0 0 0 JAY MOSKOWITZ DIRECTOR 1.00 0.00 X 0 0 0 STUART PACK DIRECTOR 1.00 0.00 X 0 0 0 MELINDA QUIAT DIRECTOR 1.00 0.00 X 0 0 0 JARED SEIDENBERG DIRECTOR 1.00 0.00 X 0 0 0 SAM ZAITZ DIRECTOR 1.00 0.00 X 0 0 0 MARC PENNER PRESIDENT/CEO 26.00 14.00 X X 277177 0 24783 RUTH MINNEMA DIRECTOR OF NURSING 40.00 0.00 X 144914 0 10335 BETH IRTZ ADMINISTRATOR 40.00 0.00 X 118963 0 10193 DENISE BILYEU DIRECTOR OF HUMAN RESOURCES 40.00 0.00 X 100289 0 14946 641343 0 60257 4 0 1 0 HAYNES MECHANICAL SYSTEMS 5700 S QUEBEC ST 210 GREENWOOD VILLAGE CO 80111 MECH. MAINTENANCE & UPGRADES 1770734 MORRISON MANAGEMENT SPECIALIST PO BOX 102289 ATLANTA GA 30368 DIETARY SERVICES 1323259 PREMERE REHAB LLC 25117 SW PARKWAY SUITE D WILSONVILLE OR 97070 THERAPY SERVICES 497597 EKS&H LLLP 8181 E TUFTS AVENUE SUITE 600 DENVER CO 80237 IT CONSULTING, AUDIT & TAX SERVICES 284968 MERIT ELECTRIC 2590 MIDPOINT DRIVE FORT COLLINS CO 80525 ELECTRIC PROJECTS & REPAIRS 179733 6 429613 8770701 227000 9427314 RESIDENT FEES 623000 13335115 13335115 ANCILLARY SERVICES 623000 98833 98833 13433948 846 846 110000 0 110000 110000 110000 33875 429613 68202 -34327 -34327 MISCELLANEOUS INCOME 900099 36577 36577 36577 22974358 13433948 0 113096 X 3747 3747 297682 148841 148841 7074475 6473439 540932 60104 420366 392248 25306 2812 569810 508794 54914 6102 18452 18452 1976 1976 1981188 1782417 198545 226 33331 29998 3333 149328 119462 14933 14933 110940 46404 58237 6299 521263 413772 105999 1492 93545 51546 38157 3842 57996 46397 11599 978961 810364 168597 329365 266683 58923 3759 PROGRAM SUPPLIES 864471 797806 62997 3668 FOOD 587278 587278 REPAIRS AND MAINTENANCE 220990 184739 36251 OTHER EXPENSES 107006 89323 15873 1810 81646 81646 14503816 12656065 1590530 257221 19091 1060343 22657 1192417 906074 170175 174705 25240972 16545229 7536483 8695743 42988 345217 8961154 11204739 915959 1558255 26700 33933 31787 856288 1055136 7092655 0 8898835 2671878 X 62319 8532861 62319 8532861 8961154 11204739 8470542 0 X 0 1 X 1 0 X 9427314 9427314 15002605 14521319 14158601 13162703 13433948 70279176 15002605 14521319 14158601 13162703 22861262 79706490 0 0 0 79706490 846 846 846 846 3504 4541 19298 10498 70452 108293 15006109 14525860 14177899 13173201 22932560 79815629 0.99860 0.99940 0.00000 0.00000 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER INCOME FUNDRAISING EVENT REVENUES 0 1 X 2898466 249998 -196966 2951498 2878912 318110 298556 2898466 2767682 125 156417 45312 2878912 2880924 400 -64937 48705 2767682 2860581 525 70854 51036 2880924 0.00000 0.80320 0.19680 1 1 1 2561563 2561563 16413049 12583547 3829502 1730614 1640085 90529 4057818 2321597 1736221 477928 477928 8695743 X 15782982 12125 12125 15770857 7203501 7203501 22974358 14515941 12125 12125 14503816 0 14503816 PART IV, LINE 2B: SHALOM PARK HOLDS RESIDENT FUNDS IN TRUST FOR THEIR SECURITY. RESIDENTS MAY ACCESS THEIR FUNDS DURING NORMAL BUSINESS HOURS BY MAKING A REQUEST AT THE BUSINESS OFFICE. THE FUNDS ARE HELD IN A SEPARATE INTEREST-BEARING ACCOUNT. THE INTEREST IS GIVEN TO THE RESIDENTS. PART V, LINE 4: BETH ISRAEL FOUNDATION FOR THE AGED, A RELATED ORGANIZATION, HOLDS ASSETS IN ENDOWMENT FUNDS. THE ENDOWMENTS CONSIST OF VARIOUS INDIVIDUAL FUNDS ESTABLISHED FOR A VARIETY OF PURPOSES. PART X, LINE 2: SHALOM PARK IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND A SIMILAR PROVISION FOR STATE LAW. HOWEVER, SHALOM PARK IS SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS. PART XI, LINE 4B - OTHER ADJUSTMENTS: GAIN ON DISPOSAL OF PROPERTY AND EQUIPMENT 110,000. INVESTMENT INCOME 846. TRANSFER OF NET ASSETS 7,092,655. ANNUAL DINNER 463488 429613 33875 2797 29606 15737 20062 463488 429613 33875 2797 29606 15737 20062 68202 -34327 X 0 1 X X X 0 0 0 0 0 0 0 1 0 MARC PENNER PRESIDENT/CEO 277177 0 0 0 0 0 4279 0 20504 0 301960 0 0 0 RUTH MINNEMA DIRECTOR OF NURSING 144914 0 0 0 0 0 2784 0 7551 0 155249 0 0 0 PART I, LINE 1A SHALOM PARK MAKES TAX GROSS-UP PAYMENTS ON EMPLOYEE BONUSES. IN 2018, THE FOLLOWING INDIVIDUALS RECEIVED TAX GROSS-UP PAYMENTS: MARC PENNER - $779 ON A BONUS OF $3,500 RUTH MINNEMA - $784 ON A BONUS OF $2,000 DENISE BILYEU - $1,046 ON A BONUS OF $2,000 BETH IRTZ - $522 ON A RETIREMENT GIFT OF $1,000 AND $2,611 ON A BONUS OF $5,000. PART I, LINE 1B THE ORGANIZATION DOES NOT HAVE A WRITTEN POLICY REGARDING TAX GROSS-UP PAYMENTS, BUT ITS PRACTICE IS THAT ALL EMPLOYEE BONUSES ARE GROSSED UP. PART I, LINE 7 THE MANAGEMENT TEAM RECEIVES HOLIDAY BONUSES THAT ARE DETERMINED AND APPROVED BY THE CEO AND THE BOARD'S FINANCE COMMITTEE. FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE IS COMPOSED OF THE CURRENT OFFICERS, THE PAST CHAIR(S) AND SUCH OTHER MEMBERS AS ARE APPOINTED BY THE CHAIR. THE EXECUTIVE COMMITTEE MAY ACT ON BEHALF OF AND IN PLACE OF THE BOARD BETWEEN REGULAR MEETINGS OF THE BOARD WHEN REASONABLY NECESSARY TO FULFILL THE PURPOSES AND DUTIES OF THE BOARD, AS DETERMINED BY THE CHAIR, AND IS RESPONSIBLE FOR MAKING RECOMMENDATIONS TO THE BOARD OF TRUSTEES AND FOR SUCH OTHER POWERS AS THE BOARD FROM TIME TO TIME MAY PRESCRIBE. ACTIONS OF THE EXECUTIVE COMMITTEE MAY BE OVERRULED OR AMENDED BY LATER ACTION OF THE BOARD, BUT ANY ACTION PROPERLY TAKEN BY THE EXECUTIVE COMMITTEE SHALL BE BINDING UPON THE ORGANIZATION UNTIL SUCH LATER ACTION OF THE BOARD. FORM 990, PART VI, SECTION A, LINE 8B THE FINANCE COMMITTEE AND EXECUTIVE COMMITTEE DO NOT KEEP MINUTES OF THEIR MEETINGS. FORM 990, PART VI, SECTION B, LINE 11B THE CONTROLLER, CEO AND THE FINANCE COMMITTEE REVIEWED THE TAX RETURN WITH THE ORGANIZATION'S AUDITOR AND TAX RETURN PREPARER. THE RETURN WAS THEN PROVIDED TO THE BOARD OF DIRECTORS FOR REVIEW PRIOR TO IT BEING FILED. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY THROUGH AN ANNUAL AFFIRMATION SIGNED BY EACH TRUSTEE. THE ORGANIZATION MONITORS COMPLIANCE WITH THE POLICY DURING THE YEAR BY INQUIRING AT ITS BOARD MEETINGS WHETHER ANY CONFLICTS OF INTEREST HAVE ARISEN SINCE THE ANNUAL AFFIRMATION WAS SIGNED. AN INDIVIDUAL WITH A CONFLICT MAY NOT VOTE ON ANY MATTER THAT MAY INVOLVE THE CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15A THE CHAIR OF THE BOARD OF DIRECTORS APPOINTS A MEMBER OF THE EXECUTIVE COMMITTEE TO ACT AS THE COMPENSATION REPRESENTATIVE FOR THE BOARD. THE COMPENSATION REPRESENTATIVE CONSIDERS SEVERAL FACTORS, SUCH AS THE COMPLEXITY AND DIVERSITY OF RESPONSIBILITIES OF THE CEO'S POSITION (INCLUDING LICENSURE, REGULATION, CERTIFICATION, AND OPERATION OF THE SKILLED NURSING FACILITY); INITIATIVES UNDERTAKEN, IN PROCESS, OR PLANNED; STATUS AND PROGRESS OF THE ORGANIZATION; THE SOCIAL SECURITY ADMINISTRATION COST OF LIVING ADJUSTMENT; THE ASSOCIATION OF JEWISH AGING SERVICE COMPENSATION SURVEY; MANAGEMENT OF MULTIPLE LINES OF BUSINESS; AND THE CONTINUOUS EMPLOYMENT AGREEMENT BETWEEN THE ORGANIZATION AND THE CEO. BASED UPON THESE FACTORS, A MUTUALLY AGREEABLE COMPENSATION AMOUNT IS DETERMINED BY THE COMPENSATION REPRESENTATIVE AND THE CEO. THE COMPENSATION REPRESENTATIVE CONFERS WITH CERTAIN MEMBERS OF THE BOARD FOR APPROVAL OF THE COMPENSATION AGREEMENT. THE ORGANIZATION MAINTAINS THE APPROPRIATE DOCUMENTATION OF THE PROCESS THROUGH WHICH THE COMPENSATION AMOUNT WAS SET. THIS COMPENSATION-SETTING PROCESS IS DONE ON AN ANNUAL BASIS. THE ORGANIZATION DOES NOT HAVE ANY OTHER OFFICERS OR KEY EMPLOYEES; HOWEVER, IT DOES HAVE A PROCESS TO DETERMINE REASONABLE COMPENSATION FOR ITS EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 1,782,417. MANAGEMENT AND GENERAL EXPENSES 198,545. FUNDRAISING EXPENSES 226. TOTAL EXPENSES 1,981,188. BETH ISRAEL FOUNDATION FOR THE AGED 14800 E BELLEVIEW DRIVE AURORA CO 80015 742195249 FUNDRAISING TO SUPPORT SHALOM PARK CO 501(C)(3) LINE 7 SHALOM PARK 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 BETH ISRAEL FOUNDATION FOR THE AGED C 8770701 CASH