2013-11-06T12:54:16-06:00 2012-12-31 461497033 EKS&H LLLP 7979 E TUFTS AVENUE SUITE 400 DENVER CO 802372521 990 2012-01-01 742376546 SHALOM PARK SHAL 3036805000 14800 E BELLEVIEW DRIVE AURORA CO 800152258 DANIEL STENERSEN 3036805000 2013-11-05 1 CRAIG R CHOUN P00173718 3037409400 2012 2016-03-07 17:11:31Z DANIEL STENERSEN 14800 E BELLEVIEW DRIVE AURORA CO 80015 14340238 0 X SHALOMPARK.ORG X 1984 CO DELIVERY AND INNOVATION OF COMMUNITY AND RESIDENTIAL HEALTH AND SOCIAL SERVICES. 18 17 280 200 0 0 200 203925 15125285 14136313 0 0 0 0 15125485 14340238 0 800 0 0 6967779 7392386 0 0 259284 7016173 7357792 13983952 14750978 1141533 -410740 21788489 21172884 16370177 16157253 5418312 5015631 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 12909524 800 14136313 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. 12909524 1 1 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 32 0 1 280 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 1.00 X 0 0 0 DANIEL STENERSEN 6.00 34.00 X X 38850 220150 53542 GARY YOURTZ 5.00 2.00 X X 0 0 0 JAY MOSKOWITZ 1.00 X 0 0 0 MARSHALL ABRAHAMS 1.00 2.00 X 0 0 0 BRUCE BENDELL 1.00 X 0 0 0 JOE BORUS 1.00 X 0 0 0 ROBIN CHOTIN 1.00 X 0 0 0 KEN FEILER 1.00 X 0 0 0 JERRY GRAY 1.00 X 0 0 0 SUSY GRAZI 1.00 1.00 X 0 0 0 ANDY MILLER 1.00 X 0 0 0 JORDON PERLMUTTER 1.00 1.00 X 0 0 0 JOHN PREGULMAN 5.00 1.00 X X 0 0 0 MICHAEL STREAR 20.00 2.00 X X 0 0 0 SANDY WOLF 1.00 X 0 0 0 LISA COOK 1.00 X 0 0 0 DAN JAPHA 1.00 1.00 X 0 0 0 38850 220150 53542 0 0 1 0 MORRISON MANAGEMENT SPECIALIST 5801 PEACHTREE DUNWOODY ROAD ATLANTA GA 30342 FOOD SERVICE 1327011 TOLIN MECHANICAL SYSTEMS 12005 EAST 45TH AVENUE DENVER CO 80239 MAINTENANCE 289405 PIONEER PHARMACY LLC PO BOX 1207 WHEATRIDGE CO 800341207 LONG TERM CARE PHARMACY 167390 THINGS THAT GROW 12345 E BATES CIRCLE AURORA CO 80014 LANDSCAPING 147885 SCHRYVER MEDICAL 12075 E 45TH AVE STE 600 DENVER CO 802393136 LABS/MEDICAL TESTING 143961 5 200000 3925 203925 PATIENT SERVICE REV 623000 11795520 11795520 RESIDENT RENTAL 623000 1757289 1757289 OTHER NURSING HOME REV 623000 583504 583504 14136313 14340238 14136313 0 0 800 800 46881 46881 6073535 5527998 545537 767441 705410 62031 504529 443249 61280 8494 7475 1019 73789 73789 16000 16000 1419568 1164573 254995 259284 259284 263899 127598 136301 527176 463915 63261 81695 71892 9803 936724 824317 112407 1337935 1177383 160552 299098 263206 35892 PROGRAM SUPPLIES 845378 845378 FOOD 625113 625113 BAD DEBT EXPENSE 400333 400333 DRUGS & PHARMACY 94774 94774 168532 150110 18422 14750978 12909524 1582170 259284 138096 0 2877945 1462207 149486 153916 33245990 19174541 14809542 14071449 54132 62114 3759288 5423198 21788489 21172884 2042815 2347358 14189180 13517251 138182 292644 16370177 16157253 X 5418312 5015631 5418312 5015631 21788489 21172884 -410740 8059 0 X 0 1 X 1 0 X 1188942 1283000 785000 200 203925 3461067 14464783 14393727 13790478 15125285 14136313 71910586 15653725 15676727 14575478 15125485 14340238 75371653 0 0 0 75371653 40093 2115 84 42292 40093 2115 84 42292 15693818 15678842 14575562 15125485 14340238 75413945 0.99940 0.99800 0.00060 0.00200 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 16000 0 0 16000 0 2321345 208559 236427 195995 2570336 2260532 -57568 -118381 2321345 3633593 972 276634 1650667 2260532 3022113 362844 307338 58702 3633593 2946820 837416 -701111 61012 3022113 0.92240 0.07760 1 1 1 2548217 2548217 26502391 15863934 10638457 2504861 1676199 828662 1690521 1634408 56113 14071449 SINKING FUND ASSETS 1601256 DUE TO/FROM AFFILIATES 3821942 5423198 DEPOSITS 114680 CASH OVERDRAFT 177964 292644 X 14348297 8059 8059 14340238 0 14340238 14750978 0 14750978 0 14750978 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: 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. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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 ASSESSED AS OF DECEMBER 31, 2012 AND 2011. THE ORGANIZATION'S TAX RETURNS SUBJECT TO EXAMINATION BY TAXING AUTHORITIES INCLUDE ALL THOSE FROM 2009 TO THE CURRENT YEAR FOR FEDERAL REPORTING PURPOSES AND FROM 2008 TO THE CURRENT YEAR FOR STATE REPORTING PURPOSES. X X X 0 0 0 0 0 0 0 0 0 DANIEL STENERSEN 38850 220150 0 0 0 0 3375 19125 4656 26386 46881 265661 0 0 SUPPLEMENTAL INFORMATION PART III COMPENSATION OF DANIEL STENERSEN SCHEDULE J, PART II 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. 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 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 -160548 46319 1.00000 1 HOMEHELP 14800 E BELLEVIEW DRIVE AURORA CO 80015 455132771 CHARITABLE CO SHALOM PARK C 1.00000 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 DUE FROM FOUNDATION Q 291551 DUE FROM BETH NEHAMAH Q 1518022 DUE FROM BETH EZRA Q 2012369 BETH ISRAEL FOUNDATION FOR THE AGED C 200000