2013-12-02T12:15:11-06:00 2013-06-30 952242818 VICENTI LLOYD & STUTZMAN LLP 2210 E ROUTE 66 SUITE 100 GLENDORA CA 91740 990 2012-07-01 710876594 HOLLENBECK PALMS HOLL 3232636195 573 SOUTH BOYLE AVENUE LOS ANGELES CA 90033 JOHNNY YOUNG 3232636195 2013-11-27 1 TIMOTHY D EVANS CPA P00050546 6268577300 2012 2015-11-30 17:44:51Z JOHNNY YOUNG 573 SOUTH BOYLE AVENUE LOS ANGELES CA 90033 22650855 0 X WWW.HOLLENBECKPALMS.COM X 2001 CA HOLLENBECK PALMS IS COMMITTED TO PROVIDING A RESIDENCE FOR THOSE IN THE LATER YEARS OF THEIR LIVES THAT ENCOMPASSES A HEALTHY ENVIRONMENT OF COMFORT, SAFETY, AND ENJOYMENT; THAT ATTENDS TO THEIR PHYSICAL, MENTAL, AND SPIRTUAL NEEDS; AND THAT IS QUICK TO RESPOND TO AND ASSIST IN THOSE NEEDS WHETHER IMMEDIATE OR LONG TERM, AND TO DO SO WITH GREAT COMPASSION, HONESTY, DIGNITY, AND GENUINE LOVE. 6 6 204 0 0 0 80559 1343818 16010627 16859676 1642529 1545326 308101 403880 18041816 20152700 0 0 0 0 7885889 7990730 0 0 0 8243071 8147777 16128960 16138507 1912856 4014193 75356168 78107280 41723708 37607049 33632460 40500231 NONE 0 0 10110548 17263556 HOLLENBECK PALMS PROVIDES CARE FOR THE AGING, INCLUDING RESIDENTIAL AND SKILLED NURSING CARE LIVING ARRANGEMENTS FOR THEIR MEMBERS. 10110548 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 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 1 34 0 1 204 1 0 0 0 0 0 0 0 0 0 0 X 6 6 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 CA X JOHNNY YOUNG 3232636195 573 SOUTH BOYLE AVENUE LOS ANGELES CA 90033 DAVID ADAMS 1.00 X 0 0 0 MICHAEL DAVIS 1.00 X 0 0 0 CAROL A JOHNSTON 1.00 X 0 0 0 CHARLENE LEIBAU 1.00 X 0 0 0 CASEY ADAMS 1.00 X 0 0 0 TRACY HIRREL 1.00 X 0 0 0 WILLIAM HEIDEMAN 40.00 X 181983 0 57855 MORRIS SHOCKLEY 40.00 X 141539 0 40501 JOHNNY YOUNG 40.00 X 95294 0 26757 RAY SHIVELY 40.00 X 139991 0 32330 CAMILLE GOLDSMITH 40.00 X 140521 0 31412 JOHN M SHIVELY 40.00 X 113014 0 27622 812342 0 216477 5 0 1 0 CREATIVE LANDSCAPE & MAINT 14877 SHETLAND LN FONTANA CA 92336 LANDSCAPING 130091 1 1343818 1343818 SNF & RESIDENTIAL CARE 623990 12733868 12733868 MEDICARE/MEDICAID PAYMENTS 623990 4125808 4125808 16859676 1067915 1067915 2975566 2498155 477411 477411 477411 ROYALTIES 900099 257082 257082 BEAUTY/BARBER SHOP 900099 56886 56886 MISCELLANEOUS REV 900099 23503 23503 66409 66409 403880 20152700 17263556 0 1545326 546372 546372 5386401 4680929 705472 2057957 1762248 295709 13544 13544 120543 120543 189215 77506 111709 181387 181387 841660 691872 149788 622123 622123 2258 2258 9712 4569 5143 243896 243896 1152766 1152766 254276 254276 PURCHASED SERVICES 1067934 813707 254227 OTHER MEDICAL & MEDICAR 990285 990285 FOOD EXPENSES 726347 726347 SERVICES 195179 144546 50633 1536652 218539 1318113 16138507 10110548 6027959 0 4109009 2919489 556732 617419 1214608 1791704 1832856 170415 176333 215653 213295 45725159 18242132 28109126 27483027 37095275 40514067 3308254 3136186 75356168 78107280 3794988 2959942 23540000 22995000 14388720 11652107 41723708 37607049 X 32034985 37531814 824152 2195094 773323 773323 33632460 40500231 75356168 78107280 X 4014193 2853578 X X 0 1 X 1 0 X 389590 192962 553614 80559 1288426 2505151 11279803 13224245 14872593 16010627 16859676 72246944 11669393 13417207 15426207 16091186 18148102 74752095 0 0 0 74752095 1006691 911599 941580 949652 1067915 4877437 1006691 911599 941580 949652 1067915 4877437 198408 149207 190090 308101 403880 1249686 12874492 14478013 16557877 17348939 19619897 80879218 0.92420 0.90950 0.06030 0.07690 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 28092 28092 39896745 14519827 25376918 266736 184225 82511 5533586 3538080 1995506 27483027 DEFERRED REVENUE FROM ACCOMODATION FEES 4099030 ASSIGNED ASSETS 7553077 11652107 X 23006278 2853578 2853578 20152700 0 20152700 16138507 0 16138507 0 16138507 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE PALMS HAS EVALUATED ITS TAX POSITIONS AND THE CERTAINTY AS TO WHETHER THOSE POSITIONS WILL BE SUSTAINED IN THE EVENT OF AN AUDIT BY TAXING AUTHORITIES AT THE FEDERAL AND STATE LEVELS. THE PRIMARY TAX POSITIONS EVALUATED ARE RELATED TO THE PALMS CONTINUED QUALIFICATION AS A TAX-EXEMPT ORGANIZATION AND WHETHER THERE IS UNRELATED BUSINESS INCOME ACTIVITIES CONDUCTED THAT WOULD BE TAXABLE. MANAGEMENT HAS DETERMINED THAT ALL INCOME TAX POSITIONS ARE MORE LIKELY THAN NOT (>50%) OF BEING SUSTAINED UPON POTENTIAL AUDIT OR EXAMINATION; THEREFORE, NO DISCLOSURES OF UNCERTAIN INCOME TAX POSITIONS ARE REQUIRED. THE PALMS FILES INFORMATIONAL RETURNS IN THE U.S. FEDERAL JURISDICTION AND THE STATE OF CALIFORNIA. THE STATUTE OF LIMITATIONS FOR FEDERAL AND CALIFORNIA STATE PURPOSES IS GENERALLY THREE AND FOUR YEARS, RESPECTIVELY. PART XI, LINE 2D - OTHER ADJUSTMENTS: UNREALIZED GAIN ON INVESTMENTS 2,908,970. DISCOUNT ON PLEDGES RECEIVABLE -55,392. X X 0 0 0 0 0 0 0 0 0 WILLIAM HEIDEMAN 181983 0 0 0 0 0 0 0 57855 0 239838 0 0 0 MORRIS SHOCKLEY 141539 0 0 0 0 0 0 0 40501 0 182040 0 0 0 RAY SHIVELY 139991 0 0 0 0 0 0 0 32330 0 172321 0 0 0 CAMILLE GOLDSMITH 140521 0 0 0 0 0 0 0 31412 0 171933 0 0 0 A CALIFORNIA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY 13079GAH6 2007-02-01 5525000 THE BONDS PROCEEDS WERE USED BY HOLLENBECK PALMS TO DEMOLISH CERTAIN 0 0 0 B CALIFORNIA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY 10379GAJ2 2007-02-01 15035000 EXISTING BUILDINGS, CONTRUCT A NEW THREE-STORY BUILDING CONSISTING OF 0 0 0 C CALIFORNIA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY 13079GAK9 2007-02-01 2700000 RESIDENTIAL UNITS, UNDERGROUND PARKING, AND RELATED FACILITIES. 0 0 0 A 0 0 0 0 B 0 0 0 0 C 0 0 0 0 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 A 0 0 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 NO REVIEW WAS OR WILL BE CONDUCTED FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST STATEMENTS ARE SIGNED BY TRUSTEES ANNUALLY AND REVIEWED BY MANAGEMENT. FORM 990, PART VI, SECTION B, LINE 15 BOARD OF TRUSTEES DETERMINES COMPENSATION FOR ALL ORGANIZATIONS AND KEY EMPLOYEES, BASED ON COMPARABLE SALARIES IN THE LOCAL AREA. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: UNREALIZED GAIN ON INVESTMENTS 2,271,822. CHANGE IN PENSION LIABILITY 637,148. DISCOUNT ON PLEDGES RECEIVABLE -55,392. DETAIL OF OTHER EXPENSES 990 PART XI LINE 24F PROGRAM: SUPPORT: REPAIR & MAINTENANCE 84,901 4,723 MISC 109,109 1,183,478 DUES 24,529 129,912 TOTAL 218,539 1,318,113