2017-08-29T11:45:23-05:00 2016-12-31 461497033 EKS&H LLLP 8181 E TUFTS AVENUE SUITE 600 DENVER CO 802372579 990 2016-01-01 742376546 SHALOM PARK SHAL 3036805000 14800 E BELLEVIEW DRIVE AURORA CO 800152258 DANIEL STENERSEN PRESIDENT/CEO 3036805000 2017-08-28 1 DORI J EGGETT P00645252 3037409400 208.42.238.132 2017-08-29 11:43:35 MD P EC37ECE0FF53FE1DFF8E980E88E00C11881B4804 4D7219D1452441062C513A13E39A5E42DAB0668F 2016 2021-01-29 14:40:06Z DANIEL STENERSEN 14800 E BELLEVIEW DRIVE AURORA CO 80015 14177899 0 X SHALOMPARK.ORG X 1984 CO DELIVERY AND INNOVATION OF COMMUNITY AND RESIDENTIAL HEALTH AND SOCIAL SERVICES. 16 15 348 170 0 0 0 0 14521319 14158601 0 0 4541 19298 14525860 14177899 5434 7360 0 0 8532919 8597222 0 0 0 7354523 7429223 15892876 16033805 -1367016 -1855906 13392243 14197449 15977268 18638380 -2585025 -4440931 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 14197698 7360 14158601 SHALOM PARK OPERATES A NURSING HOME FACILITY AND CENTER FOR THECARE OF THE AGED. DURING THE TAX YEAR, THE ORGANIZATION PROVIDEDCARE FOR OVER 300 PATIENT AND ASSISTED LIVING RESIDENTS. 14197698 1 0 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 64 0 1 348 1 0 0 0 0 0 0 0 0 0 0 X 16 15 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X DANIEL STENERSEN 3036805000 14800 E BELLEVIEW DRIVE AURORA CO 800152258 DANIEL STENERSEN PRESIDENT/CEO 37.00 3.00 X X 281483 17967 38479 GARY YOURTZ VICE CHAIR 5.00 1.00 X X 0 0 0 JAY MOSKOWITZ DIRECTOR 1.00 X 0 0 0 BRUCE BENDELL TREASURER 5.00 1.00 X X 0 0 0 JOE BORUS DIRECTOR 1.00 X 0 0 0 ROBIN CHOTIN DIRECTOR 1.00 X 0 0 0 KEN FEILER DIRECTOR 1.00 X 0 0 0 SUSY GRAZI DIRECTOR 1.00 X 0 0 0 ANDY MILLER DIRECTOR 1.00 X 0 0 0 MICHAEL STREAR CHAIR 20.00 1.00 X X 0 0 0 LISA COOK SECRETARY 1.00 1.00 X X 0 0 0 NEIL OBERFELD DIRECTOR 1.00 X 0 0 0 MELINDA QUIAT DIRECTOR 1.00 X 0 0 0 ANDY HEINS CHAIR-ELECT 1.00 1.00 X 0 0 0 VERN ENGBAR DIRECTOR 1.00 X 0 0 0 ELISA ROBYN DIRECTOR 1.00 X 0 0 0 RUTH MINNEMA DIRECTOR OF NURSING 40.00 X 119465 0 6816 BETH IRTZ ADMINISTRATOR 40.00 X 118521 0 2259 519469 17967 47554 3 0 1 0 MORRISON MANGEMENT SPECIALIST PO BOX 1202289 ATLANTA GA 30368 DIETARY/HOUSEKEEPING SERVICE 1169860 PREMERE REHAB LLC 25117 SW PARKWAY SUITE D WILSONVILLE OR 97070 THERAPY SERVICES 431893 AAM INC PO BOX 1328 EVERGREEN CO 80437 ROOFING SERVICES 387403 EKS&H LLLP 8181 E TUFTS AVE SUITE 600 DENVER CO 80237 IT CONSULTING, AUDIT, AND TAX 259670 MEDLINE INDUSTRIES INC PO BOX 121080 DALLAS TX 75312 MEDICAL SERVICES 240156 15 PATIENT SERVICE REV 623000 12146150 12146150 RESIDENT RENTAL 623000 1508029 1508029 OTHER NURSING HOME REV 623000 504422 504422 14158601 MISC REVENUE 900099 19298 19298 19298 14177899 14177899 0 0 X 7360 7360 317653 317653 7616103 6828321 787782 50958 38079 12879 612508 541076 71432 6229 5494 735 48505 42783 5722 1965747 1733846 231901 208801 183300 25501 505843 446168 59675 30242 27771 2471 420741 371106 49635 1429537 1260894 168643 801469 706919 94550 FOOD 876512 876230 282 PROGRAM SUPPLIES 819304 819304 BAD DEBT EXPENSE 142208 142208 REPAIRS AND MAINTENANCE 112650 112650 61435 54189 7246 16033805 14197698 1836107 0 64610 188214 842824 984322 348532 294176 35867015 23295219 11963712 12571796 172565 158941 13392243 14197449 806140 1282858 134145 118220 12416387 12176165 2620596 5061137 15977268 18638380 X -2585025 -4440931 -2585025 -4440931 13392243 14197449 -1855906 0 X 0 1 X 1 0 X 203925 203925 14136313 14091624 15002605 14521319 14158601 71910462 14340238 14091624 15002605 14521319 14158601 72114387 0 0 0 72114387 2338 3504 4541 19298 29681 14340238 14093962 15006109 14525860 14177899 72144068 0.99960 0.99990 0.00000 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISC REVENUE - 2013 AMOUNT: $ 2,338. 2014 AMOUNT: $ 3,504. 2015 AMOUNT: $ 4,541. 2016 AMOUNT: $ 19,298. 2767682 125 156417 45312 2878912 2880924 400 -64937 48705 2767682 2860581 525 70854 51036 2880924 2570336 625 338607 48987 2860581 2321345 208559 236427 195995 2570336 0.82350 0.17650 1 1 1 2561563 2561563 28480914 19844460 8636454 2796695 1763197 1033498 2027843 1687562 340281 12571796 DUE TO AFFILIATE 5061137 5061137 X 14177899 0 14177899 0 14177899 16033805 0 16033805 0 16033805 PART V, LINE 4: THE BETH ISRAEL FOUNDATION, 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: THE ORGANIZATION APPLIES A MORE-LIKELY-THAN-NOT MEASUREMENT METHODOLOGY TO REFLECT THE COMBINED FINANCIAL STATEMENT IMPACT OF UNCERTAIN TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. IF TAXING AUTHORITIES WERE TO DISALLOW ANY TAX POSITIONS TAKEN BY THE ORGANIZATION, THE ADDITIONAL INCOME TAXES,IF ANY, WOULD BE IMPOSED ON SHALOM PARK AND THE FOUNDATION, WHICH IS THE SOLE MEMBER OF WELLNESS CENTER. ACCORDINGLY, THERE WOULD BE NO EFFECT ON THE ORGANIZATION'S COMBINED FINANCIAL STATEMENTS. IF INCURRED, INTEREST AND PENALTIES ASSOCIATED WITH TAX POSITIONS ARE RECORDED IN THE PERIOD ASSESSED AS GENERAL EXPENSE. NO INTEREST OR PENALTIES HAVE BEEN ASSESSED AS OF DECEMBER 31, 2016. X X X 0 0 0 0 0 0 0 0 0 DANIEL STENERSEN PRESIDENT/CEO 281483 17967 0 0 0 0 16889 1078 19281 1231 317653 20276 0 0 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 MAY BE APPOINTED BY THE CHAIR. THE EXECUTIVE COMMITTEE MAY ACT ON BEHALF OF AND IN PLACE OF THE BOARD OF TRUSTEES BETWEEN REGULAR MEETINGS OF THE BOARD OF TRUSTEES WHEN REASONABLY NECESSARY TO FULFILL THE PURPOSES AND DUTIES OF THE BOARD OF TRUSTEES, AS DETERMINED BY THE CHAIR, AND SHALL BE 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 CORPORATION UNTIL SUCH LATER ACTION OF THE BOARD. FORM 990, PART VI, SECTION B, LINE 11B THE CEO AND CERTAIN BOARD MEMBERS REVIEW THE TAX RETURN WITH THE ORGANIZATION'S AUDITOR AND TAX RETURN PREPARER. THE RETURN IS AVAILABLE 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 POLICY THROUGH AN ANNUAL AFFIRMATION WITH THE BOARD. 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. FORM 990, PART VI, SECTION B, LINE 15 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 (1)THE COMPLEXITY AND DIVERSITY OF RESPONSIBILITIES OF THE CEO'S POSITION (INCLUDING LICENSURE, REGULATION, CERTIFICATION, AND OPERATION OF THE SKILLED NURSING FACILITY); (2)INITIATIVES UNDERTAKEN, IN PROCESS, OR PLANNED; (3)STATUS AND PROGRESS OF THE ORGANIZATION; (4)THE SOCIAL SECURITY ADMINISTRATION COST OF LIVING ADJUSTMENT; (5)THE ASSOCIATION OF JEWISH AGING SERVICE COMPENSATION SURVEY; (6)MANAGEMENT OF MULTIPLE LINES OF BUSINESS; AND (7)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 OTHER FEES FOR SERVICES: PROGRAM SERVICE EXPENSES 1,733,846. MANAGEMENT AND GENERAL EXPENSES 231,901. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,965,747. SHALOM PARK PROFESSIONAL SERVICES LLC 14800 E BELLEVIEW DRIVE AURORA CO 80015 264399163 HEALTH CARE CO BETH ISRAEL FOUNDATION FOR THE AGED SHALOM CARES WELLNESS CENTER LLC 14800 E BELLEVIEW DRIVE AURORA CO 80015 452808418 HEALTH CARE CO BETH ISRAEL FOUNDATION FOR THE AGED BETH ISRAEL FOUNDATION FOR THE AGED 14800 E BELLEVIEW DRIVE AURORA CO 80015 742195249 CHARITABLE CO 501(C) (3) 9-509(A)(2) SHALOM PARK 1 BETH EZRA AT SHALOM PARK 14800 E BELLEVIEW DRIVE AURORA CO 80015 320179215 CHARITABLE CO SHALOM PARK C 1.00000 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 DUE TO FOUNDATION P -5061137