2014-11-14T10:54:44-06:00 2013-12-31 461497033 EKS&H LLLP 7979 E TUFTS AVENUE SUITE 400 DENVER CO 802372521 990 2013-01-01 742376546 SHALOM PARK SHAL 3036805000 14800 E BELLEVIEW DRIVE AURORA CO 800152258 DANIEL STENERSEN PRESIDENT/CEO 3036805000 2014-11-10 1 DORI J EGGETT P00645252 3037409400 2013 2015-11-30 17:44:51Z DANIEL STENERSEN 14800 E BELLEVIEW DRIVE AURORA CO 80015 14093962 0 X SHALOMPARK.ORG X 1984 CO DELIVERY AND INNOVATION OF COMMUNITY AND RESIDENTIAL HEALTH AND SOCIAL SERVICES. 18 17 342 319 0 0 203925 0 14136313 14091624 0 -1300 0 2338 14340238 14092662 800 350 0 0 7392386 6977825 0 0 204692 7357792 7752821 14750978 14730996 -410740 -638334 21172884 20363137 16157253 15967044 5015631 4396093 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 13120220 350 14091624 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. 13120220 1 0 0 1 0 0 0 0 0 1 1 0 0 1 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 60 0 1 342 1 0 0 0 0 0 0 0 0 0 0 X 18 17 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 TOM GART DIRECTOR 1.00 X 0 0 0 DANIEL STENERSEN PRESIDENT/CEO 6.00 34.00 X X 42056 238315 38270 GARY YOURTZ TREASURER 5.00 2.00 X X 0 0 0 JAY MOSKOWITZ DIRECTOR 1.00 X 0 0 0 MARSHALL ABRAHAMS IMMEDIATE PAST CHAIR 1.00 2.00 X 0 0 0 BRUCE BENDELL TREASURER 5.00 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 1.00 X 0 0 0 ANDY MILLER DIRECTOR 1.00 X 0 0 0 JORDON PERLMUTTER DIRECTOR 1.00 1.00 X 0 0 0 JOHN PREGULMAN SECRETARY 5.00 1.00 X X 0 0 0 MICHAEL STREAR CHAIR 20.00 2.00 X X 0 0 0 SANDY WOLF DIRECTOR 1.00 X 0 0 0 LISA COOK DIRECTOR 1.00 X 0 0 0 NEIL OBERFELD DIRECTOR 1.00 X 0 0 0 MELINDA QUIAT DIRECTOR 1.00 X 0 0 0 42056 238315 38270 0 0 1 0 MORRISON MANAGEMENT SPECIALIST PO BOX 1202289 ATLANTA GA 30368 DIETARY/HOUSEKEEPING SERVICES 1518993 EKS&H LLLP 7979 E TUFTS AVE STE 400 DENVER CO 80237 ACCTG/AUDIT SERVICES 509304 TOLIN MECHANICAL SYSTEMS PO BOX 732293 DALLAS TX 75373 HVAC SERVICES 331169 GEF SERVICES LLC PO BOX 173861 DENVER CO 80217 STAFFING AGENCY 169028 SCHRYVER MEDICAL 12075 E 45TH AVE STE 600 DENVER CO 802393136 MEDICAL SERVICES 153295 5 PATIENT SERVICE REV 623000 11887759 11887759 RESIDENT RENTAL 623000 1833710 1833710 OTHER NURSING HOME REV 623000 370155 370155 14091624 1300 -1300 -1300 -1300 MISC REVENUE 900099 2338 2338 2338 14092662 14091624 0 1038 X 350 350 47796 47796 5776893 5344739 396689 35465 645267 584926 58276 2065 507869 465228 39928 2713 4954 4310 644 51691 51691 26000 26000 1535412 1199322 336090 164449 164449 170646 89806 80840 655567 570343 85224 58855 51204 7651 705226 613547 91679 1248774 1086433 162341 276890 240894 35996 PROGRAM SUPPLIES 869975 869975 BAD DEBT EXPENSE 709265 709265 FOOD 645324 645324 WRITE-OFF EXPENSE 459203 459203 170590 159351 11239 14730996 13120220 1406084 204692 1462207 1010928 153916 193862 33515532 20394302 14071449 13121230 62114 80880 0 199812 5423198 5756425 21172884 20363137 2347358 1809966 0 119435 13517251 13910705 292644 126938 16157253 15967044 X 5015631 4396093 5015631 4396093 21172884 20363137 -638334 18796 0 X 0 1 X 1 0 X 1283000 785000 200 203925 2272125 14393727 13790478 15125285 14136313 14091624 71537427 15676727 14575478 15125485 14340238 14091624 73809552 0 0 0 73809552 2115 84 2199 2115 84 2199 2338 2338 15678842 14575562 15125485 14340238 14093962 73814089 0.99990 0.99940 0.00000 0.00060 X 0 0 0 0 0 0 1 26000 0 0 26000 0 2570336 625 338607 48987 2860581 2321345 208559 236427 195995 2570336 2260532 -57568 -118381 2321345 3633593 972 276634 1650667 2260532 3022113 362844 307338 58702 3633593 0.82880 0.17120 1 1 1 2558043 2558043 26728058 16844096 9883962 2538910 1902076 636834 1690521 1648130 42391 13121230 DUE TO/FROM AFFILIATES 4264501 RESTRICTED CASH 1491924 5756425 DEPOSITS 400 CASH OVERDRAFT 126538 126938 X 14112758 18796 1300 20096 14092662 0 14092662 14732295 1300 1300 14730995 0 14730995 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, BETH NEHAMAH, BETH EZRA, AND THE FOUNDATION, WHICH IS THE SOLE MEMBER OF ETAHNU, SHALOM PARK PROFESSIONAL SERVICES, AND 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 ASSESED AS OF DECEMBER 31, 2013. THE ORGANIZATION'S TAX RETURNS SUBJECT TO EXAMINATION BY TAXING AUTHORITIES INCLUDE ALL THOSE FROM 2010 TO THE CURRENT YEAR FOR FEDERAL REPORTING PURPOSES AND FROM 2009 TO THE CURRENT YEAR FOR STATE REPORTING PURPOSES. PART XI, LINE 2D - OTHER ADJUSTMENTS: LOSS ON DISPOSAL OF ASSETS 1,300. PART XII, LINE 2D - OTHER ADJUSTMENTS: LOSS ON DISPOSAL OF ASSETS 1,300. X X X 0 0 0 0 0 0 0 0 0 DANIEL STENERSEN PRESIDENT/CEO 42056 238315 0 0 0 0 2523 14299 3217 18231 47796 270845 0 0 SCHEDULE J, PART II COMPENSATION OF DANIEL STENERSEN DANIEL STENERSEN'S TOTAL COMPENSATION REPRESENTS COMPENSATION FOR SERVICES RENDERED TO SHALOM PARK AND ITS RELATED ENTITIES, INCLUDING THE FOLLOWING: BETH ISRAEL FOUNDATION; BETH NEHAMAH HOSPICE AND PALLIATIVE CARE; SHALOM PARK PROFESSIONAL SERVICES LLC; ETAHNU LLC; BETH EZRA; AND SHALOM CARES WELLNESS CENTER LLC. 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 11 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 1,199,322. MANAGEMENT AND GENERAL EXPENSES 336,090. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,535,412. SHALOM PARK PROFESSIONAL SERVICES LLC 14800 E BELLEVIEW DRIVE AURORA CO 80015 264399163 HEALTH CARE CO BETH ISRAEL FOUNDATION FOR THE AGED ETAHNU LLC 14800 E BELLEVIEW DRIVE AURORA CO 80015 264297648 HOME HEALTH 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 HOMEHELP 14800 E BELLEVIEW DRIVE AURORA CO 80015 455132771 CHARITABLE CO SHALOM PARK 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 NEHAMAH 14800 E BELLEVIEW DRIVE AURORA CO 80015 205772447 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 -454309 21549 1.00000 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 DUE FROM FOUNDATION Q 222279 DUE FROM BETH NEHAMAH Q 1908460 DUE FROM BETH EZRA Q 2433407