ELDER CARE ALLIANCE OF SAN MATEO: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
ELDER CARE ALLIANCE OF SAN MATEO (EIN 94-0831870)
Tax period
2012-07-01 to 2013-06-30
Filed
2014-02-04
IRS object ID
201410359349300321
Schema version
2012v2.3
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2014-02-04T12:17:48-06:00Timestamp
Tax Period End Date2013-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1BKD LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1910 E ST LOUIS 200/PO BOX 1190AddressLine1
CitySPRINGFIELDCity
StateMOState
ZIP Code658062523ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN940831870EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1SALEM LUTHERAN HOME ASSOCIATION OF THE BAYBusinessNameLine1
Business Name Line2CITIESBusinessNameLine2
FieldValueIRS element (for citing)
In Care Of Name% JANICE WASHBURNInCareOfName
Name ControlSALENameControl
Phone5107692700Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11301 MARINA VILLAGE PARKWAYAddressLine1
Address Line2Suite 210AddressLine2
CityALAMEDACity
StateCAState
ZIP Code94501ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJANICE WASHBURNName
TitleINTERIM CFO/CONTROLLERTitle
Phone5107692700Phone
Date Signed2014-01-27DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameBrian D ToddName
Phone4178658701Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonJESSE JANTZENNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11301 MARINA VILLAGE PKWY 210AddressLine1
CityALAMEDACity
StateCAState
ZIP Code94501ZIPCode
FieldValueIRS element (for citing)
Gross Receipts13727536GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.SALEMLUTHERANHOME.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1924YearFormation
State Legal DomicileCAStateLegalDomicile
Activity Or Mission DescriptionSALEM LUTHERAN HOME ASSOCIATION SERVES AND ENRICHES THE LIVES OF OLDER ADULTS BY PROVIDING HOUSING AND SERVICES AT ITS CARE CENTER, AND ITS ASSISTED LIVING, MEMORY CARE, AND INDEPENDENT LIVING UNITS.ActivityOrMissionDescription
Nbr Voting Members Governing Body10NbrVotingMembersGoverningBody
Nbr Independent Voting Members10NbrIndependentVotingMembers
Total Nbr Employees214TotalNbrEmployees
Total Nbr Volunteers53TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year155161ContributionsGrantsPriorYear
Contributions Grants Current Year500576ContributionsGrantsCurrentYear
Program Service Revenue Prior Year12552480ProgramServiceRevenuePriorYear
Program Service Revenue CY12962761ProgramServiceRevenueCY
Investment Income Prior Year223606InvestmentIncomePriorYear
Investment Income Current Year88572InvestmentIncomeCurrentYear
Other Revenue Prior Year-1344OtherRevenuePriorYear
Other Revenue Current Year175627OtherRevenueCurrentYear
Total Revenue Prior Year12929903TotalRevenuePriorYear
Total Revenue Current Year13727536TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year7088468SalariesEtcPriorYear
Salaries Etc Current Year7073036SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year17124TotalFundrsngExpCurrentYear
Other Expense Prior Year5547959OtherExpensePriorYear
Other Expenses Current Year5818850OtherExpensesCurrentYear
Total Expenses Prior Year12636427TotalExpensesPriorYear
Total Expenses Current Year12891886TotalExpensesCurrentYear
Revenues Less Expenses Prior Year293476RevenuesLessExpensesPriorYear
Revenues Less Expenses CY835650RevenuesLessExpensesCY
Total Assets BOY15194984TotalAssetsBOY
Total Assets EOY15533735TotalAssetsEOY
Total Liabilities BOY6441535TotalLiabilitiesBOY
Total Liabilities EOY5703729TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY8753449NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY9830006NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionA 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.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense7322788Expense
Revenue5933140Revenue
DescriptionSALEM'S CARE CENTER IS LICENSED FOR 48 SKILLED NURSING RESIDENTS. THE CARE CENTER PROVIDES SKILLED NURSING CARE TO 44 OLDER ADULT RESIDENTS IN AN AVERAGE MONTH, FOR AN ANNUAL TOTAL OF 15,865 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.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense1379656Expense
Revenue2260101Revenue
DescriptionSALEM'S MEMORY CARE UNIT PROVIDES HOUSING AND SERVICES FOR UP 30 OLDER ADULT RESIDENTS WHO HAVE DEMENTIA OR MEMORY LOSS. THIS YEAR WE PROVIDED MEMORY CARE HOUSING FOR 29 RESIDENTS EACH MONTH ON AVERAGE FOR A TOTAL OF 10,571 RESIDENT DAYS. THE MEMORY CARE UNIT HAS MANY DAILY ACTIVITIES DESIGNED FOR DEMENTIA OR MEMORY LOSS RESIDENTS.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense1273528Expense
Revenue3040969Revenue
DescriptionSALEM'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 61 RESIDENTS EACH MONTH ON AVERAGE, EXCLUDING SECOND PERSONS IN EACH UNIT, FOR AN ANNUAL TOTAL OF 22,265 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.Description
FieldValueIRS element (for citing)
Total Of Other Program Service Exp636764TotalOfOtherProgramServiceExp
Total Of Other Program Service Rev1728550TotalOfOtherProgramServiceRev
Total Program Service Expense10612736TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingtrueCreditCounseling
Term Or Permanent EndowmentstrueTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109674NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees214NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionstrueQuidProQuoContributions
Quid Pro Quo DisclosuretrueQuidProQuoDisclosure
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members10NbrVotingGoverningBodyMembers
Number Independent Voting Members10NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiestrueDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOfalseCompensationProcessCEO
Compensation Process OtherfalseCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledCAStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonJANICE WASHBURNNamePerson
Telephone Number5107692727TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11301 MARINA VILLAGE PARKWAY SUITEAddressLine1
CityALAMEDACity
StateCAState
ZIP Code94501ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (14 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficer
CHARLES RUTHROFF
DIRECTOR1.04.0X000
CHRISTINE WHELAN
SECRETARY BEG 11/20121.08.0X000X
SISTER LINDA ORRICK
SECRETARY END 11/20121.06.0X000X
SISTER KATHLEEN KEARNEY
CHAIR1.09.0X000X
JOAN RYAN
DIRECTOR1.03.0X000
MICHAEL TELLEEN
DIRECTOR1.03.0X000
REVEREND NOREEN MEGINNESS
DIRECTOR1.03.0X000
JESSE BEAN
DIRECTOR1.03.0X000
VERN STIGGE
VICE CHAIR BEG 11/20121.09.0X000X
RAHUL JOGLEKAR
DIRECTOR BEG 11/20121.03.0X000
LYNNE KATZMAN
DIRECTOR BEG 11/20121.03.0X000
JESSE JANTZEN
CHIEF EXECUTIVE OFFICER1.045.0037427912127X
JANICE WASHBURN
CHIEF FINANCIAL OFFICER1.045.0019122712430X
ADRIENE IVERSON
ASSISTANT SECRETARY1.045.001781209041X
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs743626TotalReportableCompFrmRltdOrgs
Total Other Compensation33598TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

FieldValueIRS element (for citing)
Name PersonREHABCARE GROUP INCNamePerson

Address Of Contractor AddressOfContractor

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO BOX 50353AddressLine1
CityST LOUISCity
StateMOState
ZIP Code63150ZIPCode
FieldValueIRS element (for citing)
Description Of ServicesSKILLED NURSINGDescriptionOfServices
Compensation533588Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K
All Other Contributions500576AllOtherContributions
Total Contributions500576TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
NET PATIENT SERVICE REVENUE62300058153645815364
RESIDENT SERVICES62300070402887040288
OTHER PROGRAM SERVICE REVENU623000107109107109
FieldValueIRS element (for citing)
Total Program Service Revenue12962761TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column88572TotalRevenueColumn
Exclusion$88,572ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real7600Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real7600Real
Personal0Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column7600TotalRevenueColumn
Exclusion$7,600ExclusionAmount

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionGAIN ON INVESTMENT POOLSDescription
Business Code900099BusinessCode
Total Revenue Column168027TotalRevenueColumn
Exclusion$168,027ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue168027TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column13727536TotalRevenueColumn
Related Or Exempt Function Income12962761RelatedOrExemptFunctionIncome
Exclusion$264,199ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total0Total

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total5681131Total
Program Services5248113ProgramServices
Management And General427527ManagementAndGeneral
Fundraising5491Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total77956Total
Program Services66116ProgramServices
Management And General11840ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total868523Total
Program Services845485ProgramServices
Management And General22232ManagementAndGeneral
Fundraising806Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total445426Total
Program Services406714ProgramServices
Management And General38690ManagementAndGeneral
Fundraising22Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total956580Total
Management And General956580ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total40553Total
Management And General40553ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total45248Total
Management And General45248ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total25575Total
Management And General25575ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total1107008Total
Program Services1077543ProgramServices
Management And General23465ManagementAndGeneral
Fundraising6000Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total107277Total
Program Services1584ProgramServices
Management And General100888ManagementAndGeneral
Fundraising4805Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total1132221Total
Program Services1001982ProgramServices
Management And General130239ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total10590Total
Program Services3781ProgramServices
Management And General6809ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total606769Total
Program Services549397ProgramServices
Management And General57372ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total33348Total
Program Services19912ProgramServices
Management And General13436ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total21581Total
Program Services1662ProgramServices
Management And General19919ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total131952Total
Program Services106503ProgramServices
Management And General25449ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total808866Total
Program Services657350ProgramServices
Management And General151516ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total98658Total
Program Services79631ProgramServices
Management And General19027ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
BAD DEBT8151481514
MEDICAL SUPPLIES & DRUGS336147336147
LICENSES, DUES, SUBSCRIPTIONS49081447144610
RECRUITING & RETENTION1088607809101051

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total117022Total
Program Services117022ProgramServices

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total12891886Total
Program Services10612736ProgramServices
Management And General2262026ManagementAndGeneral
Fundraising17124Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY540125BOY
EOY1031147EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY42809BOY
EOY316929EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY952835BOY
EOY778900EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY5186BOY
EOY4736EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY61685BOY
EOY113334EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis25243633LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec16579968LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY9433283BOY
EOY8663665EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY4108608BOY
EOY4583977EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY50453BOY
EOY41047EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY15194984BOY
EOY15533735EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1145044BOY
EOY766001EOY

Grants Payable GrantsPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY450844BOY
EOY341212EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY1119BOY
EOY1473EOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY4360000BOY
EOY4142000EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY484528BOY
EOY453043EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY6441535BOY
EOY5703729EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY7213717BOY
EOY8035863EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY236681BOY
EOY491092EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1303051BOY
EOY1303051EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY8753449BOY
EOY9830006EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY15194984BOY
EOY15533735EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses835650ReconcilationRevenueExpenses
Reconciliation Unrealized Invest240907ReconciliationUnrealizedInvest
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit CommitteetrueAuditCommittee
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1159682CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years382092CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years276740CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year155161CurrentTaxYearMinus1Year
Current Tax Year500576CurrentTaxYear
Total2474251Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years10697602CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years10798997CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years11546182CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year12552480CurrentTaxYearMinus1Year
Current Tax Year12962761CurrentTaxYear
Total58558022Total

Gross Receipts From Non UBI GrossReceiptsFromNonUBI

FieldValueIRS element (for citing)
Total0Total

Tax Rev Levied For Org Benefit509 TaxRevLeviedForOrgBenefit509

FieldValueIRS element (for citing)
Total0Total

Value Of Svcs Fclts Furnishd By Govt ValueOfSvcsFcltsFurnishdByGovt

FieldValueIRS element (for citing)
Total0Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years11857284CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years11181089CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years11822922CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year12707641CurrentTaxYearMinus1Year
Current Tax Year13463337CurrentTaxYear
Total61032273Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years85534CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years165831CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years36767CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year51981CurrentTaxYearMinus1Year
Current Tax Year1428CurrentTaxYear
Total341541Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years85534CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years165831CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years36767CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year51981CurrentTaxYearMinus1Year
Current Tax Year1428CurrentTaxYear
Total341541Total
FieldValueIRS element (for citing)
Public Support Total50960690732PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years80780CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years94263CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years104924CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year109644CurrentTaxYearMinus1Year
Current Tax Year96172CurrentTaxYear
Total485783Total

Post1975 UBTI Post1975UBTI

FieldValueIRS element (for citing)
Total0Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years80780CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years94263CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years104924CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year109644CurrentTaxYearMinus1Year
Current Tax Year96172CurrentTaxYear
Total485783Total

Net Income From Other UBI NetIncomeFromOtherUBI

FieldValueIRS element (for citing)
Total0Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Total0Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years11938064CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years11275352CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years11927846CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year12817285CurrentTaxYearMinus1Year
Current Tax Year13559509CurrentTaxYear
Total61518056Total
FieldValueIRS element (for citing)
Public Support Percentage5090.98655PublicSupportPercentage509
Prior Year Support Percentage0.98415PriorYearSupportPercentage
Investment Income Percentage0.00790InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00968PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbying
Total Direct LobbyingTotalDirectLobbying
Total Lobbying ExpendituresTotalLobbyingExpenditures
Other Exempt Purpose ExpendituresOtherExemptPurposeExpenditures
Total Exempt Purpose ExpendituresTotalExemptPurposeExpenditures
Lobbying NontaxableLobbyingNontaxableAmount
Grassroots NontaxableGrassrootsNontaxableAmount
Tot Lobbying Grassroot Minus Non TxTotLobbyingGrassrootMinusNonTx
Tot Lobby Expend Mns Lobbying NontxTotLobbyExpendMnsLobbyingNontx
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationsfalseGrantsOtherOrganizations
Direct Contact LegislatorsfalseDirectContactLegislators
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiestrueOtherActivities
Not Described In501c3falseNotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierOTHER LOBBYING ACTIVITIESIdentifier
Return ReferenceSCHEDULE C, PART II-B, LINE 1IReturnReference
ExplanationTHE 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.Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts
Agent Trustee EtcfalseAgentTrusteeEtc
Included On FStrueIncludedOnFS

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance2184513BeginningOfYearBalance
Investment Earnings Or Losses302423InvestmentEarningsOrLosses
End Of Year Balance2486936EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance2283133BeginningOfYearBalance
Investment Earnings Or Losses-98620InvestmentEarningsOrLosses
End Of Year Balance2184513EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance1857561BeginningOfYearBalance
Investment Earnings Or Losses425572InvestmentEarningsOrLosses
End Of Year Balance2283133EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance1667030BeginningOfYearBalance
Investment Earnings Or Losses190531InvestmentEarningsOrLosses
End Of Year Balance1857561EndOfYearBalance

Current Year Minus4 Years CurrentYearMinus4Years

FieldValueIRS element (for citing)
Beginning Of Year Balance1942767BeginningOfYearBalance
Investment Earnings Or Losses-275737InvestmentEarningsOrLosses
End Of Year Balance1667030EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.41180BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.58820PermanentEndowmentEOYBalance
Endowments Held By Unrelated OrgsfalseEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgsfalseEndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis191734OtherCostOrOtherBasis
Book Value191734BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis18296692OtherCostOrOtherBasis
Depreciation11659476Depreciation
Book Value6637216BookValue
FieldValueIRS element (for citing)
Leasehold ImprovementsLeaseholdImprovements

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis3561709OtherCostOrOtherBasis
Depreciation3042147Depreciation
Book Value519562BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis3193498OtherCostOrOtherBasis
Depreciation1878345Depreciation
Book Value1315153BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings8663665TotalOfBookValueLandBuildings
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
ASSET RETIREMENT OBLIGATION$410,737
DUE TO RELATED PARTIES$42,306
FieldValueIRS element (for citing)
Total Of Amounts453043TotalOfAmounts
Tot Revenue Etc Audited Fincl Stmt13942868TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments240907NetUnrealizedGainsInvestments
Other Revenues-25575OtherRevenues
Revenue Not Rptd F990215332RevenueNotRptdF990
Revenue Subtotal13727536RevenueSubtotal
Total Revenue Per Form99013727536TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt12866311TotExpensesEtcAuditedFinclStmt
Expenses Subtotal12866311ExpensesSubtotal
Investment Expenses Not Included225575InvestmentExpensesNotIncluded2
Expenses Not Rptd On Fin Stmt25575ExpensesNotRptdOnFinStmt
Total Expenses Per Form99012891886TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
ESCROW ACCOUNT LIABILITYSCHEDULE D, PART IV, LINE 2BTHE ORGANIZATION HAS A SMALL SEPARATE TRUST BANK ACCOUNT AND CASH BOX HELD FOR RESIDENTS.
ENDOWMENT PURPOSESCHEDULE D, PART V, LINE 4THERE ARE THREE ENDOWMENT FUNDS, ALL OF WHICH REQUIRE THE INCOME TO BE USED FOR CHARITABLE CARE OF RESIDENTS.
UNCERTAIN TAX POSITIONSSCHEDULE D, PART X, LINE 2MANAGEMENT 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.
AMOUNTS INCLUDED ON LINE 1 BUT NOT ON FORM 990, PART VIII, LINE 12SCHEDULE D, PART XI, LINE 2DINVESTMENT FEES $(25,575)

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgtrueCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (3 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgs
JESSE JANTZEN
CHIEF EXECUTIVE OFFICER031615605692201201019270102000386406
JANICE WASHBURN
CHIEF FINANCIAL OFFICER016919001704504992012100112200203657
ADRIENE IVERSON
ASSISTANT SECRETARY0162670015000045002438066030187161

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
COMPENSATION OF THE TOP MANAGEMENT OFFICIALSCHEDULE J, PART I, LINE 3THE MANAGEMENT COMPANY AND RELATED ORGANIZATION, ELDER CARE ALLIANCE (ECA), USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE TOP MANAGEMENT OFFICIAL: COMPENSATION COMMITTEE, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE.
BONUS PAYMENTSSCHEDULE J, PART I, LINE 6AOFFICERS 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.

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
OTHER PROGRAM SERVICE ACCOMPLISHMENTSFORM 990, PART III, LINE 4DOTHER PROGRAM SERVICES INCLUDE INDEPENDENT LIVING, WHICH CONSISTS OF 35 APARTMENT-STYLE UNITS AND 4 COTTAGES.
DELEGATION OF MANAGEMENT DUTIESFORM 990, PART VI, SECTION A, LINE 3SALEM 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, CLINICAL OVERSIGHT AND INSURANCE.
MEMBERSFORM 990, PART VI, SECTION A, LINES 6, 7A, & 7BTHE ORGANIZATION'S SOLE CORPORATE MEMBER IS ELDER CARE ALLIANCE. 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 REVIEW PROCESSFORM 990, PART VI, SECTION B, LINE 11BTHE 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.
CONFLICT OF INTEREST POLICY COMPLIANCEFORM 990, PART VI, SECTION B, LINE 12CANNUALLY, 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, 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.
COMPENSATION DETERMINATIONFORM 990, PART VI, SECTION B, LINES 15A & 15BSALEM 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 2013 BY THE FINANCE COMMITTEE OF ELDER CARE ALLIANCE AS PART OF THE BUDGET REVIEW PROCESS. THE COMPENSATION FOR THE CEO AND CFO WAS REVIEWED AGAINST COMPARABLES PROVIDED FROM A COMPENSATION STUDY COMPILED BY FUTURESENSE, INC., A FIRM THAT SPECIALIZES IN COMPENSATION PROGRAMS.
GOVERNING DOCUMENT AVAILABILITYFORM 990, PART VI, SECTION C, LINE 19BECAUSE 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 PROVIDED VIA EMAIL, US MAIL, OR BY FAX IF SO REQUESTED.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (6 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
ELDER CARE ALLIANCE
1301 MARINA VILLAGE PKWY 210ALAMEDACA94501943260975MANAGEMENTCA501(C)(3)11 B IINAfalse
MERCY RETIREMENT AND CARE CENTER
1301 MARINA VILLAGE PKWY 210ALAMEDACA94501941156579ELDERLY CARECA501(C)(3)9ECAfalse
ELDER CARE ALLIANCE OF CAMARILLO
1301 MARINA VILLAGE PKWY 210ALAMEDACA94501943351613ELDERLY CARECA501(C)(3)9ECAfalse
ELDER CARE ALLIANCE OF SAN FRANCISCO
1301 MARINA VILLAGE PKWY 210ALAMEDACA94501943351615ELDERLY CARECA501(C)(3)9ECAfalse
ELDER CARE ALLIANCE OF UNION CITY
1301 MARINA VILLAGE PKWY 210ALAMEDACA94501943377985ELDERLY CARECA510(C)(3)9ECAfalse
ELDER CARE ALLIANCE OF SAN RAFAEL
1301 MARINA VILLAGE PKWY 210ALAMEDACA94501760730971ELDERLY CARECA501(C)(3)9ECAfalse
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Dividends Related OrganizationfalseDividendsRelatedOrganization
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgstruePerformOfServicesByOtherOrgs
Sharing Of FacilitiestrueSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

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