2017-09-28T11:23:09-05:00 2016-12-31 410746749 CLIFTONLARSONALLEN LLP 610 W GERMANTOWN PIKE STE 400 PLYMOUTH MEETING PA 19462 990 2016-01-01 521761391 KESWICK PINES INC KESW 7328490400 509 ROUTE 530 WHITING NJ 08759 GEORGINA BAVAIS CHIEF FINANCIAL OFFICER 7328490400 2017-09-27 1 SETH BRODY CPA P01586423 2156433900 67.137.57.251 2017-09-27 11:34:30 ED P 99C95A981D0D28C6F98C4015289DF6597996F4F5 A78F1062FA74E90C671D16910DB17AD2D08C9BAB 2016 2021-01-29 14:40:06Z THE PINES AT WHITING ERIC GHAUL 509 ROUTE 530 WHITING NJ 08759 18741143 0 X WWW.THEPINESATWHITING.ORG X 1989 NJ SERVES THE ELDERLY THROUGH APARTMENT LIVING, ASSITED LIVING, AND NURSING HOME CARE. 10 10 378 85 0 0 164667 100137 16708903 16976991 134683 252305 556563 570743 17564816 17900176 22600 18110 0 0 8619310 9005222 0 0 0 7126589 6943191 15768499 15966523 1796317 1933653 29294445 28562964 38935945 36137797 -9641500 -7574833 X GUIDED BY CHRISTIAN PRINCIPLES, THE PINES AT WHITING SEEKS TO BUILD A CARING AND RESPECTFUL COMMUNITY OF TRUSTEES, RESIDENTS AND STAFF THAT SERVES THE PHYSICAL, SOCIAL, EMOTIONAL AND SPIRITUAL NEEDS OF SENIOR ADULTS THROUGH RESIDENTIAL LIVING AND HEALTH CARE. 0 0 13970700 18110 17534611 THE PINES AT WHITING OFFERS INDEPENDENT LIVING APARTMENTS WITH 24 HOUR EMERGENCY CALL SERVICE AND HOME CARE SUPPORTIVE SERVICES AS WELL AS HEALTH CARE SERVICES INCLUDING: ASSISTED LIVING, MEMORY SUPPORT, SKILLED NURSING/REHABILITATION AND LONG TERM CARE PROGRAMS. DURING 2016, THE PINES MADE A SUBSTANTIAL CONTRIBUTION TO THE GREATER WHITING AREA COMMUNITY. THESE COMMUNITY OUTREACH ACTIVITIES RANGED FROM: 1.) CELL PHONES FOR SOLDIERS - COLLECTED 11 OLD/USED CELL PHONES TO DONATE TO THE NON-PROFIT GROUP, WHICH THEY IN TURN USE TO BUY CALLING CARDS FOR SOLDIERS.2.) LACEY TOWNSHIP MUNICIPAL ALLIANCE - DONATED $30 TO DIANE TO LEAD A CHAIR EXERCISE PROGRAM FOR 80 PARTICIPANTS.3.) OCEAN COUNTY COLLEGE - $100 DONATION TOWARD CHEER TEAM.4.) AMERICA'S KESWICK - $250 DONATION IN MEMORY OF JOHN HIBBARD.5.) AMERICA'S KESWICK - $2,500 ANNUAL DONATION.6.) WHITING AND LAKEHURST CHURCHES - DONATED $93 TO HOST BREAKFAST FOR ALL THE LOCAL PASTORS TO DISCUSS WAYS WE CAN ALL WORK TOGETHER. 7.) SHAMROCKS FOR THE SHORE 5K RACE - $100 DONATION TOWARD RACE AND THEIR BENEFICIARIES.8.) CHURCH OF GRACE AND PEACE - DONATED BIBLES AND RELIGIOUS VIDEOS AND BOOKS.9.) ATLANTIC CITY RESCUE MISSION - DONATION OF CLOTHES AND OTHER ITEMS.10.) CAREGIVER VOLUNTEERS OF CENTRAL JERSEY - DROVE THEIR WHITING RESIDENT CAREGIVERS TO THEIR DINNER IN TOMS RIVER.11.) VOLUNTEER LUNCHEON - DONATED $735 TO 75 PARTICIPANTS WHO HELD A YOGA SESSION AND LUNCHEON TO HONOR OUR RESIDENT VOLUNTEERS.12.) PROVIDENCE HOUSE - KNITTED BABY HATS AND BLANKETS.13.) SOUTHERN OCEAN COUNTY PROFESSIONAL GROUP - DONATED $225 TOWARDS HOSTING A NETWORKING MEETING AND SERVED BREAKFAST.14.) MANCHESTER TOWNSHIP - $525 TOWARDS SPONSORSHIP FOR MANCHESTER DAY.15.) CAREGIVER VOLUNTEERS OF CENTRAL JERSEY - LUNCH FOR 30 PEOPLE DONATED $500.16.) AMERICAN RED CROSS - BLOOD DRIVE HOSTED AT OUR COMMUNITY, ALONG WITH SNACKS PROVIDED. RESIDENTS VOLUNTEERED AT THE REGISTRATION AND REFRESHMENT TABLES. 36 PEOPLE DONATED, 8 RESIDENTS VOLUNTEERED, DONATION OF $30.17.) CAREGIVER VOLUNTEERS OF CENTRAL JERSEY - $1,500 TOWARDS ANNUAL SPONSORSHIP OF THEIR VOLUNTEER EVENT.18.) WHITESBOG PRESERVATION TRUST - $100 DONATION FROM ACTIVTY DEPARTMENT IN EXCHANGE FOR A PRESENTATION TO OUR RESIDENTS.19.) WHITING FIRE COMPANY - $1,000 DONATION TO THANK THEM FOR ALL THEIR SERVICE. RESIDENTS CONTRIBUTED 40%.20.) HEALTH & WELLNESS FAIR - ANNUAL HEALTH FAIR BROUGHT TO RESIDENTS AND PEOPLE OUTSIDE THE COMMUNITY BY THE PINES AND MERIDIAN. 67 PEOPLE SCREENED.21.) ALZHEIMER'S NEW JERSEY - 5 STAFF MEMBERS WALKED AND AN $853 DONATION THROUGH FUNDS WAS RAISED BY STAFF AND RESIDENTS THROUGH VARIOUS MEANS. ALSO A DONATION OF SNACKS AND WATER.22.) CROP WALK - $206 DONATION THROUGH RESIDENTS AND STAFF.23.) BOARD OF SOCIAL SERVICES - $35 DONATION OF BREAKFAST.24.) SOUTHERN OCEAN COUNTY PROFESSIONAL GROUP - HOSTED NETWORKING MEETING AND SERVED BREAKFAST.25.) FRIENDS OF THE SOUTHERN OCEAN COUNTY ANIMAL SHELTER - DONATION OF CAT AND DOG FOOD FROM A MARKETING EVENT. 26.) BOARD OF SOCIAL SERVICES MANCHESTER TOWNSHIP - $135 DONATION AND OVER 300 LBS OF FOOD.27.) MANCHESTER TOWNSHIP - $35 DONATION OF 3 COOKIE TRAYS.28.) PROVIDENCE HOUSE - $200 DONATION BY WOMEN OF ACTION GROUP.29.) ST. MARY'S OF THE PINES - SCARVES, SOCKS, AND GLOVES DOANTED THROUGH A MARKETING EVENT.30.) PINELANDS PRESERVATION ALLIANCE - $100 DONATATION FROM ACTIVITY DEPARTMENT IN EXCHANGE FOR A PRESENTATION TO OUR RESIDENTS.31.) ONE SIMPLE WISH - $500 IN DONATIONS FROM STAFF VIA DRESS DOWN DAYS TO FOSTER CHILDREN. 32.) RELAY FOR LIFE(AMERICAN CANCER SOCIETY) - $817 IN DONATION FROM EMPLOYEE DRESS DOWN DAY DONATIONS & SPONSORSHIP FROM THE PINES.33.) COMMUNITY REFORM CHURCH INTERFAITY CLERGY - HOST THEIR MONTHLY MEETINGS ONSITE.34.) WHITING ELEM SCHOOL JR. IMPACT CLUB - APPROXIMATELY 22 CHILDREN COME IN MONTHLY TO PLAY GAMES AND INTERACT WITH RESIDENTS IN HEALTH CARE. OVERALL $120 DONATION.35.) NEW LISBON DEVELOPMENTAL CENTER - THE RED HAT SOCIETY IN GEORGETOWN COLLECTED ITEMS TO DONATE. APPROXIMATELY 14 RESIDENTS PARTICIPATE.36.) MOCAP MEETING - HELD MEETING FOR THE MONMOUTH OCEAN COUNTY ACTIVITY PROFESSIONALS. DONATION OF $100.37.) CATHOLIC CHARITIES - GEORGETOWN RESIDENTS KNITTED HATS & BLANKETS FOR DONATIONS.38.) ST. ELIZABETH ANN SETON - LENT THEM ITEMS TO USE AT THEIR 40TH ANNIVERSARY CELEBRATION SUCH AS AN ICE CREAM CART AND A TENT.39.) CRESTWOOD VILLAGE 7 - $50 DONATION OF COOKIE TREES FOR THEIR FESTIVAL OF THE TREES.40.) BROWNIE TROOP 948 - GIRLS CAME IN TO SING WITH RESIDENTS AND HAVE COOKIES. DONATION OF $9. 41.) ST. ELIZABETH ANN SETON - $9 DONATION TO THE YOUTH MINISTRY PROGRAM WHO CAME IN TO CAROL FOR THE RESIDENTS OF HEALTHCARE AND ENJOYED COOKIES.THE PINES ALSO PROVIDED SUBSIDY FOR 10 RESIDENTS IN THE PINES COMMUNITY WHO COULD NOT AFFORD TO PAY THE FULL RATE FOR SERVICES. FOR THE YEAR 2016, THE TOTAL AMOUNT OF FORGIVEN REVENUE WAS $108,328.OVERALL, THE PINES PROGRAM TO SERVE OTHERS BENEFITTED SENIORS, COMMUNITY MEMBERS AND STUDENTS BY SUPPORTING THEIR TALENTS, GIVING INFORMATION TO IMPROVE THE QUALITY OF LIFE AND HELPING PEOPLE TO BETTER UNDERSTAND AND APPRECIATE SENIOR ADULTS. 13970700 1 1 0 1 0 0 1 0 1 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 16 0 378 1 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NJ X GEORGINA BAVAIS CFO 7328490400 509 ROUTE 530 WHITING NJ 08759 JAY KATZ CHAIRPERSON 2.00 X X 0 0 0 MARK KOLCHIN VICE CHAIRMAN 2.00 X X 0 0 0 DOUGLAS J BAUERBAND TREASURER 2.00 X X 0 0 0 WILLIAM COOK DIRECTOR 2.00 X 0 0 0 ALAN R DINKFELT DIRECTOR 2.00 X 0 0 0 EDNA FREDERICKS DIRECTOR 2.00 X 0 0 0 CAROLYN HIBBARD DIRECTOR 2.00 X 0 0 0 JOHN R HOLLAND DIRECTOR 2.00 X 0 0 0 ROBERT HUBINGER DIRECTOR 2.00 X 0 0 0 OTTO C MORCH DIRECTOR 2.00 X 0 0 0 ERIC J GHAUL CEO 40.00 X 190430 0 7610 GEORGINA E BAVAIS CFO 40.00 X 143383 0 16535 PATRICIA A POLCHAK HEALTHCARE ADMINISTRATOR 40.00 X 133683 0 24101 ADRIANNE M SOBOCINSKI PHYSICAL THERAPIST 40.00 X 114938 0 12261 ANN EASTON DIRECTOR OF NURSING 40.00 X 111977 0 4515 694411 0 65022 5 0 1 0 SODEXO INC & AFFLIATES PO BOX 360170 PITTSBURGH PA 15251 FOOD SERVICE PROVIDER 1034496 US FOOD SERVICE INC PO BOX 33101 NEWARK NJ 07188 FOOD SUPPLIER 620964 R SOMERS CONSTRUCTION INC 1981 BROOKLYN AVENUE WHITING NJ 08759 CONSTRUCTION CONTRACTOR 366114 REMTEK SERVICES INC 204 BRANCHWOOD COURT DEPTFORD NJ 08096 ROOFING 339839 J W FINLEY INC 310 MAIN STREET TOMS RIVER NJ 08753 HEATER MAINTANENCE 316934 11 100137 100137 RESIDENT MONTHLY FEES 623990 7297358 7297358 PRIVATE PAY 623990 4779602 4779602 MEDICAID AND MEDICARE REVENUE 623990 3404422 3404422 ENTRANCE FEES REVENUE 623990 1473426 1473426 22183 22183 16976991 153018 153018 16748 7592 9156 9156 9156 929434 830147 99287 99287 99287 7195 3228 3967 3967 ANCILLARY SERVICES 623000 326305 326305 FOOD SERVICES 623000 144130 144130 BARBER AND BEAUTY 623000 87185 87185 557620 17900176 17534611 0 265428 4610 4610 13500 13500 357958 55600 302358 6843528 6054338 789190 113073 78705 34368 1068855 921098 147757 621808 541300 80508 187833 187833 25166 25166 43722 43722 31335 31335 358035 351080 6955 327501 327333 168 279574 229011 50563 115629 27657 87972 1672793 1583083 89710 16228 12534 3694 600712 600712 1580971 1343825 237146 262117 231812 30305 FOOD SERVICES 1081289 1078177 3112 MEDICAL EXPENSES 260193 260193 MISCELLANEOUS EXPENSES 100093 68299 31794 15966523 13970700 1995823 0 1765 1765 2684144 2224328 448585 728478 103778 199757 149792 53666370 35310526 18145683 18355844 7573724 6828636 240787 170343 29294445 28562964 995029 1082521 17761901 15944591 19661604 18527874 464549 535228 52862 47583 38935945 36137797 X -9681661 -7604877 40161 30044 -9641500 -7574833 29294445 28562964 X 1933653 112083 31335 -10404 X 0 1 X 1 0 X 153813 81740 105015 164667 100137 605372 16328552 16316358 16838100 17237458 17534611 84255079 16482365 16398098 16943115 17402125 17634748 84860451 0 0 0 84860451 277342 377942 232435 158490 169766 1215975 277342 377942 232435 158490 169766 1215975 323000 22296 3967 349263 16759707 16776040 17498550 17582911 17808481 86425689 0.98190 0.97850 0.01410 0.01610 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 252 252 0 PART II-B, LINE 1: THE ORGANIZATION PAYS DUES TO LEADING AGE, NEW JERSEY. A PERCENTAGE OF THOSE DUES ARE USED BY LEADING AGE, NEW JERSEY FOR LOBBYING PURPOSES. THE AMOUNT OF LOBBYING EXPENSES REPORTED ARE THE PERCENTAGE OF THE ORGANIZATION'S DUES USED BY LEADING AGE, NEW JERSEY FOR LOBBYING. X X X 1 1 1 0 1 X 2748541 2748541 40335754 32304259 8031495 10124985 2821115 7303870 457090 185152 271938 18355844 CHARITABLE GIFT ANNUITIES 47583 47583 X 17988355 112083 -23904 88179 17900176 0 17900176 15921688 0 15921688 31335 13500 44835 15966523 PART II, LINE 9: THE DEPARTMENT OF ENVIRONMENTAL PROTECTION HAS PROVIDED SIGNAGE THAT HAS BEEN PUT IN PLACE, ACCOMPANIED BY A LISTING OF APPROVED USES OF THE SITE AND ANY RESTRICTIONS. PART IV, LINE 2B: AMOUNTS HELD IN ESCROW REPRESENT CASH DEPOSITS MADE BY PROSPECTIVE RESIDENTS OF INDEPENDENT LIVING UNITS. THE CASH HAS BEEN DEPOSITED INTO A SAVINGS ACCOUNT. IF THE PROSPECTIVE RESIDENT(S) SHOULD DECIDE NOT TO FULFILL THE CONTRACT THE DEPOSITS ARE REFUNDABLE. IN ADDITION, ENTRANCE FEES RECEIVED FROM RESIDENTS HAVE BEEN REPORTED AS A LONG-TERM LIABILITY. REFUNDABLE PORTIONS OF ENTRANCE FEES ARE FULLY REFUNDABLE TO THE RESIDENT(S), LESS CERTAIN COSTS OR CHARGES INCURRED. IF THE RESIDENT(S) TERMINATE(S) THE CONTRACT, THE REFUNDABLE PORTION OF ENTRANCE FEES IS REFUNDABLE FOLLOWING THE REOCCUPANCY OF THE UNIT FOR THIRTY DAYS. PART X, LINE 2: KESWICK HAS BEEN GRANTED EXEMPT STATUS RELATIVE TO FEDERAL AND STATE CORPORATE INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND APPLICABLE STATE CODES. KESWICK FOLLOWS THE GUIDANCE IN THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE GUIDANCE CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ENTITY'S FINANCIAL STATEMENTS. THE GUIDANCE FURTHER PRESCRIBES RECOGNITION AND MEASUREMENT OF TAX PROVISIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. THE APPLICATION OF THIS STANDARD HAS NO IMPACT ON KESWICK'S FINANCIAL STATEMENTS. KESWICK'S TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL AND STATE AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN THE VALUE OF ANNUITY -10,404. SCHOLARSHIP COSTS -13,500. PART XII, LINE 4B - OTHER ADJUSTMENTS: SCHOLARSHIP COSTS 13,500. 1 EMPLOYEE SCHOLARSHIPS 6 13500 PART I, LINE 2: THE PINES BUDGETS A CERTAIN DOLLAR AMOUNT EVERY YEAR TO DONATE TO THOSE WHO PROVIDE BENEFITS TO THE COMMUNITY. THE PINES MAINTAINS RECORDS OF WHERE THE DONATIONS WERE GIVEN. PART III, LINE 1 THE SCHOLARSHIP APPLICANT MUST HAVE BEEN EMPLOYED AT THE PINES AT WHITING AS A PART-TIME EMPLOYEE FOR AT LEAST ONE YEAR AND WORKED AT LEAST 300 HOURS PER YEAR. HOURS ARE BASED ON FISCAL YEAR MAY 1 - APRIL 1. THE APPLICANT MUST PRESENT A LETTER OF ACCEPTANCE FROM EITHER A COLLEGE OR SPECIALTY SCHOOL AT THE TIME OF APPLICATION. THE APPLICANT MUST SUPPLY TWO LETTERS OF REFERENCE; ONE FROM SCHOOL (GUIDANCE COUNSELOR, TEACHER, COACH, ETC.) AND THE SECOND MUST COME FROM AN INDIVIDUAL UNRELATED TO SCHOOL OR FAMILY. IN ADDITION, EACH APPLICATION IS CAREFULLY REVIEWED BY THE STUDENT'S DIRECT SUPERVISOR. THE SUPERVISOR IS TO EXAMINE SPECIFIC CRITERIA SUCH AS SAFETY AND JOB PERFORMANCE. THE SUPERVISOR WILL INCLUDE HIS/HER RELATED REMARKS, SIGN THE APPLICATION, AND FORWARD THE APPLICATION IN ITS ENTIRETY TO THE SCHOLARSHIP COMMITTEE. APPLICANTS ALREADY IN COLLEGE, WHETHER APPLYING FOR THE FIRST TIME OR FOR RENEWAL OF THE SCHOLARSHIP MUST PRESENT A TRANSCRIPT OF FULL-TIME (12 OR MORE CREDIT HOURS) OF COLLEGE GRADES. THE APPLICANT WILL THEN NOT BE REQUIRED TO SUBMIT A LETTER OF ACCEPTANCE AND TWO LETTERS OF REFERENCE; HOWEVER, BOTH FIRST TIME APPLICANTS AND APPLICANT RENEWALS WILL BE ASKED ABOUT THEIR LEVEL OF PARTICIPATION BOTH IN THEIR SCHOOL AND THEIR COMMUNITY. X 1 1 X X X 0 0 0 0 0 0 0 0 0 ERIC J GHAUL CEO 158938 0 10000 0 21492 0 5768 0 1842 0 198040 0 0 0 GEORGINA E BAVAIS CFO 135883 0 7500 0 0 0 4291 0 12244 0 159918 0 0 0 PATRICIA A POLCHAK HEALTHCARE ADMINISTRATOR 127683 0 6000 0 0 0 4596 0 19505 0 157784 0 0 0 PART I, LINE 1A AS PART OF HIS 2016 COMPENSATION PACKAGE; ERIC GHAUL, PRESIDENT, WAS PAID A BOARD APPROVED TAKE-HOME TAX DEFERRAL BONUS OF $10,000. THE PINES PAID THE TAXES ON HIS BEHALF. A PUBLIC FINANCE AUTHORITY 273866124 NONEAVAIL 2014-11-13 21500000 SEE PART VI 0 0 0 A 2304497 21500000 894458 429999 85517 3447116 16642910 2014 1 0 1 1 A 0 0 0 0 0 0 1 A 0 1 0 0 0 0 0 0 1 A 1 SCHEDULE K, PART I, BOND ISSUES: (A) ISSUER NAME: PUBLIC FINANCE AUTHORTIY (F) DESCRIPTION OF PURPOSE: TO REFUND THE FIRST MORTGAGE REVENUE REFUNDING BONDS, SERIES 1998 AND TO FINANCE VARIOUS CAPITAL PROJECTS AND WORKING CAPITAL. FORM 990, PART VI, SECTION A, LINE 1 THE BOARD OF DIRECTORS, BY RESOLUTION ADOPTED BY A MAJORITY OF THE DIRECTORS THEN IN OFFICE, MAY DESIGNATE AN EXECUTIVE COMMITTEE COMPRISED OF THE CHAIRPERSON, VICE CHAIRPERSON, SECRETARY, TREASURER AND AN ADDITIONAL MEMBER OF THE BOARD OF DIRECTORS SELECTED BY THE CURRENT MEMBERS OF THE BOARD OF DIRECTORS IN MANAGEMENT OF THE CORPORATION, PROVIDED, THE EXECUTIVE COMMITTEE SHALL NOT HAVE THE AUTHORITY OF THE BOARD OF DIRECTORS IN REFERENCE TO (A) AMENDING, ALTERING, OR REPEALING THE BYLAWS, (B) ELECTING, APPOINTING OR REMOVING ANY MEMBER OF THE EXECUTIVE COMMITTEE OR ANY DIRECTOR OR OFFICER OF THE CORPORATION, (C) AMENDING THE ARTICLES OF INCORPORATION, (D) ADOPTING A PLAN OF MERGER OR ADOPTING A PLAN OF CONSOLIDATION WITH ANOTHER CORPORATION, (E) AUTHORIZING THE SALE, LEASE, EXCHANGE OR MORTGAGE OF ALL OR SUBSTANTIALLY ALL OF THE PROPERTY AND ASSETS OF THE CORPORATION, (F) AUTHORIZING THE VOLUNTARY DISSOLUTION OF THE CORPORATION OR REVOKING PROCEEDINGS THERFORE, (G) ADOPTING A PLAN FOR THE DISTRIBUTION OF THE ASSETS OF THE CORPORATION, (H)AMENDING, ALTERING, OR REPEALING ANY RESOLUTION OF THE BOARD OF DIRECTORS TO ANOTHER COMMITTEE OF THE BOARD THE DESIGNATION AND APPOINTMENT OF AN EXECUTIVE COMMITTEE AND THE DELEGATION THERETO OF AUTHORITY SHALL NOT OPERATE TO RELIEVE THE BOARD OF DIRECTORS, OR ANY INDIVIDUAL DIRECTOR, OF ANY RESPONSIBILITY IMPOSED UPON IT OR HIM BY LAW. FORM 990, PART VI, SECTION B, LINE 11B THE CFO REVIEWS THE FORM 990 WITH THE BOARD MEMBERS PRIOR TO FILING WITH THE IRS. A COPY OF THE FORM 990 IS PROVIDED TO ALL MEMBERS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION'S BOARD MEMBERS AND OFFICERS ARE REQUIRED TO DISCLOSE CONFLICTS OF INTEREST TO THE MEMBERS OF THE BOARD. BOARD MEMBERS SIGN A CONFLICT OF INTEREST STATEMENT ANNUALLY, WHICH ARE REVIEWED BY THE CEO. THE ORGANIZATION ALSO HAS A CONFLICT OF INTEREST SECTION IN ITS EMPLOYEE HANDBOOK WHICH ALL EMPLOYEES ARE REQUIRED TO FOLLOW AT THE APRIL QUARTERLY MEETING. ALL BOARD MEMBERS ARE TO SIGN THE CONFLICT OF INTEREST POLICY STATING THERE ARE NONE TO DECLARE OR IF THERE ARE ANY TO DECLARE. TO DATE THERE HAVE NOT BEEN ANY DECLARED.IF CONFLICTS OF INTEREST DO ARISE, THE INTERESTED PARTY OR PARTIES ARE PROHIBITED FROM VOTING ON BOARD MATTERS. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD'S EXECUTIVE COMMITTEE APPROVES WHAT THE CEO'S COMPENSATION WILL BE. IT IS SUBMITTED IN WRITING BY THE CHAIR OF THE BOARD TO THE CFO. THIS PROCESS WAS LAST COMPLETED IN 2013. OTHER OFFICERS OR KEY EMPLOYEES ARE REVIEWED BY THE SUPERVISOR ON THE ANNIVERSARY AND ARE APPROVED AN INCREASE IF THE JOB PERFORMANCE JUSTIFIES AND THIS IS DONE WITHIN THE BOARD APPROVED BUDGET. COMPARABILITY DATA INCLUDED THE 2015-2016 CCRC REPORT SALARY & BENEFITS REPORT ENDORSED BY LEADING AGE PUBLISHED BY HOSPITAL & HEALTHCARE COMPENSATION SERVICE WAS USED AS A REFERENCE. THIS PROCESS OCCURS ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. THE ANNUAL DISCLOSURE STATEMENT INCLUDES THE MOST RECENT AUDITED FINANCIAL STATEMENTS. THIS IS GIVEN TO RESIDENTS AND/OR PROSPECTIVE RESIDENTS WHO INQUIRE ABOUT THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 14: THE ORGANIZATION IS WORKING ON A DRAFT OF A FORMAL WRITTEN POLICY. CURRENTLY, THE ORGANIZATION FOLLOWS THE ESTABLISHED PERIOD OF RETENTION AND DESTRUCTION GUIDELINES OUTLINED IN THE PRACTICE BRIEF FROM THE AMERICAN HEALTH INFORMATION MANAGEMENT ASSOCIATION AND THE QUALITY ASSURANCE STANDARDS OF THE JOINT COMMISSION ON THE ACCREDITATION OF HEALTHCARE ORGANIZATIONS. FORM 990, PART XI, LINE 9: CHANGE IN THE VALUE OF ANNUITY -10,404.