2013-08-14T15:13:29-05:00 2012-09-30 271728945 O'Connor Davies LLP 100 Great Meadow Road Suite 401 Wethersfield CT 06109 990 2011-10-01 060677159 Pierce Memorial Baptist Home Inc PIER 8607749050 PO Box 326 Brooklyn CT 06234 Leonard Goldberg 8607749050 2013-08-14 1 Thomas O Marien CPA MBA CVA P01064007 8602571870 2011 2016-02-25 16:41:14Z Leonard Goldberg 44 Canterbury Road Brooklyn CT 06234 10067296 0 X N/A X 1951 CT To own and operate a benevolent and charitable home and provide nursing care to its aging residents 13 12 225 93 0 0 22291 17637 9543583 9004303 181938 208774 9522 -2712 9757334 9228002 0 0 0 0 5369117 5127981 0 0 18448 4172796 3675404 9541913 8803385 215421 424617 22731325 24375917 14370141 14478060 8361184 9897857 X Pierce Memorial provides a continuum of care by making available adult day care, housing, rehabilitative services, respite, hospice, 24 hour nursing care and other services in a Christ-centered environment. Residents are encouraged to grow spiritually as they live their lives at a level of independence appropriate to their needs. Services are provided to all as an extension of the ministry of the American Baptist Churches of Connecticut 0 0 5946983 6770645 Long Term Care and Short Term Rehabilitation Center - The approximately 55,000 square foot facility contains 80 beds, therapy space and common living, dining, and recreation areas. Long term residents enjoy a variety of programs such as daily exercise, games, music, bingo, parties, and baking, as well as a wide variety of intellectually stimulating programs. The facility provides comprehensive services to those persons in need of short term rehabilitation following surgery or acute illnesses. These include physical, occupational and speech therapies as well as 24 hour nursing care, teaching, education, etc. prior to returning home in the community. 1502093 2139997 Independent Living - This consists of 83 apartments and 10 cottages. This program is designed to be a community for retired people who seek the ease and security of gracious and exceptional living amidst familiar surroundings and friends. 21486 32300 Adult Day Care - This program provides respite for caregivers in the community and offers involved seniors the oppurtunity to enhance their social spectrum while participating in activities and events with other facility residents. This program can accomodate 12 participants. 1952 250 71415 Adult Day Care: Two days a week elderly individuals meet at PMBH in the recreation room to socialize, listen to music and participate in other activities. They are supervised for 6 hours by professionals and are given a hot lunch at noon. This is designed for caregivers to have a day off. The price is $50 a day.Brooklyn Collaborative Grant: Young children birth to eight will visit PMBH and interact with the elderly as a way for youth to gain a better connection with the elderly in their community. 1952 250 71415 7472514 1 0 0 1 0 0 0 0 1 1 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 17 0 1 225 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 12 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 0 1 0 0 CT X Diana Baule Office Manager 8607749050 Route 169 Brooklyn CT 06234 Timothy Bates 5.00 X 0 0 0 Roberta Davis 5.00 X 0 0 0 Mark Kane 5.00 X 0 0 0 Scot Rapoza 5.00 X 0 0 0 Rev Gregory Thomas 5.00 X 0 0 0 Charles Wyand 5.00 X 0 0 0 Rev Judy G Albee 5.00 X 0 0 0 Rev Dale Peterson 5.00 X 0 0 0 William Mcmunn 10.00 X 0 0 0 William Smith 10.00 X 0 0 0 Shirley DeFlavis 10.00 X 0 0 0 John Riesen 10.00 X 0 0 0 Leonard Goldberg 50.00 X 187068 0 6567 Frances Cote RN 5.00 X 110028 0 363 297096 0 6930 2 0 1 0 RehabCare Group Inc PO Box 503534 St Louis MO 63150 Provides PTOT and ST services to residen 187047 People First Rehabilitation Box 277365 Atlanta GA 303847365 Provides PTOT and ST services to residen 127104 2 250 17387 17637 Pierce Nursing/Housing 623000 6760591 6760591 Creamery Brook Housing 531110 1891407 1891407 Cottages 531110 248590 248590 Adult Day Care Program 624100 32300 32300 Brooklyn Collaborative 624100 -986 -986 72401 72401 9004303 224943 224943 6133 19085 -12952 -12952 -12952 785468 801637 -16169 -16169 -16169 1135 949 186 186 27677 17623 10054 10054 9228002 9014357 0 196008 292683 191221 83014 18448 3991500 3642869 348631 15278 13131 2147 513060 402609 110451 315460 280356 35104 18357 18357 63019 63019 105 105 42342 42342 607286 568404 38882 75310 75310 389519 277626 111893 9296 9296 462817 450702 12115 18604 546 18058 12414 8019 4395 19300 19300 508645 488885 19760 117662 27476 90186 Licenses, dues and fees 609431 442399 167032 Food 337039 337039 Property Taxes 146255 146255 Service Contracts 133589 86995 46594 104414 88682 15732 8803385 7472514 1312423 18448 373351 1203810 2656461 3294008 1471856 1041755 219150 2185 2185 78081 79808 18724232 9219126 9359460 9505106 4258867 5952740 264363 497672 497420 3769029 2579935 22731325 24375917 623433 602629 932710 1378389 12570000 12270000 238898 227042 5100 14370141 14478060 X 6234127 7524012 26760 21823 2100297 2352022 8361184 9897857 22731325 24375917 X 424617 1112056 X X 0 1 1 X 0 X 55427 70378 183693 23190 17823 350511 8943045 8899606 9443192 9540083 8941956 45767882 8998472 8969984 9626885 9563273 8959779 46118393 0 171601 194516 215911 154568 128122 864718 171601 194516 215911 154568 128122 864718 45253675 317549 230565 219365 243999 231076 1242554 317549 230565 219365 243999 231076 1242554 11187 5495 3388 9033 72401 101504 9327208 9206044 9849638 9816305 9263256 47462451 0.95350 0.94870 0.02620 0.02970 X 0 0 0 0 0 0 0 0 1 105 105 0 Explanation of Lobbying Activities: Part II-B, Line 1: The organization supported lobbying expenses through payment of dues to Connecticut Association of Healthcare Facilities. 0 1 5170296 965143 152400 30299 5952740 5239270 113474 151835 30613 5170296 4047765 130297 1245051 154660 29183 5239270 4140428 26006 1000231 154660 25885 4986120 0.85830 0.14170 0.00000 0 0 16791794 8022109 8769685 1771101 1079537 691564 161337 117480 43857 9505106 Accrued Interest 345 Construction in Progress 108712 Interest in Trust 1508684 Restricted Investments and Cash 962194 2579935 9228002 8803385 424617 1112052 4 1112056 1536673 10374497 1112052 34443 1146495 9228002 0 9228002 8837826 34441 34441 8803385 0 8803385 Part IV, Line 2b: Funds that are held on behalf of residents by the facility Description of Intended Use of Endowment Funds: Part V, Line 4: To provide interest and earnings to support operating and capital needs. Part XI, Line 8 - Other Adjustments: Rounding 4. Part XII, Line 2d - Other Adjustments: Portions of COGS shown net/gross in financials 14,409. Special Events shown gross in financials 949. Rental expenses shown gross in financials 19,085. Part XIII, Line 2d - Other Adjustments: Portions of COGS shown net/gross in financials 14,407. Special Events shown gross in financials 949. Rental expenses shown gross in financials 19,085. Part XI 8 Rounding adjustments Part XII 2d Effect of showing the costs of goods sold and special events gross in the financial statements Part XIII 2d Effect of showing the costs of goods sold and special events gross in the financial statements, effect of depreciation error Part XIII 4b Rounding adjustments X X X X X 0 0 0 0 0 0 0 1 0 Leonard Goldberg 181402 0 5666 0 0 0 0 0 6567 0 193635 0 0 0 Frances Cote RN 106721 0 3307 0 0 0 0 0 363 0 110391 0 0 0 Part I, Line 7 The CEO received a bonus in the amount of $5,666. The Head of Nursing received a bonus in the amount of $3,307. CHEFA Series A Variable Rate Bond 20774UTA3 2008-01-17 8575000 Refunding on Series 1999 Bond 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Form 990, Part VI, Section A, line 8b The Board of Trustess, which makes the final decisions, keeps minutes regarding each meeting and action taken. Committee's may hold a meeting that is not documented, but any actions agreed upon are sent to the Board of Trustees for final approval. Form 990, Part VI, Section B, line 11 A copy of the 990 is made available to each Board Member prior to filing. Any questions are then addressed by the President and CEO or the Independent Accounting Firm prior to filing the 990. Form 990, Part VI, Section B, line 12c Annually all empoyees are infomed about ethics and how to report any issues they become aware of. The ethics includes conflicts of interest. Form 990, Part VI, Section B, line 15a Compensation of the CEO is reviewed annually to outside sources such as, other form 990's of comparable facilities and independent compensation consultants recommendations and established with a compensation committee, approval of the board and a written employment contract. Form 990, Part VI, Section C, line 19 Governing documents, financial statements and the conflict of interest statement are available at the Facility's office. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 1,112,052. Rounding 4. Total to Form 990, Part XI, Line 5: 1,112,056. The facility has a committee that assumes responsibility for oversight of the financial statements and the selection of the CPA. There was no change in the process from last year.