2013-02-15T09:41:37-06:00 2012-09-30 061009205 BLUM SHAPIRO & COMPANY PC CPA'S 29 S MAIN STREET PO BOX 272000 WEST HARTFORD CT 061272000 990 2011-10-01 060763898 CHURCH HOMES INC CONGREGATIONAL CHUR 8605279126 217 AVERY HEIGHTS HARTFORD CT 061064200 RAYMOND A GASPERINI 8605279126 2013-02-15 1 ELIZABETH SOLECKI P00235171 8605614000 2011 2016-03-07 17:11:31Z RAYMOND A GASPERINI 217 AVERY HEIGHTS HARTFORD CT 06106 41820000 0 X WWW.CHURCHHOMES.ORG X 1957 CT TO PROVIDE, ON A NOT-FOR-PROFIT BASIS AND WITHOUT DISCRIMINATION, A FULL RANGE OF RESIDENTIAL LIVING AND HEALTH CARE SERVICES FOR OLDER ADULTS. 14 13 494 281 0 0 404860 598288 39796863 39865424 522706 979479 320200 367265 41044629 41810456 3650 10550 0 0 21977253 22588759 0 0 49167 17878694 17617587 39859597 40216896 1185032 1593560 58797199 58360806 27433070 24996083 31364129 33364723 X TO PROVIDE, ON A NOT-FOR-PROFIT BASIS AND WITHOUT DISCRIMINATION, A FULL RANGE OF RESIDENTIAL LIVING AND HEALTH CARE SERVICES FOR OLDER ADULTS BY PROMOTING AND IMPLEMENTING SYSTEMS THAT MAINTAIN AND SUPPORT EVERY INDIVIDUAL'S OPTIMAL INDEPENDENCE AND LIFE WISHES IN A SAFE, DIGNIFIED ATMOSPHERE CONDUCIVE TO QUALITY RETIREMENT, BY ASSURING KNOWLEDGEABLE AND CONSISTENT LEADERSHIP IN RETIREMENT LIVING, LONG-TERM CARE, HOME CARE AND SUPPORT SERVICES AND BY DEVELOPING INNOVATIVE PROGRAMS AND SERVICES WHICH RESPOND TO THE CHANGING NEEDS OF ITS RESIDENTS AND CLIENTS AND THE SOCIETY IT SERVES. 0 0 36809765 40215164 CHURCH HOMES, INC., CONGREGATIONAL IS A NOT-FOR-PROFIT CORPORATION, WHICH OWNS AND OPERATES RETIREMENT AND HEALTH CARE FACILITIES IN HARTFORD, CT (AVERY HEIGHTS), AND SALISBURY, CT (NOBLE HORIZONS). AVERY HEIGHTS CONSISTS OF 130 SKILLED NURSING BEDS, 69 INTERMEDIATE CARE BEDS, 14 ACCOMODATIONS IN A HOME FOR THE AGED, 62 INDEPENDENT LIVING COTTAGES, AND 137 INDEPENDENT LIVING APARTMENTS. IN ADDITION, AVERY HEIGHTS OPERATES A HOME HEALTH AGENCY AND BETTY LARUS ADULT DAY HEALTH CENTER. NOBLE HORIZONS CONSISTS OF 61 SKILLED NURSING BEDS, 30 INTERMEDIATE CARE BEDS, 50 INDEPENDENT LIVING COTTAGES AND 19 ACCOMODATIONS IN A HOME FOR THE AGED. 36809765 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 130 0 1 494 1 0 0 0 0 0 0 0 0 0 0 X 14 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 1 1 0 CT X RAYMOND A GASPERINI 8605279126 217 AVERY HEIGHTS HARTFORD CT 061064200 PATRICK GILLAND 40.00 X X 256803 0 47411 DAVID E POLK 1.00 X X 0 0 0 HENRY B MCNULTY 1.00 X X 0 0 0 LARRY C BROWN 1.00 X 0 0 0 JOSEPH C BLACK JR 1.00 X 0 0 0 DAVID E CANUEL 1.00 X 0 0 0 ELIZABETH S GAGNE 1.00 X 0 0 0 PETER C GERALI 1.00 X 0 0 0 PATRICK Y YUNG 1.00 X 0 0 0 STEPHEN E RONAI ESQUIRE 1.00 X 0 0 0 PETER B MATTHEWS 1.00 X 0 0 0 MERCEDESE E LARGE 1.00 X 0 0 0 PETER L HOLLAND 1.00 X 0 0 0 JEFFREY H KOENIG 1.00 X 0 0 0 RAYMOND GASPERINI 40.00 X 176089 0 34477 EILEEN MULLIGAN 40.00 X 162303 0 25082 MIRIAM PARKER 40.00 X 183416 0 35175 MARJORIE K TESSMAN 40.00 X 54235 0 17710 BONITA GANIM 40.00 X 102565 0 16766 ANNA LUKAS 40.00 X 124188 0 24963 MICHELLE PASCETTA 40.00 X 103446 0 27580 1163045 0 229164 7 0 1 0 HEALTHCARE SERVICES GROUP 3220 TILLMAN DR STE 300 BENSALEM PA 19020 HOUSEKEEPING/LAUNDRY/DIETARY SERVICES 2673899 ALLIANCE REHAB OF CT 1520 KENSINGTON ROAD STE 110 OAK BROOKE IL 60523 REHAB THERAPY 982891 H&H LINEN SERVICES 135 CITY AVE NEW BRITAIN CT 06051 LINEN SERVICE 168981 JAY'S LAWNCARE PO BOX 1154 CAANAN CT 06018 LAWN CARE, PLOWING, SANDING 155587 SECURITY SERVICES OF CONNECTICUT PO BOX 53 BRATTLEBORO VT 05302 SECURITY 142259 12 13429 584859 36114 598288 RESIDENT SERVICES 623000 39764271 39764271 OTHER SERVICES 623000 101153 101153 39865424 289151 289151 17525 0 17525 17525 17525 690328 0 690328 690328 690328 9544 13429 9544 0 OTHER INCOME 900099 345325 345325 FEES INCOME 900099 4415 4415 349740 41810456 40215164 0 997004 10550 10550 1002594 1002594 15802664 14531693 1270971 1228132 1072282 155850 3266632 2993261 273371 1288737 1125196 163541 800 800 18840 18840 76000 76000 6437324 6366481 49180 21663 121679 119941 1738 254714 158064 84366 12284 96237 13653 74085 8499 3238248 3239280 -1032 12511 4920 7591 12535 9233 3302 14554 14554 2448007 2448007 212897 179807 33090 PROVIDER TAX 1819407 1819407 SUPPLIES 651636 638649 12987 FOOD 599494 599494 MAINTENANCE 369317 369317 1233387 1095976 130690 6721 40216896 36809765 3357964 49167 8011849 10855236 1939557 1726280 3270862 3530266 186904 197690 633290 572408 76208294 46551536 30092239 29656758 14178722 11117448 428154 652608 55622 52112 58797199 58360806 3282854 2812505 23854052 21842487 296164 341091 27433070 24996083 X 22977737 24241363 5734127 6471095 2652265 2652265 31364129 33364723 58797199 58360806 X 1593560 407034 X 0 1 1 X 0 X 900844 995528 929762 404860 598288 3829282 39324192 39944247 39756122 40098913 40215164 199338638 40225036 40939775 40685884 40503773 40813452 203167920 0 0 0 203167920 458327 184505 121341 233047 289151 1286371 458327 184505 121341 233047 289151 1286371 279523 386093 398997 64383 17525 1146521 40962886 41510373 41206222 40801203 41120128 205600812 0.98820 0.98460 0.00630 0.00880 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 6929974 401654 1344982 189371 1812 8485427 7353857 239594 -163591 493454 6432 6929974 7975094 228623 702811 1550231 2440 7353857 8172455 51035 30490 276168 2718 7975094 0.50000 0.31000 0.19000 1 0 2744217 2744217 48597414 27923360 20674054 21742629 16356597 5386032 3124034 2271579 852455 29656758 ANNUITIES PAYABLE 75250 RESIDENT FUNDS AND DEPOSITS 171823 DUE TO THIRD PARTY REIMBURSEMENT AG 42992 MISCELLANEOUS 51026 341091 41810456 40216896 1593560 834924 -427890 407034 2000594 42196780 834924 -1 834923 41361857 448599 448599 41810456 40196186 0 40196186 20710 20710 40216896 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: INVESTMENT INCOME UTILIZED TO SUPPORT OPERATIONS. PART XI, LINE 8 - OTHER ADJUSTMENTS: LOSS ON REFINANCING -427,889. ROUNDING -1. TOTAL TO SCHEDULE D, PART XI, LINE 8: -427,890. PART XII, LINE 2D - OTHER ADJUSTMENTS: ROUNDING -1. PART XII, LINE 4B - OTHER ADJUSTMENTS: LOSS ON REFINANCING 427,889. DIRECT RESIDENT SUPPORT 20,710. PART XIII, LINE 4B - OTHER ADJUSTMENTS: DIRECT RESIDENT SUPPORT 20,710. FESTIVAL OF TREES 22973 13429 9544 9544 22973 13429 9544 9544 9544 0 1 SCHOLARSHIPS 5 10550 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: SCHOLARSHIP ASSISTANCE IS OFFERED TO EMPLOYEES OR THEIR CHILDREN WHO WISH TO PURSUE PROFESSIONAL AND VOCATIONAL COURSES OF STUDY THAT ARE RELATED TO THE EMPLOYEE'S POTENTIAL FOR PROMOTION OR MINIMUM JOB REQUIREMENTS. ALL COURSES MUST BE OFFERED THROUGH AN ACCREDITED INSTITUTION OF HIGHER LEARNING OR BE APPROVED FOR CONTINUING EDUCATION UNITS. TO QUALIFY, THE EMPLOYEE MUST BE EMPLOYED 32 HOURS OR MORE AND HAVE COMPLETED ONE YEAR OF CONTINUOUS EMPLOYMENT. THE EMPLOYEE MUST HAVE A GOOD WORK ATTENDANCE RECORD. THE EMPLOYEE OR THEIR CHILD MUST MEET THE REQUIREMENTS OF THE INSTITUTION OR AGENCY OFFERING THE COURSE. THE SCHOLARSHIP ASSISTANCE IS AVAILABLE IF THE APPLICANT IS NOT ELIGIBLE FOR ASSISTANCE FROM OTHER SOURCES OF REIMBURSEMENT. X 1 1 X X X X 0 0 0 0 0 0 0 1 0 PATRICK GILLAND 236803 0 20000 0 0 0 29441 0 17970 0 304214 0 0 0 RAYMOND GASPERINI 173589 0 2500 0 0 0 20334 0 14143 0 210566 0 0 0 EILEEN MULLIGAN 159803 0 2500 0 0 0 18388 0 6694 0 187385 0 0 0 MIRIAM PARKER 180916 0 2500 0 0 0 21446 0 13729 0 218591 0 0 0 PART I, LINE 7 BONUSES ARE AWARDED BASED ON THE ACHIEVEMENT OF SPECIFIC PERFORMANCE GOALS. X 1 36114 X 36114 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS REVIEWED WITH THE BOARD OF DIRECTORS AT REGULARLY SCHEDULED BOARD OF DIRECTORS MEETING. FORM 990, PART VI, SECTION B, LINE 12C THE PRESIDENT OF CHURCH HOMES, INC. REVIEWS THE RESPONSES TO THE ANNUAL CONFLICT OF INTEREST QUESTIONNAIRE WITH THE COMMITTEE ON DIRECTORS. WHERE AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST EXISTS, THE COMMITTEE ON DIRECTORS IS AUTHORIZED TO TAKE APPROPRIATE CORRECTIVE ACTION. FORM 990, PART VI, SECTION B, LINE 15 CHURCH HOMES, INC. PERSONNEL COMMITTEE REVIEWS AND APPROVES OFFICER COMPENSATION ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 834,924. LOSS ON REFINANCING -427,889. ROUNDING -1. TOTAL TO FORM 990, PART XI, LINE 5: 407,034. CONNECTICUT ALLIANCE FOR LONG TERM CARE 705A NEW BRITAIN AVE HARTFORD CT 06106 061465316 ADMINISTER PROVIDER BASED NETWORK TO PROVIDE COST-EFFECTIVE HEALTH CARE CT 501(C)(3) LINE 11A, I N/A 0 0 0 1 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0