2015-11-13T14:30:04-06:00 2014-12-31 390859910 BAKER TILLY VIRCHOW KRAUSE LLP 46 PUBLIC SQUARE SUITE 400 WILKESBARRE PA 18701 990 2014-01-01 221500537 GREEN HILL INC GREE 9737312300 103 PLEASANT VALLEY WAY WEST ORANGE NJ 07052 TONI LYNN DAVIS PRESIDENT 9737312300 2015-11-11 1 EDWARD A KOLLAR CPA EA P00012018 5708200100 2015-11-11 2014 2016-02-25 16:41:14Z TONI LYNN DAVIS 103 PLEASANT VALLEY WAY WEST ORANGE NJ 07052 14968934 0 X WWW.GREEN-HILL.COM X 1866 NJ TO CARE FOR AND ASSIST THE AGED AND SHELTER THOSE WHOSE AFFLICTIONS ARE CHRONIC. 13 10 306 15 0 0 40608 87602 13850783 14175295 718744 517526 119889 140699 14730024 14921122 1100 0 0 0 8759135 8826466 0 15000 15000 7424069 7543208 16184304 16384674 -1454280 -1463552 33610265 31977601 17142656 18180041 16467609 13797560 X CONTINUING THE TRADITION OF THOSE BEFORE US, WE STRIVE TO MAINTAIN A WARM, HOME-LIKE ENVIRONMENT OFFERING SUPPORT AND ASSISTANCE TO SENIORS AND THEIR FAMILIES. OUR STAFF IS INTEGRAL TO OUR MISSION BY PROVIDING EXCELLENT SERVICE AND OFFERING QUALITY CARE, REHABILITATION, RECREATIONAL, EDUCATION, AND SOCIAL ACTIVITIES. UNDER THE DIRECTION OF OUR BOARD OF TRUSTEES, WE CONTINUE OUR NOT-FOR-PROFIT MISSION BY ENHANCING THE QUALITY OF LIFE FOR SENIORS IN A HOME-LIKE ENVIRONMENT, ENCOURAGING RESPECT AND DIGNITY FROM A CARING STAFF WHO TAKE PRIDE IN THEIR LIFE'S WORK. 0 0 14323537 0 14175295 GREEN HILL, INC. OPERATES A RETIREMENT COMMUNITY PROVIDING HOUSING, HEALTH CARE, AND OTHER RELATED SERVICES TO ELDERLY RESIDENTS. GREEN HILL IS LICENSED FOR 77 SKILLED NURSING BEDS, WHICH INCLUDES FOUR 10-BED SKILLED NURSING HOMES, KNOWN AS GREEN HOUSE HOMES. DEVELOPED IN CONCEPT BY EDEN ALTERNATIVE ORIGINATOR DR. WILLIAM THOMAS, A GREEN HOUSE HOME IS A SMALL INTENTIONAL COMMUNITY FOR A GROUP OF ELDERS AND STAFF. IT SERVES AS A PLACE WHERE ELDERS CAN RECEIVE SKILLED NURSING ASSISTANCE AND SUPPORT IN A HOME-LIKE SETTING. GREEN HILL IS ALSO LICENSED FOR 88 COMPREHENSIVE PERSONAL CARE UNITS AND 48 RESIDENTIAL HEALTHCARE UNITS. 14323537 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 67 0 1 306 1 0 0 0 0 0 0 0 0 0 0 X 13 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NJ X KAREN JUNG DIRECTOR OF FINANCE 9737312300 103 PLEASANT VALLEY WAY WEST ORANGE NJ 07052 TONI LYNN DAVIS PRESIDENT 35.50 2.00 X X 208749 0 26085 PAUL O'CONNOR CHAIRMAN 1.00 0.50 X X 0 0 0 CALVIN TREVENEN VICE CHAIRMAN 1.00 0.50 X X 0 0 0 LORI BRAENDER SECRETARY 1.00 0.50 X X 0 0 0 VALERIE DEPIRO TREASURER 1.00 0.50 X X 0 0 0 CHRISTIAN BASTARDI TRUSTEE 1.00 0.50 X 0 0 0 HARRIS COHEN TRUSTEE 1.00 0.50 X 0 0 0 ELIZABETH DAVIS TRUSTEE 1.00 0.50 X 0 0 0 WALTER FARLEY TRUSTEE 1.00 0.50 X 0 0 0 LORIE GARDNER TRUSTEE 1.00 0.50 X 0 0 0 RODGER HERRIGEL TRUSTEE 1.00 0.50 X 0 0 0 JAIME RASKULINECZ TRUSTEE 1.00 0.50 X 0 0 0 MARC SCUDILLO TRUSTEE 1.00 0.50 X 0 0 0 A DUNCAN KIDD TRUSTEE (RESIGN 3/2014) 1.00 0.50 X 0 0 0 KAREN JUNG DIRECTOR OF FINANCE 35.50 2.00 X 106260 0 3006 IESHA CARTER DIRECTOR OF NURSING 37.50 0.00 X 100409 0 12341 415418 0 41432 3 0 1 0 MORRISON MANAGEMENT SPECIALISTS 5801 PEACHTREE DUNWOODY DR ATLANTA GA 30342 DIETARY & PLANT SERVICES 1130010 SELECT MEDICAL REHABILITATION SERVICES PO BOX 643920 PITTSBURGH PA 15264 THERAPY SERVICES 638034 RF TECHNOLOGIES INC PO BOX 8444 CAROL STREAM IL 60197 IT CONSULT/INSTALL 308825 GLYNN DEVINS MARKETING & ADVERTISING 11230 COLLEGE BLVD OVERLAND PARKS KS 66210 MARKETING 175717 4 46541 41061 87602 NET RESIDENT SERVICE REVENUE 623000 13883895 13883895 ADMISSION FEES 623000 286000 286000 APPLICATION FEES 623000 5400 5400 14175295 517526 517526 3250 46541 31779 -28529 -28529 11285 16033 -4748 -4748 BEAUTY SHOP REVENUE 623000 91336 91336 REFUND OF REAL ESTATE TAXES 900099 31105 31105 MISCELLANEOUS 623000 27078 27078 24457 24457 173976 14921122 14175295 0 658225 234834 234834 6587058 5958845 628213 253119 240796 12323 1164767 1070640 94127 586688 530995 55693 96320 96320 36547 36547 42653 42653 15000 15000 54302 54302 1191832 1116263 75569 236048 236048 436795 255636 181159 89379 25032 64347 707105 707105 43044 42563 481 59962 17374 42588 355514 355514 2142260 2099013 43247 405480 208308 197172 FOOD 555465 555465 PROVIDER ASSESSMENT 230569 230569 PHARMACY AND DRUG COSTS 217720 217720 BAD DEBT EXPENSE 166751 166751 475462 423149 52313 16384674 14323537 2046137 15000 545976 445614 10957 1233706 1180395 176605 280749 49948450 25813389 25557893 24135061 5693657 5552662 391471 383120 33610265 31977601 1127802 1432448 260100 259600 14177816 13911437 1576938 2576556 17142656 18180041 X 15062868 12393770 4523 3572 1400218 1400218 16467609 13797560 33610265 31977601 X -1463552 -1206497 X 0 1 X 1 0 X 54854 27770 47305 40608 87602 258139 7690371 11655376 12989540 13857471 14175295 60368053 7745225 11683146 13036845 13898079 14262897 60626192 0 0 0 60626192 160134 197148 555098 718744 517526 2148650 160134 197148 555098 718744 517526 2148650 64252 117109 122322 113201 173976 590860 7969611 11997403 13714265 14730024 14954399 63365702 0.95680 0.96190 0.03390 0.02850 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER - 2010 AMOUNT: $ 64,252. 2011 AMOUNT: $ 117,109. 2012 AMOUNT: $ 122,322. 2013 AMOUNT: $ 113,201. BEAUTY SHOP REVENUE - 2014 AMOUNT: $ 91,336. FINANCE CHARGE INCOME - 2014 AMOUNT: $ 24,457. CORNER STORE INCOME - 2014 AMOUNT: $ 2,304. MISCELLANEOUS INCOME - 2014 AMOUNT: $ 24,774. REFUND OF PROPERTY TAX - 2014 AMOUNT: $ 31,105. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 279792 279792 42209111 20356579 21852532 7459547 5456810 2002737 24135061 ACCRUED PENSION COST 1788001 CAPITAL LEASE OBLIGATIONS 282204 DERIVATIVE FINANCIAL INSTRUMENT 114202 DUE TO AFFILIATE 392149 2576556 X 14950376 60359 60359 14890017 31105 31105 14921122 17620425 1250751 1250751 16369674 15000 15000 16384674 PART X, LINE 2: GREEN HILL AND HOME CARE ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON THEIR EXEMPT INCOME UNDER SECTION 501(A) OF THE INTERNAL REVENUE CODE. THE CORPORATION ACCOUNTS FOR UNCERTAINTY IN INCOME TAXES BY PRESCRIBING A RECOGNITION THRESHOLD OF MORE-LIKELY-THAN-NOT TO BE SUSTAINED UPON EXAMINATION BY THE APPROPRIATE TAXING AUTHORITY. MEASUREMENT OF THE TAX UNCERTAINTY OCCURS IF THE RECOGNITION THRESHOLD HAS BEEN MET. MANAGEMENT DETERMINED THAT THERE WERE NO TAX UNCERTAINTIES THAT MET THE RECOGNITION THRESHOLD IN 2014. EFFECTIVE MAY 1, 2010, GREEN HILL AND HOME CARE CHANGED THEIR YEAR END FROM APRIL 30 TO DECEMBER 31. THE FEDERAL RETURNS OF ORGANIZATION EXEMPT FROM INCOME TAX FOR GREEN HILL AND HOME CARE FOR THE YEARS ENDED DECEMBER 31, 2013, DECEMBER 31, 2012, AND DECEMBER 31, 2011 REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN FAIR VALUE OF DERIVATIVE INSTRUMENTS 75,359. PROFESSIONAL FUNDRAISING FEES -15,000. PART XI, LINE 4B - OTHER ADJUSTMENTS: REAL ESTATE TAX REFUND LISTED IN EXPENSES 31,105. PART XII, LINE 2D - OTHER ADJUSTMENTS: PENSION LIABILITY ADJUSTMENT 1,281,856. REAL ESTATE TAX REFUND LISTED AS EXPENSE -31,105. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROFESSIONAL FUNDRAISING FEES 15,000. X X X X X 1 A SIMON SAYS LLC 64 WELLINGTON AVENUE WEST ORANGE NJ 07052 GALA FUNDRAISING 0 49791 15000 34791 49791 15000 34791 NJ GALA 49791 46541 3250 2877 28902 49791 46541 3250 2877 28902 31779 -28529 11285 3700 8145 4188 1 1.00000 11285 3700 8145 4188 16033 -4748 NJ 1 0 0 0 1.00000 KAREN JUNG 103 PLEASANT VALLEY WAY WEST ORANGE NJ 07052 0 0 X X X 0 1 0 0 0 0 0 0 0 TONI LYNN DAVIS PRESIDENT 183749 0 25000 0 0 0 3198 0 22887 0 234834 0 0 0 PART I, LINE 4B TONI LYNN DAVIS PARTICIPATED IN A 457(F) PLAN. THERE WERE NO CONTRIBUTIONS TO THE PLAN IN 2014. A NEW JERSEY ECONOMIC DEVELOPMENT AUTHORITY 222045817 645918X8N 2010-05-20 14275000 CONSTRUCTION OF FOUR GREEN HOUSE HOMES 0 0 0 A 270000 14275000 174610 297697 715091 267104 12820498 2011 0 0 1 1 A 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 1 0 0 0 1 A 1 FORM 990, PART VI, SECTION B, LINE 11 THE PRESIDENT AND THE DIRECTOR OF FINANCE WILL REVIEW THE FORM 990 PRIOR TO FILING. THE FINANCE COMMITTEE WILL REVIEW THE FORM 990 AND ADVISE AND REPORT TO THE FULL BOARD OF DIRECTORS BEFORE THE RETURN IS FILED. FORM 990, PART VI, SECTION B, LINE 12C EACH MEMBER COMPLETES AN ANNUAL QUESTIONNAIRE WHICH IS REVIEWED BY THE EXECUTIVE COMMITTEE. ANY RESTRICTIONS ARE DISCUSSED DURING REVIEW. THE EXECUTIVE COMMITTEE MONITORS AND ENFORCES THE POLICY BY ENSURING THAT THE QUESTIONNAIRE IS REQUIRED TO BE COMPLETED EACH YEAR. IF THERE ARE CONFLICTS, THEY ARE ADDRESSED AT THAT TIME WITH RESOLUTION ACCEPTABLE TO THE CONSENSUS. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMMITTEE MEETS AND REVIEWS THE PRESIDENT'S SALARY ANNUALLY IN EXECUTIVE SESSION. THE BOARD DETERMINES THE PRESIDENT'S SALARY AND UTILIZES OUTSIDE SURVEYS SUCH AS NJHA AND HCANJ TO ENSURE THAT SALARY IS AT AN ACCEPTABLE RANGE. THE EXECUTIVE COMMITTEE MEETS AND DISCUSSES ANY INCREASES AND MAKES RECOMMENDATIONS TO THE BOARD TO APPROVE. A FORM IS COMPLETED BY THE CHAIRMAN AND PUT IN THE PRESIDENT'S FILE STATING THE INCREASE, BONUS, ETC. THERE IS AN ANNUAL PROCESS FOR ADMINISTRATIVE AND MANAGEMENT POSITIONS. REGARDING OTHER SALARIES, THE BOARD UTILIZES OUTSIDE SERVICES AS WELL, AND THE PRESIDENT, ALONG WITH THE BOARD, DETERMINES THEM. 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. FORM 990, PART XI, LINE 9: PENSION LIABILITY ADJUSTMENT -1,281,856. CHANGE IN FAIR VALUE OF DERIVATIVE INSTRUMENTS 75,359. GREEN HILL AT HOME INC 103 PLEASANT VALLEY WAY WEST ORANGE NJ 07052 270425491 PROVIDES SUPPORT AND ASSISTS THE AGED WHOSE AFFLICTIONS ARE CHRONIC NJ 501(C)(3) PF GREEN HILL INC 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 1 0 1 GREEN HILL HOME CARE INC O 46411 ACTUAL WAGES INCURRED GREEN HILL HOME CARE INC S 165000 ACTUAL TRANSFER GREEN HILL HOME CARE INC Q 21187 ACTUAL EXPENSES INCURRED GREEN HILL HOME CARE INC L 33039 ACTUAL EXPENSES INCURRED GREEN HILL HOME CARE INC M 27224 ACTUAL EXPENSES INCURRED