2018-05-10T09:58:46-05:00 2017-06-30 410746749 CLIFTONLARSONALLEN LLP 2210 EAST ROUTE 66 GLENDORA CA 91740 990 2016-07-01 710876594 HOLLENBECK PALMS HOLL 3232636195 573 SOUTH BOYLE AVENUE LOS ANGELES CA 90033 MORRIS SHOCKLEY CFO 3232636195 2017-11-03 1 TIMOTHY EVANS P00050546 6268577300 2018-05-04 2016 2022-09-23 18:48:47Z MORRIS SHOCKLEY 573 SOUTH BOYLE AVENUE LOS ANGELES CA 90033 24104525 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 7 224 0 0 0 231151 193524 15989024 14497822 2058337 2386165 149584 234885 18428096 17312396 0 0 0 0 8758822 9035201 1645 0 0 8675943 8402319 17436410 17437520 991686 -125124 87213773 85445937 42428637 40161246 44785136 45284691 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 10527532 14656564 HOLLENBECK PALMS PROVIDES CARE FOR THE AGING, INCLUDING RESIDENTIAL AND SKILLED NURSING CARE LIVING ARRANGEMENTS FOR THEIR MEMBERS. 10527532 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 37 0 1 224 1 0 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 TRACY HIRREL BOARD MEMBER 1.00 X 0 0 0 EDWARD S GARLOCK BOARD MEMBER 1.00 X 0 0 0 BETTY J FOGT BOARD MEMBER 1.00 X 0 0 0 WILLIAM KUMAGAI BOARD MEMBER 1.00 X 0 0 0 DAVID ADAMS BOARD MEMBER 1.00 X 0 0 0 WILLIAM HEIDEMAN PRESIDENT/CEO 40.00 X 265889 0 76388 MORRIS SHOCKLEY ADMINSTR/VP/TREASURER 40.00 X 156479 0 55313 JOHNNY YOUNG CONTROLLER/ASST SECRETARY 40.00 X 114098 0 40242 RAY SHIVELY CHIEF ENGINEER 40.00 X 121149 0 33232 IVANIA RAMIREZ DIRECTOR OF NURSING 40.00 X 107998 0 30440 JOHN M SHIVELY ENGINEER 40.00 X 106066 0 34486 PEGGY L HEIDEMAN ADMISSIONS DIRECTOR 40.00 X 124379 0 34573 996058 0 304674 7 0 1 0 SODEXO AMERICA LLC 600 CITY PARKWAY WEST SUITE 610 ORANGE CA 92868 FOOD SERVICES 1273419 DJMB SERVICES 122 E WALNUT AVENUE MONROVIA CA 91016 MEDICAL 682280 TEAM REHAB INC 6531 SILENT HARBOR DR HUNTINGTON BEACH CA 92648 THERAPY 442803 SKILLED NURSING PHARMACY 16666 E JOHNSON DRIVE CITY OF INDUSTRY CA 91745 PHARMACY 351517 IN FOCUS ADVERTISING 5137 CLARETON DRIVE200 AGOURA HILLS CA 91301 ADVERTISING 227854 8 193524 193524 SKILLED NURSING/RESIDENTIAL 623000 10020881 10020881 MEDICARE/MEDICAID 623000 4476941 4476941 14497822 1162410 1162410 76143 76143 8015884 6792129 1223755 1223755 1223755 OTHER REVENUE 623000 158742 158742 158742 17312396 14656564 0 2462308 682983 682983 5671839 4771279 900560 70921 70921 2109548 1608567 500981 499910 457162 42748 29687 29687 120307 120307 90270 90270 1332149 870232 461917 284260 284260 996812 623202 373610 723693 14141 709552 57481 20147 37334 14013 4478 9535 1437491 91725 1345766 1190453 90228 1100225 220253 220253 VARIOUS MEDICAL EXPENSE 1099771 1099771 FOOD EXPENSES 805679 805679 17437520 10527532 6909988 0 11051272 7599001 832728 1857221 838277 426117 1537450 1194600 156746 158775 187096 216888 52936153 22553064 29209280 30383089 36943651 36564273 6457273 7045973 87213773 85445937 3701247 3235079 3934543 3783783 31180000 28698985 3612847 4443399 42428637 40161246 X 40039070 40129271 3972743 4382097 773323 773323 44785136 45284691 87213773 85445937 X -125124 -46515 671194 X X 0 1 X 1 0 X 1288426 1086911 507524 231151 193524 3307536 16859676 13770443 13874368 15989024 14497822 74991333 18148102 14857354 14381892 16220175 14691346 78298869 0 0 0 78298869 1067915 1087659 1011754 1009371 2462308 6639007 1067915 1087659 1011754 1009371 2462308 6639007 160940 160940 19216017 15945013 15393646 17229546 17314594 85098816 0.92010 0.93960 0.07800 0.06000 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2087491 274039 2361530 2079255 8236 2087491 1995950 83305 2079255 1750909 245041 1995950 1597475 153434 1750909 0.00000 0.32750 0.67250 0 0 32412 32412 46693337 18111111 28582226 6210404 4441953 1768451 30383089 CORPORATE BONDS 3021920 F MORTGAGE-BACKED SECURITIES 652161 F MUNICIPAL BONDS 2235224 F ANNUITY AND LIFE INSURANCE POLICIES 1134837 F OIL INTEREST 1831 F 7045973 ASSIGNED ASSETS, NET 4443399 4443399 X 17175611 -46515 -46515 17222126 90270 90270 17312396 18018444 671194 671194 17347250 90270 90270 17437520 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 671,194. 0 0 0 0 0 0 0 0 0 WILLIAM HEIDEMAN PRESIDENT/CEO 265889 0 0 0 0 0 0 0 76388 0 342277 0 0 0 MORRIS SHOCKLEY ADMINSTR/VP/TREASURER 156479 0 0 0 0 0 0 0 55313 0 211792 0 0 0 JOHNNY YOUNG CONTROLLER/ASST SECRETARY 114098 0 0 0 0 0 0 0 40242 0 154340 0 0 0 RAY SHIVELY CHIEF ENGINEER 121149 0 0 0 0 0 0 0 33232 0 154381 0 0 0 PEGGY L HEIDEMAN ADMISSIONS DIRECTOR 124379 0 0 0 0 0 0 0 34573 0 158952 0 0 0 A CALIFORNIA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY 710876594 13079GAA1 2007-02-01 25300000 NEW CONSTRUCTION 0 0 0 A 0 0 0 1 SCHEDULE K - PURPOSE OF ISSUE DESCRIPTION CALIFORNIA STATE COMMUNITIES DEVELOPMENT AUTHORITY NEW THREE-STORY BUILDING CONSISTING OF RESIDENTIAL UNITS, UNDERGROUND PARKING, AND RELATED FACILITIES. ADDITIONAL CUSIP NUMBERS FOR SERIES A BONDS: 13079GAB9, 13079GAC7, 13079GAD5, 13079GAE3, 13079GAF0, 13079GAG8, 13079GAH6, 13709GAJ2. FORM 990, PART VI, SECTION B, LINE 11B NO REVIEW WAS OR WILL BE CONDUCTED. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST STATEMENTS ARE SIGNED BY TRUSTEES ANNUALLY AND REVIEWED BY MANAGEMENT. FORM 990, PART VI, SECTION B, LINE 15 BOARD OF TRUSTEES DETERMINES COMPENSATION FOR THE TOP OFFICIAL BASED ON COMPARABLE SALARIES IN THE LOCAL AREA. 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 671,194. FORM 990, PART XII, LINE 2C: THE ORGANIZATION DID NOT CHANGE ITS OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE YEAR.