2015-05-14T10:26:50-05:00 2014-09-30 273256712 STARBUCK WALSH LLP 16057 KAMANA ROAD APPLE VALLEY CA 92307 990 2013-10-01 951660824 ST JOHN OF GOD RETIREMENT & CARE CENTER STJO 3237310641 2468 S ST ANDREWS PLACE LOS ANGELES CA 90018 SANTIAGO LOPZEZ EXECUTIVE DIRECTOR 3237310641 2015-05-12 1 JENNIFER STARBUCK P00401364 7602429222 2015-05-12 2013 2016-03-07 17:11:31Z SANTIAGO LOPEZ 2468 S ST ANDREWS PLACE LOS ANGELES CA 90018 19709314 0 X WWW.STJOHNOFGOSENIORS.ORG X 1942 CA THE ST. JOHN OF GOD RETIREMENT AND CARE CENTER (THE CENTER) IS A CALIFORNIA NOT-FOR-PROFIT CORPORATION WHICH OPERATES 156 BED SKILLED NURSING, 60 UNIT ASSISTED LIVING AND RESIDENTIAL CARE, AND 51 UNIT INDEPENDENT LIVING FACILITIES, AND 31 UNITS FOR ALZHEIMER'S OR RELATED DISEASES. 9 8 415 0 0 0 257568 1082837 18018227 18541378 11102 85099 0 0 18286897 19709314 0 0 0 0 10676061 10888143 0 0 0 8247175 9252275 18923236 20140418 -636339 -431104 31702493 31187843 1189996 1106450 30512497 30081393 THE HOSPITALLER BROTHERS ARE COMMITTED TO COMPASSIONATE CARE BY RESPONDING TO THE NEEDS OF THE WHOLE PERSON, WHILE ENCOURAGING TEAMWORK/COLLABORATION. BY DOING SO, THEY PROMOTE THE VALUES OF HOSPITALITY, RESPECT AND HEALING. 0 0 16612965 18541378 OPERATED A SKILLED NURSING, LONG TERM CARE, INDEPENDENT LIVING, AND RESIDENTIAL CARE FACILITY AND PROVIDED ANCILLARY SERVICES TO RESIDENTS. 16612965 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 39 0 1 415 1 0 0 0 0 0 0 0 0 0 0 X 9 8 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 0 1 1 0 CA X X X WILLY ATIENZA 3237310641 2468 S ST ANDREWS PLACE LOS ANGELES CA 90018 BROTHER STEPHEN DE LA ROSA OH CHAIRPERSON 30.00 20.00 X X 0 0 0 BROTHER GEORGE TECKU OH TRUSTEE 1.00 X 0 0 0 BROTHER THADDEUS BUI OH TRUSTEE 1.00 X 0 0 0 DR LESLIE PAUL MD TRUSTEE 1.00 X 0 0 0 DONNA BENTON PHD TRUSTEE 1.00 X 0 0 0 PHIL DEVIN PHD TRUSTEE 1.00 X 0 0 0 SANTIAGO LOPEZ CHIEF EXECUTIVE OFFICER 30.00 20.00 X 155042 0 0 RENE DRACHENBERG CHIEF EXECUTIVE OFFICER 30.00 20.00 X 149477 0 0 WILLY ATIENZA CONTROLLER 30.00 20.00 X 0 0 0 304519 0 0 2 0 1 0 REHAB ALLIANCE 22995 MILL CREEK DR SUITE A LAGUNA HILLS CA 92653 THERAPY SERVICES 579707 PROCARE MEDICAL STAFFING 127 S BRAND BLVD SUITE 100G GLENDALE CA 91204 NURSING REGISTRY 445305 CALIFORNIA UNIQUE SECURITY PO BOX 455 NORCO CA 92860 SECURITY SERVICES 325123 REHAB UNLIMITED 3545 WILSHIRE BLVD SUITE 250 LOS ANGELES CA 90010 THERAPY SERVICES 127774 4 371805 711032 1082837 MEDICARE/MEDI-CAL/HOSPICE PAYMENT 623000 11804260 11804260 PRIVATE PATIENT & RESIDENT PAY 623000 6439944 6439944 ANCILLARY SERVICES 623000 297174 297174 18541378 85099 85099 19709314 18541378 0 85099 381000 76200 304800 8932667 8025796 906871 776791 657124 119667 797685 705359 92326 116419 116419 35536 35536 27435 14465 12970 19184 19184 198659 7206 191453 58245 58245 20005 20005 346 346 5365 5365 1333555 1299980 33575 977529 782023 195506 PURCHASED SERVICES 2309277 2210583 98694 SUPPLIES 2130447 2067128 63319 ASSURANCE FEES 857208 857208 UTILITIES 816065 767101 48964 347000 347000 20140418 16612965 3527453 0 2817301 1797381 818681 821323 1016290 1663439 205349 218769 50708261 25236935 26226463 25471326 182120 182120 436289 1033485 31702493 31187843 1098692 1057128 38769 0 52535 49322 1189996 1106450 X 30512497 30081393 30512497 30081393 31702493 31187843 -431104 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 507991 507991 44547819 20676977 23870842 413084 377057 36027 2829383 2215174 614209 2409984 1967727 442257 25471326 SECURITY DEPOSITS 22363 PATIENT TRUST 26959 49322 19709314 0 19709314 0 19709314 20140418 0 20140418 0 20140418 0 0 0 0 0 0 0 0 0 SANTIAGO LOPEZ CHIEF EXECUTIVE OFFICER 155042 0 0 0 0 0 0 0 0 0 155042 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS REVIEWED BY THE EXECUTIVE COMMITTEE AND THEN APPROVED BY THE BOARD AT LARGE. FORM 990, PART VI, SECTION B, LINE 12C OFFICERS, DIRECTORS AND KEY EMPLOYEES ARE REQUIRED TO DOCUMENT PERSONAL AND BUSINESS INTERESTS. EMPLOYEES RESPONSIBLE FOR FINANCIAL TRANSACTIONS ARE AWARE OF THOSE INTERESTS AND CONSIDER THEM WHEN MAKING DECISIONS. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION REVIEWS AND APPROVES COMPENSATION OF EMPLOYEES AND DIRECTORS THROUGH REVIEW BY THE BOARD AND COMPARES SALARIES BASED UPON INSPECTION OF VARIOUS NON PROFIT ORGANIZATIONS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DISCLOSES GOVERNING DOCUMENTS, POLICIES AND FINANCIAL STATEMENTS UPON REQUEST. IN ADDITION, THE FORM 990 IS MADE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. FORM 990, PART XII, LINE 2C THE ORGANIZATION HAS A FINANCE COMMITTEE WHO MEETS TO REVIEW THE AUDIT AND RECOMMEND THAT THE BOARD EITHER ACCEPT OR REJECT THE AUDIT. THE HOSPITALLER FOUNDATION OF CA 2468 S ST ANDREWS PLACE LOS ANGELES CA 90018 953299706 RELIGIOUS ORGANIZATION CA CHARITABLE LINE 1 0 HOSPITALLER BROTHERS HEALTH CARE SERVICE 2425 S WESTERN AVE LOS ANGELES CA 90018 954334552 HEALTH INSURANCE CA CHARITABLE LINE 1 0 ST JOHN OF GOD HEALTH CARE SERVICE PO BOX 2457 VICTORVILLE CA 92392 953806996 SUBSTANCE ABUSE TREATMENT AND PREVENTION CA CHARITABLE LINE 1 0 ST JOSEPH'S HEALTH AND RETIREMENT CENTER 2464 E OJAI AVE OJAI CA 93024 953265311 SKILLED NURSING FACILITY CA CHARITABLE LINE 1 0 BROTHERS OF ST JOHN OF GOD 2425 S WESTERN AVE LOS ANGELES CA 90018 952399225 RELIGIOUS ORGANIZATION CA CHARITABLE LINE 1 0 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 ST JOSEPH'S HEALTH AND RETIREMENT CENTER B 5365 CASH THE HOSPITALLER FOUNDATION OF CA C 371805 CASH ST JOSEPH'S HEALTH AND RETIREMENT CENTER D 587000 CASH BROTHERS OF ST JOHN OF GOD M 259000 CASH