ELDER CARE ALLIANCE OF SAN MATEO: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
ELDER CARE ALLIANCE OF SAN MATEO (EIN 94-0831870)
Tax period
2011-07-01 to 2012-06-30
Filed
2013-02-11
IRS object ID
201320429349300237
Schema version
2011v1.5
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)
Timestamp2013-02-11T11:04:33-06:00Timestamp
Tax Period End Date2012-06-30TaxPeriodEndDate

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 Date2011-07-01TaxPeriodBeginDate

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
CityALAMEDACity
StateCAState
ZIP Code94501ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJANICE WASHBURNName
TitleCHIEF FINANCIAL OFFICERTitle
Date Signed2013-01-31DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameBrian D ToddName
Phone4178658701Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

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 Receipts13756288GrossReceipts
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 Body12NbrVotingMembersGoverningBody
Nbr Independent Voting Members12NbrIndependentVotingMembers
Total Nbr Employees196TotalNbrEmployees
Total Nbr Volunteers45TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year276740ContributionsGrantsPriorYear
Contributions Grants Current Year155161ContributionsGrantsCurrentYear
Program Service Revenue Prior Year11546182ProgramServiceRevenuePriorYear
Program Service Revenue CY12552480ProgramServiceRevenueCY
Investment Income Prior Year98101InvestmentIncomePriorYear
Investment Income Current Year223606InvestmentIncomeCurrentYear
Other Revenue Prior Year112681OtherRevenuePriorYear
Other Revenue Current Year-1344OtherRevenueCurrentYear
Total Revenue Prior Year12033704TotalRevenuePriorYear
Total Revenue Current Year12929903TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year5670GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year6396774SalariesEtcPriorYear
Salaries Etc Current Year7088468SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year85641TotalFundrsngExpCurrentYear
Other Expense Prior Year5457144OtherExpensePriorYear
Other Expenses Current Year5547959OtherExpensesCurrentYear
Total Expenses Prior Year11859588TotalExpensesPriorYear
Total Expenses Current Year12636427TotalExpensesCurrentYear
Revenues Less Expenses Prior Year174116RevenuesLessExpensesPriorYear
Revenues Less Expenses CY293476RevenuesLessExpensesCY
Total Assets BOY15267994TotalAssetsBOY
Total Assets EOY15194984TotalAssetsEOY
Total Liabilities BOY6495264TotalLiabilitiesBOY
Total Liabilities EOY6441535TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY8772730NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY8753449NetAssetsOrFundBalancesEOY
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
Expense6916150Expense
Revenue6008692Revenue
DescriptionSALEM'S CARE CENTER IS LICENSED FOR 48 SKILLED NURSING RESIDENTS. THE CARE CENTER PROVIDES SKILLED NURSING CARE TO 48 OLDER ADULT RESIDENTS IN AN AVERAGE MONTH, FOR AN ANNUAL TOTAL OF 15,692 RESIDENT DAYS. 69% OF RESIDENTS ARE PRIVATE PAY, WHILE 16% HAVE MEDI-CAL, 13% HAVE MEDICARE AND 2% HAVE OTHER INSURANCE COVERAGE AS PRIMARY PAYER SOURCE.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense1303043Expense
Revenue2203439Revenue
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 10,407 RESIDENT DAYS. THE MEMORY CARE UNIT HAS MANY DAILY ACTIVITIES DESIGNED FOR DEMENTIA OR MEMORY LOSS RESIDENTS.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense1102575Expense
Revenue2820595Revenue
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 21,981 RESIDENT DAYS. THE ASSISTED LIVING RESIDENTS ARE OFFERED FOUR 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 Exp701638TotalOfOtherProgramServiceExp
Total Of Other Program Service Rev1519754TotalOfOtherProgramServiceRev
Total Program Service Expense10023406TotalProgramServiceExpense
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 ActivitiestrueFundraisingActivities
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
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109668NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees196NumberOfEmployees
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 Members12NbrVotingGoverningBodyMembers
Number Independent Voting Members12NumberIndependentVotingMembers
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 (17 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
REVEREND RONALD M RENTNER
CHAIRMAN THROUGH 11/20112.0XX000
PATRICIA CONOLLY MD
DIRECTOR THROUGH 11/20112.0X000
FRED WENTKER
SEC. THROUGH 11/2011/DIRECTOR2.0XX000
ROBERT JOHNSON
CHAIRMAN BEG. 12/20112.0XX000
CHARLES RUTHROFF
DIRECTOR2.0X000
CHRISTINE WHELAN
DIRECTOR BEG. 12/20112.0X000
REVEREND PAMELA GRIFFITH POND
DIRECTOR2.0X000
SISTER LINDA ORRICK
SECRETARY BEG. 12/20112.0XX000
SISTER KATHLEEN KEARNEY
VICE CHAIR BEG. 12/20112.0XX000
JOAN RYAN
DIRECTOR2.0X000
MICHAEL TELLEEN
DIRECTOR2.0X000
REVERENT NOREEN MEGINNESS
DIRECTOR2.0X000
JESSE BEAN
DIRECTOR BEG. 11/20112.0X000
VERN STIGGE
DIRECTOR BEG. 12/20112.0X000
JESSE JANTZEN
CHIEF EXECUTIVE OFFICER40.0X02109962314
JANICE WASHBURN
CHIEF FINANCIAL OFFICER40.0X01378952771
ADRIENE IVERSON
ASSISTANT SECRETARY40.0X01487612635
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs497652TotalReportableCompFrmRltdOrgs
Total Other Compensation7720TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (2 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
REHABCARE GROUP INC
PO BOX 50353ST LOUISMO63150SKILLED NURSING498638
LIFE CARE SERVICES
MANAGEMENT SERVICES198678
FieldValueIRS element (for citing)
Number Of Contractors GT100 K2NumberOfContractorsGT100K
Fundraising Events14780FundraisingEvents
All Other Contributions140381AllOtherContributions
Total Contributions155161TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
NET PATIENT SERVICE REVENUE62300058393705839370
RESIDENT SERVICES62300066806576680657
OTHER PROGRAM SERVICE REVENUE6230003245332453
FieldValueIRS element (for citing)
Total Program Service Revenue12552480TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column103044TotalRevenueColumn
Exclusion$103,044ExclusionAmount

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)
Real6600Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real6600Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column6600TotalRevenueColumn
Exclusion$6,600ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities933553Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities803154Securities
Other9837Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities130399Securities
Other-9837Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column120562TotalRevenueColumn
Exclusion$120,562ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events5450GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events14780CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses13394FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-7944TotalRevenueColumn
Exclusion-$7,944ExclusionAmount

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Total Other Revenue0TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column12929903TotalRevenueColumn
Related Or Exempt Function Income12552480RelatedOrExemptFunctionIncome
Exclusion$222,262ExclusionAmount

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)
Total5733755Total
Program Services5021521ProgramServices
Management And General634094ManagementAndGeneral
Fundraising78140Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total99180Total
Program Services88705ProgramServices
Management And General9809ManagementAndGeneral
Fundraising666Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total815780Total
Program Services754182ProgramServices
Management And General60065ManagementAndGeneral
Fundraising1533Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total439753Total
Program Services384690ProgramServices
Management And General49761ManagementAndGeneral
Fundraising5302Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total936147Total
Management And General936147ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total24213Total
Management And General24213ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total44996Total
Management And General44996ManagementAndGeneral

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)
Total19785Total
Management And General19785ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total799775Total
Program Services768261ProgramServices
Management And General31514ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total156648Total
Program Services25175ProgramServices
Management And General131473ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total1158093Total
Program Services1028226ProgramServices
Management And General129867ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total7805Total
Program Services1414ProgramServices
Management And General6391ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total591805Total
Program Services537285ProgramServices
Management And General54520ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total31653Total
Program Services15251ProgramServices
Management And General16402ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total36616Total
Program Services1596ProgramServices
Management And General35020ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total272262Total
Program Services217779ProgramServices
Management And General54483ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total804180Total
Program Services647642ProgramServices
Management And General156538ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total86912Total
Program Services69520ProgramServices
Management And General17392ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
BAD DEBT6900069000
LICENSES, DUES & SUBSCRIPTIONS356521072024932
EMPLOYEE EXPENSES1035251354789978
MEDICAL SUPPLIES & DRUGS310370310370

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total58522Total
Program Services58522ProgramServices

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total12636427Total
Program Services10023406ProgramServices
Management And General2527380ManagementAndGeneral
Fundraising85641Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY192428BOY
EOY540125EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY699953BOY
EOY42809EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY875882BOY
EOY952835EOY

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)
BOY5556BOY
EOY5186EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY58046BOY
EOY61685EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis25206323LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec15773040LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY9260515BOY
EOY9433283EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY4175614BOY
EOY4108608EOY

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)
BOY0BOY
EOY50453EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY15267994BOY
EOY15194984EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY715391BOY
EOY1145044EOY

Grants Payable GrantsPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY718933BOY
EOY450844EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY1523BOY
EOY1119EOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY4666906BOY
EOY4360000EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY392511BOY
EOY484528EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY6495264BOY
EOY6441535EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY6942747BOY
EOY7213717EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY529586BOY
EOY236681EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1300397BOY
EOY1303051EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY8772730BOY
EOY8753449EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY15267994BOY
EOY15194984EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses293476ReconcilationRevenueExpenses
Reconcilation Other Changes-312757ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
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 Years210194CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1159682CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years382092CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year276740CurrentTaxYearMinus1Year
Current Tax Year155161CurrentTaxYear
Total2183869Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years9923946CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years10697602CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years10798997CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year11546182CurrentTaxYearMinus1Year
Current Tax Year12552480CurrentTaxYear
Total55519207Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years10134140CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years11857284CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years11181089CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year11822922CurrentTaxYearMinus1Year
Current Tax Year12707641CurrentTaxYear
Total57703076Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years71018CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years85534CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years165831CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year36767CurrentTaxYearMinus1Year
Current Tax Year51981CurrentTaxYear
Total411131Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years71018CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years85534CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years165831CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year36767CurrentTaxYearMinus1Year
Current Tax Year51981CurrentTaxYear
Total411131Total
FieldValueIRS element (for citing)
Public Support Total50957291945PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years174676CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years80780CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years94263CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year104924CurrentTaxYearMinus1Year
Current Tax Year109644CurrentTaxYear
Total564287Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years174676CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years80780CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years94263CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year104924CurrentTaxYearMinus1Year
Current Tax Year109644CurrentTaxYear
Total564287Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years10308816CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years11938064CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years11275352CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year11927846CurrentTaxYearMinus1Year
Current Tax Year12817285CurrentTaxYear
Total58267363Total
FieldValueIRS element (for citing)
Public Support Percentage5090.98326PublicSupportPercentage509
Prior Year Support Percentage0.98248PriorYearSupportPercentage
Investment Income Percentage0.00968InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00993PriorYrInvestIncomePercentage
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 Balance2283133BeginningOfYearBalance
Investment Earnings Or Losses-98620InvestmentEarningsOrLosses
End Of Year Balance2184513EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

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

Current Year Minus2 Years CurrentYearMinus2Years

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

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance1942767BeginningOfYearBalance
Investment Earnings Or Losses-275737InvestmentEarningsOrLosses
End Of Year Balance1667030EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.31820BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.68180PermanentEndowmentEOYBalance
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 Basis18029244OtherCostOrOtherBasis
Depreciation11112925Depreciation
Book Value6916319BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis0OtherCostOrOtherBasis
Depreciation0Depreciation
Book Value0BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis3522305OtherCostOrOtherBasis
Depreciation2846007Depreciation
Book Value676298BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis3463040OtherCostOrOtherBasis
Depreciation1814108Depreciation
Book Value1648932BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings9433283TotalOfBookValueLandBuildings
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
ASSET RETIREMENT OBLIGATION$387,488
DUE TO RELATED PARTIES$97,040
FieldValueIRS element (for citing)
Total Of Amounts484528TotalOfAmounts
Total Revenue12929903TotalRevenue
Total Expenses12636427TotalExpenses
Excess Or Deficit For Year293476ExcessOrDeficitForYear
Net Unrealized GL On Investments-312757NetUnrealizedGLOnInvestments
Total Adjustments-312757TotalAdjustments
Excess Or Deficit Per FS-19281ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt12620592TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments-312757NetUnrealizedGainsInvestments
Other Revenues-19785OtherRevenues
Revenue Not Rptd F990-332542RevenueNotRptdF990
Revenue Subtotal12953134RevenueSubtotal
Other Revenues Not Included-23231OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt-23231RevenueNotRptdOnFinStmt
Total Revenue Per Form99012929903TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt12639873TotExpensesEtcAuditedFinclStmt
Other Expenses Included23231OtherExpensesIncluded
Expenses Not Rptd F99023231ExpensesNotRptdF990
Expenses Subtotal12616642ExpensesSubtotal
Investment Expenses Not Included219785InvestmentExpensesNotIncluded2
Expenses Not Rptd On Fin Stmt19785ExpensesNotRptdOnFinStmt
Total Expenses Per Form99012636427TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (6 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.
OTHER REVENUE INCLUDED ON LINE 1, BUT NOT ON FORM 990, PART VIII, LINE 12SCHEDULE D, PART XII, LINE 2DINVESTMENT FEES $(19,785)
OTHER REVENUE INCLUDED ON FORM 990, PART VIII, LINE 12, BUT NOT ON LINE 1SCHEDULE D, PART XII, LINE 4BLOSS ON DISPOSAL OF ASSETS $( 9,837) SPECIAL EVENT EXPENSES (13,394) --------- TOTAL $(23,231)
OTHER EXPENSE INCLUDED ON LINE 1, BUT NOT ON FORM 990, PART IX, LINE 25SCHEDULE D, PART XIII, LINE 2DLOSS ON DISPOSAL OF ASSETS $ 9,837 SPECIAL EVENT EXPENSES 13,394 --------- TOTAL $ 23,231

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1SALEM SALUTESNameOfEvent1
Gross Receipts Event120230GrossReceiptsEvent1
Charitable Contributions Event114780CharitableContributionsEvent1
Gross Revenue Event15450GrossRevenueEvent1
Food And Beverage Event110568FoodAndBeverageEvent1
Entertainment Event1400EntertainmentEvent1
Other Direct Expenses Event12426OtherDirectExpensesEvent1
Total Number Of Other Events0TotalNumberOfOtherEvents
Gross Receipts Total20230GrossReceiptsTotal
Charitable Contributions Total14780CharitableContributionsTotal
Gross Revenue Total Events5450GrossRevenueTotalEvents
Food And Beverage Total Events10568FoodAndBeverageTotalEvents
Entertainment Total Events400EntertainmentTotalEvents
Other Direct Expenses Total Events2426OtherDirectExpensesTotalEvents
Direct Expense Summary Events13394DirectExpenseSummaryEvents
Net Income Summary-7944NetIncomeSummary

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 (2 entries)

Base 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 OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
JESSE JANTZEN
017587203489302310002314021331000
ADRIENE IVERSON
01369330114220406026002375015139600

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, INDEPENDENT COMPENSATION CONSULTANT, 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, QUALITY, SAFETY, 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 (8 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 AND OPERATING AGREEMENT 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 SUBMITTED TO THE SIERRA PACIFIC SYNOD, OR WHICH THE BOARD OF DIRECTORS MAY REQUEST BE SUBMITTED.
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 FOR THE CEO AND CFO WAS REVIEWED AND APPROVED BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS OF ELDER CARE ALLIANCE. COMPARABLE COMPENSATION INFORMATION WAS PROVIDED TO THE EXECUTIVE COMMITTEE BY AN INDEPENDENT COMPENSATION CONSULTANT. THE COMPENSATION REVIEW OF THE EXECUTIVE DIRECTORS AND KEY EMPLOYEES WAS DONE FOR FISCAL YEAR 2012 BY THE FINANCE COMMITTEE OF ELDER CARE ALLIANCE AS PART OF THE BUDGET REVIEW PROCESS.
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.
OTHER CHANGES IN NET ASSETSFORM 990, PART XI, LINE 5NET UNREALIZED LOSS ON INVESTMENTS $(312,757)

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 CARECA501(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
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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