2019-05-14T15:30:29-05:00 2018-06-30 410746749 CLIFTONLARSONALLEN LLP 2210 EAST ROUTE 66 GLENDORA CA 91740 990 2017-07-01 710876594 HOLLENBECK PALMS HOLL 3232636195 573 SOUTH BOYLE AVENUE LOS ANGELES CA 90033 MORRIS SHOCKLEY CFO 3232636195 2019-05-13 1 TIMOTHY EVANS P00050546 6268577300 2019-05-11 67.137.57.251 2019-05-13 09:25:46 PD P F0F62AA6298128500262D125680EAF6D2D38659B C809F280B091A435C58699C8EF0F07C8ABEBABE1 2017 2019-02-21 02:37:17Z MORRIS SHOCKLEY 573 SOUTH BOYLE AVENUE LOS ANGELES CA 90033 26918488 0 X WWW.HOLLENBECKPALMS.COM X 2001 CA HOLLENBECK PALMS IS A CONTINUING CARE RETIREMENT COMMUNITY OFFERING INDEPENDENT LIVING, ASSISTED LIVING, AND SKILLED NURSING FOR INDIVIDUALS IN THEIR LATER YEARS OF LIFE. 7 7 210 0 0 7057 193524 1060732 14497822 13134990 2386165 4369156 234885 201996 17312396 18766874 0 0 0 0 9035201 9230157 0 0 0 8402319 8007479 17437520 17237636 -125124 1529238 85445937 86146302 40161246 40003787 45284691 46142515 X HOLLENBECK PALMS IS COMMITTED TO PROVIDING A RESIDENCE FOR THOSE IN THE LATER YEARS OF THEIR LIVES THAT ENCOMPASSES A HEALTHY ENVIRONMENT OF COMFORT, SAFETY, AND ENJOYMENT; THAT ATTENDS TO THEIR PHYSICAL, MENTAL, AND SPIRITUAL NEEDS; AND THAT IS QUICK TO RESPOND TO AND ASSIST IN THOSE NEEDS WHETHER IMMEDIATE OR LONG TERM, AND TO DO SO WITH GREAT COMPASSION, HONESTY, DIGNITY AND GENUINE LOVE. 0 0 10570246 13293509 HOLLENBECK PALMS PROVIDES CARE FOR THE AGING, INCLUDING RESIDENTIAL AND SKILLED NURSING CARE LIVING ARRANGEMENTS FOR THEIR MEMBERS. DURING THE YEAR, SERVICES WERE PROVIDED TO APPROXIMATELY 200 MEMBERS. 10570246 1 1 0 0 0 0 0 0 0 1 1 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 43 0 210 1 1 1 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 CA X JOHNNY YOUNG 3232636195 573 SOUTH BOYLE AVENUE LOS ANGELES CA 90033 CAROL A JOHNSTON BOARD CHAIR 1.00 X 0 0 0 MICHAEL DAVIS BOARD MEMBER 1.00 X 0 0 0 CASEY ADAMS SECRETARY 1.00 X 0 0 0 EDWARD S GARLOCK BOARD MEMBER 1.00 X 0 0 0 WILLIAM KUMAGAI BOARD MEMBER 1.00 X 0 0 0 ROSAMOND FLORES BOARD MEMBER/RESIDENT REPRESENTATIVE 1.00 X 0 0 0 KATHERINE A KIRCHHOFF BOARD MEMBER 1.00 X 0 0 0 TRACY HIRREL BOARD MEMBER 1.00 X 0 0 0 BETTY FOGT BOARD MEMBER 1.00 X 0 0 0 WILLIAM HEIDEMAN PRESIDENT/CEO 40.00 X 270880 0 66967 MORRIS SHOCKLEY ADMINSTR/VP/TREASURER 40.00 X 181078 0 50470 JOHNNY YOUNG CONTROLLER/ASST SECRETARY 40.00 X 120746 0 36847 RAY SHIVELY CHIEF ENGINEER 40.00 X 122948 0 28462 IVANIA RAMIREZ DIRECTOR OF NURSING 40.00 X 120059 0 23384 JOHN M SHIVELY ENGINEER 40.00 X 107590 0 28907 PEGGY L HEIDEMAN ADMISSIONS DIRECTOR 40.00 X 119926 0 35162 1043227 0 270199 7 0 1 0 SODEXO AMERICA LLC 600 CITY PARKWAY WEST SUITE 610 ORANGE CA 92868 FOOD SERVICES 1134491 DJMB SERVICES 122 E WALNUT AVENUE MONROVIA CA 91016 MEDICAL 666406 DAN CARLONE CONSTRUCTION INC 234 N D ST SAN BERNARDINO CA 92401 CONSTRUCTION 528428 TEAM REHAB INC 6531 SILENT HARBOR DR HUNTINGTON BEACH CA 92648 THERAPY 441161 SKILLED NURSING PHARMACY 16666 E JOHNSON DRIVE CITY OF INDUSTRY CA 91745 PHARMACY 358482 11 1060732 1060732 SKILLED NURSING/RESIDENTIAL 623000 8968678 8968678 MEDICARE/MEDICAID 623000 4166312 4166312 13134990 1235375 1235375 43477 43477 11285395 8151614 3133781 3133781 3133781 OTHER REVENUE 623000 158519 158519 158519 18766874 13293509 0 4412633 769466 769466 5971410 5055960 915450 223726 223726 1733789 1233870 499919 531766 483553 48213 78577 78577 113129 113129 90675 90675 1555232 1098199 457033 223697 223697 928579 534343 394236 765718 12330 753388 46689 18931 27758 13242 6269 6973 1052472 118981 933491 1206338 93658 1112680 242705 242705 VARIOUS MEDICAL EXPENSE 869787 869787 FOOD EXPENSE 820639 820639 17237636 10570246 6667390 0 7599001 5763263 2132348 1818915 426117 109104 1194600 1336145 158775 151472 216888 216663 56481623 22777403 30383089 33704220 36289146 34529757 7045973 8516763 85445937 86146302 3235079 4399771 3783783 3252020 19150985 18449230 9548000 9374000 4443399 4528766 40161246 40003787 X 40129271 40689604 4382097 4679588 773323 773323 45284691 46142515 85445937 86146302 X 1529238 -883327 211913 X X 0 1 X 1 0 X 1086911 507524 231151 193524 241915 2261025 13770443 13874368 15989024 14497822 13134990 71266647 14857354 14381892 16220175 14691346 13376905 73527672 0 0 0 73527672 1087659 1011754 1009371 2462308 4412633 9983725 1087659 1011754 1009371 2462308 4412633 9983725 160940 155536 316476 15945013 15393646 17229546 17314594 17945074 83827873 0.87710 0.92010 0.11910 0.07800 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: ICE CREAM AND GUEST MEALS AND ROOM - 2016 AMOUNT: $ 32,349. 2017 AMOUNT: $ 32,534. BAZAAR - 2016 AMOUNT: $ 26,020. 2017 AMOUNT: $ 9,406. RENT - 2016 AMOUNT: $ 23,449. 2017 AMOUNT: $ 24,116. BEAUTY AND BARBER SHOP - 2016 AMOUNT: $ 47,449. 2017 AMOUNT: $ 54,550. MISCELLANEOUS - 2016 AMOUNT: $ 31,673. 2017 AMOUNT: $ 34,930. 2361530 243430 2604960 2087491 274039 2361530 2079255 8236 2087491 1995950 83305 2079255 1750909 245041 1995950 0.00000 0.29690 0.70310 0 0 32412 32412 50621618 18715281 31906337 5827593 4062122 1765471 33704220 CORPORATE BONDS 3902962 F MORTGAGE-BACKED SECURITIES 1738898 F MUNICIPAL BONDS 1886405 F ANNUITY AND LIFE INSURANCE POLICIES 986667 F OIL INTEREST 1831 F 8516763 ASSIGNED ASSETS, NET 4528766 4528766 X 17792872 -883327 -883327 18676199 90675 90675 18766874 17358874 211913 211913 17146961 90675 90675 17237636 PART V, LINE 4: THE PALMS' ENDOWMENT CONSISTS OF FUNDS ESTABLISHED TO PROVIDE LIFE CARE MEMBERSHIP FOR SENIORS WHOSE LIMITED RESOURCES PREVENT THEIR ENTRY INTO THE PALMS WITHOUT SUCH ASSISTANCE. PART X, LINE 2: HOLLENBECK PALMS HAS EVALUATED ITS TAX POSITIONS AND THE CERTAINTY AS TO WHETHER THOSE POSITIONS WILL BE SUSTAINED IN THE EVENT OF AN AUDIT BY TAXING AUTHORITIES AT THE FEDERAL AND STATE LEVELS. THE PRIMARY TAX POSITIONS EVALUATED ARE RELATED TO THE CONTINUED QUALIFICATION AS A TAX-EXEMPT ORGANIZATION AND WHETHER THERE ARE UNRELATED BUSINESS INCOME ACTIVITIES CONDUCTED THAT WOULD BE TAXABLE. MANAGEMENT HAS DETERMINED THAT ALL INCOME TAX POSITIONS ARE MORE LIKELY THAN NOT (GREATER THAN 50%) OF BEING SUSTAINED UPON POTENTIAL AUDIT OR EXAMINATION; THEREFORE, NO DISCLOSURES OF UNCERTAIN INCOME TAX POSITIONS ARE REQUIRED. PART XII, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN PENSION LIABILITY 211,913. X X X 0 0 0 0 0 0 0 0 0 WILLIAM HEIDEMAN PRESIDENT/CEO 270880 0 0 0 0 0 28093 0 38874 0 337847 0 0 0 MORRIS SHOCKLEY ADMINSTR/VP/TREASURER 181078 0 0 0 0 0 19043 0 31427 0 231548 0 0 0 JOHNNY YOUNG CONTROLLER/ASST SECRETARY 120746 0 0 0 0 0 13115 0 23732 0 157593 0 0 0 RAY SHIVELY CHIEF ENGINEER 122948 0 0 0 0 0 14026 0 14436 0 151410 0 0 0 PEGGY L HEIDEMAN ADMISSIONS DIRECTOR 119926 0 0 0 0 0 14773 0 20389 0 155088 0 0 0 A CALIFORNIA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY 680164610 2016-12-01 20435000 RETIRE SERIES 2007 BONDS 0 0 0 A 1705000 20435000 304908 20130092 2017 1 0 1 1 A 0 0 0 0 0 0 1 A 0 1 0 0 0 0 0 0 1 A 1 FORM 990, PART VI, SECTION A, LINE 1 THE GOVERNING BODY HAS DELEGATED TO THE AUDIT COMMITTEE, CONSISTING OF MIKE DAVIS AND BILL KUMAGAI, THE AUTHORITY TO OVERSEE THE FINANCIAL AND DISCLOSURE PROCESS, MONITOR ACCOUNTING POLICIES, AND THE HIRING AND PERFORMANCE OF THE EXTERNAL AUDITORS. FORM 990, PART VI, SECTION B, LINE 11B NO REVIEW WAS OR WILL BE CONDUCTED. FORM 990, PART VI, SECTION B, LINE 12C MONITORING IS DONE REGULARLY BY THE OFFICERS TO IDENTIFY POTENTIAL CONFLICTS OF INTEREST AS ISSUES ARISE. IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, ANY INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE TRUSTEES. AFTER DISCLOSURE AND DISCUSSION, THE TRUSTEES WILL DETERMINE IF A CONFLICT OF INTEREST EXISTS, AND IF SO, DETERMINE THE PROPER COURSE OF ACTION. FORM 990, PART VI, SECTION B, LINE 15 BOARD OF TRUSTEES DETERMINES COMPENSATION FOR ALL OFFICERS AND KEY EMPLOYEES, BASED ON COMPARABLE SALARIES IN THE LOCAL AREA. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN PENSION LIABILITY 211,913. FORM 990, PART XII, LINE 2C: THE ORGANIZATION DID NOT CHANGE ITS OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE YEAR.