2015-02-12T16:10:34-06:00 2014-06-30 BKD LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2013-07-01 940831870 SALEM LUTHERAN HOME ASSOCIATION OF THE BAY CITIES % MARJORIE BAILEY SALE 5107692700 1301 MARINA VILLAGE PARKWAY Suite 210 ALAMEDA CA 94501 MARJORIE BAILEY CFO 5107692710 2014-12-03 true Brian D Todd P00422601 5107692710 2013 2016-03-07 17:11:31Z JESSE JANTZEN 1301 MARINA VILLAGE PKWY 210 ALAMEDA CA 94501 13131340 false X WWW.SALEMLUTHERANHOME.ORG X 1924 CA SERVES & ENRICHES THE LIVES OF OLDER ADULTS BY PROVIDING HOUSING & SERVICES AT ITS CARE CENTER, & ITS ASSISTED LIVING, MEMORY CARE, & INDEPENDENT LIVING UNITS. 9 9 220 50 0 500576 123565 12962761 12672307 88572 72430 175627 263038 13727536 13131340 0 0 0 0 7073036 7256566 0 0 13121 5818850 5782205 12891886 13038771 835650 92569 15533735 15381693 5703729 5686196 9830006 9695497 X A NONPROFIT ORGANIZATION COMMITTED TO SERVING AND ENRICHING THE PHYSICAL, EMOTIONAL, AND SPIRITUAL WELL-BEING OF OLDER ADULTS THROUGH A PROFESSIONAL, FAITH-CENTERED CARE COMMUNITY AND SERVICES. false false 4833933 5768592 SALEM'S CARE CENTER IS LICENSED FOR 48 SKILLED NURSING RESIDENTS. THIS YEAR, THE CARE CENTER PROVIDES SKILLED NURSING CARE TO 42 OLDER ADULT RESIDENTS IN AN AVERAGE MONTH, FOR AN ANNUAL TOTAL OF 15,260 RESIDENT DAYS. 45% OF RESIDENTS ARE PRIVATE PAY, WHILE 32% HAVE MEDI-CAL, 19% HAVE MEDICARE AND 5% HAVE OTHER INSURANCE COVERAGE AS PRIMARY PAYER SOURCE. 2522052 3095400 SALEM'S ASSISTED LIVING UNIT PROVIDES HOUSING AND SERVICES FOR UP TO 65 OLDER ADULT RESIDENTS THAT REQUIRE SOME ASSISTANCE WITH MEDICATION OR DAILY ACTIVITIES. THIS YEAR WE PROVIDED ASSISTED LIVING HOUSING FOR 56 RESIDENTS EACH MONTH ON AVERAGE, EXCLUDING SECOND PERSONS IN EACH UNIT, FOR AN ANNUAL TOTAL OF 20,363 RESIDENT DAYS. THE ASSISTED LIVING RESIDENTS ARE OFFERED FIVE LEVELS OF CARE IN ADDITION TO THE BASE LEVEL OF CARE SO THAT THEIR INDIVIDUAL NEEDS CAN BE MET. THERE ARE MANY ACTIVITIES PROVIDED FOR OUR ASSISTED LIVING RESIDENTS, INCLUDING SOME THAT REFLECT OUR FAITH-BASED MISSION. 1576283 1878693 SALEM'S MEMORY CARE UNIT PROVIDES HOUSING AND SERVICES FOR UP TO 30 OLDER ADULT RESIDENTS WHO HAVE DEMENTIA OR MEMORY LOSS. THIS YEAR WE PROVIDED MEMORY CARE HOUSING FOR 22 RESIDENTS EACH MONTH ON AVERAGE FOR A TOTAL OF 8,119 RESIDENT DAYS. THE MEMORY CARE UNIT HAS MANY DAILY ACTIVITIES DESIGNED FOR DEMENTIA OR MEMORY LOSS RESIDENTS. 1576283 1929622 10508551 true true false true false false false false true true true false false false true false false true false false false false false false false false false false false true false false false false false false false false false false false false false true false false false true 56 0 true 220 true false false false false false true true false false false false X 9 9 false true false false true true true true true false false true true true true true true false false false CA X MARJORIE BAILEY 5107692758 1301 MARINA VILLAGE PARKWAY SUITE ALAMEDA CA 94501 CHARLES RUTHROFF DIRECTOR 2.0 5.0 X 0 0 0 CHRISTINE WHELAN SECRETARY 2.0 9.0 X X 0 0 0 SISTER KATHLEEN KEARNEY CHAIR 2.0 10.0 X X 0 0 0 JOAN RYAN DIRECTOR END 11/13 2.0 4.0 X 0 0 0 MICHAEL TELLEEN DIRECTOR 2.0 4.0 X 0 0 0 REVEREND NOREEN MEGINNESS DIRECTOR END 4/14 2.0 4.0 X 0 0 0 JESSE BEAN DIRECTOR 2.0 4.0 X 0 0 0 VERN STIGGE VICE CHAIR 2.0 10.0 X X 0 0 0 RAHUL JOGLEKAR DIRECTOR 2.0 4.0 X 0 0 0 LYNNE KATZMAN DIRECTOR 2.0 4.0 X 0 0 0 DENISE ALLEN DIRECTOR BEG 11/13 2.0 4.0 X 0 0 0 JESSE JANTZEN CHIEF EXECUTIVE OFFICER 2.0 46.0 X 0 410778 8275 JANICE WASHBURN INTERIM CFO END 11/13 2.0 46.0 X 0 174734 13987 ADRIENE IVERSON ASSISTANT SECRETARY 2.0 46.0 X 0 213956 8815 MARJORIE BAILEY CFO BEG 11/13 2.0 46.0 X 0 31538 0 0 831006 31077 0 false true false REHABCARE GROUP INC PO BOX 50353 ST LOUIS MO 63150 SKILLED NURSING 548608 1 123565 123565 NET PATIENT SERVICE REVENUE 623000 5735994 5735994 RESIDENT SERVICES 623000 6892264 6892264 OTHER PROGRAM SERVICE REVENUE 623000 44049 44049 12672307 72430 72430 0 0 6600 6600 0 6600 6600 0 0 0 0 GAIN ON INVESTMENT POOLS 900099 256438 256438 256438 13131340 12672307 335468 0 0 0 0 0 0 5843843 5266307 573382 4154 73559 69273 4286 889433 885702 3612 119 449731 402666 47065 926447 926447 71218 71218 53273 53273 0 0 24681 24681 1142607 1050366 83393 8848 113369 112 113257 1286934 1135984 150950 15547 5770 9777 0 599517 536447 63070 44723 28910 15813 0 33423 1691 31732 122960 98909 24051 0 159209 132614 26595 141046 113457 27589 BAD DEBT 195257 195257 MEDICAL SUPPLIES & DRUGS 370894 370894 LICENSES, DUES, SUBSCRIPTIONS 50893 18319 32574 RECRUITING & RETENTION 246792 12458 234334 183415 183415 13038771 10508551 2517099 13121 1031147 290691 316929 336167 0 0 778900 852341 0 0 0 0 4736 5215 0 0 113334 51677 25388347 16706529 8663665 8681818 4583977 5132144 0 0 0 0 0 0 41047 31640 15533735 15381693 766001 924692 0 0 341212 238468 0 0 1473 908 0 0 4142000 3942167 0 0 453043 579961 5703729 5686196 X 8035863 7916372 491092 476074 1303051 1303051 9830006 9695497 15533735 15381693 X 92569 263522 -490600 X false true X true false X 382092 276740 155161 500576 123565 1438134 10798997 11546182 12552480 12962761 12672307 60532727 0 0 0 11181089 11822922 12707641 13463337 12795872 61970861 0 165831 36767 51981 1428 256007 165831 36767 51981 1428 256007 61714854 94263 104924 109644 96172 79030 484033 0 94263 104924 109644 96172 79030 484033 0 0 11275352 11927846 12817285 13559509 12874902 62454894 0.98815 0.98655 0.00775 0.00790 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true false SCHEDULE C, PART II-B, LINE 1I OTHER LOBBYING ACTIVITIES: THE ORGANIZATION IS A MEMBER OF SEVERAL ORGANIZATIONS WHOSE PURPOSE IS TO DIRECT, DEVELOP, OR AFFECT PUBLIC POLICY AND LEGISLATION WITH REGARD TO HEALTHCARE ISSUES. THE AMOUNT SPENT ON DUES ALLOCABLE TO LOBBYING ACTIVITIES IS NOT SPECIFICALLY KNOWN; HOWEVER, SUCH AMOUNTS ARE INSUBSTANTIAL. false true X 2486936 346954 2833890 2184513 302423 2486936 2283133 -98620 2184513 1857561 425572 2283133 1667030 190531 1857561 0.26370 0.73630 false false 191734 191734 18448730 11728849 6719881 3614350 3107277 507073 3133533 1870403 1263130 8681818 0 DUE TO RELATED PARTIES 145980 ASSET RETIREMENT OBLIGATION 433981 579961 1245444 263522 -12139755 -11876233 13121677 24681 -15018 9663 13131340 1364935 1364935 24681 11649155 11673836 13038771 SCHEDULE D, PART IV, LINE 2B ESCROW ACCOUNT LIABILITY: THE ORGANIZATION HAS A SMALL SEPARATE TRUST BANK ACCOUNT AND CASH BOX HELD FOR RESIDENTS. SCHEDULE D, PART V, LINE 4 ENDOWMENT PURPOSE: THERE ARE THREE ENDOWMENT FUNDS, ALL OF WHICH REQUIRE THE INCOME TO BE USED FOR CHARITABLE CARE OF RESIDENTS. SCHEDULE D, PART X, LINE 2 UNCERTAIN TAX POSITIONS: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. SCHEDULE D, PART XI, LINE 2D AMOUNTS INCLUDED ON LINE 1 BUT NOT ON FORM 990, PART VIII, LINE 12: EXPENSES FROM DISCONTINUED OPERATIONS $(11,649,155) TRANSFERS TO AFFILIATES ( 490,600) ----------- TOTAL $(12,139,755) SCHEDULE D, PART XI, LINE 4B AMOUNTS INCLUDED ON FORM 990, PART VIII, LINE 12, BUT NOT ON LINE 1: DECREASE IN TRNA $( 15,018) SCHEDULE D, PART XII, LINE 4B AMOUNTS INCLUDED ON FORM 990, PART IX, LINE 25, BUT NOT ON LINE 1: EXPENSES FROM DISCONTINUED OPERATIONS $ 11,649,155 false false false false false true false false false JESSE JANTZEN CHIEF EXECUTIVE OFFICER 0 357193 0 52800 0 785 0 4375 0 3900 0 419053 0 0 JANICE WASHBURN INTERIM CFO END 11/13 0 171132 0 0 0 3602 0 2664 0 11323 0 188721 0 0 ADRIENE IVERSON ASSISTANT SECRETARY 0 192506 0 21000 0 450 0 2670 0 6145 0 222771 0 0 SCHEDULE J, PART I, LINE 3 COMPENSATION OF THE TOP MANAGEMENT OFFICIAL: THE MANAGEMENT COMPANY AND RELATED ORGANIZATION, ELDER CARE ALLIANCE (ECA), USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE TOP MANAGEMENT OFFICIAL: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. SCHEDULE J, PART I, LINE 6A BONUS PAYMENTS: OFFICERS AND CERTAIN EMPLOYEES OF THE ORGANIZATION ARE ELIGIBLE TO RECEIVE BONUS PAYMENTS BASED ON AN INDIVIDUAL INCENTIVE COMPENSATION PLAN THAT IS MADE AT THE BEGINNING OF THE FISCAL YEAR. THE BONUSES ARE BASED ON FINANCIAL, PERSONAL, AND VARIOUS OTHER GOALS, AND TARGETS AND POTENTIAL BONUS PERCENTAGES ARE DETERMINED WHEN THE INCENTIVE PLAN IS DEVELOPED EACH YEAR. THE FINANCIAL GOALS FOR MANY OF THE INDIVIDUALS INCLUDE MEETING OR EXCEEDING A NET EARNINGS AMOUNT. FORM 990, PART III, LINE 4D OTHER PROGRAM SERVICE ACCOMPLISHMENTS: OTHER PROGRAM SERVICES INCLUDE INDEPENDENT LIVING, WHICH CONSISTS OF 35 APARTMENT-STYLE UNITS AND 4 COTTAGES. FORM 990, PART VI, SECTION A, LINE 3 DELEGATION OF MANAGEMENT DUTIES: SALEM HAS A MANAGEMENT CONTRACT WITH ELDER CARE ALLIANCE, A NON-PROFIT PUBLIC BENEFIT CORPORATION THAT IS THE SOLE CORPORATE MEMBER OF SALEM, TO PROVIDE MANAGEMENT SERVICES INCLUDING, BUT NOT LIMITED TO, MARKETING, HUMAN RESOURCES, ACCOUNTING, INFORMATION TECHNOLOGY SERVICES, RISK MANAGEMENT, CLINICAL OVERSIGHT AND INSURANCE. FORM 990, PART VI, SECTION A, LINES 6, 7A, & 7B MEMBERS: APPOINTMENT OF DIRECTORS: (A) THE BOARD OF DIRECTORS OF THE CORPORATION SHALL INCLUDE NO GREATER THAN THIRTEEN (13) INDIVIDUALS APPOINTED IN ACCORDANCE WITH THE FOLLOWING: (I) FIVE (5) INDIVIDUALS APPOINTED BY THE FACILITY AND PROGRAM SPONSOR, THE SIERRA PACIFIC SYNOD OF THE EVANGELICAL LUTHERAN CHURCH OF AMERICA; (II) FIVE (5) INDIVIDUALS APPOINTED BY THE CO-SPONSOR OF THE CORPORATE MEMBER, THE BURLINGAME REGIONAL COMMUNITY OF THE SISTERS OF MERCY OF THE AMERICAS, WEST MIDWEST COMMUNITY, INC., A DIVISION OF THE SISTERS OF MERCY OF THE AMERICAS, A RELIGIOUS INSTITUTE AND PUBLIC JURIDIC PERSON OF THE ROMAN CATHOLIC CHURCH; (III)A MAXIMUM OF TWO (2) INDIVIDUALS JOINTLY APPOINTED BY THE FACILITY AND PROGRAM SPONSOR AND BY THE CO-SPONSOR OF THE CORPORATE MEMBER; AND (IV) ONE (1) INDIVIDUAL NOMINATED BY THE RESIDENT COUNCIL OF SALEM LUTHERAN HOME, THE CONTINUING CARE RETIREMENT COMMUNITY OWNED AND OPERATED BY THE CORPORATION (THE "CCRC") AND APPOINTED BY THE APPOINTEES NAMED PURSUANT TO SUBPARAGRAPHS (I), (II) AND (III) ABOVE, WHICH NOMINEE MUST BE A RESIDENT OF THE CCRC AND WHO WILL NOT HAVE VOTING RIGHTS BUT SHALL HAVE THE SAME FIDUCIARY DUTIES, INCLUDING THE DUTIES OF LOYALTY, CARE AND CONFIDENTIALITY, TO THE CORPORATION IN THEIR ROLE OF RESIDENT REPRESENTATIVE. NOMINATION OF DIRECTORS: (A) SPONSOR AND CO-SPONSOR APPOINTEES. THE BOARD DEVELOPMENT COMMITTEE OF THE CORPORATE MEMBER SHALL IDENTIFY AND EVALUATE QUALIFIED INDIVIDUALS TO SERVE AS DIRECTORS OF THE CORPORATION AND SHALL RECOMMEND THEM TO THE FACILITY AND PROGRAM SPONSOR AND THE CO-SPONSOR OF THE CORPORATE MEMBER FOR APPOINTMENT OF THE SPONSOR AND CO-SPONSOR APPOINTEES. (B) RESIDENT REPRESENTATIVE. THE RESIDENT REPRESENTATIVE SHALL BE NOMINATED BY THE RESIDENT COUNCIL OF THE CCRC IN ANY MANNER DETERMINED BY THE RESIDENT COUNCIL THAT IS REASONABLY CALCULATED TO ENCOURAGE RESIDENT INVOLVEMENT IN SELECTING AND/OR SERVING AS THE RESIDENT REPRESENTATIVE, SO LONG AS THE RESIDENT COUNCIL CONVENES A MEETING FOR SUCH PURPOSE UPON NO LESS THAN THIRTY (30) DAYS' NOTICE. NOTICE OF THE MEETING SHALL BE POSTED IN A CONSPICUOUS PLACE WITHIN THE CCRC AND SHALL STATE THAT THE PURPOSE OF THE MEETING IS TO NOMINATE A RESIDENT TO THE BOARD OF THE CORPORATION. THE FOLLOWING ACTIONS REGARDING SALEM LUTHERAN HOME ("SALEM") SHALL NOT BE IMPLEMENTED WITHOUT THE SPECIFIC APPROVAL OF ELDER CARE ALLIANCE'S CORPORATE MEMBER, SIERRA PACIFIC SYNOD: (A) THE SALE, PURCHASE LEASE OR ENCUMBRANCE OF THE REAL PROPERTY OF SALEM; (B) ANY INCREMENT OR ADDITIONS TO THE CAPITAL DEBT LIMITATION OF SALEM OR ANY OTHER NEGOTIATION, MODIFICATION OR OTHER CHANGE IN THE EXISTING CAPITAL DEBT OF SALEM; (C) ANY ACTION SEEKING BANKRUPTCY OR OTHER DEBTOR PROTECTION FOR SALEM; AND (D) ANY OTHER MATTERS WHICH MAY BE REQUIRED BY CIVIL LAW TO BE NOMINATED BY THE RESIDENT COUNCIL OF THE CCRC IN ANY MANNER DETERMINED BY THE RESIDENT COUNCIL THAT IS REASONABLY CALCULATED TO ENCOURAGE RESIDENT INVOLVEMENT IN SELECTING AND/OR SERVING AS THE RESIDENT REPRESENTATIVE, SO LONG AS THE RESIDENT COUNCIL CONVENES A MEETING FOR SUCH PURPOSE UPON NO LESS THAN THIRTY (30) DAYS' NOTICE. NOTICE OF THE MEETING SHALL BE POSTED IN A CONSPICUOUS PLACE WITHIN THE CCRC AND SHALL STATE THAT THE PURPOSE OF THE MEETING IS TO NOMINATE A RESIDENT TO THE BOARD OF THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 REVIEW PROCESS: THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. ELDER CARE ALLIANCE, SALEM'S SOLE CORPORATE MEMBER AND MANAGEMENT COMPANY, HAS AN AUDIT COMMITTEE ON ITS BOARD OF DIRECTORS THAT REVIEWS THE FORM 990 BEFORE FILING. ALSO, THE EXECUTIVE DIRECTOR, CEO, AND CFO ALL REVIEW THE FORM 990 BEFORE FILING. THE FINAL FORM 990 IS THEN PROVIDED BY E-MAIL TO ALL MEMBERS OF THE BOARD OF DIRECTORS BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY COMPLIANCE: ANNUALLY, THE ASSISTANT SECRETARY OF ELDER CARE ALLIANCE REQUESTS UPDATED CONFLICT OF INTEREST DISCLOSURE FORMS FROM THE BOARD OF DIRECTORS, OFFICERS, KEY EMPLOYEES, AND MEMBERS OF COMMITTEES WITH BOARD-DELEGATED AUTHORITY. THE ASSISTANT SECRETARY PREPARES A TABLE SUMMARIZING THE DISCLOSURES MADE AND PRESENTS THE TABLE TO THE BOARD OF DIRECTORS FOR THEIR INFORMATION. IF AN APPARENT CONFLICT OF INTEREST IS IDENTIFIED, THE MATTER IS REVIEWED BY THE BOARD OR COMMITTEE AND ACTION TAKEN. IF DEEMED NECESSARY, THE BOARD OR COMMITTEE MAY TAKE ACTION SUCH AS REQUIRING AN INTERESTED DIRECTOR TO RECUSE HIMSELF OR HERSELF FROM A VOTE ON THE MATTER OR TERMINATING A BUSINESS RELATIONSHIP ENTERED INTO IN VIOLATION OF THE POLICY. FORM 990, PART VI, SECTION B, LINES 15A & 15B COMPENSATION DETERMINATION: SALEM HAS A MANAGEMENT CONTRACT WITH ELDER CARE ALLIANCE. INCLUDED IN THE SERVICES PROVIDED UNDER THIS MANAGEMENT CONTRACT ARE THE SERVICES OF THE CEO, CFO, AND EXECUTIVE DIRECTOR. THE COMPENSATION REVIEW OF THE EXECUTIVE DIRECTORS AND KEY EMPLOYEES WAS DONE FOR FY 2014 BY THE FINANCE COMMITTEE OF ELDER CARE ALLIANCE AS PART OF THE BUDGET REVIEW PROCESS. THE COMPENSATION FOR THE CEO AND CFO WAS REVIEWED BY ECA COMPENSATION COMMITTEE, INDLUCING A COMPENSATION STUDY COMPILED BY FUTURESENSE, INC., A FIRM THAT SPECIALIZES IN COMPENSATION PROGRAMS AND PROVIDES CONSULTATION TO THE BORAD. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENT AVAILABILITY: BECAUSE SALEM IS A CONTINUING CARE RETIREMENT COMMUNITY, AN ANNUAL REPORT MUST BE FILED WITH THE STATE OF CALIFORNIA CONTAINING THE ORGANIZATION'S FINANCIAL STATEMENTS. THERE IS A NON-VOTING MEMBER OF THE BOARD OF DIRECTORS THAT REPRESENTS THE SALEM RESIDENTS WHO HAS ACCESS TO ALL GOVERNING DOCUMENTS, FINANCIAL STATEMENTS AND THE CONFLICT OF INTEREST POLICY FOR SALEM. ALL REQUESTS MUST BE IN WRITING TO ELDER CARE ALLIANCE, SALEM'S MANAGEMENT COMPANY, AND WILL BE RESPONDED TO VIA EMAIL, US MAIL, OR BY FAX IF SO REQUESTED. FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS: TRANSFER TO AFFILIATE $(490,600) ELDER CARE ALLIANCE 1301 MARINA VILLAGE PKWY 210 ALAMEDA CA 94501 943260975 MANAGEMENT CA 501(C)(3) 11 B II NA false MERCY RETIREMENT AND CARE CENTER 1301 MARINA VILLAGE PKWY 210 ALAMEDA CA 94501 941156579 ELDERLY CARE CA 501(C)(3) 9 ECA false ELDER CARE ALLIANCE OF CAMARILLO 1301 MARINA VILLAGE PKWY 210 ALAMEDA CA 94501 943351613 ELDERLY CARE CA 501(C)(3) 9 ECA false ELDER CARE ALLIANCE OF SAN FRANCISCO 1301 MARINA VILLAGE PKWY 210 ALAMEDA CA 94501 943351615 ELDERLY CARE CA 501(C)(3) 9 ECA false ELDER CARE ALLIANCE OF UNION CITY 1301 MARINA VILLAGE PKWY 210 ALAMEDA CA 94501 943377985 ELDERLY CARE CA 510(C)(3) 9 ECA false ELDER CARE ALLIANCE OF SAN RAFAEL 1301 MARINA VILLAGE PKWY 210 ALAMEDA CA 94501 760730971 ELDERLY CARE CA 501(C)(3) 9 ECA false false false false false false false false false false false false false true true true true false true false